Real-life feasibility of home-based pulmonary rehabilitation in chemotherapy-treated patients with thoracic cancers: a pilot study

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Abstract

Background

Patients with advanced lung cancer (LC) or malignant pleural mesothelioma (MPM) exhibit limitation of exercise capacities and alteration of quality of life (QoL) induced by cancer and its treatment. Few studies assessed pulmonary rehabilitation (PR) in these chemotherapy-treated patients, and none evaluated a home-based PR program.

Methods

In this prospective uncontrolled observational pilot study, patients treated by chemotherapy for LC or MPM were screened for a home-based PR program combining exercise training with global cares including therapeutic education and psychosocial management. Feasibility and safety were evaluated by attendance and adherence to PR program. Various exercise tolerance tests, including 6-min walk test (6MWT) and 6-min stepper test (6MST), were performed before and after PR associated with, QoL and psychological assessment (VSRQ and HAD, respectively).

Results

243 patients were considered eligible but only 71 (60.6 ± 8.8 years) started a PR and 47 completed the program. Refusals to participate were mostly related to lack of motivation whereas withdrawals to PR were related to cancer-related medical issues. No adverse event related to PR was observed. Baseline 6MWT distance was associated with performance status ( r = − 0.45, p = 0.001) and mMRC dyspnea scale ( r = − 0.49, p < 0.001) but not with lung cancer stage. Post-PR reassessment showed 6MWT stability and 6MST improvement in patients who completed the program. Daily physical activity ( p = 0.007) and anxiety ( p = 0.02) scores were significantly improved.

Conclusions

Home-based PR was feasible and safe in patients with advanced LC or MPM. Exercise capacities stability in patients who completed the PR program suggests that PR might be beneficial. Further studies are warranted to confirm and to improve the potential value of PR in these patients.

Electronic supplementary material

The online version of this article (10.1186/s12885-018-4102-6) contains supplementary material, which is available to authorized users.

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Most cited references 21

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Phase III study of pemetrexed in combination with cisplatin versus cisplatin alone in patients with malignant pleural mesothelioma.

Nicholas Vogelzang, James J Rusthoven, James T Symanowski … (2003)

Patients with malignant pleural mesothelioma, a rapidly progressing malignancy with a median survival time of 6 to 9 months, have previously responded poorly to chemotherapy. We conducted a phase III trial to determine whether treatment with pemetrexed and cisplatin results in survival time superior to that achieved with cisplatin alone. Chemotherapy-naive patients who were not eligible for curative surgery were randomly assigned to receive pemetrexed 500 mg/m2 and cisplatin 75 mg/m2 on day 1, or cisplatin 75 mg/m2 on day 1. Both regimens were given intravenously every 21 days. A total of 456 patients were assigned: 226 received pemetrexed and cisplatin, 222 received cisplatin alone, and eight never received therapy. Median survival time in the pemetrexed/cisplatin arm was 12.1 months versus 9.3 months in the control arm (P =.020, two-sided log-rank test). The hazard ratio for death of patients in the pemetrexed/cisplatin arm versus those in the control arm was 0.77. Median time to progression was significantly longer in the pemetrexed/cisplatin arm: 5.7 months versus 3.9 months (P =.001). Response rates were 41.3% in the pemetrexed/cisplatin arm versus 16.7% in the control arm (P <.0001). After 117 patients had enrolled, folic acid and vitamin B12 were added to reduce toxicity, resulting in a significant reduction in toxicities in the pemetrexed/cisplatin arm. Treatment with pemetrexed plus cisplatin and vitamin supplementation resulted in superior survival time, time to progression, and response rates compared with treatment with cisplatin alone in patients with malignant pleural mesothelioma. Addition of folic acid and vitamin B12 significantly reduced toxicity without adversely affecting survival time.

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Barriers to pulmonary rehabilitation: characteristics that predict patient attendance and adherence.

Emma Coombes, Paula Browne, Emma Knights … (2013)

Pulmonary rehabilitation (PR) is efficacious in chronic obstructive pulmonary disease (COPD). As completion rates of PR are poor, we wished to assess predictors of attendance and adherence. We performed a retrospective analysis of 711 patients with COPD, who were invited to attend PR. Data were compared to allow predictors (gender, smoking status, attending partner, referral route, employment status, body mass index, forced expiratory volume in 1 s (FEV(1)), oxygen therapy (LTOT), oxygen saturations, chronic respiratory questionnaire (CRQ), shuttle walk distance, travel distance and time) of attendance (0 or >0 attendance) and adherence ( 63% attendance) to be identified. 31.8% of patients referred for PR did not attend and a further 29.1% were non-adherent. Predictors of non-attendance were female gender, current smoker, and living alone. Predictors of non-adherence were extremes of age, current smoking, LTOT use, FEV(1), CRQ score and travelling distance. Multiple logistic regression revealed that LTOT and living alone were independent predictors of poor attendance and current smoking, poor shuttle walking distance and hospitalisations were independent predictors of poor adherence. Smoking status, availability of social support and markers of disease severity were predictors of attendance and adherence to PR. Copyright © 2012 Elsevier Ltd. All rights reserved.

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A home-based exercise program to improve function, fatigue, and sleep quality in patients with Stage IV lung and colorectal cancer: a randomized controlled trial.

Andrea L. Cheville, Jenny Kollasch, Justin Vandenberg … (2013)

Exercise benefits patients with cancer, but studies of home-based approaches, particularly among those with Stage IV disease, remain small and exploratory. To conduct an adequately powered trial of a home-based exercise intervention that can be facilely integrated into established delivery and reimbursement structures. Sixty-six adults with Stage IV lung or colorectal cancer were randomized, in an eight-week trial, to usual care or incremental walking and home-based strength training. The exercising participants were instructed during a single physiotherapy visit and subsequently exercised four days or more per week; training and step-count goals were advanced during bimonthly telephone calls. The primary outcome measure was mobility assessed with the Ambulatory Post Acute Care Basic Mobility Short Form. Secondary outcomes included ratings of pain and sleep quality as well as the ability to perform daily activities (Ambulatory Post Acute Care Daily Activities Short Form), quality of life (Functional Assessment of Cancer Therapy-General), and fatigue (Functional Assessment of Cancer Therapy-Fatigue). Three participants dropped out and seven died (five in the intervention and two in the control group, P=0.28). At Week 8, the intervention group reported improved mobility (P=0.01), fatigue (P=0.02), and sleep quality (P=0.05) compared with the usual care group, but did not differ on the other measures. A home-based exercise program seems capable of improving the mobility, fatigue, and sleep quality of patients with Stage IV lung and colorectal cancer. Copyright © 2013. Published by Elsevier Inc.

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Author and article information

Contributors

Cecile Olivier: cecile.olivier87@gmail.com

Jean-Marie Grosbois: jmgrosbois@formactionsante.com

Alexis B. Cortot: alexis.cortot@chru-lille.fr

Sophie Peres: speres@santelys.asso.fr

Christophe Heron: christophe.heron@chru-lille.fr

Julie Delourme: julie.delourme@ghsc.fr

Marianne Gierczynski: marianne.gierczynski@chru-lille.fr

Anne Hoorelbeke: ahoorelbeke@clinique-mitterie.com

Arnaud Scherpereel:

ORCID: http://orcid.org/0000-0002-7607-1863

+33 (0)3 20 44 49 98 , arnaud.scherpereel@chru-lille.fr

Olivier Le Rouzic: olivier.lerouzic@chru-lille.fr

Journal

Journal ID (nlm-ta): BMC Cancer

Journal ID (iso-abbrev): BMC Cancer

Title: BMC Cancer

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2407

Publication date (Electronic): 13 February 2018

Publication date PMC-release: 13 February 2018

Publication date Collection: 2018

Volume: 18

Electronic Location Identifier: 178

Affiliations

[1 ]ISNI 0000 0001 2186 1211, GRID grid.4461.7, CHU Lille, Department of Respiratory Diseases, MESOCLIN, Center for Infection and Immunity of Lille (INSERM U1019 – UMR 8204 – Pasteur Institute of Lille), , University of Lille, ; F-59000 Lille, France

[2 ]Clinique de la Louvière, Pneumologie, F-59000 Lille, France

[3 ]FormAction Santé, F-59840 Pérenchies, France

[4 ]Santelys Association, F-59120 Loos, France

[5 ]ISNI 0000 0004 0471 8845, GRID grid.410463.4, Nutrition Department, , CHU Lille, ; F-59000 Lille, France

[6 ]Department of Respiratory Diseases, CH Seclin, F-59113 Seclin, France

[7 ]Clinique de la Mitterie, Respiratory Diseases, F-59160 Lomme, France

[8 ]ISNI 0000 0004 0471 8845, GRID grid.410463.4, Pulmonary and Thoracic Oncology Department, , Hôpital Calmette - CHU de Lille, ; F-59037 Lille Cedex, France

Author information

Arnaud Scherpereel http://orcid.org/0000-0002-7607-1863

Article

Publisher ID: 4102

DOI: 10.1186/s12885-018-4102-6

PMC ID: 5810120

PubMed ID: 29433474

SO-VID: 490f9844-0465-4708-b262-2aa8f87b5eca

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 1 October 2017

Date accepted : 5 February 2018

Funding

Funded by: Santelys Association

Funded by: FundRef http://dx.doi.org/10.13039/100002429, Amgen;

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ScienceOpen disciplines: Oncology & Radiotherapy

Keywords: lung neoplasms,mesothelioma,pulmonary rehabilitation,chemotherapy,quality of life

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ScienceOpen disciplines: Oncology & Radiotherapy

Keywords: lung neoplasms, mesothelioma, pulmonary rehabilitation, chemotherapy, quality of life

Real-life feasibility of home-based pulmonary rehabilitation in chemotherapy-treated patients with thoracic cancers: a pilot study

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Karger: Oncology

Most cited references 21

Phase III study of pemetrexed in combination with cisplatin versus cisplatin alone in patients with malignant pleural mesothelioma.

Barriers to pulmonary rehabilitation: characteristics that predict patient attendance and adherence.

A home-based exercise program to improve function, fatigue, and sleep quality in patients with Stage IV lung and colorectal cancer: a randomized controlled trial.

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