Rehabilitation in patients with radically treated respiratory cancer: A randomised controlled trial comparing two training modalities
Introduction
A minority of patients with lung cancer receives a treatment with curative intent, consisting of either radical surgery or definitive radiotherapy, administered either as single modality or combined with platinum-based chemotherapy [11], [33], [34].
These treatments lead to a decrease in QoL, physical activity and enhance their morbidity [10]. Cancer-related fatigue (CRF), which is frequently reported by cancer patients, is defined as an unusual and persistent sense of tiredness, affecting both physical and mental capacity and is unrelieved by rest [35]. The underlying mechanisms are biological (anaemia, pro-inflammatory cytokines, nutritional and fluid imbalances, muscle wasting), functional (reduced aerobic capacity and decreased activity of daily living) and psycho-behavioural (sleep disorders, anxiety, depression, reduced self-efficacy, sleep disorders, distress and difficulty coping). This may lead to a further muscle deconditioning and disuse atrophy [35], which in turn may aggravate the feeling of fatigue [1].
Oncological rehabilitation has most been extensively studied in breast cancer patients [28]. The beneficial effects of rehabilitation in lung cancer patients, were currently limited to a few randomised trials. These trials showed that patients with lung cancer can improve their exercise capacity, muscle strength and QoL, however the results were not consistent [2], [9], [29].
Whole body vibration training (WBVT) has been proposed as an alternative training modality for resistance training on multigym equipment. WBVT generates vertical sinusoidal vibrations and elicits in short periods reflectory neuromuscular training without much effort [26]. It is assumed that these vibrations evoke muscle contractions via a tonic vibration reflex [32]. In elderly subjects, WBVT improved both aerobic fitness and muscle strength [4].
The present multi-centre trial, acronamed “REINFORCE” (Randomized Exercise trainINg FOr patients with Radically treated respiratory CancEr), was designed to assess the potential beneficial effect of rehabilitation in lung cancer patients. More specifically, we wanted to address the following questions: (1) does lung cancer therapy affect exercise capacity, muscle strength and QoL; (2) does a 12-week rehabilitation programme improve 6MWD (the primary outcome), maximal exercise capacity, muscle strength and QoL; and (3) are both training methods, WBVT and conventional resistance training (CRT), equally effective in improving 6MWD and other outcome variables?”
Section snippets
Materials and methods
Sequential patients with stages I-III lung cancer or mesothelioma, candidate for a treatment with curative intent, were solicited by their attending physician of four departments of Respiratory Medicine to participate in the present study. Radical treatment was defined as either radical resection with or without a peri-operative platinum-based chemo-(radio) therapy, or definitive thoracic radiotherapy with or without concurrent or sequential platinum-based induction chemotherapy. Patients were
Patient population
Between January 2009 and February 2012, 121 consecutive patients were recruited (Fig. 1). Eighty-six patients completed part I and constitute sample 1. Before randomisation, 16 additional patients dropped out. Seventy radically treated patients were randomly assigned to either CON (n = 24), CRT (n = 24) or WBVT (n = 22) (sample 2). Of these patients, 21, 20 and 17, respectively, completed the intervention (sample 3). Eighty percent of patients completed the rehabilitation programme. Twelve patients
Discussion
The present study shows that a 12-week rehabilitation programme in patients with lung cancer significantly improves exercise capacity, muscle strength and QoL, after a previously significant decrease of those variables following treatment with radical intent. The improvement in 6MWD was limited to CRT and was not observed with WBVT. Together with surgery as part of the radical treatment, the magnitude of the decrease in 6MWD by the radical treatment was predictive for reaching the change in
Conclusion
This study allows to conclude that a rehabilitation programme should be proposed to all patients with lung cancer treated with radical intent, who exhibit a certain degree of disability related to the malignancy or its treatment. In these patients, rehabilitation improves and restores their functional and maximal exercise capacity, muscle strength and QoL to at least baseline levels. A vibration platform does not fully substitute for conventional multigym equipment.
Conflicts of interest statement
We declare no conflict of interest for all the authors and that the grant provider had no influence on the design and outcome of the study, nor on its analysis or content of this manuscript.
Funding
This work was supported by The Belgian Government Agency of Innovation by Science and Technology for applied Biomedical Research (grant number IWT 070708) and the Clinical Research Fund of Ghent University Hospital, Belgium.
Acknowledgements
The authors thank the four departments of Respiratory Medicine (Ghent University Hospital, CHU Sart Tilman, Liege, CHU St Pierre, Brussels and AZ Sint Jan, Bruges, Belgium) to participate in the present study. Furthermore the authors thank the members of their rehabilitation team for their dedication and Frank Hulstaert, MD (KCE, Belgium) for a critical reading of the manuscript.
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