Low physical activity levels and functional decline in individuals with lung cancer. Outcomes of Pulmonary Rehabilitation After Treatment for Non-Small Cell Lung Cancer Stages I to IIIa: AN OBSERVATIONAL STUDY Exercise in patients with non-small cell lung cancer. Supervised physical exercise to improve the quality of life of cancer patients: the EFICANCER randomised controlled trial Safety and feasibility of a combined exercise intervention for inoperable lung cancer patients undergoing chemotherapy: a pilot study. The Impact of a Multidimensional Exercise Intervention on Physical and Functional Capacity, Anxiety, and Depression in Patients With Advanced-Stage Lung Cancer Undergoing Chemotherapy Home-based exercise: promising rehabilitation for symptom relief, improved functional status and quality of life for post-surgical lung cancer patients. Validity of the Assessment of Quality of Life (AQoL) utility instrument in patients with operable and inoperable lung cancer. POSITIVE study: physical exercise program in non-operable lung cancer patients undergoing palliative treatment A rehabilitation program for lung cancer patients during postthoracotomy chemotherapy Objective evaluation of physical function in patients with advanced lung cancer: a preliminary report. Strength and endurance training in the treatment of lung cancer patients in stages IIIA/IIIB/IV High-intensity training following lung cancer surgery: a randomised controlled trial Alpe d’HuZes Cancer Rehabilitation (A-CaRe) Research: Four Randomized Controlled Exercise Trials and Economic Evaluations in Cancer Patients and Survivors A multidimensional cancer rehabilitation program for cancer survivors: effectiveness on health-related quality of life. The impact of physical activity on fatigue and quality of life in lung cancer patients: a randomised controlled trial protocol Cancer Rehabilitation: Outcome Evaluation of a Strengthening and Conditioning Program
OBJECTIVES Physical activity has been infrequently measured objective ly in non-small cell lung cancer ( NSCLC ) . We aim ed to investigate levels of physical activity , functional and patient reported outcomes at diagnosis and over six months in participants with recently diagnosed NSCLC and compare results with both physical activity guidelines and outcomes of similar-aged healthy individuals . METHODS This prospect i ve observational study assessed 50 individuals from three Australian tertiary hospitals with stage I-IIIB NSCLC at diagnosis , then 10 weeks and six months later . Thirty five healthy individuals without cancer were assessed once . Outcome measures included  tri-axial accelerometery ( number of steps per day ) , six minute walk distance ( 6MWD ) , muscle strength and question naires including health-related quality of life ( HRQoL ) . RESULTS Individuals with NSCLC were engaged in significantly less physical activity than similar-aged healthy individuals , with 60 % not meeting physical activity guidelines . At diagnosis they had worse quadriceps strength , nutritional status and HRQoL. Over six months , participants with NSCLC experienced decline in self-reported physical activity , 6MWD and muscle strength , and worsening symptoms . CONCLUSION At diagnosis individuals with NSCLC engage in less physical activity , are weaker and more depressed than healthy individuals and their self-reported physical activity declines over six months . Future studies are required to investigate the efficacy of interventions to increase physical activity PURPOSE : Although rehabilitation after treatment for non-small cell lung cancer ( NSCLC ) was found to have a beneficial effect on exercise capacity in a number of studies , insight into its effect on quality of life ( QoL ) and fatigue is limited . The aim of this study was to examine the outcome of pulmonary rehabilitation ( PR ) regarding fatigue , QoL , and exercise capacity in adult patients curatively treated for NSCLC stages I to IIIa . METHODS : Study data were prospect ively and routinely gathered in daily practice in patients taking part in an outpatient PR program after treatment for NSCLC stages I to IIIa . PR consisted of 12 weeks of supervised exercises 3 times a week , supplemented with scheduled visits with members of a multidisciplinary team . Data were gathered at initial assessment and discharge . Outcomes included fatigue ( the Functional Assessment of Cancer Therapy-Fatigue and the fatigue domain of the Chronic Respiratory Disease Question naire ) ; QoL ( total CRQ score ) , Functional Assessment of Cancer Therapy-Lung , and the Short Form 36 ; and exercise capacity ( cardiopulmonary exercise testing ) . RESULTS : Fifty patients started the program out of the 70 patients referred to PR and 43 ( 86 % ) completed the program . Significant ( P ⩽ .01 ) and clinical ly relevant improvements were observed for all outcome measures . CONCLUSIONS : Rehabilitation after treatment for NSCLC stages I to IIIa showed promising improvements regarding patient fatigue , QoL , and exercise capacity . PR should be considered for patients after treatment for NSCLC stages I to IIIa PURPOSE This study aim ed to evaluate the safety , feasibility , and effects of an 8-wk combined resistance and endurance exercise program in patients with advanced non-small cell lung cancer ( NSCLC ) during in- and outpatient care . METHODS In this intervention study , 40 patients with predominantly advanced NSCLC receiving simultaneous or sequential radiochemotherapy or chemotherapy alone were enrolled . For a period of 8 wk , patients were instructed to exercise at least five times per week during the inpatient setting and at least three times per week in the outpatient setting . Physical performance status ( endurance capacity : 6-min walk test ; strength capacity : h and held dynamometry ) , quality -of-life ( Functional Assessment of Cancer Therapy-Lung ) , fatigue ( Multidimensional Fatigue Inventory ) , and depression ( Patient Health Question naire ) were assessed at baseline ( T0 ) , after the exercise intervention ( T1 ) , and at a follow-up time point 8 wk later ( T2 ) . The primary end point was adequate adherence ( feasibility ) defined as completing at least two training sessions per week during a minimum of 6 wk . RESULTS Of 40 patients , 31 ( 77.5 % ) completed the postexercise assessment ( T1 ) and 22 ( 55 % ) completed follow-up ( T2 ) . The stages were IIA ( 5 % ) , IIIA ( 8 % ) , IIIB ( 20 % ) , and IV ( 67 % ) , and the median age was 63 yr ( range = 22 - 75 yr ) . Overall , adherence was 82 % for those patients who completed T1 , and 55 % of the 40 participating patients fulfilled the adequate adherence criterion . Those who completed the intervention showed a significant improvement in the 6-min walk distance and in knee , elbow , and hip muscle strength after the intervention ( T1 ) . Quality of life , fatigue , and depression scores remained stable or declined slightly . Significant improvements in knee-muscle strength were also observed at T2 . CONCLUSIONS Exercise training is feasible in advanced and metastatic NSCLC patients during anticancer treatment . In this pilot study , endurance and strength capacity improved over time , indicating the rehabilitative importance of the applied intervention . To investigate the potential impact of exercise training in this patient group , a larger r and omized trial is warranted Background The optimal form of exercise for individuals with cancer has yet to be identified , but there is evidence that exercise improves their quality of life . The aim of this study is to assess the efficacy and efficiency of an innovative physical exercise programme , for individuals undergoing chemotherapy for breast , gastrointestinal or non-small cell lung tumours , for improving quality of life , reducing level of fatigue , and enhancing functional capacity over time . Design / Methods We will conduct a clinical trial in 66 patients with stage IV breast , gastrointestinal or non-small cell lung cancer , recruited by the Department of Oncology of the referral hospital from 4 primary care health centres of the Basque Health Service ( Osakidetza ) . These patients will be r and omised to one of two groups . The treatment common to both groups will be the usual care for cancer : optimized usual drug therapies and strengthening of self-care ; in addition , patients in the intervention group will participate in a 2-month exercise programme , including both aerobic and strength exercises , supervised by nurses in their health centre . The principal outcome variable is health-related quality of life , measured blindly with the 30-item European Organization for the Research and Treatment of Cancer Core Quality of Life Question naire and Short Form-36 four times : at baseline , and 2 , 6 and 12 months later . The secondary outcome variables are fatigue ( Functional Assessment of Chronic Illness Therapy-Fatigue question naire ) , functional capacity ( 6-Minute Walk Test and cardiorespiratory test ) , muscle strength ( h and -held dynamometry and sit-to-st and test ) , radiological response to treatment ( Response Evaluation Criteria In Solid Tumors ) and progression-free and overall survival . Age , sex , diagnosis , chemotherapy regimen , Eastern Cooperative Oncology Group performance status and smoking status will be considered as predictive variables . Data will be analysed on an intention-to-treat basis , comparing changes at each time point between groups , adjusting for baseline values by analysis of covariance . Discussion As well as achieving the objectives set , this study will provide us with information on patient perception of the care received and an opportunity to develop a project based on collaborative action between the primary care and oncology professionals . Trial registration Clinical Trials.gov Identifier : NCT01786122 Registration date : 02/05/2013 AIM To investigate the safety and feasibility of a six-week supervised structured exercise and relaxation training programme on estimated peak oxygen consumption , muscle strength and health related quality of life ( HRHRQOL ) in patients with inoperable lung cancer , undergoing chemotherapy . METHODS A prospect i ve , single-arm intervention study of supervised , hospital based muscle and cardiovascular group training and individual home-based training . Peak oxygen consumption ( VO(2peak ) ) was assessed using an incremental exercise test . Muscle strength was measured with one repetition maximum test ( 1RM ) . HRQOL was assessed using the Functional Assessment of Cancer Therapy-Lung ( FACT-L ) scale . RESULTS Twenty-five patients with non-small cell cancer ( NSCLC ) stage III-IV and four patients with extensive disease small cell lung cancer ( SCLC-ED ) were recruited . Six patients ( 20.7 % ) dropped out leaving 23 patients for analysis .  Exercise adherence in the group training was 73.0 % and 8.7 % in the home-based training . There were improvements in estimated VO(2peak ) and six-minute walk distance ( 6 MWD ) as well as increased muscle strength measurements ( p<0.05 ) . There was significant improvement in the " emotional well-being " parameter ( FACT-L ) while there were no significant changes in HRQOL . CONCLUSION Exercise training produces significant improvements in physiological indices and emotional HRQOL and is safe and feasible in patients with advanced stage lung cancer , undergoing chemotherapy .  No analysis on home-based training was done because of low adherence Introduction . Patients with advanced-stage lung cancer face poor survival and experience co-occurring chronic physical and psychosocial symptoms . Despite several years of research in exercise oncology , few exercise studies have targeted advanced lung cancer patients undergoing chemotherapy . The aim of the present study was to investigate the benefits of a 6-week supervised group exercise intervention and to outline the effect on aerobic capacity , strength , health-related quality of life ( HRQoL ) , anxiety , and depression . Methods . VO2peak was assessed using an incremental exercise test .  Muscle strength  was measured with one repetition maximum test ( 1RM ) . HRQoL , anxiety , and depression were assessed using Functional Assessment of Cancer Therapy – Lung ( FACT-L ) scale and the Hospital Anxiety and Depression Scale ( HADS ) . Results . One hundred and forthteen patients with advanced stage lung cancer were recruited . Forty-three patients dropped out . No serious adverse events were reported . Exercise adherence in the group training was 68 % . Improvements in VO2peak ( P < .001 ) and 6-minute walk distance ( P < .001 ) and muscle strength measurements ( P < .05 ) were seen . There was a reduction in anxiety level ( P = .0007 ) and improvement in the emotional well-being parameter ( FACT-L ) but no statistically significant changes in HRQoL were observed . Conclusion . The results of the present study show that during a 6-week hospital-based supervised , structured , and group-based exercise program , patients with advanced-stage lung cancer ( NSCLC IIIb-IV , ED-SCLC ) improve their physical capacity ( VO2peak , 1RM ) , functional capacity , anxiety level , and emotional well-being , but not their overall HRQoL. A r and omized controlled trial testing the intervention including 216 patients is currently being carried out BACKGROUND Post-thoracotomy non-small cell lung cancer ( NSCLC ) patients report cancer-related fatigue ( CRF ) as a severe symptom that may increase the occurrence and severity of other symptoms while decreasing functional status and quality of life ( QOL ) . The aim of this pilot study was to describe the effects of a home-based rehabilitative exercise intervention on CRF , other symptoms , functional status , and QOL for post-surgical NSCLC patients starting within days after hospital discharge . METHODS Seven post-thoracotomy NSCLC patients completed the  Brief Fatigue Inventory ( BFI ) measuring CRF severity , and the  M.D. And erson Symptom Inventory measuring symptom severity at pre- and post-surgery , and at the end of each week of the six-week intervention . Additionally , the Medical Outcomes Short-Form-36 measuring physical and mental functional status ; and the Quality of Life Index ( QLI ) measuring QOL were completed pre- and post-surgery , after week 3 , and at the end of the intervention ( week 6 ) . RESULTS Participants had a mean age of 65 years , a mean of 6 co-morbid conditions , and initiated the intervention within 4 days after hospital discharge . Participants ' CRF severity scores were reduced to mild levels while the mean number of symptoms decreased from 10.4 post-surgery to 7.0 at week 6 with lower levels of severity and interference . Likewise , participants ' post-intervention functional status and QOL improved to near or above pre-surgical levels . CONCLUSIONS The exercise intervention for post-surgical NSCLC patients showed promising preliminary efficacy in improving CRF , other symptom severity , functional status , and QOL . Further testing via a two-arm r and omized controlled trial is being conducted There have been few longitudinal studies of quality of life in patients with all stages of lung cancer , particularly those that have included measures of utility . The purpose of this study was to examine the psychometric properties of the Assessment of Quality of Life instrument ( AQoL )  in patients with lung cancer . The AQoL is a health-related quality of life question naire and provides a descriptive system for a multi-attribute utility instrument ( MAU ) , so that scores can be used in cost-utility evaluations . In the present study the reliability ( internal consistency ) of the AQoL was examined and the concurrent validity was assessed using the Medical Outcomes 36-item Short Form Health Survey ( SF-36 ) as the comparator instrument . The sensitivity to different health states of the AQoL and the responsiveness to change over time was also examined . A prospect i ve , non-experimental cohort study was undertaken . Ninety-two participants with all stages of lung cancer were recruited from a tertiary multi-disciplinary lung cancer clinic . Ninety participants had non-small cell lung cancer ( NSCLC ) and two had limited stage small cell lung cancer . The  AQOL and SF-36 surveys  were administered concurrently at baseline . In patients with NSCLC the surveys were then repeated 3 and 6 months later . Correlations between the baseline AQoL summary scales and SF-36 summary scales support the divergent and convergent validity of the AQoL.  Reliability was also found to be sufficient ( Cronbach 's Alpha=0.76 ) . In addition , in patients with inoperable NSCLC , baseline AQoL scores were found to be predictive of survival at 6 months in Cox proportional hazards multivariate analysis . However , the physical components summary score of the SF-36 was more sensitive to differences in health states between patients with different stages of NSCLC at 6 months of follow-up and more responsive to change over time in both operable and inoperable patients with NSCLC than the AQoL. The findings support the construct validity and reliability of the  AQoL  in this population . However , there remains some uncertainty about whether the AQoL has sufficient sensitivity to different health states in this population . Further studies using other MAU instruments may determine whether alternative instruments are more sensitive to different health states in individuals with lung cancer Background Patients with advanced stage non-small cell lung cancer ( NSCLC ) or small cell lung cancer ( SCLC ) often experience multidimensional impairments , affecting quality of life during their course of disease . In lung cancer patients with operable disease , several studies have shown that exercise has a positive impact on quality of life and physical functioning . There is limited evidence regarding efficacy for advanced lung cancer patients undergoing palliative treatment . Therefore , the POSITIVE study aims to evaluate the benefit of a 24-week exercise intervention during palliative treatment in a r and omized controlled setting . Methods / design The POSITIVE study is a r and omized , controlled trial investigating the effects of a 24-week exercise intervention during palliative treatment on quality of life , physical performance and immune function in advanced , non-operable lung cancer patients . 250 patients will be recruited in the Clinic for Thoracic Diseases in Heidelberg , enrolment begun in November 2013 . Main inclusion criterion is histologically confirmed NSCLC ( stage IIIa , IIIb , IV ) or SCLC ( Limited Disease-SCLC , Extensive Disease-SCLC ) not amenable to surgery . Patients are r and omized into two groups . Both groups receive weekly care management phone calls ( CMPCs ) with the goal to assess symptoms and side effects . Additionally , one group receives a combined resistance and endurance training ( 3x/week ) . Primary endpoints are quality of life assessed by the Functional Assessment of Cancer Therapy for patients with lung cancer ( FACT-L , subcategory Physical Well-Being ) and General Fatigue measured by the Multidimensional Fatigue Inventory ( MFI-20 ) . Secondary endpoints are physical performance ( maximal voluntary isometric contraction , 6-min walk distance ) , psychosocial ( depression and anxiety ) and immunological parameters and overall survival . Discussion The aim of the POSITIVE trial is the evaluation of effects of a 24-week structured and guided exercise intervention during palliative treatment stages . Analysis of various outcomes ( such as quality of life , physical performance , self-efficacy , psychosocial and immunological parameters ) will contribute to a better underst and ing of the potential of exercise in advanced lung cancer patients . In contrast to other studies with advanced oncological patients the POSITIVE trial provides weekly phone calls to support patients both in the intervention and control group and to segregate the impact of physical activity on quality of life . Trial registration Clinical Trials.gov NCT02055508 ( Date : December 12 , 2013 Objective The objective of this pilot study was to describe the effects of a 16-week home-based rehabilitative exercise program on cancer-related fatigue ( CRF ) , other symptoms , functional status , and quality of life ( QOL ) for patients with non-small cell lung cancer ( NSCLC ) after thoracotomy starting within days after hospital discharge and continuing through the initiation and completion of chemotherapy .  Material s and methods Five patients with NSCLC completed the Brief Fatigue Inventory ( measuring CRF severity ) and the MD And erson Symptom Inventory ( measuring symptom severity ) before and after thoractomy , and at the end of each week of the 16-week exercise program . Additionally , the Medical Outcomes Study Short Form-36 ( measuring physical and mental functional status ) and the Quality of Life Index ( measuring QOL ) were completed before and after thoracotomy , after weeks 3 , 6 , 12 , and 16 ( the end of the exercise program ) . Further , the 6-minute walk test  ( measuring functional capacity ) was administered before thoracotomy , prior to the initiation of chemotherapy and /or radiation therapy , and at the end of the 16-week exercise program , after completion of chemotherapy . Results Participants had a mean age of 63 years and a mean of five comorbid conditions ; the exercise program was initiated within 4 days after hospital discharge . Participants ’ CRF severity scores were reduced to mild levels , while the mean number of symptoms decreased from 9 postthoracotomy to 6 after the exercise program , with mean levels of severity and interference decreasing to below prethoracotomy levels . Likewise , participants ’ functional status and QOL after completing the exercise program improved to near or above prethoracotomy levels . Conclusion The home-based , light-intensity exercise program for NSCLC patients receiving and completing adjuvant chemotherapy postthoracotomy showed promising trends in improving CRF severity , other symptom severity , functional status , and QOL . Further testing via a two-arm r and omized controlled trial is being conducted PURPOSE This prospect i ve study was design ed in order to compare the most common subjective measurements of physical function in patients with advanced lung cancer with an objective physical functional test ( Simmonds Functional Assessment Tool [ SFA ] ) . PATIENTS AND METHODS One hundred patients agreed to participate and complete the study before or after their outpatient medical oncology appointment . Patients underwent assessment using the  Karnofsky , the Brief fatigue Inventory , The Functional Assessment of Cancer Therapy-Lung patients ( FACT-L ) and the  Edmonton Symptom Assessment Scale ( ESAS ) . These results were compared to the SFA tool . The SFA consists of six tasks : tying a belt , putting coins in a cup , reaching above head , st and ing up/sitting down , reaching forward and walking 50 feet . RESULTS Ninety-nine patients completed the study over 8 months : median Karnofsky performance status was 85 ( 70 to 100 ) , Edmonton Symptom Assessment Scale ( ESAS ) score ( 0 to 10 ) was generally low ( 0.5 to 2.8 ) . SFA scores were significantly different in patients compared to a control group . The correlation between the subscales of the SFA and the Karnofsky , the Brief Fatigue Inventory , The FACT-L and the ESAS was generally low to moderate ( r values : 0.22 to 0.38 ) . There was generally a moderate correlation between the different subjective scales ( r values : 0.3 to 0.62 ) . CONCLUSION Adherence to the SFA tool was excellent . The low to moderate correlation between the abnormalities found in the objective SFA and the subjective fatigue tests suggest that objective evaluation of the functional capacity provides a potentially useful and independent end-point for clinical trials and therapeutic interventions . These assessment tools should be used complementary to each other to better assess the functional status of patients with advanced lung cancer . Large trials of objective functional assessment are justified Purpose This r and omized controlled trial tested the effects of a specially design ed strength and endurance training on the independence and quality of life in lung cancer patients in stages IIIA/IIIB/IV during palliative chemotherapy . Methods Between August 2010 and December 2011 , 46 patients were r and omized into two groups receiving either conventional physiotherapy or special physiotherapeutic training . The Barthel Index served as primary endpoint . The secondary endpoints were the European Organization for Research and Treatment of Cancer Quality of Life Question naire Core-30 ( EORTC QLQ C-30/LC-13 ) question naire , the 6-Minute Walk Test ( 6MWT ) , stair walking , the Modified Borg Scale , and muscle strength . Nonparametrical data were analyzed with the Wilcoxon and Mann – Whitney U test . For parametric , data student t tests were used . A p value of ≤.05 was accepted . Results Twenty-nine patients completed the trial ( Intervention group ( IG ) , n = 18 ; control group ( CG ) , n = 11 ) . Significant differences were detectable in the Barthel Index ( IGmean = 92.08 ; CGmean = 81.67 ; p = .041 ) , in single scores of the EORTC QLQ C-30/LC-13 question naire ( physical functioning , p = .025 ; hemoptysis , p = .019 ; pain in arms or shoulder , p = .048 ; peripheral neuropathy , p = .050 ; cognitive functioning , p = .050 ) , in the 6MWT , stair walking , strength capacity , and in the patient ’s dyspnoea perception during submaximal walking activities ( IG > CG ) . Conclusion According to these findings , lung cancer patients should receive enhanced physical activity intervention during palliative chemotherapy Background Many patients with lung cancer are deconditioned with poor physical fitness . Lung resection reduces physical fitness further , impairing the patient 's ability to function in daily life . Methods We conducted a single-blind r and omised controlled trial of high-intensity endurance and strength training ( 60 min , three times a week , 20 weeks ) , starting 5–7 weeks after surgery . The control group received st and ard postoperative care . The primary outcome was the change in peak oxygen uptake measured directly during walking until exhaustion . Other outcomes included changes in pulmonary function , muscular strength by one-repetition maximum ( 1RM ) , total muscle mass measured by dual energy X-ray absorptiometry , daily physical functioning and quality of life ( QoL ) . Results The intention-to-treat analysis of the 61 r and omised patients showed that the exercise group had a greater increase in peak oxygen uptake ( 3.4 mL/kg/min between-group difference , p=0.002 ) , carbon monoxide transfer factor ( Tlco ) ( 5.2 % predicted , p=0.007 ) , 1RM leg press ( 29.5 kg , p<0.001 ) , chair st and ( 2.1 times p<0.001 ) , stair run ( 4.3 steps , p=0.002 ) and total muscle mass ( 1.36 kg , p=0.012 ) compared with the controls . The mean±SD QoL ( SF-36 ) physical component summary score was 51.8±5.5 and 43.3±11.3 ( p=0.006 ) , and the mental component summary score was 55.5±5.3 and 46.6±14.0 ( p=0.015 ) in the exercise and control groups , respectively . Conclusions In patients recently operated for lung cancer , high-intensity endurance and strength training was well tolerated and induced clinical ly significant improvements in peak oxygen uptake , Tlco , muscular strength , total muscle mass , functional fitness and QoL. This study may provide a basis for exercise therapy after lung cancer surgery . Trial registration number NCT01748981 Background Previous studies showed that exercise in cancer patients is feasible and may reduce fatigue and improve physical fitness and quality of life . However , many previous studies had method ological weaknesses related to trial design , sample size , comparison group , outcome measures , short follow-up duration s and programme content . Purpose This paper aims to present the rationale and design of the clinical research subprogramme of the Alpe d’HuZes Cancer Rehabilitation ( A-CaRe ) programme . Method A-CaRe Clinical Research includes four r and omized controlled trials in patients : ( a ) after chemotherapy , ( b ) during chemotherapy , ( c ) after stem cell transplantation and ( d ) during childhood cancer . These trials compare high-intensity resistance and endurance exercise interventions with usual care or a waiting list control group . In two studies , a second intervention arm consisting of low-to-moderate intensity exercise is included . All four A-CaRe trials use similar methods . Results Outcome measures are carefully chosen based on the International Classification of Functioning Disability and Health model . Measurements will be performed prior to r and omization ( T0 ) , after completion of the intervention ( T1 ) and at follow-up ( T2 ) . The primary outcome measures are cardiorespiratory fitness , muscle strength and fatigue . Secondary outcome measures include health-related quality of life and psychosocial functioning . Furthermore , cost-effectiveness and cost-utility analyses are performed from a societal perspective . Conclusion We hypothesize that exercise is more effective at improving physical fitness and thereby reducing fatigue and more cost-effective compared with usual care or a waiting list control group . If so , the programmes will be implemented in the Dutch clinical practice OBJECTIVE A multidimensional rehabilitation program for cancer survivors was developed to overcome cancer-related problems and to improve quality of life . The two purpose s of the study were to describe the effectiveness of the program and to obtain information about patient preferences for multi or mono dimensional rehabilitation programs . METHODS SUBJECTS cancer survivors with different diagnoses , and cancer-related physical and psychosocial problems . INTERVENTION a 15-week rehabilitation program including individual exercise , sports , psycho-education , and information . Group-wise r and omization was implemented by assigning one half of the patients to the complete program while the other half were allowed to choose which program components they considered relevant . MEASURES Health-Related Quality of Life [ R AND -36 and Rotterdam Symptom Check List ( RSCL ) ] , exercise capacity ( symptom limited bicycle ergometry ) , muscle force ( h and -held dynamometry ) , and patient preferences . Measurements were performed before ( T0 ) and after the rehabilitation program ( T1 ) , and at a 3-month follow-up ( T2 ) . RESULTS After the rehabilitation program , cancer survivors ( n=63 ) displayed statistically significant improvements on health-related quality of life with effect sizes ( ES ) varying from 0.38 to 0.99 ( R AND -36 ) and from -0.34 to -0.57 ( RSCL ) , most persistent at 3-month follow-up . Furthermore , statistically significant improvements in exercise capacity and muscle force of upper and lower extremities were displayed after rehabilitation . If offered a choice , 80 % of the patients prior to start and 58 % of the patients after completion of the program indicated that they preferred the entire multidimensional program . CONCLUSION A multidimensional rehabilitation program has statistically and clinical ly relevant beneficial effects on health-related quality of life , exercise capacity , and muscle force in cancer patients with different diagnoses . Furthermore , if offered the choice , the majority of cancer survivors seem to prefer multidimensional programs to programs with only one component Background People with lung cancer have substantial symptom burden and more unmet needs than the general cancer population . Physical activity ( PA ) has been shown to positively influence quality of life ( QOL ) , fatigue and daily functioning in the curative treatment of people with breast and colorectal cancers and lung diseases , as well as in palliative setting s. A r and omised controlled trial ( RCT ) is needed to determine if lung cancer patients benefit from structured PA intervention . The Physical Activity in Lung Cancer ( PAL ) trial is design ed to evaluate the impact of a 2-month PA intervention on fatigue and QOL in patients with non-resectable lung cancer . Biological mechanisms will also be studied . Methods / design A multi-centre RCT with patients r and omised to usual care or a 2-month PA programme  , involving supervised PA sessions including a behavioural change component and home-based PA . QOL question naires , disease and functional status and body composition will be assessed at baseline , 2 , 4 and 6 months follow-up . The primary endpoint is comparative levels of fatigue between the 2 arms . Secondary endpoints include : QOL , functional abilities and physical function . Exploratory endpoints include : anxiety , depression , distress , dyspnoea , PA behaviour , fitness , hospitalisations , survival , cytokines and insulin-like growth factor levels . Discussion This study will provide high-level evidence of the effect of PA programmes on cancer-related fatigue and QOL in patients with advanced lung cancer . If positive , the study has the potential to change care for people with cancer using a simple , inexpensive intervention to improve their QOL and help them maintain independent function for as long as possible . Trial registration Australian New Zeal and Clinical Trials Registry No. Background : Cancer treatments can lead to detriments in patients ’ health and declines in quality of life ( QOL ) . Cancer rehabilitation programs may improve functional status , symptom control , and QOL . Objective : The objective of this study was to determine if an outpatient , physical therapy – supervised Cancer Rehabilitation Strengthening and Conditioning ( CRSC ) program improved patients ’ conditioning level , functional status , QOL , and symptoms . Methods : This was a prospect i ve study of oncology patients participating in CRSC program .  Measurements included conditioning level ( 6-minute walk test [ SMWT ] , metabolic equivalent level , grip strength ) , functional status ( Physical Component Summary of Short Form 36 ) , QOL ( Mental Component Summary of Short Form 36 ) , and symptoms ( M. D. And erson Symptom Inventory ) . Paired t tests were conducted to determine significant changes between pre- and post-CRSC program measures , and regression methods identified predictors of change from baseline . Results : One hundred fifteen patients with cancer were enrolled in the study ; 75 patients completed pre- and post-CRSC program measures . Significant improvements were noted in SMWT by 186.4 ft , SMWT speed by 0.35 mph , treadmill time ( 3.5 minutes longer ) , metabolic equivalent level ( by 0.87 units ) , QOL , symptom severity , symptom interference with daily life , fatigue , shortness of breath , and sadness . Conclusions : In a pretest-posttest design , significant improvements were noted in conditioning level , functional status , QOL , and symptoms . Greater improvements were noted in participants who were most deconditioned at baseline . Implication s for Practice : Further research should be conducted to provide additional support for CRSC programs . Cancer rehabilitation strengthening and condition programs may benefit patients across the continuum of care , including deconditioned patients
Criterion validity for three of these measures was established in NSCLC but not the reliability or responsiveness .
Background The measurement properties of instruments used to assess functional capacity , physical activity and muscle strength in participants with non-small cell lung cancer ( NSCLC ) have not been systematic ally review ed .
Method Objectives : To identify outcome measures used to assess these outcomes in participants with NSCLC ; and to evaluate , synthesis e and compare the measurement properties of the outcome measures identified .