Download - Pulmonary Rehabilitation in Lung Cancer
Pulmonary Pulmonary Rehabilitation in Lung Rehabilitation in Lung
CancerCancer Pınar Ergün MD.Pınar Ergün MD.
Atatürk Chest Disease and Chest Surgery Center
Pulmonary Rehabilitation and Home Care Unit
Outline;Outline; Definition and the rational of pulmonary
rehabilitation Pre-post operative Pulmonary
Rehabilitation in Lung Cancer Cancer related fatigue and pulmonary
rehabilitation Pulmonary rehabilitation and
chemotheraphy Conclusion
Pulmonary Rehabilitation;Pulmonary Rehabilitation; Restoration of the individual to the fullest physical, social, physicological and occupational potential of which the person is capable with the limitations of the disease and therapies.
Turk Phys Med Rehab 2007;53:74-7
Pulmonary rehabilitation is a multidisciplinary and individualised Pulmonary rehabilitation is a multidisciplinary and individualised theraphytheraphy
OUTCOMES
Functional performanceHRQOLDyspneaCost-effectivity
PATIENT
Multi Disciplinary TEAM
Family
STAGES
Patient selectionAssessment
Rehabilitation Maintenance
Follow-up
COMPONENTSExercise training
EducationNutritional assessment / theraphy
Psychological assessment /theraphy
Pulmonary Rehabilitation for Pulmonary Rehabilitation for which diseases?which diseases?
Obstructive pulmonary diseases
COPDPersistan AsthmaBronchiectasisCystic Fibrosis
Resrictive pulmonary diseases
Intertstitial lung diseaseThoracic wall pathologiesNeuromuscular diseasesBOOP
OtherLung CancerLung CancerProstate CaBreast CaHematological malignanciesPPHPre-post OperativePre-Post Lung
TransplantationVentilatory dependent
patientObesity related pulmonary
disease
Chest 2007; 131:4-42
JCPR&P 2007; 27: 61-4
Pulmonary Rehabilitation; evidence based out-Pulmonary Rehabilitation; evidence based out-comescomes Increases in functional
capacity Decreases in dyspnea Increases in HRQOL ( Grade A)
Reduces the number of
hospital days ( Grade B)
Chest 2007; 131:4-42
Pulmonary rehabilitation should be taken into consideration as a treatment strategy in the management of Lung cancer patients regardless of the diagnosis and the disease stages.
Rationals of Rationals of pulmonary rehabilitationpulmonary rehabilitation
??
Rationals Rationals (I);(I);
Malignancy Treatment strategies, Decreased level of activity during treatment
Exercise capacity is the best independent predictor of postoperative complications.
Exercise capacity is a modifiable risk factor !!!
Physical performance Physical performance ↓↓
Cancer 2001; 92(Suppl 4): 988-997
AACVPR 2004;86-8
Rationals Rationals (II);(II); Pulmonary rehabilitation is an effective treatment
strategy in; Symptom control
DyspneaPain
Nutritional abnormality Self management Psychologic distress
TREATMENT GOAL
Increases in HRQOLIncreases in HRQOL
•Median survival in lung cancer; 1 year after diagnosis
• 5 year survival: 15 %
•HRQOL is an independent predictor of survival in Chemotherapy !!!
Chest 2007; 132(3):1–19Chest 2007; 132:234-42J Clin Oncol 2005; 23: 6865-72
Rationals Rationals (III);(III);
Rationals Rationals (IV);(IV);Cancer related fatigue syndrome;Cancer related fatigue syndrome; Impairment of physical performance Sleep disturbance Depression Cognitive dysfunction Social isolation
Multidisciplinary Multidisciplinary approachapproach
NCCN Practice Guidelines in Oncology- 2008
Chest 2006; 129: 1305-12
Rationals (V);Rationals (V); COPD and LUNG CANCER
•Males %73•Females %53
Pre-Post OperativePre-Post Operative Pulmonary rehabilitation in Pulmonary rehabilitation in Lung cancerLung cancer
Preoperative Pulmoner Preoperative Pulmoner RehabilitationRehabilitation
Potential benefitsPotential benefits Risk modification Improvements in the lung resection
outcomes and recovery
•Risk modification 20 %•Changing from high to low risk category 13.5 %
Chest 2005;128:3799-809
European Journal of Cardio-thorac Surgery, 2008
Pulmonary Rehabilitation;Inpatient Duration (1.5h,day/ 4 w)Patient education;Smoking cessationCoughingBreathing techniquesPeripheral muscle training (Endurance)
Lung Cancer 2007;57:118-19
•Sypmtom limited endurance and NMESSypmtom limited endurance and NMES
•Lobectomy + mediastinal systematic lymph node dissectionLobectomy + mediastinal systematic lymph node dissection
•0 mortality, %25 morbidity0 mortality, %25 morbidity
Jpn J Thorac Cardipvasc Surg 2005• Pulmonary rehabilitation program for high risk thoracic
surgical patients. Chest Surg Clin N Am 1997; 7:
697-706
• Factors associated with perioperative complications after pneumonectomy for primary carcinoma of the lung patients
Interactive Cardiovascular and Thoracic Surgery, 2006
Pulmonary Rehabilitation Decreases the Complication Rates
Jpn J Thorac Cardipvasc Surg 2005
Cost effective !
Cancer,2007
► Cardiopulmonary function lost due to resection was avoided
►Chance for implementing Adjuant Chemotheraphy increases!
► Improvement in the recovery period
Preoperative Pulmonary Rehabilitation The risk of delay in curative resection
??
Lung Cancer, 2001
Admition…. Duration to treatment ► mean: 48 day
Is not the predictor of survival !!!
Postoperative Pulmonary Postoperative Pulmonary RehabilitationRehabilitationPotential benefits Potential benefits Symptom control Improvements in
functional capacity Improvements in
HRQOL
Lung Cancer ,2007
IMPROVEMENTS in respiratory functions and exercise capacity
Treatment strategies;
Surgery, Surgery+ RT,
Surgery + RT+CT
•∆ 6MWT distance = 145m
•∆ Peak work rate = 26 W
Lung Cancer,2006
(P=0.0020)
(P=0.0078)
Pre-postoperatif Pulmonary RehabilitationSpecial considerations for pre- post operative
patientsSmoking cessation !Assessments of patients; ►Functional limitations ►Exercise capacity
Airway clearance and pulmonary expansion techniques
► Assisted coughing► Insentive spirometry► NIMV
Energy conservation strategies
Transfer-mobilityPrevention of venous thromboembolismPain controlStress and anxiety managementNutritional evaluation / support
Cancer-Related Fatigue Cancer-Related Fatigue Chemotheraphy Chemotheraphy
Pulmonary rehabilitationPulmonary rehabilitation
PR for Cancer-Related Fatigue PR for Cancer-Related Fatigue PR During Chemotheraphy PR During Chemotheraphy
Potential benefits; Symptom control Improvement of performance status Improvements in HRQOL Promotion of a self management for
symptom control and increase in hope
Cancer- related fatigue is a distressing persistent, subjective sense of physical, emotional and/or cognitive tiredness or exhaustion to cancer or cancer treatment that is not proportional to recent activity and interferes with unusual functioning
Fatigue should be recognised, evaluated and treated promptly for all age groups, at all stages of disease, prior to, during and following
Implementation of guidelines for fatigue management is best accomplish by interdisciplinary teams who are able to tailor interventions to the needs of the patient
NCCN Practice Guidlines in Oncology- 2008
Rehabilitation should begin with the cancer diagnosis
Fatigue in ambulatory patients with advanced lung cancer: prevalance, correlated factors and screening
Lung Cancer and FATIGUE
Conlusion:In advanced lung cancer patients, cancer related fatigue limited at least one HRQOL
Impact of dyspnea, pain and fatigue on daily life activities in ambulatory patients with advanced lung cancer.
J Pain Symptom Manage 2002;23 417-23
Conclusion:The most stressing symptom is fatigue
J Pain Symptom Manage 2001; 22: 554-64
Interventions in Cancer Related Fatigue;
Non-pharmacologic
Activity enhancement ►Maintain optimal level of activity /Exercise prescription/ Exercise training►Energy conservation techniques
Education Psychosocial interventions ►Assessment/support (Stress management /Relaxation ) Nutritional assessment /support Cautions:
Bone metastasis Immunosuppression / neutropenia Thrombocytopenia Anemia Fever Limitations due to metastasis or co-morbidities
NCCN Practice Guidlines in Oncology- 2008
NCCN Practice Guidelines in Oncology-2008 Exercise is an effective treatment
strategy in cancer related fatigue
Level of fatigue %40-50 ↓ Impairments in emotional status ↓ HRQOL
Category 1
Conlusions: Aerobic exercise can reduce fatigue and improve physical distress in cancer patients undergoing chemotheraphy
Blood, 1997
P< 0.05
Conclusion: Conclusion: Pulmonary Rehabilitation must be Pulmonary Rehabilitation must be taken into consideration of lung cancer management taken into consideration of lung cancer management for;for; Management of risk modification Improvement of lung resection outcomes and
recovery Symptom control Improvement of Cancer related Fatigue Improvement in HRQOL Promoting of self management
THANKSTHANKS