Pulmonary Rehab Techniques Helpful to Lung Cancer Patients

BETHESDA, Md—Rehabilitation techniques, honed over years of experience with patients suffering from chronic obstructive pulmonary disease (COPD), offer the potential to improve the quality of life for lung cancer patients and lower the cost of their care, Andrew L. Ries, MD, said at a workshop sponsored by the Alliance for Lung Cancer Advocacy, Support, and Education (ALCASE) and the International Cancer Alliance. These techniques should be tested further in clinical trials with lung cancer patients, he added.

Dr. Ries, of the University of California, San Diego (UCSD), Medical Center, said that his group has used pulmonary rehabilitation techniques on a few lung cancer patients in recent years with encouraging results and is now in the midst of a pilot study of about 10 lung cancer patients.

Pulmonary rehabilitation is known to be beneficial for COPD patients, Dr. Ries said. These people must “cope and deal with very frightening and disabling symptoms of being breathless and being on oxygen” and experience depression, anxiety, anger, and loss of self-control and confidence in their ability to cope with their daily lives.

“We’ve realized that many of the principles that have been applied to patients with chronic lung disease can be applied to other types of illnesses, including lung transplant patients, patients with cystic fibrosis, asthma, neuromuscular conditions, and, more recently, patients with lung cancer,” he said.

Three Key Elements

Any rehabilitation program, whatever the illness, has three key elements, Dr. Ries told the workshop.

• A specific plan for each patient. “These programs, to really be effective, have to be tailored to the needs of individual patients,” he said. “We really try to work with individual issues, individual goals, and individual problems.”
• A multidisciplinary team. “Physicians work under tremendous time pressures these days, and may not have the time or skills to counsel and work with patients,” Dr. Ries said. Thus, at the University of California, San Diego, “we utilize the wonderful wealth of expertise of allied health care professionals—nurses, respiratory and physical therapists, dietitians, and social workers.”
• A recognition of all the elements of a disease. “In order to rehabilitate individuals with these kinds of difficult illnesses, one needs to grasp the important psychological, emotional, and social aspects of illness, and not just the physical aspects, and that is what these programs are really geared to do,” he said.

Physical Fitness Programs Urged

Bill Evans, MD, director of the Ottawa Regional Cancer Center, said that researchers at his institution are exploring specialized physical fitness programs to help rehabilitate cancer patients.

These efforts include a randomized, controlled clinical trial in women with breast cancer who are undergoing adjuvant therapy, and pilot studies in patients with prostate and lung cancer.

He believes that physical rehabilitation, such as Dr. Ries is doing with lung cancer patients (see article above), should be a new focus of research activity. “Instead of measuring quality of life,” he said, “we should be actually doing things to change the quality of life. Fitness training is one of them.”

The goal of rehabilitation programs, he said, is to restore patients to the highest level of independent function possible, not necessarily to change the disease process. That is a particularly important point in dealing with lung cancer.

“One of the frustrations that patients and physicians have in dealing with this illness is that we are not very good at providing treatments that are going to reverse or even improve the physical aspects of the illness,” Dr. Ries said. “So we are trying to develop strategies that will help patients improve their symptoms, quality of life, and ability to cope more effectively with this illness.”

The multidisciplinary team at UCSD begins with a careful initial evaluation to determine specific goals and then tailors strategies to meet the needs of individual patients. A program typically includes education for the patient and family, instruction in chest and respiratory physiotherapy, breathing retraining and exercise reconditioning, training in ways to deal with the sensation of breathlessness, and emotional and social support.

Two Issues for Patients

Lung cancer poses two particular issues for patients. First, “many of these patients, because they may have been smokers, have underlying lung disease,” Dr. Ries said. “As a result of their treatment, whether radiation, surgery, or chemotherapy, they have a loss of additional lung function, which produces new problems. They are now more short of breath.”

Second, he added, “the issue of cancer provides a whole set of challenges irrespective of the pulmonary aspects—the emotional, psychological, and physical aspects of dealing with cancer.”

The UCSD researchers are working on an outpatient basis with lung cancer patients who have significant respiratory problems. Their limited results so far have proved quite encouraging, Dr. Ries said.

“Patients feel better; their symptoms improve; their shortness of breath declines; they are less depressed, less anxious, and less frightened,” he told the workshop. “They improve their physical function, become more independent, and, more importantly from a cost point of view, demand less of us in the health care professions.”