Abstract
BackgroundSystemic inflammation plays an important role in the initiation, promotion, and progression of lung carcinogenesis. In patients with non-small cell lung cancer (NSCLC), fibrinogen levels correlate with neoplasia. Here we compared the effects of pulmonary rehabilitation (PR) with chest physical therapy (CPT) on fibrinogen and albumin levels in patients with LC and previous inflammatory lung disease awaiting lung resection.MethodsWe conducted a randomized clinical trial with 24 patients who were randomly assigned to Pulmonary Rehabilitation (PR) and Chest Physical Therapy (CPT) groups. Each group underwent training 5 days weekly for 4 weeks. All patients were assessed before and after four weeks of training through clinical assessment, measurement of fibrinogen and albumin levels, spirometry, 6-minute Walk Test (6MWT), quality of life survey, and anxiety and depression scale. PR involved strength and endurance training, and CPT involved lung expansion techniques. Both groups attended educational classes.ResultsA mixed between-within subjects analysis of variance (ANOVA) revealed a significant interaction between time (before and after intervention) and group (PR vs. CPT) on fibrinogen levels (F(1, 22) = 0.57, p < 0.0001) and a significant main effect of time (F(1, 22) = 0.68, p = 0.004). Changes in albumin levels were not statistically significant relative to the interaction effect between time and group (F(1, 22) = 0.96, p = 0.37) nor the main effects of time (F(1, 22) = 1.00, p = 1.00) and group (F(1, 22 ) = 0.59, p = 0.45). A mixed between-within subjects ANOVA revealed significant interaction effects between time and group for the peak work rate of the unsupported upper limb exercise (F(1, 22) = 0.77, p = 0.02), endurance time (F(1, 22) = 0.60, p = 0.001), levels of anxiety (F(1, 22) = 0.60, p = 0.002) and depression (F(1, 22) = 0.74, p = 0.02), and the SF-36 physical component summary (F(1, 22) = 0.83, p = 0.07).ConclusionPR reduced serum fibrinogen levels, improved functional parameters, and quality of life of patients with LC and inflammatory lung disease awaiting lung resection.Trial registrationCurrent Controlled Trials RBR-3nm5bv.
Highlights
Systemic inflammation plays an important role in the initiation, promotion, and progression of lung carcinogenesis
Nineteen patients were diagnosed with chronic obstructive pulmonary disease (COPD), two with interstitial lung disease, and three with bronchiectasis
Of the patients in the pulmonary rehabilitation (PR) and chest physical therapy (CPT) groups, 50% and 60% were classified as Stage III of the Global Initiative for Chronic Obstructive Lung Disease, respectively (p = 0.1)
Summary
Systemic inflammation plays an important role in the initiation, promotion, and progression of lung carcinogenesis. In patients with non-small cell lung cancer (NSCLC), fibrinogen levels correlate with neoplasia. Surgery without adjuvant treatment is most frequently indicated to treat patients with early stages (I and II) of non-small cell lung cancer (NSCLC) [4], and surgery for patients with up to stage III may be more beneficial compared with other modalities [1,4]. In patients with NSCLC there is a relationship between fibrinogen levels and neoplasia. This is because >50% of patients with primary tumors and 90% of those with metastases present with altered coagulation—a prothrombotic state caused by the ability of cancer cells to activate the coagulation system [5,6,7]. Serum fibrinogen and albumin levels serve as prognostic factors for postoperative complications after lung resection [7,8]
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