Feasibility of a multimodal exercise, nutrition, and palliative care intervention in advanced lung cancer

Abstract Background Advanced lung cancer patients face significant physical and psychological burden leading to reduced physical function and quality of life. Separately, physical activity, nutrition, and palliative symptom management interventions have been shown to improve functioning in this population, however no study has combined all three in a multimodal intervention. Therefore, we assessed the feasibility of a multimodal physical activity, nutrition, and palliative symptom management intervention in advanced lung cancer. Methods Participants received an individually tailored 12-week intervention featuring in-person group-based exercise classes, at-home physical activity prescription, behaviour change education, and nutrition and palliative care consultations. Patients reported symptom burden, energy, and fatigue before and after each class. At baseline and post-intervention, symptom burden, quality of life, fatigue, physical activity, dietary intake, and physical function were assessed. Post-intervention interviews examined participant perspectives. Results The multimodal program was feasible, with 44% (10/23) recruitment, 75% (75/100) class attendance, 89% (8/9) nutrition and palliative consult attendance, and 85% (17/20) assessment completion. Of ten participants, 70% (7/10) completed the post-intervention follow-up. Participants perceived the intervention as feasible and valuable. Physical activity, symptom burden, and quality of life were maintained, while tiredness decreased significantly. Exercise classes prompted acute clinically meaningful reductions in fatigue, tiredness, depression, pain, and increases in energy and well-being. Conclusion A multimodal physical activity, nutrition, and palliative symptom management intervention is feasible and shows potential benefits on quality of life that warrant further investigation in a larger cohort trial. Trial registration NCT04575831, Registered 05 October 2020 – Retrospectively registered.

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Feasibility and preliminary efficacy of a multimodal exercise, nutrition, and palliative care intervention in advanced lung cancer

10.31236/osf.io/r5t4y ◽

2020 ◽

Author(s):

Manuel Ester ◽

S. Nicole Culos-Reed ◽

Amane Abdul-Razzak ◽

Julia Daun ◽

Delaney Duchek ◽

...

Keyword(s):

Quality Of Life ◽

Physical Activity ◽

Lung Cancer ◽

Palliative Care ◽

Symptom Burden ◽

Advanced Lung Cancer ◽

Post Intervention ◽

Management Intervention ◽

Exercise Classes

Introduction: Advanced lung cancer patients face significant physical and psychological burden leading to reduced quality of life. Physical activity, nutrition, and palliative care interventions may enhance quality of life, however no study has combined these modalities in a multimodal intervention. Therefore, we assessed the feasibility and preliminary efficacy of an exercise, nutrition, and palliative symptom management intervention to improve quality of life in advanced lung cancer. Methods: Participants received an individually-tailored 12-week intervention featuring in-person group-based exercise classes, at-home physical activity prescription, and nutritional and palliative care consults. Patients reported symptom burden and quality of life pre-/post-class, as well as pre-/post-intervention, along with self-reported physical activity and a physical function assessment. Post-intervention interviews examined participant perspectives. Results: The multimodal program was feasible, with 44% recruitment, 75% class attendance, 89% nutrition and palliative consult attendance, and 85% assessment completion. Participants perceived the intervention as feasible and valuable. Physical activity, symptom burden, and quality of life were maintained, while tiredness decreased significantly. Exercise classes prompted acute clinically meaningful reductions in fatigue, tiredness, depression, pain, and increases in energy and well-being. Conclusion: A multimodal exercise, nutrition, and palliative symptom management intervention is feasible and shows potential benefits on quality of life that warrant further investigation.

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Impact of physical activity on fatigue and quality of life in people with advanced lung cancer: a randomized controlled trial

Annals of Oncology ◽

10.1093/annonc/mdx205 ◽

2017 ◽

Vol 28 (8) ◽

pp. 1889-1897 ◽

Cited By ~ 30

Author(s):

H.M. Dhillon ◽

M.L. Bell ◽

H.P. van der Ploeg ◽

J.D. Turner ◽

M. Kabourakis ◽

...

Keyword(s):

Quality Of Life ◽

Physical Activity ◽

Lung Cancer ◽

Randomized Controlled Trial ◽

Controlled Trial ◽

Advanced Lung Cancer ◽

Randomized Controlled

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1514P Patient-reported outcomes of early integration palliative care in quality of life and symptom burden in advanced lung cancer – A randomized study

Annals of Oncology ◽

10.1016/j.annonc.2020.08.140 ◽

2020 ◽

Vol 31 ◽

pp. S935

Author(s):

R. Félix Soares ◽

R. Silva ◽

É. Rodrigues ◽

M. Amaral ◽

M.J. Nabais ◽

...

Keyword(s):

Quality Of Life ◽

Lung Cancer ◽

Palliative Care ◽

Patient Reported Outcomes ◽

Randomized Study ◽

Symptom Burden ◽

Advanced Lung Cancer ◽

Early Integration ◽

Patient Reported

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An investigation of symptom burden and quality of life in Chinese chemo-naïve advanced lung cancer patients by using the Instrument-Cloud QOL System

Lung Cancer ◽

10.1016/j.lungcan.2014.01.027 ◽

2014 ◽

Vol 84 (3) ◽

pp. 301-306 ◽

Cited By ~ 5

Author(s):

Yuxiang Ma ◽

Yunpeng Yang ◽

Yan Huang ◽

Hongyun Zhao ◽

Xue Hou ◽

...

Keyword(s):

Quality Of Life ◽

Lung Cancer ◽

Cancer Patients ◽

Symptom Burden ◽

Advanced Lung Cancer ◽

Lung Cancer Patients

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Assessing the Correlation Between Physical Activity and Quality of Life in Advanced Lung Cancer

Integrative Cancer Therapies ◽

10.1177/1534735416684016 ◽

2016 ◽

Vol 17 (1) ◽

pp. 73-79 ◽

Cited By ~ 12

Author(s):

Brett C. Bade ◽

Mary C. Brooks ◽

Sloan B. Nietert ◽

Ansley Ulmer ◽

D. David Thomas ◽

...

Keyword(s):

Quality Of Life ◽

Physical Activity ◽

Lung Cancer ◽

Correlation Coefficients ◽

Step Count ◽

Advanced Lung Cancer ◽

Advanced Stage ◽

Daily Step ◽

Daily Step Count

Background and objective. Increasing physical activity (PA) is safe and beneficial in lung cancer (LC) patients. Advanced-stage LC patients are under-studied and have worse symptoms and quality of life (QoL). We evaluated the feasibility of monitoring step count in advanced LC as well as potential correlations between PA and QoL. Methods. This is a prospective, observational study of 39 consecutive patients with advanced-stage LC. Daily step count over 1 week (via Fitbit Zip), QoL, dyspnea, and depression scores were collected. Spearman rank testing was used to assess correlations. Correlation coefficients (ρ) >0.3 or <−0.3 (more and less correlated, respectively) were considered potentially clinically significant. Results. Most (83%) of the patients were interested in participating, and 67% of those enrolled were adherent with the device. Of those using the device (n = 30), the average daily step count was 4877 (range = 504-12 118) steps/d. Higher average daily step count correlated with higher QoL (ρ = 0.46), physical (ρ = 0.61), role (ρ = 0.48), and emotional functioning (ρ = 0.40) scores as well as lower depression (ρ = −0.40), dyspnea (ρ = −0.54), and pain (ρ = −0.37) scores. Conclusion. Remote PA monitoring (Fitbit Zip) is feasible in advanced-stage LC patients. Interest in participating in this PA study was high with comparable adherence to other PA studies. In those utilizing the device, higher step count correlates with higher QoL as well as lower dyspnea, pain, and depression scores. PA monitoring with wearable devices in advanced-stage LC deserves further study.

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“Randomized trial of physical activity on quality of life and lung cancer biomarkers in patients with advanced stage lung cancer: a pilot study”

BMC Cancer ◽

10.1186/s12885-021-08084-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Brett C. Bade ◽

Geliang Gan ◽

Fangyong Li ◽

Lingeng Lu ◽

Lynn Tanoue ◽

...

Keyword(s):

Quality Of Life ◽

Physical Activity ◽

Lung Cancer ◽

Randomized Trial ◽

Cancer Biomarkers ◽

Advanced Stage ◽

Home Based ◽

Advanced Stage Lung Cancer ◽

Stage Lung Cancer

Abstract Background Lung cancer survivors need more options to improve quality of life (QoL). It is unclear to what extent patients with advanced stage disease are willing to participate in home-based physical activity (PA) and if these interventions improve QoL. The goal of our study was to determine interest in participating in our 3-month home-based walking regimen in patients with advanced stage lung cancer. We used a randomized design to evaluate for potential benefit in PA and patient-reported outcomes. Methods We performed an open-label, 1:1 randomized trial in 40 patients with stage III/IV non-small cell lung cancer (NSCLC) evaluating enrollment rate, PA, QoL, dyspnea, depression, and biomarkers. Compared to usual care (UC), the intervention group (IG) received an accelerometer, in-person teaching session, and gain-framed text messages for 12 weeks. Results We enrolled 56% (40/71) of eligible patients. Participants were on average 65 years and enrolled 1.9 years from diagnosis. Most patients were women (75%), and receiving treatment (85%) for stage IV (73%) adenocarcinoma (83%). A minority of patients were employed part-time or full time (38%). Both groups reported low baseline PA (IG mean 37 (Standard deviation (SD) 46) vs UC 59 (SD 56) minutes/week; p = 0.25). The IG increased PA more than UC (mean change IG + 123 (SD 212) vs UC + 35 (SD 103) minutes/week; p = 0.051)). Step count in the IG was not statistically different between baseline (4707 step/day), week 6 (5605; p = 0.16), and week 12 (4606 steps/day; p = 0.87). The intervention improved EORTC role functioning domain (17 points; p = 0.022) with borderline improvement in dyspnea (− 13 points; p = 0.051) compared to UC. In patients with two blood samples (25%), we observed a significant increase in soluble PD-1 (219.8 (SD 54.5) pg/mL; p < 0.001). Conclusions Our pilot trial using a 3-month, home-based, mobile health intervention enrolled over half of eligible patients with stage III and IV NSCLC. The intervention increased PA, and may improve several aspects of QoL. We also identified potential biomarker changes relevant to lung cancer biology. Future research should use a larger sample to examine the effect of exercise on cancer biomarkers, which may mediate the association between PA and QoL. Clinical trial registration Clinicaltrials.gov (NCT03352245).

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Exercise referral to promote cardiovascular health in stroke and TIA patients: a pilot feasibility study

BMJ Open Sport & Exercise Medicine ◽

10.1136/bmjsem-2020-000929 ◽

2020 ◽

Vol 6 (1) ◽

pp. e000929

Author(s):

Sheharyar Baig ◽

Bethany Moyle ◽

Jessica Redgrave ◽

Arshad Majid ◽

Ali Ali

Keyword(s):

Quality Of Life ◽

Physical Activity ◽

Perceived Exertion ◽

Cardiovascular Health ◽

Rating Of Perceived Exertion ◽

Moderate Physical Activity ◽

Post Intervention ◽

Related Quality ◽

Exercise Programmes

ObjectivesExercise programmes studied after stroke often involve specialist supervision. Determine the feasibility and safety for people with stroke (PwS) or transient ischaemic attack (TIA) participating in readily accessible, non-stroke specialised, community-based exercise programmes.MethodsParticipants were recruited into a structured, group-based, 12-week programme of aerobic and resistance exercise delivered two times per week at one of five local leisure centres. Completion rates, successful attainment of intended exercise intensity (Borg Rating of Perceived Exertion (RPE)) and safety outcomes were recorded. Measures of physical activity (International Physical Activity Questionnaire), health-related quality of life (EQ-5D) and blood pressure (BP) were recorded at baseline and day 1 post intervention.Results79% of participants completed >75% of the intended sessions, with >90% attainment of intended RPE. Exercise was safe with no serious and very few minor adverse events related to exercise. Exercise led to significant increases in EQ-5D (Best of Health p<0.001), levels of weekly moderate physical activity (p<0.001) and decreases in systolic BP (mean change [95% CI]=−5.4 mmHg [−2.84 to −7.96]; p<0.001).ConclusionGeneralised exercise programmes delivered through existing local services, appears feasible, safe and may improve quality of life, physical activity and systolic BP, for PwS and TIA.

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