The Effects of Preoperative Short-term Intense Physical Therapy in Lung Cancer Patients:A Randomized Controlled Trial

Pehlivan, Esra; Turna, Akif; Gürses, Atilla; Gürses, Hülya Nilgün

doi:10.5761/atcs.oa.11.01663

Cited by 134 publications

(141 citation statements)

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“…Three studies did not specify the time frame of intervention implementation prior to treatment [16][17][18]. 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.…”

Section: Resultsmentioning

confidence: 99%

“…Findings from three studies [12,17,22] were combined in a meta-analysis which indicated a significant benefit for presurgical pulmonary exercise versus usual care on the total number of days spent in the hospital among lung cancer patients (MD = − 4.20, 95% CI = − 5.45-− 2.95, I 2 = 0%) (see Fig. 3).…”

Section: Lung Cancer Pre-surgical Exercise Versus Usual Carementioning

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: Resultsmentioning

confidence: 99%

Section: Lung Cancer Pre-surgical Exercise Versus Usual Carementioning

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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“…Pulmonary rehabilitation, including exercise and education, is effective in candidates for lung volume reduction surgery, 19) and preoperative intensive physical therapy appears to be effective for surgical patients with lung cancer. 20) Inhalation therapy can improve exercise tolerability by decreasing hyperinflation of lungs, 21) and preoperative smoking cessation can also play a role. 22) ERS/ESTS guidelines recommend smoking cessation two to four weeks before surgery for lung cancer, 3) but 28.6% of patients continue to smoke within two weeks of surgery.…”

Section: Discussionmentioning

confidence: 99%

Worse Prognosis for Stage IA Lung Cancer Patients with Smoking History and More Severe Chronic Obstructive Pulmonary Disease

Yoshida

Kage

Murakawa

et al. 2015

ATCS

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IntroductionLung cancer is the most commonly diagnosed cancer and the leading cause of cancer death in males worldwide. 1) Tobacco smoking is the best established risk factor for lung cancer and the most common risk factor for chronic obstructive lung disease (COPD). 2) COPD is the fourth leading cause of death worldwide and occurs in 30% of patients with lung cancer. 2) Spirometry is used to assess the risk for perioperative death and cardiopulmonary complications after resection of the lung, with a predicted postoperative forced expiratory volume in one second (FEV 1 ) value of 30% indicating a high risk. 3,4) Purpose: This retrospective study examined whether the severity of chronic obstructive lung disease (COPD) affects surgical outcomes. Methods: The subjects were 243 consecutive patients who underwent lobectomy for clinical stage IA lung cancer from 1999 to 2008 in our hospital. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) grading system was used to classify the severity of COPD in smokers. Results: Among the 149 smokers, 62 were diagnosed with COPD (25 as GOLD 1, 33 as GOLD 2, and 4 as GOLD 3). In univariate analysis, postoperative pulmonary complications were associated with male sex and more severe COPD. The frequencies were 17.1% in non-COPD, 24.0% in GOLD 1-COPD, and 46.0% in GOLD 2/3-COPD smokers (p = 0.0006). In univariate analysis, older age, smoking history, higher smoking pack-years and more severe COPD were associated with poor relapse-free survival. Relapse-free survival at five years was 80.7%, 66.9%, and 61.3% in non-COPD, GOLD 1-COPD, and GOLD 2/3-COPD smokers, respectively (p = 0.0005). Multivariate analyses showed that only GOLD 2/3-COPD was associated with postoperative pulmonary complications and relapse-free survival. Inhaled bronchodilators were prescribed preoperatively to 24.3% of the GOLD 2/3-COPD group. Conclusion: Smokers with GOLD 2/3-COPD are at high risk for pulmonary complications and have an unfavorable long-term prognosis.

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“…Early postoperative respiratory physiotherapy following lung resection reduces respiratory complications in adult patients. 1,2 However, children have specific physiological differences, suggesting that their postoperative complications may differ from those of adults. 3,4 Children rarely undergo lung resection.…”

Section: Introductionmentioning

confidence: 99%

Early Respiratory Therapy Reduces Postoperative Atelectasis in Children Undergoing Lung Resection

2013

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BACKGROUND: Early physiotherapy reduces pulmonary complications after lung resection in adult patients. However, the effectiveness and the techniques used in postoperative physiotherapy in children undergoing lung resection have not been well described. Therefore, the standardization of a physiotherapeutic attendance after lung resection in children is necessary. METHODS: This was a retrospective and prospective, interventional, descriptive, and quantitative study. We evaluated 123 pediatric subjects undergoing lung resection. Fifty-two children were prospectively submitted to a standardized physiotherapy protocol that included a mask with a positive expiratory pressure of 10 cm H 2 O, expiratory rib cage compression, coughing, lifting the upper limbs, and ambulation, starting within the first 4 hours after surgery and continuing 3 times each day. A historical control group of 71 subjects received physiotherapeutic techniques without specific standardization and with variability in the start date and number of days attended. We recorded the presence of postoperative complications, prolonged air leak, postoperative bronchoscopy, the time of chest tube removal, and hospital stay following surgery. RESULTS: The group that received a standardized protocol of physiotherapy had fewer instances of atelectasis than the control group (15.4% vs 7.6%, P ‫؍‬ .01). Subjects in the control group were more likely than those in the intervention group to require fiberoptic bronchoscopy for bronchial toilet (n ‫؍‬ 14 [19.7%] vs n ‫؍‬ 5 [9.6%], P < .001). There was no difference in the time of drainage or hospital stay between the groups. CONCLUSIONS: Implementation of a standardized physiotherapeutic protocol after lung resection in children decreases atelectasis but does not reduce the time of chest tube removal or the duration of hospital stay.

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The Effects of Preoperative Short-term Intense Physical Therapy in Lung Cancer Patients:A Randomized Controlled Trial

Cited by 134 publications

References 12 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

Worse Prognosis for Stage IA Lung Cancer Patients with Smoking History and More Severe Chronic Obstructive Pulmonary Disease

Early Respiratory Therapy Reduces Postoperative Atelectasis in Children Undergoing Lung Resection

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