Comprehensive Pulmonary Rehabilitation for Patients with Malignant Pleural Mesothelioma: A Feasibility Pilot Study

Our plain-English summary of Comprehensive Pulmonary Rehabilitation for Patients with Malignant Pleural Mesothelioma: A Feasibility Pilot Study, by L. Lippi, A. de Sire, A. Folli, et al (Cancers, 2024).

The study

• Authors: L. Lippi, A. de Sire, A. Folli, C. Curci, D. Calafiore, M. Lombardi, L. Bertolaccini, A. Turco, A. Ammendolia, N. Fusco, L. Spaggiari, M. Invernizzi
• Journal: Cancers
• Published: 2024;16(11)
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma (MPM) represents a significant health burden, with limited treatment options and poor prognosis. Despite advances in pharmacological and surgical interventions, the role of rehabilitation in MPM management remains underexplored. This study aims to assess the feasibility of a tailored pulmonary rehabilitation intervention addressing physical and respiratory function in MPM patients. A prospective pilot study was conducted on surgically treated MPM patients referred to a cardiopulmonary rehabilitation service. The intervention comprised multidisciplinary educational sessions, physical rehabilitation, and respiratory physiotherapy. Feasibility was evaluated based on dropout rates, adherence to the rehabilitation program, safety, and patient-reported outcomes. Twelve patients were initially enrolled, with seven completing the study. High adherence to physical (T1: 93.43%, T2: 82.56%) and respiratory (T1: 96.2%, T2: 92.5%) rehabilitation was observed, with minimal adverse events reported. Patient satisfaction remained high throughout the study (GPE scores at T1: 1.83 ± 1.17; T2: 2.0 ± 1.15), with improvements noted in physical function, pain management, and health-related quality of life. However, some issues, such as time constraints and lack of continuous supervision, were reported by participants. This pilot study demonstrates the feasibility and potential benefits of a tailored pulmonary rehabilitation intervention in MPM patients. Despite its promising outcomes, further research with larger samples is warranted to validate its efficacy and integrate rehabilitation as a component into the multidisciplinary management of MPM.

In plain English

This prospective pilot study, without a comparison group, tested whether a tailored pulmonary rehabilitation programme was feasible for people surgically treated for malignant pleural mesothelioma (MPM). Patients were referred to a rehabilitation service in Alessandria, Italy, between March 2022 and February 2023. The programme combined an educational session, home exercise three times weekly, and twice-daily device-assisted breathing exercises. Of 12 patients enrolled, five left by one month (two declined, three worsened clinically); seven completed six months. Although inclusion required previous talc pleurodesis or pleurectomy/decortication, the patient table lists one completer as having had no surgery. Among the seven, mean exercise adherence was 93.43% at one month and 82.56% at six months. Breathing-exercise adherence was 96.2% and 92.5%. No major adverse events were reported. Sit-to-stand performance improved significantly at six months. Oxygen saturation during walking and a mesothelioma symptom score (LCSS-meso) worsened significantly. Lung function and pain changes were not statistically significant. The authors concluded the findings suggest promising effects and larger controlled studies are needed. They stated the small sample and lack of comparison severely limit their results.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Prospective single-arm pilot feasibility study of a rehabilitation intervention, with a qualitative questionnaire
• Who was studied: Consecutive patients surgically treated for MPM and referred to the Cardiopulmonary Rehabilitation Service in Alessandria, Italy, between March 2022 and February 2023. Of 14 assessed, 12 were included at baseline, and 7 completed the study and were analysed. The 7 were six males and one female, mean age 67 plus or minus 6 years, all with epithelioid histology. Table 1 lists 4 of the 7 as having had talc pleurodesis, 2 pleurectomy/decortication and 1 no surgery, even though the inclusion criteria required previous talc pleurodesis or pleurectomy/decortication.
• Exposure: The exposure studied was the rehabilitation programme, not asbestos. It had three parts: one multidisciplinary educational session; home-based physical exercise of 50 to 60 minutes three times a week (warm-up, resistance, aerobic and cool-down phases); and respiratory physiotherapy with a TPEP ONE device, twice daily for 15 minutes. Outcomes were assessed at baseline, 1 month (T1) and 6 months (T2). No asbestos fiber types or exposure histories were reported.
• Main results:
  • Mean adherence to the physical rehabilitation programme was 93.43% at T1 (1 month) and 82.56% at T2 (6 months).
  • For the respiratory physiotherapy programme, 96.2% of sessions were completed at T1 and 92.5% at T2.
  • No major adverse events were reported. Minor side effects were coughing (T1: n = 2; T2: n = 4), dizziness (T1: n = 1) and transient muscular pain (T1: n = 1; T2: n = 1).
  • The Global Perceived Effect scale runs from 1 (best satisfaction) to 7 (unsatisfaction). The score was 1.83 plus or minus 1.17 at T1 and 2 plus or minus 1.15 at T2.
  • The 30-second sit-to-stand test improved significantly at T2, from a mean of 9.71 at baseline to 15.57 at T2 (p = 0.047 in the text). The authors reported that the improvement exceeded the minimal clinically important difference.
  • Oxygen saturation during the two-minute walking test worsened significantly, from a mean of 96.14 at baseline to 90.86 at T2 (p = 0.031 in the text).
  • Handgrip strength and the Short Physical Performance Battery showed no significant changes. Arterial blood gases and spirometry also showed no significant changes.
  • Pain on the Visual Analog Scale fell from a mean of 20.00 at baseline to 8.14 at T1 and 9.29 at T2. The reduction was not statistically significant.
  • The LCSS-meso symptom score worsened significantly at T2 compared with baseline (change from T0 to T2 of minus 7.70 plus or minus 7.86, p = 0.047).
  • EORTC QLQ-C30 and PROMIS showed no significant differences between time points. PROMIS changes exceeded the minimal clinically important difference at both time points.
  • In the qualitative questionnaire, the time needed to learn and do the exercises was the main barrier. Participants also reported a lack of continuous supervision.
• The authors' conclusion: The authors concluded that their findings suggest promising effects of a multidisciplinary approach including educational therapy, counseling, and physical and pulmonary rehabilitation. They said multi-centre studies with larger samples and control groups are needed.
• Limitations the authors state:
  • Small sample and no comparison group.
  • Five patients dropped out after baseline. The authors said this suggests the intervention may only be suitable for some patients with MPM.

Topics

Medical terms in this study, explained in our Lexicon: Pulmonary Rehabilitation, Pleural Mesothelioma, Prognosis, Quality of Life.

Related studies

• Real-life feasibility of home-based pulmonary rehabilitation in chemotherapy-treated patients with thoracic cancers: a pilot study — C. Olivier, J.M. Grosbois, et al. (2018)
• Rehabilitation for Functioning and Quality of Life in Patients with Malignant Pleural Mesothelioma: A Scoping Review — L. Lippi, A. de Sire, et al. (2024)
• Short-term integrated rehabilitation for people with newly diagnosed thoracic cancer: a multi-centre randomized controlled feasibility trial — J. Bayly, L. Fettes, et al. (2020)
• MesoTRAP: a feasibility study that includes a pilot clinical trial comparing video-assisted thoracoscopic partial pleurectomy decortication with indwelling pleural catheter in patients with trapped lung due to malignant pleural mesothelioma designed to address recruitment and randomisation uncertainties and sample size requirements for a phase III trial — C. Matthews, C. Freeman, et al. (2019)
• Exercise-Based Pulmonary Rehabilitation for Interstitial Lung Diseases: A Review of Components, Prescription, Efficacy, and Safety — R.G. Mendes, V. Castello-Simões, et al. (2021)
• Unilateral pulmonary artery pre-operative occlusion test: technical feasibility and safety prior to pneumonectomy or pleuropneumonectomy for malignancy — M. Shimohira, T. Hashizume, et al. (2018)

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