Perioperative physical exercise interventions for patients undergoing lung cancer surgery: What is the evidence?

Surgical resection appears to be the most effective treatment for early-stage non-small cell lung cancer. Recent studies suggest that perioperative pulmonary rehabilitation improves functional capacity, reduces mortality and postoperative complications and enhances recovery and quality of life in operated patients. Our aim is to analyse and identify the most recent evidence-based physical exercise interventions, performed before or after surgery. We searched in MEDLINE, EMBASE, CINAHL, Cochrane Library and PsycINFO. We included randomised controlled trials aimed at assessing efficacy of exercise-training programmes; physical therapy interventions had to be described in detail in order to be reproducible. Characteristics of studies and programmes, results and outcome data were extracted. Six studies were included, one describing preoperative rehabilitation and three assessing postoperative intervention. It seems that the best preoperative physical therapy training should include aerobic and strength training with a duration of 2–4 weeks. Although results showed improvement in exercise performance after preoperative pulmonary rehabilitation, it was not possible to identify the best preoperative intervention due to paucity of clinical trials in this area. Physical training programmes differed in every postoperative study with conflicting results, so comparison is difficult. Current literature shows inconsistent results regarding preoperative or postoperative physical exercise in patients undergoing lung resection. Even though few randomised trials were retrieved, treatment protocols were difficult to compare due to variability in design and implementation. Further studies with larger samples and better methodological quality are urgently needed to assess efficacy of both preoperative and postoperative exercise programmes.

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The Role of VATS in Lung Cancer Surgery: Current Status and Prospects for Development

Minimally Invasive Surgery ◽

10.1155/2015/938430 ◽

2015 ◽

Vol 2015 ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

Dariusz Dziedzic ◽

Tadeusz Orlowski

Keyword(s):

Lung Cancer ◽

Early Stage ◽

Thoracoscopic Surgery ◽

Lung Resection ◽

Lung Cancer Surgery ◽

Cancer Surgery ◽

Current Status ◽

Invasive Technique ◽

Early Stage Lung Cancer ◽

Surgical Modality

Since the introduction of anatomic lung resection by video-assisted thoracoscopic surgery (VATS) 20 years ago, VATS has experienced major advances in both equipment and technique, introducing a technical challenge in the surgical treatment of both benign and malignant lung disease. The demonstrated safety, decreased morbidity, and equivalent efficacy of this minimally invasive technique have led to the acceptance of VATS as a standard surgical modality for early-stage lung cancer and increasing application to more advanced disease. Formerly there was much debate about the feasibility of the technique in cancer surgery and proper lymph node handling. Although there is a lack of proper randomized studies, it is now generally accepted that the outcome of a VATS procedure is at least not inferior to a resection via a traditional thoracotomy.

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Comparison of the effects of pulmonary rehabilitation with chest physical therapy on the levels of fibrinogen and albumin in patients with lung cancer awaiting lung resection: a randomized clinical trial

BMC Pulmonary Medicine ◽

10.1186/1471-2466-14-121 ◽

2014 ◽

Vol 14 (1) ◽

Cited By ~ 13

Author(s):

Maria Tereza Aguiar Pessoa Morano ◽

Rafael Mesquita ◽

Guilherme Pinheiro Ferreira Da Silva ◽

Amanda Souza Araújo ◽

Juliana Maria De Sousa Pinto ◽

...

Keyword(s):

Lung Cancer ◽

Clinical Trial ◽

Physical Therapy ◽

Randomized Clinical Trial ◽

Pulmonary Rehabilitation ◽

Lung Resection ◽

Chest Physical Therapy

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Attitudes and Perceptions to Prehabilitation in Lung Cancer

Integrative Cancer Therapies ◽

10.1177/1534735420924466 ◽

2020 ◽

Vol 19 ◽

pp. 153473542092446 ◽

Cited By ~ 1

Author(s):

Anna Shukla ◽

Catherine L. Granger ◽

Gavin M. Wright ◽

Lara Edbrooke ◽

Linda Denehy

Keyword(s):

Lung Cancer ◽

Patient Outcomes ◽

Pulmonary Rehabilitation ◽

Response Rate ◽

Lung Resection ◽

Lung Cancer Surgery ◽

Allied Health Professionals ◽

Perceived Benefit ◽

Attitudes And Perceptions ◽

Risk Patients

Background: Prehabilitation to maximize exercise capacity before lung cancer surgery has the potential to improve operative tolerability and patient outcomes. However, translation of this evidence into clinical practice is limited. Aims: To determine the acceptability and perceived benefit of prehabilitation in lung cancer among thoracic surgeons. Procedure: 198 cardiothoracic surgeons within Australia and New Zealand were surveyed to evaluate their attitudes and perceived benefits of prehabilitation in lung cancer. Results: Response rate was 14%. A moderate proportion of respondents reported that there is a need to refer lung resection patients to preoperative physiotherapy/prehabilitation, particularly high-risk patients or those with borderline fitness for surgery. 91% of surgeons were willing to delay surgery (as indicated by cancer stage/type) to optimize patients via prehabilitation. The main barriers to prehabilitation reported were patient comorbidities and access to allied health professionals, with 33% stating that they were unsure who to refer to for prehabilitation in thoracic surgery. This is despite 60% of the cohort reporting that pulmonary rehabilitation is available as a preoperative resource. 92% of respondents believe that further research into prehabilitation in lung cancer is warranted. Conclusion: The benefits of prehabilitation for the oncology population have been well documented in the literature over recent years and this is reflected in the perceptions surgeons had on the benefits of prehabilitation for their patients. This survey demonstrates an interest among cardiothoracic surgeons in favor of prehabilitation, and therefore further research and demonstration of its benefit is needed in lung cancer to facilitate implementation into practice.

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Early-Stage Non-Small Cell Lung Cancer: Surgery, Stereotactic Radiosurgery, and Individualized Adjuvant Therapy

Seminars in Oncology ◽

10.1053/j.seminoncol.2013.12.011 ◽

2014 ◽

Vol 41 (1) ◽

pp. 40-56 ◽

Cited By ~ 33

Author(s):

Sukhmani K. Padda ◽

Bryan M. Burt ◽

Nicholas Trakul ◽

Heather A. Wakelee

Keyword(s):

Lung Cancer ◽

Adjuvant Therapy ◽

Small Cell Lung Cancer ◽

Stereotactic Radiosurgery ◽

Cell Lung Cancer ◽

Early Stage ◽

Lung Cancer Surgery ◽

Small Cell ◽

Cancer Surgery ◽

Small Cell Lung

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Effect of an antiracism intervention on disparities in time to lung cancer surgery.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.101 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 101-101

Author(s):

Jacob Newton Stein ◽

Samuel Cykert ◽

Christina Yongue ◽

Eugenia Eng ◽

Isabella Kathryn Wood ◽

...

Keyword(s):

Lung Cancer ◽

Racial Disparities ◽

Cancer Care ◽

Retrospective Cohort ◽

Early Stage ◽

Lung Cancer Surgery ◽

Cancer Surgery ◽

Early Stage Lung Cancer ◽

Black Patients ◽

White Patients

101 Background: Racial disparities are well described in the management of early-stage lung cancer, with Black patients less likely to receive potentially curative surgery than non-Hispanic Whites. A multi-site pragmatic trial entitled Accountability for Cancer Care through Undoing Racism and Equity (ACCURE), designed in collaboration with community partners, eliminated racial disparities in lung cancer surgery through a multi-component intervention. The study involved real-time electronic health record (EHR) monitoring to identify patients not receiving recommended care, a nurse navigator who reviewed and addressed EHR alerts daily, and race-specific feedback provided to clinical teams. Timeliness of cancer care is an important quality metric. Delays can lead to disease progression, upstaging, and worse survival, and Black patients are more likely to experience longer wait times to lung cancer surgery. Yet interventions to reduce racial disparities in timely delivery of lung cancer surgery have not been well studied. We evaluated the effect of ACCURE on timely receipt of lung cancer surgery. Methods: We analyzed data of a retrospective cohort at five cancer centers gathered prior to the ACCURE intervention and compared results with prospective data collected during the intervention. We calculated mean time from clinical suspicion of lung cancer to surgery and evaluated the proportion of patients who received surgery within 60 days stratified by race. We performed a t-test to compare mean days to surgery and chi2 for the delivery of surgery within 60 days. Results: 1320 patients underwent surgery in the retrospective arm, 160 were Black. 254 patients received surgery in the intervention arm, 85 were Black. Results are summarized in Table. Mean time to surgery in the retrospective cohort was 41.8 days, compared with 25.5 days in the intervention cohort (p<0.01). In the retrospective cohort, 68.8% of Black patients received surgery within 60 days versus 78.9% of White patients (p<0.01). In the intervention, the difference between Blacks and Whites with respect to surgery within 60 days was no longer significant (89.41% of Black patients vs 94.67% of White patients, p=0.12). Conclusions: Racial disparities exist in the delivery of timely lung cancer surgery. The ACCURE intervention improved time to surgery and timeliness of surgery for Black and White patients with early-stage lung cancer. A combination of real-time EHR monitoring, nurse navigation, and race-based feedback markedly reduced racial disparities in timely lung cancer care. [Table: see text]

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Diagnosis and outcome of resected solitary pulmonary nodules after liver transplantation

Japanese Journal of Clinical Oncology ◽

10.1093/jjco/hyz159 ◽

2019 ◽

Author(s):

Mari Tone ◽

Nobuyasu Awano ◽

Takehiro Izumo ◽

Hanako Yoshimura ◽

Tatsunori Jo ◽

...

Keyword(s):

Computed Tomography ◽

Lung Cancer ◽

Liver Transplantation ◽

Early Stage ◽

Lung Resection ◽

Invasive Pulmonary Aspergillosis ◽

Primary Lung Cancer ◽

Pulmonary Nodules ◽

Solitary Pulmonary Nodules ◽

Computed Tomography Scans

Abstract Objective Solitary pulmonary nodules after liver transplantation are challenging clinical problems. Herein, we report the causes and clinical courses of resected solitary pulmonary nodules in patients who underwent liver transplantation. Methods We retrospectively obtained medical records of 68 patients who underwent liver transplantation between March 2009 and June 2016. This study mainly focused on patients with solitary pulmonary nodules observed on computed tomography scans during follow-ups that were conducted until their deaths or February 2019. Results Computed tomography scans revealed solitary pulmonary nodules in 7 of the 68 patients. Definitive diagnoses were obtained using video-assisted lung resection in all seven patients. None experienced major postoperative complications. The final pathologic diagnoses were primary lung cancer in three patients, pulmonary metastases from hepatocellular carcinoma in one patient, invasive pulmonary aspergillosis in one patient, post-transplant lymphoproliferative disorder in one patient, and hemorrhagic infarction in one patient. The three patients with lung cancer were subsequently treated with standard curative resection. Conclusions Solitary pulmonary nodules present in several serious but potentially curable diseases, such as early-stage lung cancer. Patients who present with solitary pulmonary nodules after liver transplantation should be evaluated by standard diagnostic procedures, including surgical biopsy if necessary.

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