Impact of self-reported physical activity and health promotion behaviors on lung cancer survivorship

Jeff A Sloan, Andrea L Cheville, Heshan Liu, Paul J Novotny, Jason A Wampfler, Yolanda I Garces, Matthew M Clark, Ping Yang, Jeff A Sloan, Andrea L Cheville, Heshan Liu, Paul J Novotny, Jason A Wampfler, Yolanda I Garces, Matthew M Clark, Ping Yang

Abstract

Background: There is some initial evidence that an enhanced physical activity level can improve fquality of life, and possibly survival among patients with lung cancer. The primary aim of this project was to evaluate the impact of physical activity on the quality and quantity of life of lung cancer survivors.

Methods: Between January 1, 1997, and December 31, 2009, a total of 1466 lung cancer survivors completed a questionnaire with patient-reported outcomes for quality of life (QOL), demographics, disease and clinical characteristics, and a measure of physical activity (Baecke Questionnaire). Chi-square tests compared lung cancer survivors who reported being physically active versus not on a variety of the other covariates. Kaplan-Meier estimates and Cox models evaluated the prognostic importance of physical activity level on Overall Survival (OS).

Results: Roughly half of the lung cancer survivors had advanced stage disease at the time of survey. Treatment prevalence rates were 61, 54, and 33 % for surgery, chemotherapy and radiotherapy, respectively. The majority (77 %) of survivors reported themselves as physically active. Physically active survivors reported greater activity across all individual Baecke items. Lung cancer survivor-reported QOL indicated the benefits of physical activity in all domains. Survivors receiving chemotherapy or radiation at the time of questionnaire completion were less likely to be physically active (74 and 73 % respectively). In contrast, 84 % of surgical patients were physically active. Disease recurrence rates were the same for physically active and inactive patients (81 % vs 82 %, p = 0.62). Physically active patients survived an average of 4 more years than those who were not physically active (8.4 years versus 4.4 years respectively, log rank p < 0.0001).

Conclusions: Being physically active was related to profound advantages in QOL and survival in a large sample of lung cancer survivors.

Figures

Fig. 1
Fig. 1
Kaplan-Meier survival curves for lung cancer survivors by level of physical activity
Fig. 2
Fig. 2
Kaplan-Meier survival curves for lung cancer survivors by stage of disease (early vs late)
Fig. 3
Fig. 3
Kaplan-Meier survival curves for lung cancer survivors by type of lung cancer (Non-Small Cell Lung Cancer(NSCLC) vs Small Cell Lung Cancer(SCLC))
Fig. 4
Fig. 4
Cluster dendogram for lung cancer survivors

References

    1. Jones LW, Eves ND, Waner E, Joy AA. Exercise therapy across the lung cancer continuum. Curr Oncol Rep. 2009;11(4):255–62. doi: 10.1007/s11912-009-0036-0.
    1. Betof AS, Dewhirst MW, Jones LW. Effects and potential mechanisms of exercise training on cancer progression: A translational perspective. Brain Behav Immun.2013 Mar; 30(0): S75–S87.
    1. Jones LW, Demark-Wahnefried W. Diet, exercise, and complementary therapies after primary treatment for cancer. Lancet Oncol. 2006;7(12):1017–26. doi: 10.1016/S1470-2045(06)70976-7.
    1. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Cancer J Clin. 2012;62(1):10–29. doi: 10.3322/caac.20138.
    1. Jones LW. Physical activity and lung cancer survivorship. Recent Results Cancer Res. 2014;186:255–274. doi: 10.1007/978-3-642-04231-7_11.
    1. Coups EJ, Park BJ, Feinstein MB, et al. Physical activity among lung cancer survivors: changes across the cancer trajectory and associations with quality of life. Cancer Epidemiol Biomarkers Prev. 2009;18(2):664–72. doi: 10.1158/1055-9965.EPI-08-0589.
    1. Loewen GM, Watson D, Kohman L, et al. Preoperative exercise Vo2 measurement for lung resection candidates: results of Cancer and Leukemia Group B Protocol 9238. J Thorac Oncol. 2007;2(7):619–25. doi: 10.1097/JTO.0b013e318074bba7.
    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(8):1790–7. doi: 10.1016/j.rmed.2007.02.012.
    1. Bobbio A, Chetta A, Ampollini L, et al. Preoperative pulmonary rehabilitation in patients undergoing lung resection for non-small cell lung cancer. Eur J Cardiothorac Surg. 2008;33(1):95–8. doi: 10.1016/j.ejcts.2007.10.003.
    1. Kasymjanova G, Correa JA, Kreisman H, et al. Prognostic value of the six-minute walk in advanced non-small cell lung cancer. J Thorac Oncol. 2009;4(5):602–7. doi: 10.1097/JTO.0b013e31819e77e8.
    1. Jones LW, Peddle CJ, Eves ND, et al. Effects of presurgical exercise training on cardiorespiratory fitness among patients undergoing thoracic surgery for malignant lung lesions. Cancer. 2007;110(3):590–8. doi: 10.1002/cncr.22830.
    1. Cesario A, Ferri L, Galetta D, et al. Pre-operative pulmonary rehabilitation and surgery for lung cancer. Lung Cancer. 2007;57(1):118–9. doi: 10.1016/j.lungcan.2007.03.022.
    1. Spruit MA, Janssen PP, Willemsen SC, Hochstenbag MM, Wouters EF. Exercise capacity before and after an 8-week multidisciplinary inpatient rehabilitation program in lung cancer patients: a pilot study. Lung Cancer. 2006;52(2):257–60. doi: 10.1016/j.lungcan.2006.01.003.
    1. Temel JS, Greer JA, Goldberg S, et al. A structured exercise program for patients with advanced non-small cell lung cancer. J Thorac Oncol. 2009;4(5):595–601. doi: 10.1097/JTO.0b013e31819d18e5.
    1. Cheville AL, Kollasch J, Vandenberg J, et al. A Home-Based Exercise Program to Improve Function, Fatigue, and Sleep Quality in Patients With Stage IV Lung and Colorectal Cancer: A Randomized Controlled Trial. J Pain Symptom Manage. 2013;45(5):811–21.
    1. Clark MM, Novotny PJ, Patten CA, Rausch SM, Garces YI, Jatoi A, Sloan JA, Yang P. Motivational readiness for physical activity and quality of life in long-term lung cancer survivors. Lung Cancer. 2008;61(1):117–22. doi: 10.1016/j.lungcan.2007.12.012.
    1. Yang P, Allen MS, Aubry MC, et al. Clinical Features of 5,628 Primary Lung Cancer Patients: Experience at Mayo Clinic from 1997–2003. Chest. 2005;128:452–62. doi: 10.1378/chest.128.1.452.
    1. Hollen PJ, Gralla RJ, Kris MG, et al. Normative data and trends in quality of life from the Lung Cancer Symptom Scale (LCSS) Support Care Cancer. 1999;7:140–8. doi: 10.1007/s005200050244.
    1. Hollen PJ, Gralla RJ, Kris MG, McCoy S, Donaldson GW, Moinpour CM. A comparison of visual analogue and numerical rating scale formats for the Lung Cancer Symptom Scale (LCSS): does format affect patient ratings of symptoms and quality of life? Qual Life Res. 2005;14(3):837–47. doi: 10.1007/s11136-004-0833-8.
    1. Sloan JA. Applying QOL assessments: solutions for oncology clinical practice and research. Curr Prob Cancer. Part 1, 2005;29(6) and Part 2, 2006;30(6).
    1. Huschka MM, Mandrekar SJ, Schaefer PL, Jett JR, Sloan JA. A pooled analysis of quality of life measures and adverse events data in north central cancer treatment group (NCCTG) lung cancer clinical trials. Cancer. 2007;109(4):787–95. doi: 10.1002/cncr.22444.
    1. Buchanan DR, O'Mara AM, Kelaghan JW, Minasian LM. Quality-of-Life Assessment in the Symptom Management Trials of the National Cancer Institute-Supported Community Clinical Oncology Program. J Clin Oncol. 2005;23(3):591–8. doi: 10.1200/JCO.2005.12.181.
    1. Giorgi F, Cellerino R, Gramazio A, Tummarello D, Menichetti ET, Giordani P, Antognoli S, Carle F, Piga A. Assessing quality of life in patients with cancer: a comparison of a visual-analogue and a categorical model. Am J Clin Oncol. 1996;19(4):394–9. doi: 10.1097/00000421-199608000-00016.
    1. Ballatori E, Porzio G, Roila F, Ruggeri B, Mattei A, Cortesi E. Is there still a role for the uniscale assessment of quality of life? Tumori. 2007;93(1):78–81.
    1. Sloan JA, Berk L, Roscoe J, Fisch MJ, Shaw EG, Wyatt G, Morrow GR, Dueck AC. National Cancer Institute. Integrating patient-reported outcomes into cancer symptom management clinical trials supported by the National Cancer Institute-sponsored clinical trials networks. J Clin Oncol. 2007;25(32):5070–7. doi: 10.1200/JCO.2007.12.7670.
    1. Locke DE, Decker PA, Sloan JA, Brown PD, Malec JF, Clark MM, Rummans TA, Ballman KV, Schaefer PL, Buckner JC. Validation of Single-Item Linear Analog Scale Assessment of Quality of Life in Neuro-Oncology Patients. J Pain Symptom Manage. 2007;34(6): 628–38.
    1. Ginns P, Barrie S. Reliability of single-item ratings of quality in higher education: a replication. Psychol Rep. 2004;95(3 Pt 1):1023–30. doi: 10.2466/pr0.95.3.1023-1030.
    1. Zimmerman M, Ruggero CJ, et al. Developing brief scales for use in clinical practice: the reliability and validity of single-item self-report measures of depression symptom severity, psychosocial impairment due to depression, and quality of life. J Clin Psychiatry. 2006;67(10):1536–41. doi: 10.4088/JCP.v67n1007.
    1. Butt Z, et al. Use of a Single-Item Screening Tool to Detect Clinically Significant Fatigue, Pain, Distress, and Anorexia in Ambulatory Cancer Practice. J Pain Symptom Manag. 2008;35:20–30. doi: 10.1016/j.jpainsymman.2007.02.040.
    1. Jeff AS, Xinghua Z, et al. Relationship Between Deficits in Overall Quality of Life and Non–Small-Cell Lung Cancer Survival. J Clin Oncol. 2012;30(13):1498–504. doi: 10.1200/JCO.2010.33.4631.
    1. Pols MA, Peeters PH, Bueno-De-Masquita HB, et al. Validity and repeatability of a modified Baecke questionnaire on physical activity. Int J Epidemiol. 1995;24:381–8. doi: 10.1093/ije/24.2.381.
    1. JA Baecke JA, Burema J, Frijters JE. A short questionnaire for the measurement of habitual physical activity in epidemiological studies. Am J Clin Nutr. 1982;36:936–42.
    1. Ono R, Hirata S, et al. Reliability and validity of the Baecke physical activity questionnaire in adult women with hip disorders. BMC Musculoskelet Disord. 2007;8:61.
    1. Richardson MT, Ainsworth BE, et al. Ability of the atherosclerosis risk in communities (ARIC)/Baecke questionnaire to assess leisure-time physical activity. Int J Epidemiol. 1995;24:685–93. doi: 10.1093/ije/24.4.685.
    1. Van Baak MA, van Mil E, Astrup AV, Finer N, Van Gaal LF, Hilsted J, Kopelman PG, Rossner S, James WP, Saris WH, STORM Study Group Leisure-time activity is an important determinant of long-term weight maintenance after weight loss in the Sibutramine Trial on Obesity Reduction and Maintenance (STORM trial) Am J Clin Nutr. 2003;78:209–14.
    1. Nielens H, Lejeune TM, Lalaoui A, Squifflet JP, Pirson Y, Goffin E. Increase of physical activity level after successful renal transplantation: a 5 year follow-up study. Nephrol Dial Transplant. 2001;16:134–40. doi: 10.1093/ndt/16.1.134.
    1. Bonnefoy M, Normand S, Pachiaudi C, Lacour JR, Laville M, Kostka T. Simultaneous validation of ten physical activity questionnaires in older men: a doubly labeled water study. J Am GeriatrSoc. 2001;49:28–35. doi: 10.1046/j.1532-5415.2001.49006.x.
    1. Emmy MH, Evelyn MM, Evert GS, Petra HMP, Albertine JS. Validity of the Modified Baecke Questionnaire: comparison with energy expenditure according to the doubly labeled water method. Int J Behav Nutr Phys Act. 2008;5:30. doi: 10.1186/1479-5868-5-30.
    1. Cohen J. Statistical Power Analysis for the Behavioral Sciences. Hillsdale, New Jersey: Lawrence Erlbaum Associates; 1988.
    1. I-Min L, Eric JSH. Using accelerometers to measure physical activity in large-scale epidemiological studies: issues and challenges. Br J Sports Med. 2014;48:197–201. doi: 10.1136/bjsports-2013-093154.
    1. Howard VJ, Rhodes JD, Mosher A, Hutto B, Stewart MS, Colabianchi N, Vena JE, Blair SN, Hooker SP. Obtaining Accelerometer Data in a National Cohort of Black and White Adults. Med Sci Sports Exerc. 2015;47(7):1531–7. doi: 10.1249/MSS.0000000000000549.

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