Low physical activity levels and functional decline in individuals with lung cancer
Introduction
Physical inactivity is a global pandemic [1]. The World Health Organisation (WHO) recommends that adults aged 65 years and above engage in 150 min of moderate intensity physical activity (PA) per week [2]. The same guidelines apply for individuals with cancer [3]. Increased PA in breast and colon cancer is associated with a trend towards survival benefit [4]. Exercise interventions are associated with benefits on cardiorespiratory fitness, health related quality of life (HRQoL), mood, symptoms and treatment side-effects in individuals with a range of cancer types [3], [5], [6]. Whilst there is a strong body of research regarding levels of PA of individuals with cancer, limited research has been undertaken in NSCLC, specifically using objective measures. Lung cancer is associated with significant disease burden, high symptom levels and impairment in HRQoL [7], [8]; for these reasons we hypothesise that PA levels will be low in this patient group.
The primary aims of this study were, therefore, to: (1) measure the level of PA of individuals with newly diagnosed NSCLC in an Australian setting and compare this to (a) recommended WHO PA guidelines and (b) levels of PA in similar-aged healthy individuals; and (2) measure change in PA level of individuals with NSCLC (a) from time of diagnosis to 10 weeks (during treatment) and (b) from time of diagnosis to six months. Secondary aims were to: (1) compare functional and patient-reported outcomes of individuals with NSCLC at time of diagnosis with that of a group of similar-aged healthy individuals; and (2) measure the change in functional and patient-reported outcomes of individuals with NSCLC (a) from diagnosis to 10 weeks and (b) from diagnosis to six months. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines were followed in reporting this study [9].
Section snippets
Participants and study design
A multicentre prospective cohort study was conducted at three tertiary hospitals in Melbourne, Australia from November 2010 to October 2012. All sites had ethical approval (AH H2010/03933; PMCC 10/123; MH 2010.236) and written consent was obtained from all patients. Two groups of participants were recruited. Group one were English speaking individuals with newly diagnosed stage I–IIIB NSCLC pre-treatment (surgery, chemotherapy and/or radiotherapy) and group two were similar-aged healthy
Results
Between November 2010 and April 2012, 1018 patients were screened, of whom 20% (n = 206) were eligible and 9% (n = 90) were approached (Fig. 1). The consent rate was 67% (n = 60). Main reasons for non-consent were ‘too distressed/anxious with diagnosis’ 27% (n = 8) or ‘too busy’ 20% (n = 6). There were no significant differences between consenters and non-consenters for age, gender, cancer stage or physician rated ECOG-PS. Fifty patients with NSCLC and 35 healthy individuals were studied (Fig. 1).
At
Discussion
This is the first study which has followed the level of PA of individuals with NSCLC longitudinally in their pre/during/post-treatment phases. Our results show that individuals with early-stage NSCLC, many of whom were planned for treatment with curative intent, have low levels of PA before they start treatment. Subsequently the level of PA based on self-report declines over ten weeks from diagnosis and then, despite a slight improvement, by six months PA is still lower than baseline levels.
Conclusion
In conclusion we found that individuals with NSCLC engage in less physical activity, are weaker and more depressed than healthy individuals at time of diagnosis. Following diagnosis, individuals with lung cancer experience a decline in physical activity, functional capacity and strength.
Conflict of interest statement
None declared.
Funding sources
This study was supported by grant funding from the Victorian Cancer Agency and Eirene Lucas Foundation. Dr Catherine Granger was supported by an Australian Post-graduate Award PhD scholarship.
Acknowledgements
The authors would like to thank Selina Parry, Danny Brazzale and Nadia Gagliardi from the Austin Hospital; Maeve O’Reilly from the Royal Melbourne Hospital; Clare Fitzmaurice from The University of Melbourne for their assistance with participant recruitment and data collection. The authors would also like to thank the participants for their contribution to the study.
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2023, Journal of Geriatric OncologyCitation Excerpt :Non-small cell lung cancer (NSCLC) is the leading cause of cancer-related death in the US with 68% of cases diagnosed in adults age ≥ 65 [1]. Older adults who receive systemic therapy are at risk for impaired physical function from both the cancer and the treatment [2–7], and functional decline is associated with worse quality of life and survival [2,8,9]. In a study of older adults, >70% of those with cancer reported that they would not select a treatment that caused severe functional impairment, even if it improved survival [10].