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Timing of Pulmonary Rehabilitation (PR) Relative to Cancer Treatment Impacts PR Benefits Among Patients With NSCLC and Moderate to Severe COPD FREE TO VIEW

Vickie Shannon, MD; Chantielle Thurman, RN; Jana Maldonado, APN
Chest. 2011;140(4_MeetingAbstracts):855A. doi:10.1378/chest.1118758
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PURPOSE: The study aim was to investigate the utility of a 12-week, outpatient, multidisciplinary PR program on exercise capacity among patients with non-small cell lung cancer and (NSCLC) during and following cancer therapy.

METHODS: The study included 189 patients with NSCLC and moderate to severe COPD. All patients underwent an initial medical screening examination. Tests of exercise performance, pulmonary function, dyspnea and fatigue were performed at baseline and immediately following PR program completion. Baseline assessments were used to develop a 12-week, individualized PR program which included high intensity exercise strategies (60 to 80% of maximal work rate). Exercise prescriptions included thrice weekly muscle strength training and aerobic exercises and incorporated weekly educational sessions. Patients were followed for 1 year.

RESULTS: One hundred thirteen patients completed radiation and/or chemotherapy treatments prior to initiation of PR, whereas 76 patients underwent cancer therapy concurrent with PR. Compared to patients in which PR was initiated following cancer therapy, patients undergoing PR during cancer treatment showed greater increases in maximal exercise tolerance (+2.9 metabolic equivalents [METS] compared with +1.5 METS [P < 0.001]; maximal oxygen uptake, +0.27 L/min compared with +0.12 L/min [P < 0.01]), six minute walk distance (+92.5 meters compared with +64.3 meters [P < 0.001]), symptoms of perceived breathlessness(score of -3.5 compared with -1.2 [P < 0.001]) and muscle fatigue (score of -2.4 compared with -1.2 [P < 0.01]). Improvements tended to diminish after 6 months follow-up, with larger declines seen among patients in which PR was initiated following cancer therapy.

CONCLUSIONS: Comprehensive PR significantly improved exercise performance and symptoms among patients with COPD and NSCLC during and after cancer treatment. Greater improvements and more durable benefits were seen when PR was initiated concomitantly during lung cancer treatment.

CLINICAL IMPLICATIONS: The integration of a PR program into lung cancer treatment strategies among patients with moderate to severe COPD improves performance status and mitigates symptoms of fatigue and dyspnea during and after cancer therapy. The benefits of PR are greater and more sustainable when initiated early during the course of lung cancer therapy.

DISCLOSURE:The following authors have nothing to disclose: Vickie Shannon, Chantielle Thurman, Jana Maldonado

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