New Recommendations Spotlight Exercise-Based Interventions to Boost Function in Patients With Lung Cancer

A recent systematic review explored current clinical practice guidelines for optimizing functional outcomes in patients with lung cancer and generated new evidence-based recommendations on exercise-based interventions to improve mobility and general function in this patient population.

Mary Vargo, MD, of the MetroHealth Rehabilitation Institute at Case Western University, and colleagues conducted the study and published their findings in Cancer Medicine. It was important to conduct this study because “Individuals with lung cancer frequently experience functional limitations, yet best practice to achieve functional recovery has not been synthesized.”

The systematic review of literature to inform the research was performed by a multispecialty expert workgroup from 2010 to 2021 “examining interventions for improving patient function at any stage or phase of disease.” Bias assessment was conducted by using National Institutes of Health Quality Assessment standards.

The investigators generated recommendations per GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology for “mobility, physical activity, general function, and social function outcomes, during phases of prehabilitation, surgical post-operative acute (hospitalization), during-or-immediate post-treatment (first year), and survivorship.”

A total of 54 studies were included in the review. According to the results, during the prehabilitation, and the during and immediate post-treatment phases, combined exercise approaches should be employed to improve mobility in patients with lung cancer. In addition, combined interventions using physical activity “may be beneficial” during the surgical postoperative acute phase.

In the during and immediate post-treatment phases, the researchers explained that multimodal interventions “may improve function” when administered with exercise and education, while combined exercise approaches “may improve general function” in the during and immediate post-treatment phases.

In reflecting on the findings, the investigators noted that “Current evidence emphasized mobility outcomes, in prehabilitation and early post-treatment phases, with moderate level benefits of combined aerobic with resistance and/or breathing exercise.”

They also noted that further investigation is warranted to explore the sustainability of performing these interventions, to determine durability of outcomes for patients, to examine “increased breadth of interventions and functional outcome domains,” and to explore “specific contexts including advanced disease, survivorship, high medical complexity and frailty, and caregiver-related factors.”

“These recommendations are applicable for clinicians including oncologists, rehabilitation specialists, surgeons, primary and pulmonary care providers, nurses, and other supportive care personnel,” the investigators concluded.