Exercise training as part of lung cancer therapy

Vinicius Cavalheri, Catherine L Granger, Vinicius Cavalheri, Catherine L Granger

Abstract

Exercise training is playing an increasing role in lung cancer care. Lung cancer is associated with significant burden to the individual and healthcare system. There is now substantial evidence that exercise training is safe, feasible and effective at improving several outcomes in people with lung cancer, especially in those with NSCLC. Exercise is beneficial across the lung cancer disease and treatment pathway, including in patients with early stage disease before and after surgery, and in patients with advanced disease. This review describes the impact of lung cancer and lung cancer treatment on patient health outcomes and summarizes the aims, safety, feasibility and effects of exercise training in the context of both early stage and advanced stage lung cancer. The paper also includes a discussion of current topical discussion areas including the use of exercise in people with bone metastases and the potential effect of exercise on suppression of tumour growth. Finally, seven clinical questions are included, which are a priority to be addressed by future research over the next decade as we strive to progress the field of lung cancer and improve patient outcomes.

Keywords: exercise; lung neoplasms; quality of life; rehabilitation; survivorship.

© 2020 Asian Pacific Society of Respirology.

References

REFERENCES

    1. Wall LM. Changes in hope and power in lung cancer patients who exercise. Nurs. Sci. Q. 2000; 13: 234-42.
    1. Batchelor TJP, Rasburn NJ, Abdelnour-Berchtold E, Brunelli A, Cerfolio RJ, Gonzalez M, Ljungqvist O, Petersen RH, Popescu WM, Slinger PD et al. Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERAS(R)) Society and the European Society of Thoracic Surgeons (ESTS). Eur. J. Cardiothorac. Surg. 2019; 55: 91-115.
    1. Campbell KL, Winters-Stone KM, Wiskemann J, May AM, Schwartz AL, Courneya KS, Zucker DS, Matthews CE, Ligibel JA, Gerber LH et al. Exercise guidelines for cancer survivors: consensus statement from international multidisciplinary roundtable. Med. Sci. Sports Exerc. 2019; 51: 2375-90.
    1. Hayes SC, Newton RU, Spence RR, Galvao DA. The Exercise and Sports Science Australia position statement: exercise medicine in cancer management. J. Sci. Med. Sport 2019; 22: 1175-99.
    1. Segal R, Zwaal C, Green E, Tomasone JR, Loblaw A, Petrella T; Exercise for People with Cancer Guideline Development Group. Exercise for people with cancer: a clinical practice guideline. Curr. Oncol. 2017; 24: 40-6.
    1. Tew GA, Ayyash R, Durrand J, Danjoux GR. Clinical guideline and recommendations on pre-operative exercise training in patients awaiting major non-cardiac surgery. Anaesthesia 2018; 73: 750-68.
    1. Athey VL, Suckling RJ, Tod AM, Walters SJ, Rogers TK. Early diagnosis of lung cancer: evaluation of a community-based social marketing intervention. Thorax 2012; 67: 412-7.
    1. Buccheri G, Ferrigno D. Lung cancer: clinical presentation and specialist referral time. Eur. Respir. J. 2004; 24: 898-904.
    1. Cooley ME. Symptoms in adults with lung cancer. A systematic research review. J. Pain Symptom Manage. 2000; 19: 137-53.
    1. Iyer S, Taylor-Stokes G, Roughley A. Symptom burden and quality of life in advanced non-small cell lung cancer patients in France and Germany. Lung Cancer 2013; 81: 288-93.
    1. Benzo R, Kelley GA, Recchi L, Hofman A, Sciurba F. Complications of lung resection and exercise capacity: a meta-analysis. Respir. Med. 2007; 101: 1790-7.
    1. Lugg ST, Agostini PJ, Tikka T, Kerr A, Adams K, Bishay E, Kalkat MS, Steyn RS, Rajesh PB, Thickett DR et al. Long-term impact of developing a postoperative pulmonary complication after lung surgery. Thorax 2016; 71: 171-6.
    1. Agostini P, Lugg ST, Adams K, Vartsaba N, Kalkat MS, Rajesh PB, Steyn RS, Naidu B, Rushton A, Bishay E. Postoperative pulmonary complications and rehabilitation requirements following lobectomy: a propensity score matched study of patients undergoing video-assisted thoracoscopic surgery versus thoracotomy. Interact. Cardiovasc. Thorac. Surg. 2017; 24: 931-7.
    1. Agostini PJ, Lugg ST, Adams K, Smith T, Kalkat MS, Rajesh PB, Steyn RS, Naidu B, Rushton A, Bishay E. Risk factors and short-term outcomes of postoperative pulmonary complications after VATS lobectomy. J. Cardiothorac. Surg. 2018; 13: 28.
    1. Kaufmann KB, Loop T, Heinrich S. Risk factors for post-operative pulmonary complications in lung cancer patients after video-assisted thoracoscopic lung resection: results of the German Thorax Registry. Acta Anaesthesiol. Scand. 2019; 63: 1009-18.
    1. Bolliger CT, Jordan P, Soler M, Stulz P, Tamm M, Wyser C, Gonon M, Perruchoud AP. Pulmonary function and exercise capacity after lung resection. Eur. Respir. J. 1996; 9: 415-21.
    1. Cavalheri V, Jenkins S, Cecins N, Gain K, Phillips M, Sanders LH, Hill K. Impairments after curative intent treatment for non-small cell lung cancer: a comparison with age and gender-matched healthy controls. Respir. Med. 2015; 109: 1332-9.
    1. Handy JR Jr, Asaph JW, Douville EC, Ott GY, Grunkemeier GL, Wu Y. Does video-assisted thoracoscopic lobectomy for lung cancer provide improved functional outcomes compared with open lobectomy? Eur. J. Cardiothorac. Surg. 2010; 37: 451-5.
    1. Kenny PM, King MT, Viney RC, Boyer MJ, Pollicino CA, McLean JM, Fulham MJ, McCaughan BC. Quality of life and survival in the 2 years after surgery for non small-cell lung cancer. J. Clin. Oncol. 2008; 26: 233-41.
    1. Kushibe K, Kawaguchi T, Kimura M, Takahama M, Tojo T, Taniguchi S. Changes in ventilatory capacity, exercise capacity, and pulmonary blood flow after lobectomy in patients with lung cancer - which lobectomy has the most loss in exercise capacity? Interact. Cardiovasc. Thorac. Surg. 2008; 7: 1011-4.
    1. Wang JS, Abboud RT, Wang LM. Effect of lung resection on exercise capacity and on carbon monoxide diffusing capacity during exercise. Chest 2006; 129: 863-72.
    1. Socinski MA, Evans T, Gettinger S, Hensing TA, Sequist LV, Ireland B, Stinchcombe TE. Treatment of stage IV non-small cell lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2013; 143: e341S-68S.
    1. Edbrooke L, Granger CL, Clark RA, Denehy L. Physical activity levels are low in inoperable lung cancer: exploratory analyses from a randomised controlled trial. J. Clin. Med. 2019; 8: 1288.
    1. Granger CL, McDonald CF, Irving L, Clark RA, Gough K, Murnane A, Mileshkin L, Krishnasamy M, Denehy L. Low physical activity levels and functional decline in individuals with lung cancer. Lung Cancer 2014; 83: 292-9.
    1. Kasymjanova G, Correa JA, Kreisman H, Dajczman E, Pepe C, Dobson S, Lajeunesse L, Sharma R, Small D. Prognostic value of the six-minute walk in advanced non-small cell lung cancer. J. Thorac. Oncol. 2009; 4: 602-7.
    1. Lin YY, Rau KM, Lin CC. Longitudinal study on the impact of physical activity on the symptoms of lung cancer survivors. Support. Care Cancer 2015; 23: 3545-53.
    1. Silver JK, Baima J. Cancer prehabilitation: an opportunity to decrease treatment-related morbidity, increase cancer treatment options, and improve physical and psychological health outcomes. Am. J. Phys. Med. Rehabil. 2013; 92: 715-27.
    1. Cavalheri V, Granger C. Preoperative exercise training for patients with non-small cell lung cancer. Cochrane Database Syst. Rev. 2017; 6: CD012020.
    1. Brunelli A, Kim AW, Berger KI, Addrizzo-Harris DJ. Physiologic evaluation of the patient with lung cancer being considered for resectional surgery: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2013; 143: e166S-90S.
    1. Rosero ID, Ramirez-Velez R, Lucia A, Martinez-Velilla N, Santos-Lozano A, Valenzuela PL, Morilla I, Izquierdo M. Systematic review and meta-analysis of randomized, controlled trials on preoperative physical exercise interventions in patients with non-small-cell lung cancer. Cancer 2019; 11: 944.
    1. Granger CL, Denehy L, Remedios L, Retica S, Phongpagdi P, Hart N, Parry SM. Barriers to translation of physical activity into the lung cancer model of care. A qualitative study of clinicians' perspectives. Ann. Am. Thorac. Soc. 2016; 13: 2215-22.
    1. Granger CL, Parry SM, Denehy L, Remedios L. Evidence, education and multi-disciplinary integration are needed to embed exercise into lung cancer clinical care: a qualitative study involving physiotherapists. Physiother. Theory Pract. 2018; 34: 852-60.
    1. Karenovics W, Licker M, Ellenberger C, Christodoulou M, Diaper J, Bhatia C, Robert J, Bridevaux PO, Triponez F. Short-term preoperative exercise therapy does not improve long-term outcome after lung cancer surgery: a randomized controlled study. Eur. J. Cardiothorac. Surg. 2017; 52: 47-54.
    1. Granger CL. Physiotherapy management of lung cancer. J. Physiother. 2016; 62: 60-7.
    1. Mayor MA, Khandhar SJ, Chandy J, Fernando HC. Implementing a thoracic enhanced recovery with ambulation after surgery program: key aspects and challenges. J. Thorac. Dis. 2018; 10: S3809-14.
    1. Castelino T, Fiore JF Jr, Niculiseanu P, Landry T, Augustin B, Feldman LS. The effect of early mobilization protocols on postoperative outcomes following abdominal and thoracic surgery: a systematic review. Surgery 2016; 159: 991-1003.
    1. Rogers LJ, Bleetman D, Messenger DE, Joshi NA, Wood L, Rasburn NJ, Batchelor TJP. The impact of enhanced recovery after surgery (ERAS) protocol compliance on morbidity from resection for primary lung cancer. J. Thorac. Cardiovasc. Surg. 2018; 155: 1843-52.
    1. Arbane G, Tropman D, Jackson D, Garrod R. Evaluation of an early exercise intervention after thoracotomy for non-small cell lung cancer (NSCLC), effects on quality of life, muscle strength and exercise tolerance: randomised controlled trial. Lung Cancer 2011; 71: 229-34.
    1. Granger CL, Chao C, McDonald CF, Berney S, Denehy L. Safety and feasibility of an exercise intervention for patients following lung resection: a pilot randomized controlled trial. Integr. Cancer Ther. 2013; 12: 213-24.
    1. Cavalheri V, Burtin C, Formico VR, Nonoyama ML, Jenkins S, Spruit MA, Hill K. Exercise training undertaken by people within 12 months of lung resection for non-small cell lung cancer. Cochrane Database Syst. Rev. 2019; 6: CD009955.
    1. Reeve J, Stiller K, Nicol K, McPherson KM, Birch P, Gordon IR, Denehy L. A postoperative shoulder exercise program improves function and decreases pain following open thoracotomy: a randomised trial. J. Physiother. 2010; 56: 245-52.
    1. Peddle-McIntyre CJ, Singh F, Thomas R, Newton RU, Galvao DA, Cavalheri V. Exercise training for advanced lung cancer. Cochrane Database Syst. Rev. 2019; 2: CD012685.
    1. Quist M, Adamsen L, Rorth M, Laursen JH, Christensen KB, Langer SW. The impact of a multidimensional exercise intervention on physical and functional capacity, anxiety, and depression in patients with advanced-stage lung cancer undergoing chemotherapy. Integr. Cancer Ther. 2015; 14: 341-9.
    1. Quist M, Rorth M, Langer S, Jones LW, Laursen JH, Pappot H, Christensen KB, Adamsen L. Safety and feasibility of a combined exercise intervention for inoperable lung cancer patients undergoing chemotherapy: a pilot study. Lung Cancer 2012; 75: 203-8.
    1. Temel JS, Greer JA, Goldberg S, Vogel PD, Sullivan M, Pirl WF, Lynch TJ, Christiani DC, Smith MR. A structured exercise program for patients with advanced non-small cell lung cancer. J. Thorac. Oncol. 2009; 4: 595-601.
    1. Jensen W, Oechsle K, Baumann HJ, Mehnert A, Klose H, Bloch W, Bokemeyer C, Baumann FT. Effects of exercise training programs on physical performance and quality of life in patients with metastatic lung cancer undergoing palliative chemotherapy - a study protocol. Contemp. Clin. Trials 2014; 37: 120-8.
    1. Quist M, Langer SW, Rorth M, Christensen KB, Adamsen L. "EXHALE": exercise as a strategy for rehabilitation in advanced stage lung cancer patients: a randomized clinical trial comparing the effects of 12 weeks supervised exercise intervention versus usual care for advanced stage lung cancer patients. BMC Cancer 2013; 13: 477.
    1. Wiskemann J, Hummler S, Diepold C, Keil M, Abel U, Steindorf K, Beckhove P, Ulrich CM, Steins M, Thomas M. POSITIVE study: physical exercise program in non-operable lung cancer patients undergoing palliative treatment. BMC Cancer 2016; 16: 499.
    1. Edbrooke L, Aranda S, Granger CL, McDonald CF, Krishnasamy M, Mileshkin L, Clark RA, Gordon I, Irving L, Denehy L. Multidisciplinary home-based rehabilitation in inoperable lung cancer: a randomised controlled trial. Thorax 2019; 74: 787-96.
    1. Quist M. Critically appraised paper: in people with inoperable lung cancer, home-based rehabilitation provides no benefit over usual care in optimising functional exercise capacity [Commentary]. J. Physiother. 2020; 66: 57.
    1. Santini D, Barni S, Intagliata S, Falcone A, Ferrau F, Galetta D, Moscetti L, La Verde N, Ibrahim T, Petrelli F et al. Natural history of non-small-cell lung cancer with bone metastases. Sci. Rep. 2015; 5: 18670.
    1. Broder MS, Gutierrez B, Cherepanov D, Linhares Y. Burden of skeletal-related events in prostate cancer: unmet need in pain improvement. Support. Care Cancer 2015; 23: 237-47.
    1. Cormie P, Newton RU, Spry N, Joseph D, Taaffe DR, Galvao DA. Safety and efficacy of resistance exercise in prostate cancer patients with bone metastases. Prostate Cancer Prostatic Dis. 2013; 16: 328-35.
    1. Galvao DA, Taaffe DR, Spry N, Cormie P, Joseph D, Chambers SK, Chee R, Peddle-McIntyre CJ, Hart NH, Baumann FT et al. Exercise preserves physical function in prostate cancer patients with bone metastases. Med. Sci. Sports Exerc. 2018; 50: 393-9.
    1. Pedersen L, Christensen JF, Hojman P. Effects of exercise on tumor physiology and metabolism. Cancer J. 2015; 21: 111-6.
    1. Pedersen L, Idorn M, Olofsson GH, Lauenborg B, Nookaew I, Hansen RH, Johannesen HH, Becker JC, Pedersen KS, Dethlefsen C et al. Voluntary running suppresses tumor growth through epinephrine- and IL-6-dependent NK cell mobilization and redistribution. Cell Metab. 2016; 23: 554-62.
    1. Higgins KA, Park D, Lee GY, Curran WJ, Deng X. Exercise-induced lung cancer regression: mechanistic findings from a mouse model. Cancer 2014; 120: 3302-10.

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