Real-life feasibility of home-based pulmonary rehabilitation in chemotherapy-treated patients with thoracic cancers: a pilot study

Our plain-English summary of Real-life feasibility of home-based pulmonary rehabilitation in chemotherapy-treated patients with thoracic cancers: a pilot study, by C. Olivier, J.M. Grosbois, A.B. Cortot, et al (BMC Cancer, 2018).

The study

• Authors: C. Olivier, J.M. Grosbois, A.B. Cortot, S. Peres, C. Heron, J. Delourme, M. Gierczynski, A. Hoorelbeke, A. Scherpereel, O. Le Rouzic
• Journal: BMC Cancer
• Published: 2018;18(1):178
• Cited by: 28 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Patients with advanced lung cancer (LC) or malignant pleural mesothelioma (MPM) exhibit limitation of exercise capacities and alteration of quality of life (QoL) induced by cancer and its treatment. Few studies assessed pulmonary rehabilitation (PR) in these chemotherapy-treated patients, and none evaluated a home-based PR program.

Methods: In this prospective uncontrolled observational pilot study, patients treated by chemotherapy for LC or MPM were screened for a home-based PR program combining exercise training with global cares including therapeutic education and psychosocial management. Feasibility and safety were evaluated by attendance and adherence to PR program. Various exercise tolerance tests, including 6-min walk test (6MWT) and 6-min stepper test (6MST), were performed before and after PR associated with, QoL and psychological assessment (VSRQ and HAD, respectively).

Results: 243 patients were considered eligible but only 71 (60.6 ± 8.8 years) started a PR and 47 completed the program. Refusals to participate were mostly related to lack of motivation whereas withdrawals to PR were related to cancer-related medical issues. No adverse event related to PR was observed. Baseline 6MWT distance was associated with performance status (r = - 0.45, p = 0.001) and mMRC dyspnea scale (r = - 0.49, p < 0.001) but not with lung cancer stage. Post-PR reassessment showed 6MWT stability and 6MST improvement in patients who completed the program. Daily physical activity (p = 0.007) and anxiety (p = 0.02) scores were significantly improved.

Conclusions: Home-based PR was feasible and safe in patients with advanced LC or MPM. Exercise capacities stability in patients who completed the PR program suggests that PR might be beneficial. Further studies are warranted to confirm and to improve the potential value of PR in these patients.

In plain English

This pilot study at Lille University Hospital, France (March 2012 to December 2013) tested whether an 8-week home-based pulmonary rehabilitation program was workable for patients on chemotherapy for lung cancer or malignant pleural mesothelioma. The program combined exercise training with education and psychological support, delivered through weekly home visits. The study did not look at asbestos exposure. Of 253 patients screened, 83 were included and 71 started the program, 17 of them with mesothelioma. 47 finished. Most refusals were attributed to lack of motivation, and most dropouts to cancer-related medical problems. No adverse events related to the rehabilitation were reported. Among the 47 who finished, walking-test distance changed little (5 m less, not statistically significant). Stepper-test steps rose by 63 (p = 0.02), and by 106 in mesothelioma patients. Anxiety scores fell (p = 0.03). Overall quality of life did not change significantly (p = 0.06), but it rose among mesothelioma patients (p = 0.02). The authors concluded the program seemed feasible and safe. They noted there was no control group and that withdrawal of sicker patients may have biased the 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, uncontrolled observational pilot study
• Who was studied: Adults starting chemotherapy (with or without radiotherapy) for lung cancer or malignant pleural mesothelioma at the Pulmonary and Thoracic Oncology Department of Lille University Hospital, France, March 2012 to December 2013. 253 were screened, 83 were included and 71 started the program. Of these 71, 54 were men and 17 women, mean age 60.6 years, and 17 had mesothelioma. 47 completed the program.
• Exposure: No asbestos exposure was studied. The intervention was an 8-week home-based pulmonary rehabilitation program. It included a weekly 90-minute home visit by a nurse or physiotherapist covering exercise training, therapeutic education, psychological counseling and nutritional advice. Patients also followed a daily 30 or 45 minute exercise program on their own at least 5 days per week.
• Main results:
  • Of 253 screened patients, 83 were included, an uptake of 32.8% of screened patients. 47 completed the program, a retention rate of 56.6% of included patients.
  • 65.8% of eligible patients refused to take part, mostly because of personal lack of motivation or needing time to think (46.9%).
  • After starting, 24 of the 71 patients stopped before the end of the program, mostly for medical reasons (worsening condition, infection, death).
  • No potential adverse events related to the rehabilitation activities were reported.
  • At baseline, in all 71 patients, 6-minute walk distance was correlated with WHO performance status (r = -0.45, p = 0.001). General condition, symptoms and albumin levels, but not disease stage, were associated with exercise capacity.
  • In the 47 patients who completed the program, 6-minute walk distance was stable (change of -5 m, not significant). The number of steps in the 6-minute stepper test increased (+63 steps, p = 0.02).
  • In mesothelioma patients who completed the program, stepper-test steps increased by 106 (p less than 0.01).
  • Overall quality of life (VSRQ) did not improve significantly in all completers (+4 points, p = 0.06). It increased significantly in mesothelioma patients (+9 points, p = 0.02).
  • In completers, the HAD anxiety score decreased (-1 point, p = 0.03). The depression score did not decrease significantly.
  • Patients with performance status 2 had a decreased 6-minute walk distance and stable stepper-test steps after the program. Gains in exercise capacity were seen mostly in performance status 0 to 1 patients.
• The authors' conclusion: The authors concluded that home-based pulmonary rehabilitation seems feasible and safe in patients with advanced lung cancer or malignant pleural mesothelioma. They said the benefits seen in completers may have been partly biased by withdrawal of the most severe patients, and that further research is needed.
• Limitations the authors state:
  • The study group was small.
  • There was no control group, which limits interpretation of benefits.
  • Withdrawals for cancer-related issues may have biased the study by selecting more stable patients.
  • The authors could not affirm that the patients' stability was due to the rehabilitation program.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pulmonary Rehabilitation, Chemotherapy, Lung Cancer, Pleural Mesothelioma, Quality of Life, Performance Status, Dyspnea.

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• Ventilatory insufficiency due to asbestos-related diffuse pleural fibrosis successfully treated with noninvasive home mechanical ventilation — X. Muñoz, A. Roger, et al. (2001)
• Comprehensive Pulmonary Rehabilitation for Patients with Malignant Pleural Mesothelioma: A Feasibility Pilot Study — L. Lippi, A. de Sire, et al. (2024)
• Symptom burden in mesothelioma patients admitted to home palliative care — S. Mercadante, D. Degiovanni, et al. (2016)
• 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)

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