Exercise-Based Rehabilitation in Patients with Lung Cancer

  • Martijn A. Spruit
  • Khaled Mansour
  • Emiel F.M. Wouters
  • Monique M. Hochstenbag
Chapter

Abstract

Lung cancer was a rare disease at the start of the last century, but exposures to new etiologic agents and an increasing lifespan have combined to make it one of the most prevalent forms of the disease in the 21st century. Furthermore, lung cancer remains the most common cause of cancer-related death. Pre-operative QoL and exercise capacity are poor in patients with lung cancer and become worse following (surgical) treatment. Moreover, post-operative recovery of QoL and exercise tolerance are only partial over extended periods of time. Therefore, in patients with lung cancer, there is a clear indication for comprehensive peri- and post-operative exercise-based rehabilitation. Indeed, exercise-based pulmonary rehabilitation could prove to be a powerful non-pharmacological intervention to improve exercise performance and health status, irrespective of change in pulmonary function. To date, the effects of exercise-based rehabilitation in patients with lung cancer have not been extensively studied but preliminary results from small-scale intervention studies suggest that lung cancer patients are good candidates for peri- and post-operative pulmonary rehabilitation programmes.

Keywords

Fatigue Toxicity Adenocarcinoma Peri Radon 

References

  1. 1.
    Bosetti C, Levi F, Lucchini F, Negri E, La VC. (2005) Lung cancer mortality in European women: recent trends and perspectives. Ann Oncol 16:1597–1604.CrossRefPubMedGoogle Scholar
  2. 2.
    Samet JM. (1989) Radon and lung cancer. J Natl Cancer Inst 81(10):745–757.CrossRefPubMedGoogle Scholar
  3. 3.
    American Cancer Society. Cancer Facts and Figures. 2006. Atlanta, GA, USA.Google Scholar
  4. 4.
    Jemal A, Thun MJ, Ries LA, et al. (2008) Annual report to the nation on the status of cancer, 1975–2005, featuring trends in lung cancer, tobacco use, and tobacco control. J Natl Cancer Inst 100:1672–1694.Google Scholar
  5. 5.
    Govindan R, Page N, Morgensztern D, et al. (2006) Changing epidemiology of small-cell lung cancer in the united states over the last 30 years: analysis of the surveillance, epidemiologic, and end Results database. J Clin Oncol 24:4539–4544.CrossRefPubMedGoogle Scholar
  6. 6.
    Brambilla E, Travis WD, Colby TV, Corrin B, Shimosato Y. (2001) The new world health organization classification of lung tumours. Eur Respir J 18:1059–1068.CrossRefPubMedGoogle Scholar
  7. 7.
    Yoshimi I, Ohshima A, Ajiki W, Tsukuma H, Sobue T. (2003) A comparison of trends in the incidence rate of lung cancer by histological type in the Osaka cancer registry, Japan and in the surveillance, epidemiology and end Results program, USA. Jpn J Clin Oncol 33:98–104.CrossRefPubMedGoogle Scholar
  8. 8.
    Spiro SG, Gould MK, Colice GL. (2007) Initial evaluation of the patient with lung cancer: symptoms, signs, laboratory tests, and paraneoplastic syndromes: ACCP evidenced-based clinical practice guidelines (2nd edition). Chest 132:149S–160S.CrossRefPubMedGoogle Scholar
  9. 9.
    (1997) Pretreatment evaluation of non-small-cell lung cancer. The American Thoracic Society and the European Respiratory Society. Am J Respir Crit Care Med 156:320–332.Google Scholar
  10. 10.
    Mountain CF. (1997) Revisions in the international system for staging lung cancer. Chest 111:1710–1717.CrossRefPubMedGoogle Scholar
  11. 11.
    Boyle P, Ferlay J. (2005) Mortality and survival in breast and colorectal cancer. Nat Clin Pract Oncol 2:424–425.CrossRefPubMedGoogle Scholar
  12. 12.
    Firat S, Bousamra M, Gore E, Byhardt RW. (2002) Comorbidity and KPS are independent prognostic factors in stage I non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 52:1047–1057.CrossRefPubMedGoogle Scholar
  13. 13.
    Scott WJ, Howington J, Feigenberg S, Movsas B, Pisters K. (2007) Treatment of non-small cell lung cancer stage I and stage II: ACCP evidence-based clinical practice guidelines (2nd edition). Chest 132:234S–242S.CrossRefPubMedGoogle Scholar
  14. 14.
    Ginsberg RJ, Rubinstein LV. (1995) Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung cancer study group. Ann Thorac Surg 60:615–622.CrossRefPubMedGoogle Scholar
  15. 15.
    Daniels LJ, Balderson SS, Onaitis MW, D‘Amico TA. (2002) Thoracoscopic lobectomy: a safe and effective strategy for patients with stage I lung cancer. Ann Thorac Surg 74:860–864.CrossRefPubMedGoogle Scholar
  16. 16.
    Strauss GM, Herndon JE, Maddaus MA, Johnstone DW, Johnson EA, Watson DM, Sugarbaker DJ, Schilsky RA, Vokes EE, Green MR. (2006) Adjuvant chemotherapy in stage IB non-small cell lung cancer (NSCLC): Update of Cancer and Leukemia Group B (CALGB) protocol 9633. ASCO Annual Meeting. J Clin Oncol, ASCO Meeting Proceedings Part I 24:18S (June 20 Supplement).Google Scholar
  17. 17.
    Auperin A, Le PC, Pignon JP, et al. (2006) Concomitant radio-chemotherapy based on platin compounds in patients with locally advanced non-small cell lung cancer (NSCLC): a meta-analysis of individual data from 1764 patients. Ann Oncol 17:473–483.CrossRefPubMedGoogle Scholar
  18. 18.
    Detterbeck F, Rivera M. (2001) Clinical presentation and diagnosis. In: Detterbeck, FC, Rivera, MP, Socinski, MA, Rosenman, JG (eds) Diagnosis and Treatment of Lung Cancer: An Evidence-Based Guide for the Practicing Clinician. W.B. Saunders Co., Philadelphia, pp. 45–72.Google Scholar
  19. 19.
    Socinski MA, Crowell R, Hensing TE. (2007) Treatment of non-small cell lung cancer, stage IV: ACCP evidence-based clinical practice guidelines (2nd edition). Chest 132:277S–289S.CrossRefPubMedGoogle Scholar
  20. 20.
    Makitaro R, Paakko P, Huhti E, Bloigu R, Kinnula VL. (2002) Prospective population-based study on the survival of patients with lung cancer. Eur Respir J 19:1087–1092.CrossRefPubMedGoogle Scholar
  21. 21.
    Socinski MA, Morris DE, Masters GA, Lilenbaum R. (2003) Chemotherapeutic management of stage IV non-small cell lung cancer. Chest 123:226S–243S.CrossRefPubMedGoogle Scholar
  22. 22.
    Socinski MA, Baggstrom MQ, Hensing TA. (2003) Duration of therapy in advanced, metastatic non-small-cell lung cancer. Clin Adv Hematol Oncol 1:33–38.PubMedGoogle Scholar
  23. 23.
    De RD, Pijls-Johannesma M, Vansteenkiste J, Kester A, Rutten I, Lambin P. (2006) Systematic review and meta-analysis of randomised, controlled trials of the timing of chest radiotherapy in patients with limited-stage, small-cell lung cancer. Ann Oncol 17:543–552.CrossRefGoogle Scholar
  24. 24.
    Arriagada R, Le Chevalier T, Borie F. (1994) Randomized trial of prophylactic cranial irradiation (PCI) for patients with small cell lung cancer (SCLC) in complete remission. ASCO Annual Conference, 13.Google Scholar
  25. 25.
    The Prophylactic Cranial Irradiation Overview Collaborative Group (2000) Cranial irradiation for preventing brain metastases of small cell lung cancer in patients in complete remission. Cochrane Database Systematic Review CD002805.Google Scholar
  26. 26.
    Nici L, Donner C, Wouters E, et al. (2006) American thoracic society/european respiratory society statement on pulmonary rehabilitation. Am J Respir Crit Care Med 173:1390–1413.CrossRefPubMedGoogle Scholar
  27. 27.
    Lacasse Y, Goldstein R, Lasserson TJ, Martin S. (2006) Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev CD003793Google Scholar
  28. 28.
    Jaeschke R, Singer J, Guyatt GH. (1989) Measurement of health status. Ascertaining the minimal clinically important difference. Control Clin Trials 10:407–415.CrossRefPubMedGoogle Scholar
  29. 29.
    Spruit MA, Vanderhoven-Augustin I, Janssen PP, Wouters EF. (2008) Integration of pulmonary rehabilitation in COPD. Lancet 371:12–13.CrossRefPubMedGoogle Scholar
  30. 30.
    Holland AE, Hill CJ, Conron M, Munro P, McDonald CF. (2008) Short term improvement in exercise capacity and symptoms following exercise training in interstitial lung disease. Thorax 63:549–554.CrossRefPubMedGoogle Scholar
  31. 31.
    Spruit MA, Wouters EF. (2007) New modalities of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease. Sports Med 37:501–518.CrossRefPubMedGoogle Scholar
  32. 32.
    Jones LW, Eves ND, Mackey JR, et al. (2007) Safety and feasibility of cardiopulmonary exercise testing in patients with advanced cancer. Lung Cancer 55:225–232.CrossRefPubMedGoogle Scholar
  33. 33.
    Wilcock A, Maddocks M, Lewis M, England R, Manderson C. (2008) Symptoms limiting activity in cancer patients with breathlessness on exertion: ask about muscle fatigue. Thorax 63:91–92.CrossRefPubMedGoogle Scholar
  34. 34.
    Weinstein H, Bates AT, Spaltro BE, Thaler HT, Steingart RM. (2007) Influence of preoperative exercise capacity on length of stay after thoracic cancer surgery. Ann Thorac Surg 84:197–202.CrossRefPubMedGoogle Scholar
  35. 35.
    Epstein SK, Faling LJ, Daly BD, Celli BR. (1995) Inability to perform bicycle ergometry predicts increased morbidity and mortality after lung resection. Chest 107:311–316.CrossRefPubMedGoogle Scholar
  36. 36.
    Morice RC, Peters EJ, Ryan MB, Putnam JB, Ali MK, Roth JA. (1992) Exercise testing in the evaluation of patients at high risk for complications from lung resection. Chest 101:356–361.CrossRefPubMedGoogle Scholar
  37. 37.
    Wilcock A, Maddocks M, Lewis M, et al. (2008) Use of a cybex NORM dynamometer to assess muscle function in patients with thoracic cancer. BMC Palliat Care 7:3.CrossRefPubMedGoogle Scholar
  38. 38.
    Nezu K, Kushibe K, Tojo T, Takahama M, Kitamura S. (1998) Recovery and limitation of exercise capacity after lung resection for lung cancer. Chest 113:1511–1516.CrossRefPubMedGoogle Scholar
  39. 39.
    Bobbio A, Chetta A, Ampollini L, et al. (2008) Preoperative pulmonary rehabilitation in patients undergoing lung resection for non-small cell lung cancer. Eur J Cardiothorac Surg 33:95–98.CrossRefPubMedGoogle Scholar
  40. 40.
    Nagamatsu Y, Maeshiro K, Kimura NY, et al. (2007) Long-term recovery of exercise capacity and pulmonary function after lobectomy. J Thorac Cardiovasc Surg 134:1273–1278.CrossRefPubMedGoogle Scholar
  41. 41.
    Nezu K, Iioka S, Kushibe K, et al. (1994) [The relationship between postoperative changes of exercise capacity and pulmonary blood flow in the residual lung after lobectomy of the lung]. Nippon Kyobu Geka Gakkai Zasshi 42:340–345.PubMedGoogle Scholar
  42. 42.
    Bobbio A, Chetta A, Carbognani P, et al. (2005) Changes in pulmonary function test and cardio-pulmonary exercise capacity in COPD patients after lobar pulmonary resection. Eur J Cardiothorac Surg 28:754–758.CrossRefPubMedGoogle Scholar
  43. 43.
    Brunelli A, Socci L, Refai M, Salati M, Xiume F, Sabbatini A. (2007) Quality of life before and after major lung resection for lung cancer: a prospective follow-up analysis. Ann Thorac Surg 84:410–416.CrossRefPubMedGoogle Scholar
  44. 44.
    Handy JR Jr., Asaph JW, Skokan L, et al. (2002) What happens to patients undergoing lung cancer surgery? Outcomes and quality of life before and after surgery. Chest 122:21–30.CrossRefPubMedGoogle Scholar
  45. 45.
    Schulte T, Schniewind B, Dohrmann P, Kuchler T, Kurdow R. (2008) The extent of lung parenchyma resection significantly impacts long-term quality of life in patients with non small cell lung cancer. Chest 135(2):322–9.Google Scholar
  46. 46.
    Man WD, Polkey MI, Donaldson N, Gray BJ, Moxham J. (2004) Community pulmonary rehabilitation after hospitalisation for acute exacerbations of chronic obstructive pulmonary disease: randomised controlled study. BMJ 329:1209.CrossRefPubMedGoogle Scholar
  47. 47.
    Jones LW, Peddle CJ, Eves ND, et al. (2007) Effects of presurgical exercise training on cardiorespiratory fitness among patients undergoing thoracic surgery for malignant lung lesions. Cancer 110:590–598.CrossRefPubMedGoogle Scholar
  48. 48.
    Spruit MA, Janssen PP, Willemsen SC, Hochstenbag MM, Wouters EF. (2006) Exercise capacity before and after an 8-week multidisciplinary inpatient rehabilitation program in lung cancer patients: a pilot study. Lung Cancer 52:257–260.CrossRefPubMedGoogle Scholar
  49. 49.
    Mejia R, Ward J, Lentine T, Mahler DA. (1999) Target dyspnea ratings predict expected oxygen consumption as well as target heart rate values. Am J Respir Crit Care Med 159:1485–1489.PubMedGoogle Scholar
  50. 50.
    Horowitz MB, Littenberg B, Mahler DA. (1996) Dyspnea ratings for prescribing exercise intensity in patients with COPD. Chest 109:1169–1175.CrossRefPubMedGoogle Scholar
  51. 51.
    Ries AL. (2005) Minimally clinically important difference for the UCSD shortness of breath questionnaire, borg scale, and visual analog scale. COPD 2(1):105–110.CrossRefPubMedGoogle Scholar
  52. 52.
    Jones LW, Eves ND, Peterson BL, et al. (2008) Safety and feasibility of aerobic training on cardiopulmonary function and quality of life in postsurgical nonsmall cell lung cancer patients: a pilot study. Cancer 113:3430–3439.CrossRefPubMedGoogle Scholar
  53. 53.
    Cesario A, Ferri L, Galetta D, et al. (2007) Post-operative respiratory rehabilitation after lung resection for non-small cell lung cancer. Lung Cancer 57:175–180.CrossRefPubMedGoogle Scholar
  54. 54.
    Gosker HR, Lencer NH, Franssen FM, van der Vusse GJ, Wouters EF, Schols AM. (2003) Striking similarities in systemic factors contributing to decreased exercise capacity in patients with severe chronic heart failure or COPD. Chest 123:1416–1424.CrossRefPubMedGoogle Scholar
  55. 55.
    Gosselink R, Troosters T, Decramer M. (1996) Peripheral muscle weakness contributes to exercise limitation in COPD. Am J Respir Crit Care Med 153:976–980.PubMedGoogle Scholar
  56. 56.
    Nicoletti I, Cicoira M, Zanolla L, et al. (2003) Skeletal muscle abnormalities in chronic heart failure patients: relation to exercise capacity and therapeutic implications. Congest Heart Fail 9:148–154.CrossRefPubMedGoogle Scholar
  57. 57.
    Spruit MA, Troosters T, Trappenburg JC, Decramer M, Gosselink R. (2004) Exercise training during rehabilitation of patients with COPD: a current perspective. Patient Educ Couns 52:243–248.CrossRefPubMedGoogle Scholar
  58. 58.
    Spruit MA, Wouters EFM, Gosselink R. (2005) Rehabilitation programmes in sarcoidosis: a multidisciplinary approach. In: Drent, M, Costabel, U (eds.) European Respiratory Monograph: Sarcoidosis. European Respiratory Society Ltd., Wakefield, UK, pp. 316–326.Google Scholar
  59. 59.
    Probst VS, Troosters T, Pitta F, Decramer M, Gosselink R. (2006) Cardiopulmonary stress during exercise training in patients with COPD. Eur Respir J 27:1110–1118.CrossRefPubMedGoogle Scholar
  60. 60.
    Sillen MJ, Janssen PP, Akkermans MA, Wouters EF, Spruit MA. (2008) The metabolic response during resistance training and neuromuscular electrical stimulation (NMES) in patients with COPD, a pilot study. Respir Med 102:786–789.CrossRefPubMedGoogle Scholar
  61. 61.
    Vanderthommen M, Duchateau J. (2007) Electrical stimulation as a modality to improve performance of the neuromuscular system. Exerc Sport Sci Rev 35:180–185.CrossRefPubMedGoogle Scholar
  62. 62.
    Sillen MJ, et al. (2009) Effects of neuromuscular electrical stimulation of muscles of ambulation in patients with CHF or COPD: a systematic review of the English-language literature. Chest (in press). 136(1):44–61.CrossRefPubMedGoogle Scholar
  63. 63.
    Crevenna R, Marosi C, Schmidinger M, Fialka-Moser V. (2006) Neuromuscular electrical stimulation for a patient with metastatic lung cancer – a case report. Support Care Cancer 14:970–973.CrossRefPubMedGoogle Scholar
  64. 64.
    Slotman BJ, Mauer ME, Bottomley A, et al. (2009) Prophylactic cranial irradiation in extensive disease small-cell lung cancer: short-term health-related quality of life and patient reported symptoms: Results of an international phase III randomized controlled trial by the EORTC radiation oncology and lung cancer groups. J Clin Oncol 27:78–84.CrossRefPubMedGoogle Scholar
  65. 65.
    Maddocks M, Mockett S, Wilcock A. (2007) Neuromuscular electrical stimulation (NMES): a reactive palliative therapy, a proactive supportive therapy or both? Support Care Cancer 15:111.CrossRefPubMedGoogle Scholar
  66. 66.
    Dimeo FC, Thomas F, Raabe-Menssen C, Propper F, Mathias M. (2004) Effect of aerobic exercise and relaxation training on fatigue and physical performance of cancer patients after surgery. A randomised controlled trial. Support Care Cancer 12:774–779.CrossRefPubMedGoogle Scholar
  67. 67.
    Schneider CM, Hsieh CC, Sprod LK, Carter SD, Hayward R. (2007) Exercise training manages cardiopulmonary function and fatigue during and following cancer treatment in male cancer survivors. Integr Cancer Ther 6:235–241.CrossRefPubMedGoogle Scholar
  68. 68.
    Dy SM, Lorenz KA, Naeim A, Sanati H, Walling A, Asch SM. (2008, Aug 10) Evidence-based recommendations for cancer fatigue, anorexia, depression, and dyspnea. J Clin Oncol. 26(23):3886–95.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Martijn A. Spruit
    • 1
  • Khaled Mansour
    • 2
  • Emiel F.M. Wouters
    • 1
    • 2
  • Monique M. Hochstenbag
    • 2
  1. 1.Department of ResearchDevelopment and Education of the Centre for Integrated Rehabilitation of Organ failure (CIRO)HornThe Netherlands
  2. 2.Department of Respiratory MedicineMaastricht University Medical Centre (MUMC+)MaastrichtThe Netherlands

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