‘Prehab’ may make surgery possible for more lung cancer patients

Reuters Health - 16/12/2020- Some high-risk patients with non-small-cell lung cancer that's classified as inoperable may be able to undergo surgery if they first receive pulmonary physiotherapy, a recent study suggests.

Researchers examined data on 216 patients (mean age 71.7 years) who were diagnosed with lung cancer and considered inoperable based on criteria such as significant dyspnoea, impaired performance status, and low diffusing capacity for carbon monoxide. They were all referred to pulmonary physiotherapy to determine if this might make them eligible for surgery, participants received an average of 3.1 pulmonary physiotherapy sessions over 39 days.

Before physiotherapy, every participant was ineligible for surgery based on the subjective criteria of having a dyspnoea score of less than 3 and a performance status score of less than 2. After "prehab," 84.2% of these high-risk patients could get radical treatment and 52.6% could get surgery.

In addition, 78.8% of the participants were ineligible for surgery at the start of the study based on the objective criteria of having diffusing capacity for carbon monoxide below 50%. After prehab, 86.5% of these high-risk patients could get radical treatment and 59.1% could get surgery.

"High-risk patients who are otherwise considered inoperable due to significant dyspnoea, poor performance status, borderline or poor pulmonary function or frailty, with a standardized Prehab program, started at the very beginning of the patients' pathway, can be optimized with pre-treatment pulmonary rehabilitation allowing them to undergo curative surgery safely," said lead study author Dr. Ira Goldsmith of Morriston Hospital in Swansea, Wales.

"As more patients receive curative surgery it is hoped that this strategy will contribute to the national aim of improving the overall long-term survival of patients with lung cancer, and allowing patients to do so with a meaningful quality of life sustained by pulmonary rehabilitation following surgery," Dr. Goldsmith said by email.

Prior to the start of prehab, 40.4% of patients had dyspnoea scores of 2 or less, compared with 65.1% afterwards, researchers report in EClinicalMedicine.

Similarly, impaired performance scores improved from just 45.1% with scores of 1 or less before prehab to 62.4% afterwards.

The majority of participants (80.8%) had a sedentary lifestyle prior to prehab, and afterward, most (81%) improved and became at least moderately active.

Many patients experienced postoperative complications including atrial fibrillation (11.3%), major cardiac events (2%), retained secretions (16%), lobar collapse or consolidation (6.0%), and respiratory infections (2.7%)

Mortality rates were 1.3% in the hospital, 1.3% at 30 days, 4.7% at 90 days, and 16% at one year.

Prehab was delivered by trained cardiothoracic physiotherapists and included respiratory muscle training, breathing exercises, cardiovascular exercises, health education, and bronchodilator therapy if needed. Participants were offered two weekly sessions of 70 minutes over 2-4 weeks.

One limitation of the study is that while prehab also included a home exercise component, researchers lacked data on compliance with home exercise regimens, the study team notes.

Even so, the results suggest that prehab may be an effective way to improve outcomes for many lung cancer patients, said Dr. Richard Cassidy, a radiation oncologist at Cancer Specialists of North Florida in Jacksonville who wasn't involved in the study.

"Prehab is something any patient with a new lung cancer diagnosis could consider, whether their disease is potentially resectable or not," Dr. Cassidy said by email. "Prehab will optimize the patient for any subsequent cancer therapy, whether that is definitive surgery for early stage cases or for chemotherapy and radiation in more advanced cases."

SOURCE: https://bit.ly/34jihjH EClinicalMedicine, online November 30, 2020.

By Lisa Rapaport



Posted on 16 December 202023 February 2021