1 / 47

PULMONARY REHABILITATION IN LUNG CANCER

PULMONARY REHABILITATION IN LUNG CANCER. Dr. Tuğba GÖKTALAY Celal Bayar University Department of Pulmonology Manisa. Conflict of interest. Support for participation in the congress and the course ( last 3 years ) Deva GSK Bayer. Presentation Plan.

mare
Download Presentation

PULMONARY REHABILITATION IN LUNG CANCER

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. PULMONARY REHABILITATION IN LUNG CANCER Dr. Tuğba GÖKTALAY Celal Bayar University Department of Pulmonology Manisa

  2. Conflict of interest • Support for participation in the congress and the course (last 3 years) • Deva • GSK • Bayer

  3. Presentation Plan • Rationale of pulmonary rehabilitation in lung cancer • Goals of pulmonary rehabilitation in lung cancer • Pre-post operativepulmonaryrehabilitation in lungcancer • Pulmonaryrehabilitationapproaches • Cancer-related fatigueandpulmonary rehabilitation • Conclusion

  4. Pulmonary rehabilitation; • Exercisecapacity, • Functionalstatus, • Improve health-related quality of life (HRQOL) • In patients with chronic lung problems • Chronicdyspneaandfatigue   a multidisciplinaryintervention.

  5. CancerRehabilitation; • Restoration of the individual to the fullest physical, social, physicologicalandoccupational potential of which the person is capablewiththelimitations of thediseaseandtherapies.

  6. RationaleCancerRehabilitation; • Cancer-relatedfatigue • Mobility • Self-caredisability • Pain • Dyspnea • Malnutrition • Psycho-socialproblems

  7. Goals of CancerRehabilitation; • Improve health-related quality of life • Increasethefunctionalcapacity • Enhance the efficacy of treatment • Increasetheoxygenconsumption • Reducechemotherapy-relatedfatigue

  8. To achieve targets; • Multidisciplinary health care team, • Exercise training, • Patient and family education, • Psycho-social and behavioral interventions

  9. 5-year survival 15.6% in lungcancer • A small amount of patients eligible for surgery curative (25%) • Cardiopulmonarycomorbidities

  10. The coexistence of COPD-Lungcancer • Males 73%, females 53% • Loganathan R, Stover DE, Shi W, Venkatraman E. Chest 2006; 129:1305– 1312.

  11. Postoperative effects of COPD patients undergoing lobectomy due to lungcancer • n=100 • LobectomyforLungcancer • Patientwith COPD • Similarpostoperative DLCO and VO2max • Greaterdecline in FEV1 • (p=0.0002) • Increasedcardiopulmonarymorbidity(p=0.04) • Lowerpostoperative FEV1 (p=0.0001) • Pompili C, Brunelli A, Refai M et al. Eur. J Cardio-thoracicSurg 2010; 525-530

  12. Preoperative pulmonary rehabilitation, leads to a significant increaseexercise capacity, dyspnea and health-related quality of life in this patients. • Shannon VR. Current Opinion in Pulmonary Medicine 2010;16:334–339

  13. PR forpatientswithadvanced NSCLC • n=11 • Pulmonaryrehabilitation; • 2 times/week, 8week • Aerobicandstrengtheningexercises • Reduction in symptoms • Temel JS, Greer JA, Goldberg S et al. J ThoracOncol 2009 (4): 595-601

  14. Survivalwasnegativelyaffected? • ≤48 day is not thepredictor of survival* • The Swedish Cancer Study Group Proposal for LungCancer;** • Consultation and investigations to be completed within 4 wk, treatment should start within the next 2 weeks • *Bozcuk H, Martin C. Lung Cancer 2001; 34:243– 252. • **Myrdal G, Lambe M, Hillerdal G, et al. Thorax 2004; 59:45–49.

  15. Prepeoperatif pulmonary rehabilitation, many patients in the window period of 4-6 weeks can be done without adversely affecting survival.

  16. Poor performance status and exercise capacitymorbidity and mortality* • Exercise capacity is a modifiable risk factor!!** • *Oga T, Nishimura K, TsukinoM, et al. Am J RespirCrit Care Med 2003; 167:544–549. • *Baser S, Shannon VR, Eapen GA, et al. Clin Lung Cancer 2006; 5:344–349. • *Brunelli A, Salati M. CurrOpinPulm Med 2008; 14:275–281. • **Fishman A, Martinez F, Nauheim K, et al. N Engl J Med 2003; 348: 2059–2073

  17. CPET themainoutcome • SFT predictive value is not clear • Pre-operative interventions aimed at improving VO2 peak, post-operative results improve and increase surgical candidacy.* • 6MWT, CPET to be used as an alternative. ** • *Brunelli A, Belardinelli R, Refai M, et al.Chest 2009; 135:1260–1267. • **Cote C, Pinto-Plata V, Kasprzyk K, et al. Chest 2007; 132:1778–1785.

  18. Efficacy of PreoperativePulmonaryRahabilitation in Patients withLungCancer

  19. Complete surgical resection is the most effective treatment method • Preoperative PR, recommended to reduce surgical morbidity. • Fishman A, Martinez F, Nauheim K, et al. N Engl J Med 2003; 348: 2059–2073

  20. PR before surgery for cancer; • n=19 • Thestandardand non-standardarm • Pulmonearyrehabilitation; • Short-term(4w) A) Standard arm • Accordancewithguidelines B) Patient-based • Self-sufficiency • Inspiratorymuscletraining • Slowbreathingtraining • Shorter duration of hospital stay of at least 3 days(p=0.058), • The number of days for chest tubewaslessthan(p = 0.04), • The need for prolonged chest tube drainage was less than (p = 0.03). • Can be applied to the patient-based PR • Benzo R, Wigle D, Novotny P, et al. LungCancer 2011 Dec;74(3):441-5

  21. The Effects of cardiorespiratorytrainingprior to surgery • n=13 • Preoperatively and 30 days after the assessment • PulmonaryRehabilitation; • Short-term • Consecutive days from the operation • 1-4 week • Peripheralmuscleexercise (endurance • There is a significant increase in peak VO2 and 6MWT (respectively 21%, 13%) • Jones L. Cancer ChemotherPharmacol 2007; 110:590–598

  22. The effect of preoperative pulmonary rehabilitation in NSCLC • n=12 akciğer • PulmonaryRehabilitation; • Inhospital • Shortterm(1.5 h, 5day/ 4 week süreli • Patienteducation; • Smokingcessation • Effectivecoughing • Controlledbreathingtechniques • Peripheralmuscletraining (Endurance) • The average increase in peak VO2 2.8mL/kg/min • Increase in exerciseperformance • Positiveeffects of cardiopulmonary • Bobbio A, Chetta A, Ampollini L, et al. Eur J Cardio-thoracicSurg2008;33:95–98

  23. Preoperative PR in patients with limited performance • n=8 • Candidates for surgery, patients with limited respiratory function and performance • PulmonaryRehabilitation; • Shortterm(4 week) • Aerobicexercise, • Controlledbreathingtechniques • Trainingsessions • Increase in 6MWT (47%) • Increase in PaO2(7,2mmHg) • Increase in Pulmonaryfunction(FEV1, FVC) • Cesario A, Ferri L, Galetta D, et al. Lung Cancer 2007; 57:118–119.

  24. Cost-effectiveness of PR before lobectomy • n=119 • Reduction of postoperative atelectasis (p= 0.003) •  Reduction in length of hospital stay • Cost reduction • Varela G, Ballesteros E, Jimenez MF et al. Eur J Cardio-thoracicSurg 2006; 216-220

  25. Preoperative PR is useful? • Exercise capacity improved • Shorter duration of hospital stay • Reduces postoperative pulmonary complications • Preserved lung function after surgery in patients with COPD • Nagarajan K, Bennerr A, Agostini P et al. InteractCardiovascularThoracSurg 2011; 300-302

  26. Thebenefits of preoperativepulmonaryrehabilitation; • Shorten length of hospital stay, • Improves postoperative complications, reduces complications, • Improves exercise capacity after surgery, • Creates a positive impact on the post-operative period of cardiopulmonary, • Borderline patients eligible for surgery makes • Cost-effective

  27. Efficacy of PostoperativePulmonaryRahabilitation in PatientswithLungCancer

  28. Pulmonary rehabilitation after surgery, 6-9 weeks is continued.

  29. PR in patients undergoing radical treatment • n=16 • 12 weekmultidisciplinary PR program • PulmonaryRehabilitation; • Resistanceandenduranceexercise • Nutritionalassessment • Dyspneaandfatigueassessment (CRDQ) • Improved exercise capacity • Increased muscle strength • ImprovedQuality of life (dyspnea and fatigue) • Salhi B, Demedts I, Simpelere A et al. RehabilitationResearchandPractice 2010, Article ID 481546, 7 pages, doi:10.1155/2010/481546

  30. The effect of postoperative PR in NSCLC • Cesario A, Ferri L, Galetta D, et al.LungCancer 2007; 57:175–180 • Improvement in respiratory function • Improvement in exercise capacity

  31. Postoperative PR in NSCLC • n=103 • Patients undergoingsurgery for NSCLC • Improvement inexercise capacity •   Improvement in respiratory function •   Improvement in the perception of dyspnea •   Improvement in SaO2 •   Improvement in BODE index • Cesario A, Dall’Armi V, Cusumano G et al. LungCancerNovember 2009, 66(2); 268–269

  32. Effect on exercise capacity in postoperative PR • n=10 • Surgery, Surgery+ RT, Surgery + RT+ KT • Pulmonaryrehabilitation; • 8 week • Multidisciplinary • Increase the capacity of doing work (P=0.0020) (P=0.0078) • Increase in 6MWT (43%) and peak workload (34%) • Spruit M, Janssen PP, Willemsen SC, et al. LungCancer 2006; 52:257–260.

  33. The benefits of postoperative pulmonary rehabilitation;; • Increases exercise capacity • Increases muscle strength • Provides symptom control • Improves quality of life • Shorten length of hospital stay

  34. Pre-Post operativePulmonaryRehabilitationApproaches • Smokingcessation • Assessments of patients; • Functionallimitations • Exercisecapacity • Airwayclearanceandpulmonaryexpansiontechniques • Assistedcoughing • Insentivespirometry • NIMV • Energyconservationstrategies • Transfer-mobility • Prevention of venousthromboembolism • Paincontrol • Stressandanxietymanagement • Nutritionalevaluation / support

  35. The effect of fast-trackPR after lobectomy • n=109 • Avoidance of long-term preoperative benzodiazepine • Earlyextubation • Patient-controlled analgesia • Early ambulation • Oral nutrition • Shortening length of hospital stay • Reduction in complication • Das-Neves-Pereira JC, Bagan P, Coimbra-Israel AP et al. Eur J Cardio-thoracicSurg 2009; 383-392

  36. Cancer Related FatigueandPulmonary Rehabilitation

  37. Fatigue • Shortness of breath • Involuntary weight loss

  38. Cancer Related Fatigue (CRF) • 70-100 % * • CRF duringoraftertreatment • Decrease in activity participation and life** • *Mock V.Cancer.2001;92(6 suppl):1699–1707 • **Curt GA, Breitbart W, Cella D,et al. Oncologist.2000;5:353–360

  39. CRF • Cancer- relatedfatigue is a distressingpersistent, subjective sense of physical, emotionaland/orcognitivetirednessorexhaustiontocancerorcancertreatmentthat is not proportionaltorecentactivityandinterfereswithunusualfunctioning. • NCCN PracticeGuidlines in Oncology-1.2012, CancerRelatedFatigue

  40. CRF • May be isolatedor accompanied by other symptoms such as pain, distress, anemia, and sleep disorders • Patient-specific systematic assessment should be performed • Guides should be approached with a multidisciplinary applied • Rehabilitationshouldbeginwiththecancerdiagnosis • NCCN PracticeGuidlines in Oncology-1.2012, CancerRelatedFatigue

  41. Causes of cancer-relatedfatigue • Wagner LI,Cella D. British Journal of Cancer (2004) 91, 822 – 828

  42. Approachtocancer-relatedfatigue Non-pharmacologic Activityenhancement Maintain optimal level of activity /Exerciseprescription/ Exercisetraining Energyconservationtechniques Education Psychosocialinterventions Assessment/support (Stressmanagement /Relaxation ) Nutritionalassessment /support Sleepassesment Cautions: Bone metastasis Immunosuppression / neutropenia Thrombocytopenia Anemia Fever Limitationsduetometastasisorco-morbidities • NCCN PracticeGuidlines in Oncology-1.2012, CancerRelatedFatigue

  43. CRF • CRF is associated with muscle mass and strength. * • The most common symptom, fatigue • Increased fatigue, associated with low physical activity levels. • Physical activity level, regardless of age, significant in predicting the level of fatigue. • Physical activity level, a factor that can be changed in CRF.** • *Kilgour RD, Vigano A, Trutschnigg B et al. J Cachexia Sarcopenia Muscle (2010) 1:177–185 • **Luctkar-Flude M, Groll D, Woodend K, et al. OncolNurs Forum. 2009 Mar; 36 (2):194-202

  44. Exercise;reduces fatigue, increases walking, • improves the quality of life • Wagner LI,Cella D. British Journal of Cancer (2004) 91, 822 – 828

  45. The benefits of pulmonary rehabilitation in CRF; • Reduces fatigue • Provides symptom control • Increases the functional capacity • Improves the quality of life

  46. PulmonaryRehabilitation; • Makes it ready for surgery patients with borderline • Shorten length of hospital stay, cost-effective • Reduce the complication rates • Accelerate recovery after surgery • Provides symptom control • Improvescancer-related fatigue and quality of life

  47. THANKS

More Related