Telemedicine-based inspiratory muscle training and walking promotion with lung cancer survivors following curative intent therapy: a parallel-group pilot randomized trial.

Autor: Ha DM; Institute for Health Research, Kaiser Permanente Colorado2550 S Parker Rd Suite 200, Aurora, CO, 80014, USA. Duc.Ha@cuanschutz.edu.; Section of Pulmonary and Critical Care, Medical & Research Service, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA. Duc.Ha@cuanschutz.edu.; Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA. Duc.Ha@cuanschutz.edu., Comer A; Institute for Health Research, Kaiser Permanente Colorado2550 S Parker Rd Suite 200, Aurora, CO, 80014, USA., Dollar B; Institute for Health Research, Kaiser Permanente Colorado2550 S Parker Rd Suite 200, Aurora, CO, 80014, USA., Bedoy R; Institute for Health Research, Kaiser Permanente Colorado2550 S Parker Rd Suite 200, Aurora, CO, 80014, USA., Ford M; Institute for Health Research, Kaiser Permanente Colorado2550 S Parker Rd Suite 200, Aurora, CO, 80014, USA., Gozansky WS; Institute for Health Research, Kaiser Permanente Colorado2550 S Parker Rd Suite 200, Aurora, CO, 80014, USA., Zeng C; Institute for Health Research, Kaiser Permanente Colorado2550 S Parker Rd Suite 200, Aurora, CO, 80014, USA., Arch JJ; Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA.; Cancer Prevention and Control, University of Colorado Cancer Center, Aurora, CO, USA., Leach HJ; Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, USA., Malhotra A; Division of Pulmonary, Critical Care, Sleep Medicine and Physiology, University of California San Diego, San Diego, CA, USA., Prochazka AV; Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA., Keith RL; Section of Pulmonary and Critical Care, Medical & Research Service, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA.; Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA., Boxer RS; Division of Geriatrics, Hospice and Palliative Care Medicine, University of California Davis, Sacramento, CA, USA.
Jazyk: angličtina
Zdroj: Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer [Support Care Cancer] 2023 Sep 01; Vol. 31 (9), pp. 546. Date of Electronic Publication: 2023 Sep 01.
DOI: 10.1007/s00520-023-07999-7
Abstrakt: Purpose: Following curative-intent therapy of lung cancer, many survivors experience dyspnea and physical inactivity. We investigated the feasibility, acceptability, safety, and potential efficacy of inspiratory muscle training (IMT) and walking promotion to disrupt a postulated "dyspnea-inactivity" spiral.
Methods: Between January and December 2022, we recruited lung cancer survivors from Kaiser Permanente Colorado who completed curative-intent therapy within 1-6 months into a phase-IIb, parallel-group, pilot randomized trial (1:1 allocation). The 12-week intervention, delivered via telemedicine, consisted of exercise training (IMT + walking), education, and behavior change support. Control participants received educational materials on general exercise. We determined feasibility a priori: enrollment of ≥ 20% eligible patients, ≥ 75% retention, study measure completion, and adherence. We assessed acceptability using the Telemedicine-Satisfaction-and-Usefulness-Questionnaire and safety events that included emergency department visits or hospitalizations. Patient-centered outcome measures (PCOMs) included dyspnea (University-of-California-San-Diego-Shortness-of-Breath-Questionnaire), physical activity (activPAL™ steps/day), functional exercise capacity (mobile-based-six-minute-walk-test), and health-related quality of life (HRQL, St.-George's-Respiratory-Questionnaire). We used linear mixed-effects models to assess potential efficacy.
Results: We screened 751 patients, identified 124 eligible, and consented 31 (25%) participants. Among 28 participants randomized (14/group), 22 (11/group) completed the study (79% retention). Intervention participants returned > 90% of self-reported activity logs, completed > 90% of PCOMs, and attended > 90% of tele-visits; 75% of participants performed IMT at the recommended dose. Participants had high satisfaction with tele-visits and found the intervention useful. There was no statistically significant difference in safety events between groups. Compared to control participants from baseline to follow-up, intervention participants had statistically significant and clinically meaningful improved HRQL (SGRQ total, symptom, and impact scores) (standardized effect size: -1.03 to -1.30).
Conclusions: Among lung cancer survivors following curative-intent therapy, telemedicine-based IMT + walking was feasible, acceptable, safe, and had potential to disrupt the "dyspnea-inactivity" spiral. Future efficacy/effectiveness trials are warranted and should incorporate IMT and walking promotion to improve HRQL.
Trial Registration: ClinicalTrials.gov NCT05059132.
(© 2023. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)
Databáze: MEDLINE
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