High-intensity training and cardiopulmonary exercise testing in patients with chronic obstructive pulmonary disease and non-small-cell lung cancer undergoing lobectomy

Stefanelli, Francesco; Meoli, Ilernando; Cobuccio, Raffaele; Curcio, Carlo; Amore, Dario; Casazza, Dino; Tracey, Maura C.; Rocco, Gaetano

doi:10.1093/ejcts/ezt375

Cited by 129 publications

(163 citation statements)

References 23 publications

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“…Participants with lung cancer and comorbid chronic obstructive pulmonary disease (COPD) who received a pre-operative pulmonary rehabilitation programme (versus usual care) had significantly increased peak volume oxygen (VO 2 ) levels on the day of surgery (p < 0.0001) and 60 days post-surgery (p < 0.005). However, significant between-group differences in pulmonary function (FEV 1 ) were not observed at any time point [25]. There was a significant beneficial effect of exercise on total heart rate (p = 0.04) [22], walking distance ((p < 0.001) [22], (p = 0.001) [18], (p = 0.029) [17]), walking speed (p < 0.001) [22] and walking duration (p < 0.001) [22] compared to usual care.…”

Section: Lung Cancer Pre-surgical Exercise Versus Usual Carementioning

confidence: 82%

“…Standard care varied according to individual institutions whereby verbal or written instructions were given [15,[19][20][21], physical activity was delivered in the rehabilitation setting post-treatment [22,23], generic risk management and active mobilisation was given [18] or fast-track surgery was implemented [24]. Five studies delivered interventions in the pre-treatment period only [12,17,18,[25][26][27]; the remaining studies continued the interventions during or after treatment. In total, 22 interventions were compared to a usual care control group.…”

Section: Resultsmentioning

confidence: 99%

“…Seven studies investigated the effects of pre-surgical exercise compared to usual care on health service utilisation [12,17,18,22], post-operative complications [12,17,18,22], cardiopulmonary [12,17,18,22,25], QoL [17] and psychological [26] outcomes among lung cancer patients. Each study was rated as having a high risk of bias.…”

Section: Lung Cancer Pre-surgical Exercise Versus Usual Carementioning

confidence: 99%

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An international review and meta-analysis of prehabilitation compared to usual care for cancer patients

2017

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Purpose The purpose of the study is to systematically review and synthesise randomised controlled trials investigating the effectiveness of prehabilitation compared to usual care for newly diagnosed, adult-onset cancer patients. Methods MEDLINE, EMBASE, PsycINFO, CINAHL and SSCI were searched up to April 2017. Studies were included if disease-related, treatment-related, patient-reported and health service utilisation outcomes were assessed. Two reviewers independently reviewed and appraised the risk of bias of each study. Results Eighteen studies were included. Interventions comprised one or more of the following components: psychological support, education and exercise. Meta-analyses found that pelvic floor muscle training (PFMT) significantly increased odds of continence at 3 months (OR = 3.29, 95% CI = 1.57-6.91), but did not significantly reduce daily pad use at 6 months post-surgery Mean Difference (MD)= ( = − 0.96, 95% CI = − 2.04-0.12) for prostate cancer patients. Although quality of life improved due to PFMT, functional ability or distress did not. Further meta-analyses indicated that presurgical exercise significantly reduced length of hospital stay (MD = − 4.18, 95% CI = − 5.43-− 2.93) and significantly lowered odds of post-surgery complications (OR = 0.25, 95% CI = 0.10-0.66) for lung cancer patients. Psychology-based prehabilitation significantly improved mood, physical wellbeing and immune function for prostate cancer patients and improved fatigue and psychological outcomes and a trend for better quality of life among breast cancer patients. Risk of bias was high for most studies. Conclusions Prehabilitation appears to benefit cancer patients. Rigorous trials are needed to investigate the effectiveness of prehabilitation among other cancer sites and other related effects. The cost-effectiveness of prehabilitation remains unanswered. Implications for cancer survivors Providing interventions earlier in the care pathway may lead to better outcomes for patients during survivorship.

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Section: Lung Cancer Pre-surgical Exercise Versus Usual Carementioning

confidence: 82%

Section: Resultsmentioning

confidence: 99%

Section: Lung Cancer Pre-surgical Exercise Versus Usual Carementioning

confidence: 99%

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An international review and meta-analysis of prehabilitation compared to usual care for cancer patients

2017

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“…We are not aware of any other study associating prehabilitation and severity of complications, according to the Clavien-Dindo classification. Moreover, the vast majority of prehabilitation studies performed to date included populations with COPD preparing for pulmonary resection surgery (24)(25)(26)(27), a context which is not relevant to all patients at operative risk (12). Only two studies included populations of all thoracic surgery patients without an underlying chronic disease criterion and authors concluded an increase in VO 2 max (28) and the distance traveled to 6 minutes walking test (29).…”

Section: Discussionmentioning

confidence: 99%

Impact of prehabilitation on morbidity and mortality after pulmonary lobectomy by minimally invasive surgery: a cohort study

Boujibar¹,

Bonnevie²,

Debeaumont³

et al. 2018

J. Thorac. Dis.

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“…In this perspective, randomized controlled trials suggests benefits from preoperative high intensity training in subjects with non-small-cell lung cancer bring new therapeutic modalities when addressing surgical risk for lung cancer patients. 34,35 However, exercise training in patients with NAC may represent a significant challenge.…”

Section: Implications For Clinical Decision and Researchmentioning

confidence: 99%

Preoperative Peak Oxygen Uptake in Lung Cancer Subjects With Neoadjuvant Chemotherapy: A Cross-Sectional Study

et al. 2016

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BACKGROUND:In non-small-cell lung cancer patients, high peak oxygen uptake (peak V O 2 ) predicts lower rates of postoperative complications and better long-term survival. Neoadjuvant chemotherapy (NAC) may negatively impact peak V O 2 . METHODS: Cardiopulmonary exercise testing (CPET) was performed in 34 consecutive stage IIIA/IIIB non-small-cell lung cancer subjects scheduled for elective lung surgery. Using multivariate linear regression adjusted for potential confounders, we compared CPET results in subjects receiving or not receiving NAC (NAC؉, n ‫؍‬ 19; NAC؊, n ‫؍‬ 15). RESULTS: Adjusted peak V O 2 was lower in NAC ؉ compared with NAC؊ subjects (؊5.3 mL/min/kg [95% CI ؊8.3 to ؊2.2], P ‫؍‬ .01). Likewise, oxygen pulse, maximal work load, and ventilatory threshold were also lower in NAC؉ subjects, whereas peak heart rate and breathing reserve were similar. NAC؉ subjects presented lower values of diffusion capacity for carbon monoxide (D LCO ) (P ‫؍‬ .035) and hemoglobin concentrations (P < .001). D LCO was strongly correlated with peak V O 2 (r 2 ‫؍‬ 0.56). Adjustment for D LCO reduced the effect of NAC on peak V O 2 without suppressing it. CONCLUSIONS: NAC was associated with lower preoperative peak V O 2 in subjects with non-small-cell lung cancer. This lower aerobic fitness may result from NAC-induced reduction in pulmonary gas exchange or heart toxicity. Since lower fitness is linked to poorer outcome, the decision for NAC may have to be balanced with its possible toxicity.

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High-intensity training and cardiopulmonary exercise testing in patients with chronic obstructive pulmonary disease and non-small-cell lung cancer undergoing lobectomy

Abstract: PRP was a valid preoperative strategy to improve physical performance in patients with both NSCLC and COPD and this advantage was also maintained after surgery.

Cited by 129 publications

References 23 publications

An international review and meta-analysis of prehabilitation compared to usual care for cancer patients

An international review and meta-analysis of prehabilitation compared to usual care for cancer patients

Impact of prehabilitation on morbidity and mortality after pulmonary lobectomy by minimally invasive surgery: a cohort study

Preoperative Peak Oxygen Uptake in Lung Cancer Subjects With Neoadjuvant Chemotherapy: A Cross-Sectional Study

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