Home-Based Exercise and Self-Management After Lung Cancer Resection: A Randomized Clinical Trial.

Autor:	Granger CL; Department of Physiotherapy, The University of Melbourne, Parkville, Victoria, Australia.; Department of Physiotherapy, The Royal Melbourne Hospital, Parkville, Victoria, Australia., Edbrooke L; Department of Physiotherapy, The University of Melbourne, Parkville, Victoria, Australia.; Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia., Antippa P; Department of Cardiothoracic Surgery, The Royal Melbourne Hospital, Parkville, Victoria, Australia., Wright G; Department of Cardiothoracic Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.; Research and Education Lead Program, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia., McDonald CF; Institute for Breathing and Sleep, Heidelberg, Victoria, Australia.; Department of Respiratory and Sleep Medicine, Austin Hospital, Heidelberg, Victoria, Australia., Zannino D; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia.; MISCH (Methods and Implementation Support for Clinical Health) Research Hub, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia., Abo S; Department of Physiotherapy, The University of Melbourne, Parkville, Victoria, Australia., Krishnasamy M; Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.; Research and Education Lead Program, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.; Department of Nursing, The University of Melbourne, Parkville, Victoria, Australia., Irving L; Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia., Lamb KE; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia.; MISCH (Methods and Implementation Support for Clinical Health) Research Hub, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia., Whish-Wilson G; Department of Physiotherapy, The University of Melbourne, Parkville, Victoria, Australia., Denehy L; Department of Physiotherapy, The University of Melbourne, Parkville, Victoria, Australia.; Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia., Parry SM; Department of Physiotherapy, The University of Melbourne, Parkville, Victoria, Australia.
Jazyk:	angličtina
Zdroj:	JAMA network open [JAMA Netw Open] 2024 Dec 02; Vol. 7 (12), pp. e2447325. Date of Electronic Publication: 2024 Dec 02.
DOI:	10.1001/jamanetworkopen.2024.47325
Abstrakt:	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.
Databáze:	MEDLINE
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