Pulmonary rehabilitation programme for patients undergoing curative lung cancer surgery

• Published in: European journal of cardio-thoracic surgery 2013-10, Vol.44 (4), p.e266-e271
• Main Authors: Bradley, Amy, Marshall, Andrea, Stonehewer, Louisa, Reaper, Lynn, Parker, Kim, Bevan-Smith, Elaine, Jordan, Chris, Gillies, James, Agostini, Paula, Bishay, Ehab, Kalkat, Maninder, Steyn, Richard, Rajesh, Pala, Dunn, Janet, Naidu, Babu
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Chi-Square Distribution; Exercise Therapy - statistics & numerical data; Female; Humans; Lung Neoplasms - rehabilitation; Lung Neoplasms - surgery; Male; Middle Aged; Patient Acceptance of Health Care; Prospective Studies; Smoking Cessation - statistics & numerical data; Treatment Outcome
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1093/ejcts/ezt381

The aim of the study was to develop a multistranded pragmatic rehabilitation programme for operable lung cancer patients, that looks into feasibility, process indicators, outcome measures, local adaptability, compliance and potential cost benefit. An outpatient-based complex intervention, rehabilitation for operated lung cancer (ROC) programme, was developed to optimize physical status, prepare for the inpatient journey and support through recovery after surgery. It includes exercise classes, smoking cessation, dietary advice and patient education and was tested in an enriched cohort study within a regional thoracic unit over 18 months. A multistranded pragmatic rehabilitation programme pre- and post-surgery is feasible. Fifty-eight patients received the intervention and 305 received standard care. Both groups were matched for age, lung function comorbidity and type of surgery. Patients in the intervention group attended exercise classes twice a week until surgery, which was not delayed. Patients attended four sessions presurgery (range 1-15), resulting in an improvement of 20 m (range -73-195, P = 0.001) in a 6-min walk test and 0.66 l in forced expiratory volume in 1 s (range -1.85 from 1.11, P = 0.009) from baseline to presurgery. Fifty-four percentage of smokers in the intervention group stopped smoking. Sixteen percentage of patients were identified as being at risk of malnourishment and received nutritional intervention. There was a trend in patients in the intervention group towards experiencing fewer postoperative pulmonary complications than those in the non-intervention group (9 vs 16%, respectively, P = 0.21) and fewer readmissions to hospital because of complications (5 vs 14% respectively, P = 0.12). Chronic obstructive pulmonary disease-type pulmonary rehabilitation before and after lung cancer surgery is viable, and preliminary results suggest improvement in physical measures. A multicentre, randomized controlled trial is warranted to confirm clinical efficacy. ISRCTN00061628.