Home-Based Exercise and Self-Management After Lung Cancer Resection: A Randomized Clinical Trial
- Author(s)
- Granger, CL; Edbrooke, L; Antippa, P; Wright, G; McDonald, CF; Zannino, D; Abo, S; Krishnasamy, M; Irving, L; Lamb, KE; Whish-Wilson, G; Denehy, L; Parry, SM;
- Details
- Publication Year 2024-12-02,Volume 7,Issue #12,Page e2447325
- Journal Title
- JAMA Network Open
- Publication Type
- Research article
- Abstract
- IMPORTANCE: Patients with lung cancer have poor physical functioning and quality of life. Despite promising outcomes for those who undertake exercise programs, implementation into practice of previously tested hospital-based programs is rare. OBJECTIVE: To evaluate a home-based exercise and self-management program for patients after lung resection. DESIGN, SETTING, AND PARTICIPANTS: A randomized clinical trial with assessor blinding was conducted among 116 patients undergoing surgery for non-small cell lung cancer from November 23, 2017, to July 31, 2023, at tertiary hospitals in Australia. Patients were followed up for 12 months postoperatively. INTERVENTION: Patients randomized to the intervention group received a postoperative 3-month home-based exercise and self-management program, supported by weekly physiotherapist-led telephone consultations. Patients randomized to the control group received usual care. MAIN OUTCOMES AND MEASURES: The primary outcome was self-reported physical function (30-item European Organization for the Research and Treatment of Cancer Core Quality of Life Questionnaire [EORTC QLQ-C30] score) at 3 months. Secondary outcomes included objective measures of physical function and exercise capacity (at 3 and 6 months) and patient-reported outcomes including quality of life (at 3 and 6 months, with some questionnaires completed at 12 months). Analysis was performed on an intent-to-treat basis. RESULTS: A total of 1370 patients were screened, with 177 eligible and 116 consented (mean [SD] age, 66.4 [9.6] years; 68 women [58.6%]). Of these 116 patients, 58 were randomized to the intervention and 58 to the control. A total of 103 patients (88.8%) completed assessments at 3 months, 95 (81.9%) at 6 months, and 95 (81.9%) at 12 months. There were no statistically significant differences between the intervention and control groups for self-reported physical function (EORTC QLQ-C30 physical functioning domain score) at the 3-month primary end point (mean [SD] score, 77.3 [20.9] vs 76.3 [18.8]; mean difference, 1.0 point [95% CI, -6.0 to 8.0 points]). Patients in the intervention group, compared with the control group, had significantly greater exercise capacity (6-minute walk distance: mean difference, 39.7 m [95% CI, 6.8-72.6 m]), global quality of life (mean difference, 7.1 points [95% CI, 0.4-13.8 points]), and exercise self-efficacy (mean difference, 16.0 points [95% CI, 7.0-24.9 points]) at 3 months as well as greater objectively measured physical function (Short Physical Performance Battery score: mean difference, 0.8 points [95% CI, 0.1-1.6 points]), exercise capacity (6-minute walk distance: mean difference, 50.9 m [95% CI, 6.7-95.1 m]), and exercise self-efficacy (mean difference, 10.1 points [95% CI, 1.9-18.2 points]) at 6 months. One minor adverse event and no serious adverse events occurred. CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, a postoperative home-based exercise and self-management program did not improve self-reported physical function in patients with lung cancer. However, it did improve other important clinical outcomes. Implementation of this program into lung cancer care should be considered. TRIAL REGISTRATION: http://anzctr.org.au Identifier: ACTRN12617001283369.
- Publisher
- JAMA Network
- Keywords
- Humans; Female; Male; *Lung Neoplasms/surgery; *Self-Management/methods; Aged; Middle Aged; *Quality of Life; *Exercise Therapy/methods; Australia; Carcinoma, Non-Small-Cell Lung/surgery; Home Care Services
- Department(s)
- Health Services Research
- Publisher's Version
- https://doi.org/10.1001/jamanetworkopen.2024.47325
- Terms of Use/Rights Notice
- Refer to copyright notice on published article.
Creation Date: 2024-12-12 03:22:33
Last Modified: 2024-12-12 03:29:25