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Should pulmonary rehabilitation be a standard of care in lung cancer?
  1. Michael C Steiner
  1. Department of Respiratory Sciences, University of Leicester, Leicester, Leicestershire, UK
  1. Correspondence to Michael C Steiner, Department of Respiratory Sciences, Glenfield Hospital, University of Leicester, Leicester, LE3 9QP, UK; ms346{at}le.ac.uk

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There are few therapeutic interventions as effective as pulmonary rehabilitation (PR) in the management of the chronic respiratory disease. The scientific evidence base demonstrating the clinical benefit of PR is incontestable, indeed the most recent iteration of the Cochrane systematic review summarising clinical trials of PR in chronic obstructive pulmonary disease (COPD) concluded that no further clinical trials testing effectiveness were needed.1 The gains in physical capacity and health-related quality of life conferred by PR in routine clinical practice are comparable to those seen in clinical trials2 and the available evidence suggests that completion of PR reduces subsequent healthcare costs through a reduction in the number of days spent in the hospital.3 This substantial body of evidence is derived largely from studies in people with COPD but, perhaps unsurprisingly, PR is also effective in other chronic respiratory diseases characterised by exercise limitation due to dyspnoea and muscle fatigue such as bronchiectasis, interstitial lung disease and pulmonary hypertension. This benefit, long understood by rehabilitation practitioners in the field, is increasingly now backed up by clinical trials of PR in these specific patient populations.4–6

In this issue of the journal, Edbrooke and colleagues further extend our understanding of the broader role of PR in respiratory disease by undertaking a clinical trial of a home-based rehabilitation intervention in patients receiving non-surgical therapy for lung cancer.7 The trial aimed to encourage participation in an 8-week programme of structured, progressive physical activity and exercise while volunteers were also attending medical centres for active cancer treatment (chemotherapy or radiotherapy, commenced no more than 4 weeks prior to enrolment). On the face of it, there is a strong rationale for such an intervention; patients presenting with inoperable lung cancer frequently have low-performance status, poor exercise capacity and are physically inactive.8 Rehabilitation …

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