Author(s): MACHADO, P., PIMENTA, S., GARCIA, A.L., NOGUEIRA, T., SILVA, S., DOS SANTOS, C.L., MARTINS, M.V., CANHA, A., OLIVEIROS, B., MARTINS, R.A., CRUZ, J., Institution: INSTITUTO POLITÉCNICO DE LEIRIA, Country: PORTUGAL, Abstract-ID: 374

INTRODUCTION:
Exercise prehabilitation has shown to improve clinical outcomes after lung cancer surgery. However, its efficacy in preventing deterioration in postoperative quality of life (QoL) has not been determined. Moreover, although patients awaiting major cancer surgery express a preference to exercise in their home-based environment, most prehabilitation trials in lung cancer surgery have focused on hospital-based interventions. The main purpose of this study was to investigate whether a preoperative home-based exercise program (PHEP) prevents the deterioration in QoL after lung cancer surgery. Secondarily, it aimed to determine the effects of the PHEP on physical performance.
METHODS:
A parallel, assessor-blinded, randomized controlled trial was conducted at 4 hospitals in Portugal. Patients awaiting lung cancer resection (clinical stage I-IIIA), were randomly allocated to either a non-exercise control group (n=21) or to a PHEP group (n=20). The PHEP consisted of moderate-intensity aerobic plus resistance training, with weekly telephone supervision. Primary endpoint was QoL measured with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C-30. Secondary endpoints were exercise capacity (incremental shuttle-walk test) and muscle strength (maximal handgrip strength and 5 times sit-to-stand). Outcomes were measured at baseline (i.e., before randomization), 1-5 days pre-surgery, and 1-month post-surgery. A repeated measures analysis of variance (ANOVA) was employed to compare groups over time based on the intention-to-treat principle. The proportion of patients who had clinically relevant deterioration on QoL was analyzed based on the minimal importance difference.
RESULTS:
A significant group X time interaction was found for global QoL (p=0.004). Significantly and clinically relevant differences between groups were found on global QoL at pre-surgery (mean difference [MD], 13.5 points; 95% confidence interval [CI], 2.4–24.6; p=0.019) and post-surgery (MD, 12.4 points; 95% CI, 1.3–23.4; p= 0.029), favoring the PHEP group. After surgery, the proportion of patients who had a clinically relevant deterioration on QoL was significantly lower in the PHEP group compared with the CG in the following domains: physical function (PHEP: 20% vs CG: 66.7%; p=0.004), role function (PHEP: 10% vs CG: 52.4%; p=0.006), social function (PHEP: 15% vs CG: 47.3%; p=0.043), pain (PHEP: 25% vs CG: 61.9%; p=0.028) and appetite loss (PHEP: 5% vs CG: 38.1%; p=0.020). In addition, between-group differences were found in preoperative five-times sit-to-stand (median difference, −1.8 s; 95% CI, −0.1 to −3.7 s; p=0.041) and postoperative exercise capacity (MD, 147.4 m; 95% CI, 17.3–264.2 m; p=0.027), favoring the PHEP group. No between-group differences were found on handgrip strength.
CONCLUSION:
This study found that a PHEP prevents deterioration in QoL and exercise capacity after lung cancer surgery. Further research is needed to determine its efficacy on surgical outcomes.