High-Intensity Exercise Best During Lung Cancer Therapy

Laird Harrison

October 24, 2011

October 24, 2011 (Honolulu, Hawaii) — High-intensity exercise during treatment for nonsmall-cell lung cancer can be more effective than the same program after cancer treatment, researchers reported here at CHEST 2011: American College of Chest Physicians Annual Meeting.

"This [study] shows 2 things," said Vickie R. Shannon, MD, professor of medicine at the University of Texas M.D. Anderson Cancer Center in Houston, who presented the results. "One is that you can refer patients during their cancer treatment, and 2 is that those patients get some benefit from the rehabilitation."

Dr. Shannon and her colleagues looked retrospectively at the records of 361 patients with nonsmall-cell lung cancer and moderate to severe chronic obstructive pulmonary disease who completed an individualized program of pulmonary rehabilitation.

The patients participated in a 12-week outpatient pulmonary rehabilitation program 2 to 3 times a week. The program included exercising at 60% to 80% of their maximal work rate, strength training, and aerobic exercises.

Each week, the patients also had 2 individual sessions with an occupational therapist and 1 group-education session. They were also given referrals to tobacco-cessation and nutrition programs.

Overall, 132 patients underwent rehabilitation during their cancer therapy and 229 underwent rehabilitation after they completed cancer therapy.

The researchers evaluated the patients at baseline, at 2 weeks, and at 3, 6, and 12 months after completing the rehabilitation program. Seventy-six of the patients who underwent rehabilitation during cancer therapy and 113 of those who underwent rehabilitation after cancer therapy remained in the study until its completion.

Both groups improved, but the improvement was greater in the during-therapy group. Immediately after rehabilitation, the Borg scores of those patients had dropped 3.5 points (±1.3) for dyspnea and 2.4 points (±1.1) for fatigue.

By comparison, the after-therapy group dropped 1.2 points (±0.06) for dyspnea and 1.2 points (±0.7) for fatigue. (The between-group differences were statistically significant; P < .001 for dyspnea and P < .01 for fatigue.)

Likewise, 6 months after rehabilitation, Chronic Respiratory Disease Questionnaire scores had improved 8.4 points (±4.5) in the during-therapy group, compared with 2.4 points (±3.2) in the after-therapy group (P = .001). (Six months later, the difference was no longer statistically significant.)

The during-therapy group's improvements in 6-minute walk distance, work load, maximal oxygen intake, oxygen, and oxygen pulse were all statistically greater than those of the after-therapy group. In general, the improvements were more durable and greater for the during-therapy group.

Patients are pleased with the results, said Dr. Shannon. "We do have a hard time getting them into the program, but once they are in, they love it.... Those patients are very debilitated, so to be able to get out of a chair and comb their hair is a very big deal."

Many clinicians have hesitated to refer their patients for pulmonary rehabilitation until after cancer therapy is completed, panel comoderator Michael Ezzie, MD, assistant professor of pulmonary medicine, allergy, critical care, and sleep medicine at Ohio State University, Columbus, told Medscape Medical News.

"Most cancer specialists have concerns about putting patients undergoing cancer therapy near other patients who might have respiratory diseases," said Dr. Ezzie, who was not involved in this study. Dr. Shannon's group has not yet analyzed data on respiratory diseases, he pointed out.

Despite that concern, "I think this study and a couple of other small studies show that it's valuable to refer patients during therapy," he said.

Dr. Shannon and Dr. Ezzie have disclosed no relevant financial relationships.

CHEST 2011: American College of Chest Physicians Annual Meeting: Abstract 855A. Presented October 23, 2011.

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