Home-based rehabilitation in inoperable lung cancer: a randomised controlled trial

Abstract

Background: Lung cancer is associated with poor health-related quality of life (HRQoL) yet few controlled trials have assessed rehabilitation impact. Aims: Assess the efficacy of home-based rehabilitation compared with usual care (UC) at active treatment commencement for inoperable lung cancer. Methods: Multi-site, stratified, assessor-blinded RCT (concealed allocation), with intention-to-treat. Participants received UC plus 8-weeks of aerobic and resistance exercise with weekly behavior change and symptom management telephone support (intervention group [IG]) or UC. Primary outcome was between-group change in six-minute walk (6MWD) from baseline to 9-weeks. Secondary outcomes included; physical activity (PA), muscle strength, HRQoL, symptoms and exercise motivation measured at baseline, 9-weeks and 6-months (Edbrooke, L. et al. BMC Cancer 2017; 17:633). Results: 92 participants were recruited (45 IG, 47 UC): mean (SD) age 64 (12) years; male 55%; disease stage n (%) III=35 (38) and IV=48 (52); radical treatment intent n (%) 42 (46). Attrition was 15% at 9-weeks and 28% at 6-months. Median survival (days): 636 (IG), 406 (UC), p=0.15. Exercise adherence was 65% (26/40). Between-group differences in 6MWD, PA and strength were non-significant at 9-weeks or 6-months. Significant differences (mean diff (95% CI)), favouring the IG, were found at 6-months for HRQoL (FACT-L 13.0 (3.9 to 22.1), p=0.005), symptom severity (MDASI-LC -2.2 (-3.6 to -0.9, p=0.001) and exercise motivation (BREQ-2 -0.6 (-1.2 to -0.03), p=0.04). Conclusions: Home-based rehabilitation resulted in significant improvements in HRQoL, symptoms and exercise motivation at 6-month follow-up but did not change physical function outcomes.