Elsevier

Lung Cancer

Volume 89, Issue 2, August 2015, Pages 167-174
Lung Cancer

Rehabilitation in patients with radically treated respiratory cancer: A randomised controlled trial comparing two training modalities

https://doi.org/10.1016/j.lungcan.2015.05.013Get rights and content

Highlights

  • Lung cancer patients increase Wmax, 6MWD and QoL after rehabilitation.

  • 6MWD recovers with conventional training but not with usual care or WBV.

  • Wmax significantly increases with conventional training and with WBV.

  • Surgery and drop in 6MWD by treatment were prognostic for the increase in 6MWD.

Abstract

Introduction

The evidence on the effectiveness of rehabilitation in lung cancer patients is limited. Whole body vibration (WBV) has been proposed as an alternative to conventional resistance training (CRT).

Methods

We investigated the effect of radical treatment (RT) and of two rehabilitation programmes in lung cancer patients. The primary endpoint was a change in 6-min walking distance (6MWD) after rehabilitation. Patients were randomised after RT to either CRT, WBVT or standard follow-up (CON). Patients were evaluated before, after RT and after 12 weeks of intervention.

Results

Of 121 included patients, 70 were randomised to either CON (24), CRT (24) or WBVT (22). After RT, 6MWD decreased with a mean of 38 m (95% CI 22–54) and increased with a mean of 95 m (95% CI 58–132) in CRT (p < 0.0001), 37 m (95% CI −1–76) in WBVT (p = 0.06) and 1 m (95% CI −34–36) in CON (p = 0.95), respectively. Surgical treatment, magnitude of decrease in 6MWD by RT and allocation to either CRT or WBVT were prognostic for reaching the minimally clinically important difference of 54 m increase in 6MWD after intervention.

Conclusions

RT of lung cancer significantly impairs patients’ exercise capacity. CRT significantly improves and restores functional exercise capacity, whereas WBVT does not fully substitute for CRT.

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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