Short-term integrated rehabilitation for people with newly diagnosed thoracic cancer: a multi-centre randomized controlled feasibility trial.

OBJECTIVES: The main objective of this study is to determine the feasibility of recruiting and retaining patients recently diagnosed with thoracic cancer to a trial of short-term integrated rehabilitation; evaluate uptake of theoretically informed components targeting physical function, symptom self-management and participation; estimate sample size requirements for an efficacy trial. DESIGN: Parallel group randomized controlled feasibility trial. SETTING: Three U.K. hospitals. PARTICIPANTS: Patients ⩽eight weeks of thoracic cancer diagnosis, Eastern Cooperative Oncology Group Performance Status 0-3, any cancer stage and treatment plan. INTERVENTIONS: Participants randomly allocated (1:1) to short-term integrated rehabilitation and standard care or standard care alone over 30 days. MAIN MEASURES: Primary: participant recruitment and retention, targeting ⩾30% of eligible patients enrolling and ⩾50% of participants reporting outcomes at 30 days. Secondary: intervention fidelity; missing data and performance of outcome measures for self-efficacy, symptoms, physical activity and health-related quality of life. RESULTS: Of 159 eligible patients approached, 54 (34%) were recruited. A total of 44 (82%) and 39 (72%) participants reported outcomes at 30 and 60 days, respectively. Intervention fidelity was high. Rehabilitation was delivered across 3 (1-3) sessions over 32 (22-45) days (median (range)). Changes in clinical outcomes were modest but most apparent at 60 days for health-related quality of life: Functional Assessment of Cancer Therapy Lung Cancer score median (interquartile range) change 9.7 (-12.0 to 16.0) rehabilitation versus 2.3 (-15.0 to 14.5) standard care. CONCLUSION: A trial to examine efficacy of short-term integrated rehabilitation for people newly diagnosed with thoracic cancer is feasible. A sample of 336 participants could detect a meaningful effect on health-related quality of life as the primary outcome.

Return to work after surgical treatment for malignant pleural mesothelioma: report of a case.

We report the case of a 56-year-old woman who underwent pleural biopsy to identify the cause of the right pleural effusion. The pathological diagnosis was epithelial malignant pleural mesothelioma. The patient worked as a junior high school teacher and strongly hoped for continuing work. Thus, we performed pleurectomy/decortication (P/D) as a curative surgery. The operative findings showed pleural thickening that in the lower lobe of the lung. Thus, peeling of the lower lobe was performed. Pleural biopsy was only performed on the upper and middle lobes. As a result, the operation was limited P/D. The pathological findings showed a small number of mesothelioma cells in the upper and middle lobes. The patient received four courses of cisplatin plus pemetrexed systemic chemotherapy after surgery. Continuous maintenance chemotherapy using pemetrexed has been performed until the time of writing. At present, she has continued her work for 6 years after the operation and has extended her retirement age without recurrence.

Early specialist palliative care on quality of life for malignant pleural mesothelioma: a randomised controlled trial.

PURPOSE: Malignant pleural mesothelioma (MPM) has a high symptom burden and poor survival. Evidence from other cancer types suggests some benefit in health-related quality of life (HRQoL) with early specialist palliative care (SPC) integrated with oncological services, but the certainty of evidence is low. METHODS: We performed a multicentre, randomised, parallel group controlled trial comparing early referral to SPC versus standard care across 19 hospital sites in the UK and one large site in Western Australia. Participants had newly diagnosed MPM; main carers were additionally recruited. INTERVENTION: review by SPC within 3 weeks of allocation and every 4 weeks throughout the study. HRQoL was assessed at baseline and every 4 weeks with the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30. PRIMARY OUTCOME: change in EORTC C30 Global Health Status 12 weeks after randomisation. RESULTS: Between April 2014 and October 2016, 174 participants were randomised. There was no significant between group difference in HRQoL score at 12 weeks (mean difference 1.8 (95% CI -4.9 to 8.5; p=0.59)). HRQoL did not differ at 24 weeks (mean difference -2.0 (95% CI -8.6 to 4.6; p=0.54)). There was no difference in depression/anxiety scores at 12 weeks or 24 weeks. In carers, there was no difference in HRQoL or mood at 12 weeks or 24 weeks, although there was a consistent preference for care, favouring the intervention arm. CONCLUSION: There is no role for routine referral to SPC soon after diagnosis of MPM for patients who are cared for in centres with good access to SPC when required. TRIAL REGISTRATION NUMBER: ISRCTN18955704.

Real-life feasibility of home-based pulmonary rehabilitation in chemotherapy-treated patients with thoracic cancers: a pilot study.

BACKGROUND: Patients with advanced lung cancer (LC) or malignant pleural mesothelioma (MPM) exhibit limitation of exercise capacities and alteration of quality of life (QoL) induced by cancer and its treatment. Few studies assessed pulmonary rehabilitation (PR) in these chemotherapy-treated patients, and none evaluated a home-based PR program. METHODS: In this prospective uncontrolled observational pilot study, patients treated by chemotherapy for LC or MPM were screened for a home-based PR program combining exercise training with global cares including therapeutic education and psychosocial management. Feasibility and safety were evaluated by attendance and adherence to PR program. Various exercise tolerance tests, including 6-min walk test (6MWT) and 6-min stepper test (6MST), were performed before and after PR associated with, QoL and psychological assessment (VSRQ and HAD, respectively). RESULTS: 243 patients were considered eligible but only 71 (60.6 ± 8.8 years) started a PR and 47 completed the program. Refusals to participate were mostly related to lack of motivation whereas withdrawals to PR were related to cancer-related medical issues. No adverse event related to PR was observed. Baseline 6MWT distance was associated with performance status (r = - 0.45, p = 0.001) and mMRC dyspnea scale (r = - 0.49, p < 0.001) but not with lung cancer stage. Post-PR reassessment showed 6MWT stability and 6MST improvement in patients who completed the program. Daily physical activity (p = 0.007) and anxiety (p = 0.02) scores were significantly improved. CONCLUSIONS: Home-based PR was feasible and safe in patients with advanced LC or MPM. Exercise capacities stability in patients who completed the PR program suggests that PR might be beneficial. Further studies are warranted to confirm and to improve the potential value of PR in these patients.

Physical function and health-related quality of life in patients undergoing surgical treatment for malignant pleural mesothelioma.

INTRODUCTION: Malignant pleural mesothelioma (MPM) is a rare cancer that affects the thin cell wall lining of internal organs and structures. Studies have shown that patients with lung cancer have decreased pulmonary function and exercise capacity after pneumonectomy. However, to date, physical function and health-related quality of life (HRQOL) in surgically treated MPM patients have not been evaluated in detail. The aim of this study was to assess physical function and HRQOL of MPM patients following pleurectomy/decortication (P/D). METHODS: The subjects were 22 MPM patients (20 men and 2 women) who completed P/D between December 2013 and March 2015. Physical function was assessed using handgrip strength and knee extensor strength tests, the 6-min walk distance (6MWD), and pulmonary function tests, including forced expiratory vital capacity (FVC) and forced expiratory volume in 1 s (FEV1). HRQOL was assessed using the Medical Outcome Study 36-item Short Form Health Survey (SF-36). RESULTS: The handgrip strength (P < 0.05), 6MWD, FVC, and FEV1 values following P/D decreased significantly compared to baseline (P < 0.001 for each comparison). Additionally, scores of three of the eight SF-36 domains were significantly lower following P/D: physical functioning (P < 0.001), body pain (P = 0.002), and vitality (P = 0.005). 6MWD correlated role physical (P < 0.05) and vitality (P < 0.01). Significant correlations were also observed between FEV1 and physical functioning (P < 0.05) and social functioning (P < 0.05). CONCLUSION: Patients with MPM who completed P/D have decreased physical function and HRQOL. Following surgery, exercise capacity and pulmonary function decreased more than limb muscle strength. Physicians, nurses, and rehabilitation staff should note these findings, which may provide insight into the development of customized rehabilitation strategies for patients with MPM who completed P/D.

[Evaluation of the rehabilitation program in a patient submitted to pleuropneumonectomy for malignant pleural mesothelioma]. / Valutazione degli aspetti riabilitativi in un paziente sottoposto ad intervento di pleuropneumonectomia per mesotelioma.

OBJECTIVE: The purpose of this study is to test a rehabilitation program for the patients with malignant pleural mesothelioma (MPM) subordinates to pleuropneumonectomy. MATERIALS AND METHODS: A single patient was evaluated at baseline (TI) and at the end of the pulmonary rehabilitation (T2), by undergoing spirometric measurements, emogasanalisys and 6-Minute Walking Test (6-MWT). Outcome evaluation were administered with Visual Analogic Scales (VAS), Hospital Anxiety and Depression Scales (HADS) and Short 36 Form Health Survey version 2 (SF-36). The rehabilitative program included exercise to improve the respiratory functionality, the cardiovascular fitness and the global posture. OUTCOME: Pulmonary function, effort tolerance, estimated by the 6-Minute Walking Test, quality of life, estimated by means of SF-36 v2 improved, and pain, estimated by Visual Analogic Scales, anxiety and depression estimated by Hospital Anxiety and Depression Scales reduction was obtained. DISCUSSION: Actually does not exist a specific rehabilitation protocol for MPM patients. We report that our protocol relieved dyspnoea, increased the capacity to walk, and improved health-related quality of life. CONCLUSIONS: Future studies will define the role of the rehabilitation for MPM patients and will optimize the protocol.