Abstract
BackgroundPatients 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.MethodsIn 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).Results243 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.ConclusionsHome-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.
Highlights
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
In chronic obstructive pulmonary disease (COPD), we have previously shown that home-based pulmonary rehabilitation (PR) is as safe and effective as PR performed in an outpatient rehabilitation center [7, 8]
6 patients had a medical contraindication to PR and 4 were considered ineligible for social reasons; 65.8% of eligible patients refused to participate mostly because personal lack of motivation or time needed to think (46.9%) and few because tiredness (11.3%) or excess of constraint (7.5%)
Summary
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. The prognosis of malignant pleural mesothelioma (MPM) patients is bleak with mOS of 13 months with standard first line treatment by cisplatin-pemetrexed chemotherapy, slightly improved up to 18.8 months in our recently published phase III trial [1, 2]. These patients with advanced thoracic cancers, often combined with several pulmonary and/or cardio-vascular comorbidities, as chronic obstructive pulmonary disease (COPD), frequently exhibit physical symptoms responsible for altered quality of life (QoL), reduced physical activity and a decline of their exercise capacities during chemotherapy [3,4,5]. Supportive care is essential in their treatment to counteract all these adverse effects
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