Lung Cancer, Perioperative/Postoperative Complications, Pulmonary Complications, Tobacco Use Disorder
Conditions
Keywords
pulmonary complications, perioperative/postoperative complications, tobacco use disorder, non-small cell lung cancer, small cell lung cancer
Brief summary
RATIONALE: Exercise may help improve lung function and lessen complications of surgery in patients with chronic obstructive pulmonary disease who are undergoing surgery for lung cancer. It is not yet known whether lung rehabilitation is more effective than standard therapy in improving lung function in patients with chronic obstructive pulmonary disease who are undergoing surgery for lung cancer. PURPOSE: This randomized clinical trial is studying lung rehabilitation to see how well it works compared to standard therapy in treating patients with chronic obstructive pulmonary disease who are undergoing surgery for lung cancer.
Detailed description
OBJECTIVES: Primary * Compare the impact of preoperative pulmonary rehabilitation (including upper and lower extremity resistance training) vs usual care in patients with lung cancer and moderate to severe chronic obstructive pulmonary disease who require lung resection for lung cancer. * Compare the impact of this study intervention vs usual care on functional status after surgery. OUTLINE: This is a randomized, multicenter study. Patients are randomized to 1 of 2 intervention arms. * Arm I: Patients undergo pulmonary rehabilitation (including daily upper and lower extremity resistance training, education, and smoking cessation counseling) twice a day for 5 days prior to surgical resection. Beginning 2-3days after surgery, patients undergo pulmonary rehabilitation once a day until discharge from the hospital. * Arm II: Patients receive usual care (education and smoking cessation counseling alone) twice a day for 5 days prior to surgical resection. Following surgery, patients will receive usual care once a day until discharge from the hospital. Days of hospitalization, ICU admissions, postoperative complications (i.e., pneumonia, mechanical ventilation \> 48 hours, or atelectasis requiring bronchoscopy) and spirometry and imaging studies will be evaluated after surgery. After completion of study intervention, patients are followed at 4-6 weeks, at 12 weeks, and at 6 months. PROJECTED ACCRUAL: A total of 90 patients will be accrued for this study.
Interventions
BEHAVIORALexercise intervention
life style
BEHAVIORALsmoking cessation intervention
Life style
OTHERcounseling intervention
life style
OTHEReducational intervention
life style
PROCEDUREconventional surgery
life style
life style
Sponsors
National Cancer Institute (NCI)
Mayo Clinic
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
40 Years to 120 Years
Healthy volunteers
No
Inclusion criteria
DISEASE CHARACTERISTICS: * Diagnosis of lung cancer * Scheduled to undergo any thoracotomy for lung cancer resection (including wedge) or VATS lobectomy or pneumonectomy for lung resection * Diagnosis of COPD, meeting the following criteria: * FEV\_1/FVC \< 0.71 * Smoking history ≥ 10 pack/years * Presence of moderate to severe lung disease, meeting 1 of the following: * FEV\_1 ≤ 60% predicted\* * FEV\_1\< 80% predicted AND significant shortness of breath defined by a score of 2 or higher in the Medical Research Council Dyspnea Score NOTE: \*Patients with an FEV1 \< 60% predicted (most severe) and scheduled to undergo VATS segmentectomy or wedge resection will also be included. PATIENT CHARACTERISTICS: * Able to physically utilize exercise equipment as part of rehabilitation program * No poor motivation or likely not to participate fully in PR program * No recent history (within the past 3 months) of a clinically-significant myocardial infarction, unstable angina, serious cardiac arrhythmia, or other serious medical condition which the attending physician performing the preoperative evaluation deems incompatible with participation in the study PRIOR CONCURRENT THERAPY: * Not specified
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Length of stay in hospital and functional status measured at 12 weeks post-operatively | 12 weeks |
Secondary
| Measure | Time frame |
|---|---|
| Oxygen requirement | 12 months |
| Post-operative pulmonary function | 12 months |
| Hospital re-admission | 12 months |
| Number and percentage of patients with postoperative complications (defined as pneumonia, mechanical ventilation of more than 2 days, or atelectasis requiring a bronchoscopy) | 12 months |
| Measured physical activity at 6 months | 12 months |
| Respiratory care interventions | 12 months |
Countries
United States
Outcome results
None listed