Download PDF
Semin Respir Crit Care Med 2009; 30(6): 670-674
DOI: 10.1055/s-0029-1242636
© Thieme Medical Publishers

The Role of Pulmonary Rehabilitation in the Lung Cancer Patient

Linda Nici1 , 2
  • 1Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
  • 2Pulmonary and Critical Care Section, Providence VA Medical Center, Providence, Rhode Island
Further Information

Publication History

Publication Date:
25 November 2009 (online)

    Permissions and Reprints

ABSTRACT

Lung cancer is the most common deadly malignancy in the United States. It is estimated that 219,440 men and women in the United States will be diagnosed with lung cancer and 159,390 will die of lung cancer in 2009. The overall 5-year survival rate is 15.6%; however, survival rates are much higher (52.6%) for patients who are diagnosed when the cancer is confined to the primary site. Unfortunately, a minority of patients (15%) are diagnosed at this stage.

Although the most effective treatment for lung cancer is surgical resection, many patients have significant underlying chronic lung disease as well as other comorbidities, which may increase perioperative risk and possibly exclude them from undergoing surgery. Preoperative assessment is essential for proper risk stratification, but there are important questions that remain to be answered as to (1) whether preoperative or postoperative pulmonary rehabilitation can result in less perioperative morbidity and mortality, (2) whether the institution of preoperative pulmonary rehabilitation can allow more patients to undergo potentially curative surgical resection, and (3) whether pulmonary rehabilitation can play a role in those patients not eligible for surgery.

KEYWORDS

Surgery - lung resection - lung cancer - pulmonary rehabilitation

REFERENCES

  • 1 Lung cancer. Available at: http://www.cancer.gov/cancertopics/types/lung
    Google Scholar
  • 2 Loganathan R S, Stover D E, Shi W, Venkatraman E. Prevalence of COPD in women compared to men around the time of diagnosis of primary lung cancer.  Chest. 2006;  129 1305-1312
    CrossrefPubMedGoogle Scholar
  • 3 Nici L, Donner C, Wouters E ATS/ERS Pulmonary Rehabilitation Writing Committee et al. American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation.  Am J Respir Crit Care Med. 2006;  173 1390-1413
    CrossrefPubMedGoogle Scholar
  • 4 Doorenbos A, Given B, Given C et al.. Physical functioning: effect of behavioral intervention for symptoms among individuals with cancer.  Nurs Res. 2006;  55 161-171
    CrossrefPubMedGoogle Scholar
  • 5 Hopwood P, Stephens R J. Depression in patients with lung cancer: prevalence and risk factors derived from quality-of-life data.  J Clin Oncol. 2000;  18 893-903
    CrossrefPubMedGoogle Scholar
  • 6 Ries A L, Bauldoff G S, Carlin B W et al.. Pulmonary Rehabilitation: Joint ACCP/AACVPR evidence-based clinical practice guidelines.  Chest. 2007;  131(5, Suppl) 4S-42S
    CrossrefPubMedGoogle Scholar
  • 7 Reilly Jr J J, Mentzer S J, Sugarbaker D J. Preoperative assessment of patients undergoing pulmonary resection.  Chest. 1993;  103(4, Suppl) 342S-345S
    CrossrefPubMedGoogle Scholar
  • 8 Wang J S. Pulmonary function tests in preoperative pulmonary evaluation.  Respir Med. 2004;  98 598-605
    CrossrefPubMedGoogle Scholar
  • 9 Miller M R, Crapo R, Hankinson J ATS/ERS Task Force et al. General considerations for lung function testing.  Eur Respir J. 2005;  26 153-161
    CrossrefPubMedGoogle Scholar
  • 10 Wang J S, Abboud R T, Evans K G, Finley R J, Graham B L. Role of CO diffusing capacity during exercise in the preoperative evaluation for lung resection.  Am J Respir Crit Care Med. 2000;  162(4 Pt 1) 1435-1444
    PubMedGoogle Scholar
  • 11 Wang J, Olak J, Ultmann R E, Ferguson M K. Assessment of pulmonary complications after lung resection.  Ann Thorac Surg. 1999;  67 1444-1447
    CrossrefPubMedGoogle Scholar
  • 12 Szekely L A, Oelberg D A, Wright C et al.. Preoperative predictors of operative morbidity and mortality in COPD patients undergoing bilateral lung volume reduction surgery.  Chest. 1997;  111 550-558
    CrossrefPubMedGoogle Scholar
  • 13 Bolliger C T, Jordan P, Solèr M et al.. Exercise capacity as a predictor of postoperative complications in lung resection candidates.  Am J Respir Crit Care Med. 1995;  151 1472-1480
    CrossrefPubMedGoogle Scholar
  • 14 Alberts W M. American College of Chest Physicians . Diagnosis and management of lung cancer executive summary: ACCP evidence-based clinical practice guidelines (2nd edition).  Chest. 2007;  132(3, Suppl) 1S-422S
    CrossrefPubMedGoogle Scholar
  • 15 British Thoracic Society . BTS guidelines: guidelines on the selection of patients with lung cancer for surgery.  Thorax. 2001;  56 89-108
    CrossrefPubMedGoogle Scholar
  • 16 Brutsche M H, Spiliopoulos A, Bolliger C T, Licker M, Frey J G, Tschopp J M. Exercise capacity and extent of resection as predictors of surgical risk in lung cancer.  Eur Respir J. 2000;  15 828-832
    CrossrefPubMedGoogle Scholar
  • 17 Villani F, Busia A. Preoperative evaluation of patients submitted to pneumonectomy for lung carcinoma: role of exercise testing.  Tumori. 2004;  90 405-409
    PubMedGoogle Scholar
  • 18 Datta D, Lahiri B. Preoperative evaluation of patients undergoing lung resection surgery.  Chest. 2003;  123 2096-2103
    CrossrefPubMedGoogle Scholar
  • 19 Bobbio A, Chetta A, Ampollini L et al.. Preoperative pulmonary rehabilitation in patients undergoing lung resection for non-small cell lung cancer.  Eur J Cardiothorac Surg. 2008;  33 95-98
    CrossrefPubMedGoogle Scholar
  • 20 Weiner P, Man A, Weiner M et al.. The effect of incentive spirometry and inspiratory muscle training on pulmonary function after lung resection.  J Thorac Cardiovasc Surg. 1997;  113 552-557
    CrossrefPubMedGoogle Scholar
  • 21 Wilson D J. Pulmonary rehabilitation exercise program for high-risk thoracic surgical patients.  Chest Surg Clin N Am. 1997;  7 697-706
    PubMedGoogle Scholar
  • 22 Benzo R. Randomized study of pulmonary rehabilitation in patients with moderate to severe chronic obstructive pulmonary disease who require lung resection for lung cancer. National Cancer Institute clinical trial. Available at: http://www.cancer.gov/search/ViewClinicalTrials
    Google Scholar
  • 23 Bozcuk H, Martin C. Does treatment delay affect survival in non-small cell lung cancer? A retrospective analysis from a single UK center.  Lung Cancer. 2001;  34 243-252
    CrossrefPubMedGoogle Scholar
  • 24 Cesario A, Ferri L, Galetta D et al.. Post-operative respiratory rehabilitation after lung resection for non-small cell lung cancer.  Lung Cancer. 2007;  57 175-180
    CrossrefPubMedGoogle Scholar
  • 25 Spruit M A, Janssen P P, Willemsen S C, Hochstenbag M M, Wouters E F. Exercise capacity before and after an 8-week multidisciplinary inpatient rehabilitation program in lung cancer patients: a pilot study.  Lung Cancer. 2006;  52 257-260
    CrossrefPubMedGoogle Scholar
  • 26 Varela G, Ballesteros E, Jiménez M F, Novoa N, Aranda J L. Cost-effectiveness analysis of prophylactic respiratory physiotherapy in pulmonary lobectomy.  Eur J Cardiothorac Surg. 2006;  29 216-220
    CrossrefPubMedGoogle Scholar
  • 27 Cesario A, Ferri L, Galetta D et al.. Pre-operative pulmonary rehabilitation and surgery for lung cancer.  Lung Cancer. 2007;  57 118-119
    CrossrefPubMedGoogle Scholar
  • 28 Palmer S M, Tapson V F. Pulmonary rehabilitation in the surgical patient. Lung transplantation and lung volume reduction surgery.  Respir Care Clin N Am. 1998;  4 71-83
    PubMedGoogle Scholar
  • 29 Takaoka S T, Weinacker A B. The value of preoperative pulmonary rehabilitation.  Thorac Surg Clin. 2005;  15 203-211
    CrossrefPubMedGoogle Scholar
  • 30 Manzetti J D, Hoffman L A, Sereika S M, Sciurba F C, Griffith B P. Exercise, education, and quality of life in lung transplant candidates.  J Heart Lung Transplant. 1994;  13 297-305
    PubMedGoogle Scholar
  • 31 Fishman A, Martinez F, Naunheim K National Emphysema Treatment Trial Research Group et al. A randomized trial comparing lung-volume-reduction surgery with medical therapy for severe emphysema.  N Engl J Med. 2003;  348 2059-2073
    CrossrefPubMedGoogle Scholar
  • 32 Rajendran A J, Pandurangi U M, Murali R et al.. Pre-operative pulmonary rehabilitation for patients of chronic obstructive pulmonary disease undergoing coronary bypass graft surgery.  Indian Heart J. 1998;  50 531-534
    PubMedGoogle Scholar
  • 33 Benzo R P. Pulmonary rehabilitation in lung cancer: a scientific opportunity.  J Cardiopulm Rehabil Prev. 2007;  27 61-64
    PubMedGoogle Scholar
  • 34 Adamsen L, Midtgaard J, Andersen C, Quist M, Moeller T, Roerth M. Transforming the nature of fatigue through exercise: qualitative findings from a multidimensional exercise programme in cancer patients undergoing chemotherapy.  Eur J Cancer Care (Engl). 2004;  13 362-370
    CrossrefPubMedGoogle Scholar
  • 35 Dimeo F C, Fetscher S, Lange W et al.. Effects of aerobic exercise on physical performance and incidence of treatment-related complications after high-dose chemotherapy.  Blood. 1997;  90 3390-3394
    PubMedGoogle Scholar

Linda NiciM.D. 

Pulmonary and Critical Care Section, Providence VA Medical Center

830 Chalkstone Ave., Providence, RI 02908

Email: Linda_Nici@brown.edu

      >