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Exercise capacity and cancer-specific quality of life following curative intent treatment of stage I–IIIA lung cancer

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Abstract

Purpose

Lung cancer survivors are at risk for health impairments resulting from the effects and/or treatment of lung cancer and comorbidities. Practical exercise capacity (EC) assessments can help identify impairments that would otherwise remain undetected. In this study, we characterized and analyzed the association between functional EC and cancer-specific quality of life (QoL) in lung cancer survivors who previously completed curative intent treatment.

Methods

In a cross-sectional study of 62 lung cancer survivors who completed treatment ≥ 1 month previously, we assessed functional EC with the 6-min walk distance (6MWD) and cancer-specific QoL with the European Organization for Research and Treatment of Cancer QoL Questionnaire Core 30 (EORTC-QLQ-C30). Cancer-specific QoL was defined using a validated composite EORTC-QLQ-C30 summary score. Univariable (UVA) and multivariable linear regression analyses (MVA) were performed to assess the relationship between functional EC and cancer-specific QoL.

Results

Lung cancer survivors had reduced functional EC (mean 6MWD = 335 m, 65% predicted) and QoL (mean EORTC-QLQ-C30 summary score = 77, scale range 0–100). In UVA, 6MWD was significantly associated with cancer-specific QoL (R2 = 0.16, p = 0.001). In MVA, in a final model that also included heart failure, obstructive sleep apnea, and psychiatric illness, 6MWD was independently associated with cancer-specific QoL (partial R2 = 0.20, p = 0.001).

Conclusions

Functional EC was independently associated with cancer-specific QoL in lung cancer patients postcurative intent treatment. Exercise-based interventions aimed at improving EC may improve cancer-specific QoL in these patients.

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Abbreviations

6MWD:

Six-minute walk distance

6MWT:

Six-minute walk test

ATS:

American Thoracic Society

BFI:

Brief Fatigue Inventory

CI:

Confidence interval

CPET:

Cardiopulmonary exercise test

COPD:

Chronic obstructive pulmonary disease

DLCO :

Diffusion capacity of the lung for carbon monoxide

EC:

Exercise capacity

EORTC-QLQ-C30:

European Organization for Research and Treatment of Cancer QoL Questionnaire Core 30

EORTC-QLQ-LC13:

European Organization for Research and Treatment of Cancer QoL Questionnaire Lung Cancer Module 13

EQ-5D/VAS:

EuroQoL-5 Dimensions/visual analogue scale

FEV1 :

Forced expiratory volume in 1 s

HADS:

Hospital Anxiety and Depression Scale

HF:

Heart failure

LDCT:

Low-dose computed tomography

LLN:

Lower limit of normal

MVA:

Multivariable linear regression analysis

NSCLC:

Nonsmall cell lung cancer

OSA:

Obstructive sleep apnea

PRO:

Patient-reported outcome

PSQI:

Pittsburgh Sleep Quality Index

QoL:

Quality of life

TLC:

Total lung capacity

SBRT:

Stereotactic body radiotherapy

TNM:

Tumor node metastasis

UCSD:

University of California San Diego

UCSD SOBQ:

University California San Diego Shortness of Breath Questionnaire

US:

United States

UVA:

Univariable linear regression analysis

VASDHS:

VA San Diego Healthcare System

VO2peak :

Peak oxygen consumption

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Acknowledgements

We would like to thank Dr. Florin Vaida for assistance in the statistical analyses in this study, Dr. Michael Gould and Dr. Lyudmila Bazhenova for manuscript feedback and edits, the Division of Pulmonary, Critical Care and Sleep Medicine and the Clinical and Translation Research Institute Clinical Research Enhancement through Supplemental Training Program at UCSD for financial and scholarship support, Svetlana Sheinkman for maintaining an ongoing list of lung cancer patients at the VASDHS, Christine Miller for assistance with patient recruitment, and staff of the Pulmonary Function Laboratory at the VASDHS for assistance with patient scheduling and 6-min walk test assessments.

Funding

Duc Ha, MD was supported directly by a Postdoctoral Fellowship, PF-17-020-01-CPPB, from the American Cancer Society; and Institutional National Research Service Award 1T32HL134632-01, from the NHLBI; and indirectly by the NCI through the NIH Loan Repayment Program for Extramural Clinical Research. Scott Lippman, MD was supported by the Specialized Cancer Center Support Grant, 3P30CA023100-31, from the NCI. Mark Fuster, MD was supported by the Lung Cancer Discovery Award, LCD-400697, from the American Lung Association; and R01-HL107652, from the NHLBI; and Sleep and Cancer Grant, from the ResMed Foundation. Data management was supported by the University of California San Diego Clinical and Translational Research Institute, grant number UL1TR001442.

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Authors and Affiliations

  1. Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, 9300 Campus Point Drive, MC 7381, La Jolla, CA, 92037, USA

    Duc Ha, Andrew L. Ries & Mark M. Fuster

  2. Cleveland Clinic, Respiratory Institute, 9500 Euclid Avenue, MC A90, Cleveland, OH, 44195, USA

    Peter J. Mazzone

  3. Moores Cancer Center, University of California San Diego, 9500 Gilman Drive, MC 0658, La Jolla, CA, 92093, USA

    Scott M. Lippman

  4. Section of Pulmonary and Critical Care Medicine, VA San Diego Healthcare System, 3350 La Jolla Village Drive, MC 111 J, San Diego, CA, 92161, USA

    Mark M. Fuster

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  1. Duc Ha
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Correspondence to Duc Ha.

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Ha, D., Ries, A.L., Mazzone, P.J. et al. Exercise capacity and cancer-specific quality of life following curative intent treatment of stage I–IIIA lung cancer. Support Care Cancer 26, 2459–2469 (2018). https://doi.org/10.1007/s00520-018-4078-4

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