Cardiorespiratory Fitness and Physical Activity following Lung Transplantation: A National Cohort Study.

BACKGROUND: Low cardiorespiratory fitness and inactivity are common after lung transplantation (LTx). The causes of exercise intolerance are incompletely understood. OBJECTIVES: The aim of this study was to objectively assess cardiorespiratory fitness and physical activity, evaluate causes of exercise intolerance, and explore clinical factors associated with cardiorespiratory fitness after bilateral LTx (BLTx). MATERIALS AND METHODS: Peak oxygen uptake (V∙O2peak) and exercise-limiting factors were evaluated by a treadmill cardiopulmonary exercise test (CPET) 6-60 months after BLTx. Physical activity was measured with accelerometers, and results were compared with Norwegian normative data and the World Health Organization's (WHO) recommendations for physical activity. RESULTS: In 54 included BLTx recipients (mean age 50 ± 15 years, 50% females), V∙O2peak (mL × kg-1 × min-1) was 21.8 ± 7.7 for men and 22.4 ± 6.2 for women, corresponding to 57 ± 17 and 70 ± 12% of predicted, respectively. Three patients (6%) met criteria for normal V∙O2peak. Deconditioning limited V∙O2peak in 22 patients (41%), while ventilatory limitation and abnormal gas exchange were observed in 14 (26%) and 20 (37%) patients, respectively (some had more than 1 finding). Forty-three patients (86%) did not meet the WHO physical activity recommendations. There was a moderate correlation between V∙O2peak and physical activity (r = 0.642, p < 0.01). Body mass index, physical activity, forced expiratory volume after 1 second, sex, and hemoglobin together accounted for 73% of the variability in V∙O2peak. CONCLUSIONS: Low cardiorespiratory fitness was observed in the majority of BLTx recipients. Both deconditioning and cardiopulmonary limitations were common findings. Nearly 90% were classified as being inactive according to physical activity recommendations. CPET appears to identify a deconditioned subgroup of BLTx recipients for whom exercise training may be especially beneficial.

Changes in Symptom Occurrence and Severity Before and After Lung Cancer Surgery.

BACKGROUND: Patients need information about the course of recovery after surgery for lung cancer, but knowledge about symptoms in this period is limited. OBJECTIVE: The purpose of this study was to assess for changes in symptom occurrence rates and severity scores from the preoperative period to 1 month after surgery. METHODS: Patients (n = 228) completed questionnaires before and at 1 month after surgery. McNemar tests were used to evaluate for changes over time in symptom occurrence rates and paired t tests for changes in symptom severity scores. General linear model was used to determine if select demographic and clinical characteristics were associated with the number of symptoms after surgery. RESULTS: The total number of symptoms increased significantly from the preoperative (mean, 9.4) to the postoperative (mean, 13.1) assessment. Of the 11 symptoms that occurred in 50% or more of the patients 1 month after surgery, 8 increased significantly in both occurrence and severity. Four symptoms were experienced by more than 80% of the patients 1 month after surgery: shortness of breath (85.5%), lack of energy (83.8%), pain (83.8%), and feeling drowsy (82.5%). CONCLUSIONS: Patients experienced a high number of symptoms after lung cancer surgery. The only characteristic that was associated with a higher number of symptoms 1 month after surgery was the number of symptoms reported preoperatively. IMPLICATIONS FOR PRACTICE: These findings can be used to educate patients about the normal course of postoperative recovery. Clinicians need to assess for these symptoms and develop effective interventions to improve symptom management for these patients.

Trajectories of Symptom Occurrence and Severity From Before Through Five Months After Lung Cancer Surgery.

CONTEXT: Limited information is available about lung cancer patients' symptoms in the pre- and postoperative periods. OBJECTIVES: Study purposes were to evaluate for changes in symptom occurrence and severity from the preoperative period to five months after surgery and to evaluate for predictors of the occurrence and trajectories of these symptoms. METHODS: Patients completed the Memorial Symptom Assessment Scale before and at one and five months after surgery. Changes in the six most common physical symptoms and the most common psychological symptom were evaluated using multilevel growth mixture modeling. Age, gender, comorbidity, and receipt of adjuvant chemotherapy were included as covariates in the conditional models for symptom occurrence and severity. RESULTS: The total number of symptoms increased significantly from the preoperative to the one month assessment. At five months, the number of symptoms was lower than at one month but significantly higher than at the preoperative assessment. The occurrence of five of the symptoms (i.e., pain, lack of energy, shortness of breath, feeling drowsy, and worrying) increased significantly from before through the first month after surgery and then decreased over time. Cough and difficulty sleeping persisted over the five months of the study. In general, the effect of the four covariates was to increase patients' overall symptom burden. CONCLUSION: Changes in the occurrence and severity of these seven symptoms were variable. All seven symptoms occurred at relatively high rates and were of moderate severity. Findings can be used to identify patients who are at higher risk for more severe symptoms.

Does age influence the symptom experience of lung cancer patients prior to surgery?

OBJECTIVES: Older patients with lung cancer are less likely to be offered surgery then younger patients. Although higher preoperative symptom burden is associated with poorer postoperative outcomes, few studies have examined age-related differences in symptom experience of lung cancer patients prior to surgery. This study evaluated for differences in symptom occurrence, severity, and distress between older (≥65 years) and younger (<65 years) patients prior to surgery. MATERIALS AND METHODS: Data were collected through chart review and a symptom assessment scale (i.e., Memorial Symptom Assessment Scale (MSAS)) that evaluated multiple dimensions of 32 symptoms. Descriptive statistics were used to present demographic and clinical characteristics of the sample. Logistic regression analyses were used to evaluate for age-related differences in each dimension of the symptom experience. RESULTS: A total of 270 patients completed the MSAS prior to surgery (113 younger and 157 older patients). Few age-related differences were found. When age differences were identified, older patients reported lower occurrence rates and lower severity and distress ratings. Cough, lack of energy, feeling drowsy and worrying was the four most common symptoms in both age groups. In the younger patients, feeling nervous was ranked fourth. Shortness of breath was ranked third by the older patients. The study confirmed the high occurrence rates for cough, pain, fatigue, shortness of breath, and sleep disturbance found in previous studies. However, "new" symptoms were identified including feeling nervous, worrying, sweats, feeling bloated, and problems with sexual interest. These "new" symptoms were reported by over 40% of the patients. CONCLUSIONS: Measurement of symptoms in lung cancer patients before surgery is important, because patients reported an average of 10 symptoms. Few age-related differences in the patients' symptom experience were identified. Psychological symptoms were common and warrant consideration.