Several users on a recent thread have raised questions about whether exercise after surgery or chemo and radiation is harmful, beneficial, or has no effect on outcomes among people with lung cancer. Unfortunately, this field has so few answers that it’s easy to imagine doctors filling in the void with half-truths or less. I explained that I had seen so little information on this subject that I couldn’t shed much light, but I’d try to dig up some information.
There is really little to nothing out there on exercise programs for patients with lung cancer specifically. The American College of Chest Physicians put out a set of guidelines ten years ago (article here) that really focused on the value of exercise programs for patients with chronic obstructive pulmonary disease (COPD), or emphysema, but not cancer. Overall, the findings of various trials suggest that lower extremity exercise (ambulating) is beneficial, in terms of improved exercise tolerance, but no significant improvement in pulmonary function, and no detrimental effects appreciated. Many of these programs also include some upper extremity (or, you may know it as the arm) training, and breathing training, with some support for increased arm function in these exercise programs, but no improvement in breathing function. So these studies in aggregate show convincing improvement in exercise capacity, in activity levels, but also psychological benefits with improved quality of life as activity levels increase. A summary table of results from the article is shown here (grade of evidence summarizes the strength of the evidence, from A for very strong to C for rather sketchy and only suggestive):
And yet, we really don’t have information on exercise in the setting of lung cancer.
The Southwest Oncology Group has actually been trying to run a clinical trial (called SWOG 0229) that tests the value of a supervised exercise program for patients with stage III, locally advanced NSCLC who have received chemo and radiation. In addition, the study is also assessing the health-related quality of life for participating patients. The trial actually randomizes patients to an educational program about the value of exercise or the same educational program along with a supervised 12-week exercise program. Participants undergo testing in the form of a six minute walk in which the total distance is recorded, as well as lung function tests and quality of life surveys.
Great idea, but unfortunately this concept just hasn’t captured the lung cancer community. The trial was opened in September of 2004, but as of an update several months ago, just a single patient had been enrolled (by one of the lead investigators of the study). The trial was designed to enroll 82 patients per arm, for a total of 164 patients. At this rate, we should get some answers in about 500 years.
Some of the problem may be a lack of interest among potential patients, but I also suspect that most oncologists forget about it and don’t mention it to their patients in the middle of their busy clinic days, where they are more focused on scan results and chemo plans (and since I wasn’t the one who enrolled the only patient on this study, consider me guilty as charged). Unfortunately, this suggests that it may be a long, long time before physicians and patients prioritize exercise programs in lung cancer enough to answer questions about the potential contribution(s) of exercise on physical and psychological well being. The study has liberalized its entry criteria, but it may well be closed down if interest in it doesn’t pick up dramatically. I’ll have to remember to offer it to my eligible patients.
Until then, I can tell you that I support people pursuing an exercise program and don’t see any evidence of a harmful effect, but there is precious little information to address how much it adds.
posted by Dr. West @ 10:32 pm link to this post
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February 27th, 2008 at 6:29 am
After reading your post, I had a quick look around the net for exercise info using references from “Cancer Fitness: Exercise Programs for Patients and Survivors” by Anna L. Schwartz (one of the only books I could find on cancer and exercise through our city library). It looks like there are some researchers who may be or have done some work with lung cancer patients - one being F.C. Dimeo. I don’t have access to any medical journals, but was able to find a couple of papers online that have references to his studies that included a few lung cancer patients. They are:
Aerobic exercise as Therapy for Cancer Fatigue (a small study with one lung cancer participant)
http://www.nacer.org.uk/assets/docs/DimoeMSSE1998.pdf
and
“Effects of Aerobic Exercise on the Physical Performance and Incidence of Treatment-Related Complications After High-Dose Chemotherapy” (a larger study with a small group of lung cancer patients in the control and exercise groups)
http://fig.cox.miami.edu/~cmallery/113/amber.paper.pdf
Neither of the above address the relative safety of exercise for lung cancer patients, so aren’t helpful in that respect.
Anyhow, my guess is that there are studies where lung cancer patients are among the participants, but suspect that it would be difficult to uncover them.
By the way, on the purely anecdotal side of the exercise subject, my husband has seemed to benefit considerably from modest exercise (walking, exercise bike, light weights, breathing exercises, etc…), so we’re interested on any info on the subject. We don’t push things too much - mainly just do what feels comfortable and avoid anything that seems to cause pain. Seems to be working so far.
February 28th, 2008 at 12:30 pm
Having always believed regular exercise led to a better quality of life, and perhaps a longer life, it was a comeuppance when in 2003, a non-smoker at the age 68, I was diagnosed with NSCLC Stage IV.
Since then I have had a round of chemo (taxotere/carboplatin), 2 lung surgeries (rignt then left), and 3 stomach surgeries for intestinal blockages (not cancer related). I am presently taking another round of chemo (Taxotere/carboplatin/Avastin).
During these years I did my best to regain and maintain good physical condition - tennis, softball, basketball, swimming, walking, short distance jogging, weight conditioning.
Was it worth it?
Both the oncologist and thorasic surgeon said they would not have attempted the first operation had I not been in good shape. After the second, the surgeon remarked to his resident assistant, “he would not be here today if he had not been in good physical condition.”
Equally as significant, not only do I feel psychologically better, but the guys I play sports with, the people I exercise with, have become a very important support groups.
Where ever you are on the scale - getting started, staying in shape, going for the senior olympics - don’t stop. You’ll come out ahead.
March 2nd, 2008 at 7:03 am
Hig: Your post is just what I needed to hear. Before being dx’d, I’d been exercising for years. I biked, did water exercises, walked and went three years to the gym trying to find my exercise “fit.” After much internet research, I got myself Chuck Norris’s Total Gym .for my 60th birthday. I used it faithfully 3 to 4 times a week for over three years. I was hospitalized with a pleural effusion and pneumonia and was eventually dx’s with IIIb lung cancer due to a malignant pleura. Like you, I commonly heard doctors and nurses referring to the advantages of my being so healthy and fit. Unfortunately, ever since I got sick and throughout my chemo treatments I’ve been afraid to get back on my Total Gym. I had my husband set it back down to beginner level and even watched the video again planning on starting with warm-up only. That was weeks ago and I realized I was really afraid it would hurt me. I find myself periodically feeling depressed which has never been my “thing,” but now I know I am starting my new exercise routine TODAY. It’s worth the risk.