Pulmonary Rehabilitation in Advanced Non-small Cell Lung Cancer Patients

Effect of a Pulmonary Rehabilitation Program on Skeletal Muscle Mass, Pulmonary Function, Inflammatory Response and Overall Survival on Patients Diagnosed With Non-small-cell Advanced Cancer

Lung cancer (LC) is usually diagnosed in advanced stages and continues to be the leading cause of cancer related deaths worldwide. Cancer cachexia are frequent among patients with LC affecting up to 80% of patients with advanced stage disease, and it has been related with higher risk of complications, length of hospital stay, and worst overall survival. During cancer cachexia, both muscle and fat mass can be wasted, however, the loss of muscle mass has been associated to higher treatment related toxicity, loss of functional status, shorter progression free survival and overall survival in different types of cancer under various treatments. Hence, preservation of muscle mass and function should be an important focus of the multidisciplinary treatment of patients with LC.

Pulmonary rehabilitation (PR) has been known to improve pulmonary function, reduce fatigue and improve exercise tolerance in patients with LC undergoing curative surgery. However, few studies have focused on the efficacy of PR on patients with advanced cancer undergoing palliative care with chemotherapy or targeted therapies.

The main objective of this study is to determine the effects of a pulmonary rehabilitation program on the pulmonary function and muscle mass. Moreover, the effects on exercise tolerance, inflammatory response, quality of live and overall survival will be explored.

Patients will be randomized into intervention group (IG) or control group (CG). Patients in the IG will be scheduled to receive 12 sessions of PR over a period of 4-6 weeks (2-3 session/week). CG will receive information and recommendations on physical activity. Both groups will receive nutritional assessment and intervention as needed.

Inclusion Criteria:

• Confirmed diagnosis of advanced non-small-cell lung cancer
• Good performance status (ECOG 0-1)
• Life expectancy >12 weeks
• Eligible to receive treatment with chemotherapy or tyrosinkinase inhibitors
• Recent electrocardiogram without evidence of arrythmia

Exclusion Criteria:

• Symptomatic brain metastasis
• Uncontrolled pain (Visual Analog Scale >5)
• Uncontrolled hypertension (>140/100mmHg)
• Practice of regular moderate to intense physical activity at least 3 day/week
• Not residents of Mexico City or unable to attend to therapy sessions