Evidence-Based Nursing Plus Progressive Exercise for Cancer-Related Fatigue in Advanced Lung Cancer

Effect of Evidence-Based Nursing Combined With Progressive Gymnastics Training on Cancer-Related Fatigue, Quality of Life, and Treatment Adherence in Patients With Advanced Lung Cancer Undergoing Chemotherapy: A Randomized Controlled Trial

This study aims to evaluate the effectiveness and safety of evidence-based nursing combined with progressive exercise training in patients with advanced lung cancer undergoing chemotherapy. Cancer-related fatigue (CRF) is a common and distressing symptom in this population and is associated with poor quality of life and reduced treatment adherence.

In this single-center, prospective randomized controlled trial, 100 patients with stage III-IV lung cancer receiving platinum-based chemotherapy were randomly assigned to either a control group or an intervention group. The control group received routine nursing care, while the intervention group received evidence-based nursing combined with a structured progressive exercise program for 8 weeks.

The primary outcomes are cancer-related fatigue assessed by the Brief Fatigue Inventory (BFI) and functional exercise capacity assessed by the 6-minute walk test (6MWT). Secondary outcomes include quality of life (EORTC QLQ-C30), treatment adherence (MMAS-8), psychological status (HADS), sleep quality (PSQI), and safety outcomes.

The study is designed to determine whether a combined intervention approach integrating nursing care and exercise rehabilitation can provide greater benefits than routine care alone in improving both physical and psychological outcomes in patients with advanced lung cancer.

This study is a single-center, prospective, randomized controlled trial designed to evaluate the effectiveness and safety of evidence-based nursing combined with progressive exercise training in patients with advanced lung cancer undergoing chemotherapy.

Eligible patients with stage III-IV lung cancer receiving platinum-based chemotherapy were consecutively recruited and randomly assigned in a 1:1 ratio to either the control group or the intervention group using a random number table. Stratified randomization was performed according to age, sex, and Karnofsky Performance Status (KPS). Allocation was implemented using sealed opaque envelopes. Due to the nature of the intervention, participants and intervention providers were not blinded; however, outcome assessment and statistical analysis were conducted by independent personnel blinded to group allocation.

The control group received routine nursing care, including health education, symptom monitoring, dietary guidance, and general psychological support. The intervention group received, in addition to routine care, a comprehensive intervention consisting of evidence-based nursing and progressive exercise training. Evidence-based nursing included individualized health education, psychological support, symptom management, and family involvement strategies developed based on current best evidence. The progressive exercise program was supervised by rehabilitation specialists and included aerobic and resistance training with gradually increasing intensity, tailored to individual patient tolerance.

The intervention duration was 8 weeks. Patients were followed throughout the intervention period with regular monitoring of symptoms, adherence, and safety.

Primary outcomes included changes in cancer-related fatigue assessed by the Brief Fatigue Inventory (BFI) and functional exercise capacity assessed by the 6-minute walk test (6MWT). Secondary outcomes included quality of life measured by the EORTC QLQ-C30, treatment adherence measured by the MMAS-8, psychological status assessed by the Hospital Anxiety and Depression Scale (HADS), sleep quality assessed by the Pittsburgh Sleep Quality Index (PSQI), and the incidence of adverse events.

The study aims to provide evidence for a multidimensional supportive care model integrating nursing interventions and exercise rehabilitation to improve clinical outcomes in patients with advanced lung cancer.

Inclusion Criteria:

• Pathologically confirmed advanced lung cancer (stage III-IV)
• Currently receiving platinum-based chemotherapy (first to fourth cycle)
• Age ≥18 years
• Karnofsky Performance Status (KPS) score ≥60
• Presence of moderate or more severe cancer-related fatigue, defined as a Brief Fatigue Inventory (BFI) score ≥4
• Expected survival time of more than 6 months
• Ability to understand the study procedures and provide written informed consent

Exclusion Criteria:

• Severe cardiopulmonary insufficiency or other conditions that contraindicate exercise intervention
• Cognitive impairment or mental disorders affecting compliance with the intervention
• Musculoskeletal disorders that limit physical activity or exercise participation
• Presence of other advanced malignant tumors
• Rapid disease progression during the study period requiring discontinuation of the intervention