Home-based rehabilitation in inoperable non-small cell lung cancer—the patient experience
Exercise is important in lung cancer, yet most people do not meet the physical activity guidelines. The aim of this study was to characterise the views and experiences of participants with inoperable lung cancer who completed a home-based rehabilitation program.
Ninety-two participants were recruited (45 intervention group [IG], 47 usual care). Individual semi-structured interviews were conducted with participants randomised to the IG of a trial of home-based exercise, behaviour change and symptom management. Data were independently coded by two researchers, cross-checked and analysed using content analysis with a summary of arising themes.
Of the IG (25/45), 55% were interviewed: mean (SD) age 67 (13) years; male 52%; disease stage n (%) III = 9 (36), IV = 11 (44); radical treatment intent n (%) 13 (52). The majority of participants reported program benefits, both in the physical domain (reduced sedentary time and improved strength, fitness and function) and the mental domain (motivation to keep healthy, preventing boredom). Support to self-manage symptoms was well received and many participants reported increased confidence in managing their symptoms. Exercise enablers included having expert health professional support; motivation to be stronger and better prepared for future challenges; and having an achievable and familiar program that was monitored. Treatment side-effects, pain from comorbidities and the weather were exercise barriers. For the majority of participants the use of a Fitbit™ activity tracker, text message exercise reminders and an exercise diary helped to promote adherence.
This home-based rehabilitation program was acceptable to most participants with multiple benefits reported including improved fitness, motivation and ability to manage symptoms.
KeywordsLung cancer Physical activity Exercise Symptoms
The authors would like to thank all participants who were interviewed for the study. In addition, we would like to thank Dr. Selina Parry, Ms. Lucy Bucci and Ms. Jennifer Jones for the research assistance they provided in developing the interview schedule and conducting the interviews.
This research was funded through a National Health and Medical Research Council project grant (APP1060484). Lara Edbrooke is the recipient of a Victorian Government Olivia Newton John Cancer Wellness and Research Centre Supportive Care PhD scholarship, through the Victorian Cancer Agency (ONJ16010).
Compliance with ethical standards
All procedures performed were in accordance with the ethical standards of the Peter MacCallum Cancer Centre ethics committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.Schmitz KH, Courneya KS, Matthews C, Demark-Wahnefried W, Galvao DA, Pinto BM, Irwin ML, Wolin KY, Segal RJ, Lucia A, Schneider CM, von Gruenigen VE, Schwartz AL (2010) American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc 42(7):1409–1426. https://doi.org/10.1249/MSS.0b013e3181e0c112 CrossRefGoogle Scholar
- 4.Buffart LM, Kalter J, Sweegers MG, Courneya KS, Newton RU, Aaronson NK, Jacobsen PB, May AM, Galvao DA, Chinapaw MJ, Steindorf K, Irwin ML, Stuiver MM, Hayes S, Griffith KA, Lucia A, Mesters I, van Weert E, Knoop H, Goedendorp MM, Mutrie N, Daley AJ, McConnachie A, Bohus M, Thorsen L, Schulz KH, Short CE, James EL, Plotnikoff RC, Arbane G, Schmidt ME, Potthoff K, van Beurden M, Oldenburg HS, Sonke GS, van Harten WH, Garrod R, Schmitz KH, Winters-Stone KM, Velthuis MJ, Taaffe DR, van Mechelen W, Kersten MJ, Nollet F, Wenzel J, Wiskemann J, Verdonck-de Leeuw IM, Brug J (2017) Effects and moderators of exercise on quality of life and physical function in patients with cancer: an individual patient data meta-analysis of 34 RCTs. Cancer Treat Rev 52:91–104. https://doi.org/10.1016/j.ctrv.2016.11.010 CrossRefGoogle Scholar
- 8.Mustian KM, Alfano CM, Heckler C, Kleckner AS, Kleckner IR, Leach CR, Mohr D, Palesh OG, Peppone LJ, Piper BF, Scarpato J, Smith T, Sprod LK, Miller SM (2017) Comparison of pharmaceutical, psychological, and exercise treatments for cancer-related fatigue: a meta-analysis. J Am Med Assoc Oncol 3(7):961–968. https://doi.org/10.1001/jamaoncol.2016.6914 Google Scholar
- 11.Granger CL, McDonald CF, Parry SM, Oliveira CC, Denehy L (2013) Functional capacity, physical activity and muscle strength assessment of individuals with non-small cell lung cancer: a systematic review of instruments and their measurement properties. BioMed Central Cancer 13. https://doi.org/10.1186/1471-2407-13-135
- 14.Licker M, Karenovics W, Diaper J, Fresard I, Triponez F, Ellenberger C, Schorer R, Kayser B, Bridevaux PO (2017) Short-term preoperative high-intensity interval training in patients awaiting lung Cancer surgery: a randomized controlled trial. J Thorac Oncol 12(2):323–333. https://doi.org/10.1016/j.jtho.2016.09.125 CrossRefGoogle Scholar
- 15.Solheim TS, Laird BJA, Balstad TR, Stene GB, Bye A, Johns N, Pettersen CH, Fallon M, Fayers P, Fearon K, Kaasa S (2017) A randomized phase II feasibility trial of a multimodal intervention for the management of cachexia in lung and pancreatic cancer. J Cachexia Sarcopenia Muscle 8(5):778–788. https://doi.org/10.1002/jcsm.12201 CrossRefGoogle Scholar
- 27.Edbrooke L, Aranda S, Granger CL, McDonald CF, Krishnasamy M, Mileshkin L, Irving L, Braat S, Clark RA, Gordon I, Denehy L (2017) Benefits of home-based multidisciplinary exercise and supportive care in inoperable non-small cell lung cancer - protocol for a phase II randomised controlled trial. BioMed Central Cancer 17(1):663. https://doi.org/10.1186/s12885-017-3651-4 Google Scholar
- 31.Onwuegbuzie AJ, Collins KM (2007) A typology of mixed methods sampling designs in social science research. Qual Rep 12(2):281–316Google Scholar
- 33.Burke L, Miller M (2001) Phone interviewing as a means of data collection: lessons learned and practical recommendations. Forum: Qualitative Social Research 2 (2, Art. 7)Google Scholar
- 39.Spruit MA, Singh SJ, Garvey C, ZuWallack R, Nici L, Rochester C, Hill K, Holland AE, Lareau SC, Man WD, Pitta F, Sewell L, Raskin J, Bourbeau J, Crouch R, Franssen FM, Casaburi R, Vercoulen JH, Vogiatzis I, Gosselink R, Clini EM, Effing TW, Maltais F, van der Palen J, Troosters T, Janssen DJ, Collins E, Garcia-Aymerich J, Brooks D, Fahy BF, Puhan MA, Hoogendoorn M, Garrod R, Schols AM, Carlin B, Benzo R, Meek P, Morgan M, Rutten-van Molken MP, Ries AL, Make B, Goldstein RS, Dowson CA, Brozek JL, Donner CF, Wouters EF (2013) An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med 188(8):e13–e64. https://doi.org/10.1164/rccm.201309-1634ST CrossRefGoogle Scholar
- 41.Cheville AL, Dose AM, Basford JR, Rhudy LM (2012) Insights into the reluctance of patients with late-stage cancer to adopt exercise as a means to reduce their symptoms and improve their function. J Pain Symptom Manag 44(1):84–94. https://doi.org/10.1016/j.jpainsymman.2011.08.009 CrossRefGoogle Scholar
- 45.Huang CC, Kuo HP, Lin YE, Chen SC (2017) Effects of a web-based health education program on quality of life and symptom distress of initially diagnosed advanced non-small cell lung cancer patients: a randomized controlled trial. J Cancer Educ 34:41–49. https://doi.org/10.1007/s13187-017-1263-y CrossRefGoogle Scholar
- 46.Tsai LL, McNamara RJ, Moddel C, Alison JA, McKenzie DK, McKeough ZJ (2017) Home-based telerehabilitation via real-time videoconferencing improves endurance exercise capacity in patients with COPD: the randomized controlled TeleR Study. Respirology (Carlton, Vic) 22(4):699–707. https://doi.org/10.1111/resp.12966 CrossRefGoogle Scholar