Low physical activity levels and functional decline in individuals with lung cancer. Validity of the Assessment of Quality of Life (AQoL) utility instrument in patients with operable and inoperable lung cancer. Effects of exercise training on exercise capacity in patients with non-small cell lung cancer receiving targeted therapy Combined aerobic exercise and high-intensity respiratory muscle training in patients surgically treated for non-small cell lung cancer: a pilot randomized clinical trial. Exercise in patients with non-small cell lung cancer. Which field walking test should be used to assess functional exercise capacity in lung cancer? an observational study Neuromuscular Electrical Stimulation of the Quadriceps in Patients with Non-Small Cell Lung Cancer Receiving Palliative Chemotherapy: A Randomized Phase II Study Outcomes of Pulmonary Rehabilitation After Treatment for Non-Small Cell Lung Cancer Stages I to IIIa: AN OBSERVATIONAL STUDY Long-term survival after lobectomy for non-small cell lung cancer by video-assisted thoracic surgery versus thoracotomy. An Evidence-Based Approach to the Use of Predictive Biomarkers in the Treatment of Non- Small Cell Lung Cancer (NSCLC) Quality of life and comorbidity score as prognostic determinants in non-small-cell lung cancer patients. Inspiratory muscle training improves respiratory muscle strength, functional capacity and quality of life in patients with chronic kidney disease: a systematic review. Effect of postoperative physical training on activity after curative surgery for non-small cell lung cancer: a multicentre randomised controlled trial. Survival following lobectomy and limited resection for the treatment of stage I non-small cell lung cancer<=1 cm in size: a review of SEER data. Supervised physical exercise to improve the quality of life of cancer patients: the EFICANCER randomised controlled trial Patient‐Reported Outcomes in OAK: A Phase III Study of Atezolizumab Versus Docetaxel in Advanced Non–Small‐cell Lung Cancer A rehabilitation program for lung cancer patients during postthoracotomy chemotherapy Clinical effectiveness of first-line chemoradiation for adult patients with locally advanced non-small cell lung cancer: a systematic review. Rehabilitation for people with multiple sclerosis: an overview of Cochrane Reviews. Ceritinib in ALK-rearranged non-small-cell lung cancer. A five-gene signature and clinical outcome in non-small-cell lung cancer. The lung cancer exercise training study: a randomized trial of aerobic training, resistance training, or both in postsurgical lung cancer patients: rationale and design Safety and feasibility of a combined exercise intervention for inoperable lung cancer patients undergoing chemotherapy: a pilot study.
OBJECTIVES Physical activity has been infrequently measured objective ly in non-small cell lung cancer ( NSCLC ) . We aim ed to investigate levels of physical activity , functional and patient reported outcomes at diagnosis and over six months in participants with recently diagnosed NSCLC and compare results with both physical activity guidelines and outcomes of similar-aged healthy individuals . METHODS This prospect i ve observational study assessed 50 individuals from three Australian tertiary hospitals with stage I-IIIB NSCLC at diagnosis , then 10 weeks and six months later . Thirty five healthy individuals without cancer were assessed once . Outcome measures included  tri-axial accelerometery ( number of steps per day ) , six minute walk distance ( 6MWD ) , muscle strength and question naires including health-related quality of life ( HRQoL ) . RESULTS Individuals with NSCLC were engaged in significantly less physical activity than similar-aged healthy individuals , with 60 % not meeting physical activity guidelines . At diagnosis they had worse quadriceps strength , nutritional status and HRQoL. Over six months , participants with NSCLC experienced decline in self-reported physical activity , 6MWD and muscle strength , and worsening symptoms . CONCLUSION At diagnosis individuals with NSCLC engage in less physical activity , are weaker and more depressed than healthy individuals and their self-reported physical activity declines over six months . Future studies are required to investigate the efficacy of interventions to increase physical activity There have been few longitudinal studies of quality of life in patients with all stages of lung cancer , particularly those that have included measures of utility . The purpose of this study was to examine the psychometric properties of the Assessment of Quality of Life instrument ( AQoL )  in patients with lung cancer . The AQoL is a health-related quality of life question naire and provides a descriptive system for a multi-attribute utility instrument ( MAU ) , so that scores can be used in cost-utility evaluations . In the present study the reliability ( internal consistency ) of the AQoL was examined and the concurrent validity was assessed using the Medical Outcomes 36-item Short Form Health Survey ( SF-36 ) as the comparator instrument . The sensitivity to different health states of the AQoL and the responsiveness to change over time was also examined . A prospect i ve , non-experimental cohort study was undertaken . Ninety-two participants with all stages of lung cancer were recruited from a tertiary multi-disciplinary lung cancer clinic . Ninety participants had non-small cell lung cancer ( NSCLC ) and two had limited stage small cell lung cancer . The  AQOL and SF-36 surveys  were administered concurrently at baseline . In patients with NSCLC the surveys were then repeated 3 and 6 months later . Correlations between the baseline AQoL summary scales and SF-36 summary scales support the divergent and convergent validity of the AQoL.  Reliability was also found to be sufficient ( Cronbach 's Alpha=0.76 ) . In addition , in patients with inoperable NSCLC , baseline AQoL scores were found to be predictive of survival at 6 months in Cox proportional hazards multivariate analysis . However , the physical components summary score of the SF-36 was more sensitive to differences in health states between patients with different stages of NSCLC at 6 months of follow-up and more responsive to change over time in both operable and inoperable patients with NSCLC than the AQoL. The findings support the construct validity and reliability of the  AQoL  in this population . However , there remains some uncertainty about whether the AQoL has sufficient sensitivity to different health states in this population . Further studies using other MAU instruments may determine whether alternative instruments are more sensitive to different health states in individuals with lung cancer Purpose Peak oxygen consumption ( VO2peak ) is an important predictive factor for long-term prognosis in patients with non-small cell lung cancer ( NSCLC ) . The purpose of this study was to investigate whether 8 weeks of exercise training improves exercise capacity , as assessed by VO2peak , and other related factors in patients with NSCLC receiving targeted therapy . Methods A total of 24 participants with adenocarcinoma were r and omly assigned to either the control group ( n = 11 ) or the exercise group ( n = 13 ) . Subjects in the exercise group participated in individualized , high-intensity aerobic interval training of exercise . The outcome measures assessed at baseline and after 8 weeks were as follows : VO2peak and the percentage of predicted VO2peak ( % predVO2peak ) , muscle strength and endurance of the right quadriceps , muscle oxygenation during exercise , insulin resistance as calculated by the homeostasis model , high-sensitivity C-reactive protein , and quality of life ( QoL ) question naire inventory . Results No exercise-related adverse events were reported . After exercise training , VO2peak and % predVO2peak increased by 1.6 mL kg−1 min−1 and 5.3 % ( p < 0.005 ) , respectively ; these changes were associated with improvements in circulatory , respiratory , and muscular functions at peak exercise ( all p = 0.001 ) . The exercise group also had less dyspnea ( p = 0.01 ) and favorably lower fatigue ( p = 0.05 ) than baseline . Conclusions Patients with NSCLC receiving targeted therapy have quite a low exercise capacity , even with a relatively high QoL. Exercise training appears to improve exercise capacity and alleviate some cancer-related symptoms BACKGROUND Lung resection surgery further decreases exercise capacity and negatively affects respiratory muscle function in patients with non-small cell lung cancer ( NSCLC ) . The best design for exercise interventions in these patients has not been determined yet . AIM To assess the impact of aerobic exercise and high-intensity respiratory muscle training on patient outcomes following lung cancer resection surgery . DESIGN Prospect i ve , single-blind , pilot r and omized controlled trial . SETTING Outpatient cardiopulmonary rehabilitation unit of two university hospitals . POPULATION Thirty-seven patients with NSCLC after tumor resection . METHODS Patients were r and omly assigned to exercise training or usual post-operative care . The training program consisted of aerobic exercises and high-intensity respiratory muscle training ( 24 supervised sessions , 3 per week , 8 weeks ) . Primary outcome was exercise capacity assessed with peak oxygen uptake ( VO2peak ) during cardiopulmonary exercise test . Secondary outcomes included changes in respiratory muscle strength , levels of serum insulin growth factor I ( IGF-I ) and IGF binding protein 3 ( IGFBP-3 ) , and quality of life assessed with the European Organization for Research and Treatment of Cancer ( EORTC QLQ-C30 ) question naire . RESULTS The 8-week training program was associated with significant improvement in VO2peak ( 2.13 mL/Kg/min [ 95%CI 0.06 to 4.20 ] ) , maximal inspiratory and expiratory pressures ( 18.96 cmH2O [ 95 % CI 2.7 to 24.1 ] and 18.58 cmH2O [ 95 % CI 4.0 to 33.1 ] , respectively ) and IGFBP-3 ( 0.61 µg/mL [ % 95 CI 0.1 to 1.12 ] ) . No significant differences were observed in the EORTC QLQ-C30 . CONCLUSIONS An 8-week exercise program consisting of aerobic exercise and high-intensity respiratory muscle training improved exercise capacity , respiratory muscle strength , and serum IGFBP-3 levels in NSCLC patients after lung resection . There was no impact on the other outcomes assessed . CLINICAL REHABILITATION IMPACT A combination of aerobic exercise and respiratory muscle training could be included in the rehabilitation program of deconditioned patients with NSCLC after lung resection surgery PURPOSE This study aim ed to evaluate the safety , feasibility , and effects of an 8-wk combined resistance and endurance exercise program in patients with advanced non-small cell lung cancer ( NSCLC ) during in- and outpatient care . METHODS In this intervention study , 40 patients with predominantly advanced NSCLC receiving simultaneous or sequential radiochemotherapy or chemotherapy alone were enrolled . For a period of 8 wk , patients were instructed to exercise at least five times per week during the inpatient setting and at least three times per week in the outpatient setting . Physical performance status ( endurance capacity : 6-min walk test ; strength capacity : h and held dynamometry ) , quality -of-life ( Functional Assessment of Cancer Therapy-Lung ) , fatigue ( Multidimensional Fatigue Inventory ) , and depression ( Patient Health Question naire ) were assessed at baseline ( T0 ) , after the exercise intervention ( T1 ) , and at a follow-up time point 8 wk later ( T2 ) . The primary end point was adequate adherence ( feasibility ) defined as completing at least two training sessions per week during a minimum of 6 wk . RESULTS Of 40 patients , 31 ( 77.5 % ) completed the postexercise assessment ( T1 ) and 22 ( 55 % ) completed follow-up ( T2 ) . The stages were IIA ( 5 % ) , IIIA ( 8 % ) , IIIB ( 20 % ) , and IV ( 67 % ) , and the median age was 63 yr ( range = 22 - 75 yr ) . Overall , adherence was 82 % for those patients who completed T1 , and 55 % of the 40 participating patients fulfilled the adequate adherence criterion . Those who completed the intervention showed a significant improvement in the 6-min walk distance and in knee , elbow , and hip muscle strength after the intervention ( T1 ) . Quality of life , fatigue , and depression scores remained stable or declined slightly . Significant improvements in knee-muscle strength were also observed at T2 . CONCLUSIONS Exercise training is feasible in advanced and metastatic NSCLC patients during anticancer treatment . In this pilot study , endurance and strength capacity improved over time , indicating the rehabilitative importance of the applied intervention . To investigate the potential impact of exercise training in this patient group , a larger r and omized trial is warranted Background There is emerging evidence regarding the efficacy of exercise training to improve exercise capacity for individuals with non-small cell lung cancer ( NSCLC ) .  Cardiopulmonary exercise testing ( CPET ) is the gold st and ard measure of exercise capacity ; however this laboratory test has limitations for use in research and clinical practice . Alternative field walking tests are the six-minute walk test ( 6MWT ) , incremental-shuttle walk test ( ISWT ) and endurance-shuttle walk test ( ESWT ) ; however there is limited information about their clinimetric properties in NSCLC . Aims : In NSCLC to determine the 1 ) criterion validity of the 6MWT , ISWT and ESWT against CPET ; 2 ) construct validity of the 6MWT , ISWT and ESWT against measures of function , strength , respiratory function and health-related quality of life ( HRQoL ) ; and 3 ) clinical applicability of the tests . Methods Twenty participants ( 40 % male , mean ± SD age 66.1 ± 6.5 years ) with stage I-IIIb NSCLC completed the 6MWT , ISWT , ESWT and CPET within six months of treatment . Testing order was r and omised . Additional measures included Eastern Cooperative Oncology Group Performance-Status ( ECOG-PS , function ) , respiratory function , h and -grip dynamometry and HRQoL. Correlations and regression analyses were used to assess relationships . Results The ISWT demonstrated criterion validity with a moderate relationship between ISWT distance and CPET peak oxygen consumption ( r = 0.61 , p = 0.007 ) . Relationships between CPET and six minute walk distance ( 6MWD ) ( r = 0.24 , p = 0.329 ) or ESWT time ( r = 0.02 , p = 0.942 ) were poor . Moderate construct validity existed for the 6MWD and respiratory function ( forced vital capacity % predicted r = 0.53 , p = 0.019 ; forced expiratory volume in the first second % predicted r = 0.55 , p = 0.015 ) . There were no relationships between the walking tests and measures of function , strength or HRQoL. The ESWT had a ceiling effect with 18 % reaching maximum time . No floor effects were seen in the tests . The mean ± SD time required to perform the individual 6MWT , ISWT and ESWT was 12.8 ± 2.5 , 14.7 ± 3.7 and 16.3 ± 5.0 min respectively ; in comparison to CPET which was 51.2 ± 12.7 min . Only one assessor was required to perform all field walking tests and no adverse events occurred . Conclusions The ISWT is a promising measure of functional exercise capacity in lung cancer . Findings need to be confirmed in a larger sample prior to translation into practice Background A reduced exercise capacity is associated with increased morbidity and mortality in patients with advanced non-small cell lung cancer ( NSCLC ) .  Therapeutic exercise can be beneficial and neuromuscular electrical stimulation ( NMES ) of the quadriceps muscles may represent a practical approach . The primary aim of this study was to determine the acceptability of NMES of the quadriceps to patients with NSCLC used alongside palliative chemotherapy .  Secondary aims explored aspects of safety and efficacy of NMES in this setting . Methods Patients with advanced NSCLC due to receive first-line palliative chemotherapy were r and omized to usual care with or without NMES . They were asked to undertake 30 minute sessions of NMES , ideally daily , but as a minimum , three times weekly . For NMES to be considered acceptable , it was predetermined that ≥80 % of patients should achieve this minimum level of adherence . Qualitative interviews were held with a subset of patients to explore factors influencing adherence . Safety was assessed according to the Common Terminology Criteria for Adverse Events . Quadriceps muscle strength , thigh lean mass , and physical activity level were assessed at baseline and after three cycles of chemotherapy . Results 49 patients ( 28 male , median ( IQR ) age 69 ( 64−75 ) years ) participated . Of 30 r and omized to NMES , 18 were eligible for the primary endpoint , of whom 9 ( 50 % [ 90 % CI , 29 to 71 ] ) met the minimum level of adherence . Adherence was enhanced by incorporating sessions into a daily routine and hindered by undesirable effects of chemotherapy . There were no serious adverse events related to NMES , nor significant differences in quadriceps muscle strength , thigh lean mass or physical activity level between groups . Conclusions NMES is not acceptable in this setting , nor was there a suggestion of benefit . The need remains to explore NMES in patients with cancer in other setting s. Trial Registration Current Controlled Trials IS RCT N 42944026 www.controlled-trials.com/IS RCT PURPOSE : Although rehabilitation after treatment for non-small cell lung cancer ( NSCLC ) was found to have a beneficial effect on exercise capacity in a number of studies , insight into its effect on quality of life ( QoL ) and fatigue is limited . The aim of this study was to examine the outcome of pulmonary rehabilitation ( PR ) regarding fatigue , QoL , and exercise capacity in adult patients curatively treated for NSCLC stages I to IIIa . METHODS : Study data were prospect ively and routinely gathered in daily practice in patients taking part in an outpatient PR program after treatment for NSCLC stages I to IIIa . PR consisted of 12 weeks of supervised exercises 3 times a week , supplemented with scheduled visits with members of a multidisciplinary team . Data were gathered at initial assessment and discharge . Outcomes included fatigue ( the Functional Assessment of Cancer Therapy-Fatigue and the fatigue domain of the Chronic Respiratory Disease Question naire ) ; QoL ( total CRQ score ) , Functional Assessment of Cancer Therapy-Lung , and the Short Form 36 ; and exercise capacity ( cardiopulmonary exercise testing ) . RESULTS : Fifty patients started the program out of the 70 patients referred to PR and 43 ( 86 % ) completed the program . Significant ( P ⩽ .01 ) and clinical ly relevant improvements were observed for all outcome measures . CONCLUSIONS : Rehabilitation after treatment for NSCLC stages I to IIIa showed promising improvements regarding patient fatigue , QoL , and exercise capacity . PR should be considered for patients after treatment for NSCLC stages I to IIIa BACKGROUND Video-assisted thoracic surgery ( VATS ) lobectomy for non-small cell lung cancer ( NSCLC ) is increasingly popular . However , the oncologic soundness of VATS for patients with NSCLC as measured by long-term survival has not been proven . The objective here is to determine the overall survival ( OS ) and disease-free survival ( DFS ) in two well-matched groups of patients with NSCLC resected by VATS or thoracotomy .  METHODS We conducted a retrospective review of a prospect i ve data base to identify patients who had a lobectomy for NSCLC . A propensity score-matched analysis was done with variables of age , sex , smoking history , Charlson comorbidity index , forced expiratory volume in 1 second , lung diffusing capacity for carbon monoxide , histology , and clinical T and N status . Medical records were review ed and survival was analyzed . RESULTS After matching , there were 208 patients in each group . Patient and tumor characteristics were similar . The VATS group had a shorter length of stay . More nodes ( 14.3 versus 11.3 ; p=0.001 ) and more nodal stations ( 3.8 versus 3.1 ; p<0.001 ) were removed by thoracotomy . No differences were seen in OS and DFS . Median follow-up was 36 months . More than 90 % of patients had clinical stage I disease , with 3- and 5-year OS of 87.4 % and 76.5 % , respectively , for VATS , and 81.6 % and 77.5 % , respectively , for thoracotomy ( p=0.672 ) . Both the incidence and distribution of recurrence were similar . Multivariate Cox regression analyses of OS and DFS confirmed the noninferiority of VATS . CONCLUSIONS For patients with clinical stage I NSCLC , VATS lobectomy offered similar OS and DFS compared with thoracotomy . Thoracotomy offers a more thorough lymph node evaluation , and may be appropriate for patients with more advanced clinical disease Recent advances in the treatment of non-small cell lung cancer ( NSCLC ) have led to improvements in patient survival and quality of life . It is unclear whether molecular abnormalities associated with NSCLC cell survival , growth and proliferation are useful in predicting treatment benefit . We conducted a systematic review to establish which biomarkers contribute meaningfully to the management of NSCLC . A team of research ers search ed PubMed and conference proceedings ( ASCO , ESMO , IASLC , USCAP ) using MESH terms for NSCLC and r and omized trials ( RCT ) , plus keywords for variables of interest . Evidence from multiple RCTs confirmed that histologic subtype is prognostic for survival and predictive of treatment efficacy and /or toxicity in NSCLC . Likewise , activating mutations of the epidermal growth factor receptor ( EGFR ) are associated with benefit from EGFR tyrosine kinase inhibitors in patients with advanced non-squamous NSCLC and should be assessed routinely . No biomarkers to date reliably predict response to anti-Vascular Endothelial Growth Factor ( VEGF ) therapies . There are inconsistent data on the role of ERCC1 , BRCA , Beta tubulin III , RRM1 , K-RAS , or TP-53 in treatment decisions . These tests should not be routinely used in selecting treatment at this time , whereas EML4/ALK translocations predict responses to specific targeted agents , the optimal assessment of this molecular abnormality has yet to be established . Personalized care of patients with NSCLC based on biomarkers is increasingly important to both clinical practice and research BACKGROUND Both  quality of life ( QoL ) and comorbidity influence therapy and prognosis of non-small-cell lung cancer ( NSCLC ) . We previously developed a lung cancer disease-specific simplified comorbidity score ( SCS ) and demonstrated the prognostic impact of this disease-specific instrument . This study aim ed at validating the SCS in a prospect i ve bicentric NSCLC population by measuring its relative prognostic determinant impact taking into account well-established variables such as QoL , performance status ( PS ) , Charlson comorbidity index ( CCI ) and disease stage . PATIENTS AND METHODS Prognostic values of different pretherapeutic features were tested in univariate and multivariate analyses in a population of 301 NSCLC . RESULTS Median survival was 17 months . One-third of patients reporting difficulties in their normal daily activities and an overall poor QoL. The following pretreament variables were independent determinants of a shorter overall survival : advanced disease , SCS , Lung Cancer Symptoms Scale global symptoms score , anaemia , hyponatremia , serum alkaline phosphatases level , serum CYFRA 21 - 1 and serum neuron-specific enolase . CONCLUSION In this extended validation population , the SCS is more informative than the CCI in predicting NSCLC patient outcome as the former is also more disease specific . Combination of both SCS comorbidity score and LSCC QoL yields a more accurate information that conventional analysis of PS QUESTION Does inspiratory muscle training improve respiratory muscle strength , functional capacity , lung function and quality of life of patients with chronic kidney disease ? Does inspiratory muscle training improve these outcomes more than breathing exercises ? DESIGN Systematic review and meta- analysis of r and omised trials . PARTICIPANTS People with chronic kidney disease undergoing dialysis treatment . OUTCOME MEASURES The primary outcomes were : maximal inspiratory pressure , maximal expiratory pressure , and distance covered on the 6-minute walk test . The secondary outcomes were : forced vital capacity , forced expiratory volume in the first second ( FEV1 ) , and quality of life . RESULTS The search identified four eligible studies . The sample consisted of 110 participants . The inspiratory muscle training used a Threshold ® or PowerBreathe ® device , with a load ranging from 30 to 60 % of the maximal inspiratory pressure and lasting from 6 weeks to 6 months . The studies showed moderate to high risk of bias , and the quality of the evidence was rated low or very low , due to the studies ' method ological limitations . The meta- analysis showed that inspiratory muscle training significantly improved maximal inspiratory pressure ( MD 23 cmH2O , 95 % CI 16 to 29 ) and the 6-minute walk test distance ( MD 80 m , 95 % CI 41 to 119 ) when compared with controls . Significant benefits in lung function and quality of life were also identified . When compared to breathing exercises , significant benefits were identified in maximal expiratory pressure ( MD 6 cmH2O , 95 % CI 2 to 10 ) and FEV1 ( MD 0.24litres 95 % CI 0.14 to 0.34 ) , but not maximal inspiratory pressure or forced vital capacity . CONCLUSION In patients with chronic renal failure on dialysis  , inspiratory muscle training with a fixed load significantly improves respiratory muscle strength , functional capacity , lung function and quality of life . The evidence for these benefits may be influenced by some sources of bias . REGISTRATION PROSPERO ( CRD 42015029986 ) . [ de Medeiros AIC , Fuzari HKB , Rattesa C , Br and ão DC , de Melo Marinho PÉ ( 2017 ) Inspiratory muscle training  improves respiratory muscle strength , functional capacity and quality of life in patients with chronic kidney disease : a systematic review . Journal of Physiotherapy 63 : 76 - 83 ] OBJECTIVE To evaluate the effect of a combined hospital plus home exercise programme following curative surgery for non-small cell lung cancer ( NSCLC ) . DESIGN R and omised controlled trial . SETTING Teaching hospital . PARTICIPANTS One hundred and thirty-one subjects with NSCLC admitted for curative surgery . INTERVENTIONS Participants were r and omised to usual care or a hospital plus home exercise programme . OUTCOMES The primary outcome was the between-group difference in physical activity 4 weeks after surgery . Secondary outcomes were the difference in quadriceps strength , exercise tolerance and quality of life [ Short Form-36 ( SF-36 ) and European Organisation for Research and Treatment of Cancer ( EORTC ) QLQ-LC13 ] from pre-operatively ( baseline ) to 4 weeks after surgery . RESULTS The participants ( n=131 ) had a mean age of 68 [ st and ard deviation ( SD ) 11 ] years and mean forced expiratory volume in 1 second of 2.4 ( SD 1.1)l . There were no significant differences in physical activity between the groups 4 weeks after surgery [ mean difference adjusted for baseline 12minutes/day , 95 % confidence interval ( CI ) -20.2 to 44.1 ] . In addition , there were no significant differences in total SF-36 or EORTC QLQ-LC13 scores from baseline to 4 weeks after surgery . Both groups had recovered their pre-operative walking distance 4 weeks after surgery , and there were no differences between the groups ( mean difference in Incremental Shuttle Walk Test from baseline to 4 weeks after surgery ( -26 m , 95 % CI -94.2 to 42.3 ) . CONCLUSIONS A hospital plus home exercise programme showed little benefit in unselected patients with NSCLC following surgery . Regardless of group allocation , the patients had recovered their pre-operative exercise tolerance levels by 4 weeks after surgery BACKGROUND Although lobectomy is the st and ard treatment for stage I non-small cell lung cancer ( NSCLC ) , recent studies have suggested that limited resection may be a viable alternative for small-sized tumors . The objective of this study was to compare survival after lobectomy and limited resection among patients with stage IA tumors≤1 cm by using a large , US-based cancer registry . METHODS Using the Surveillance , Epidemiology , and End Results ( SEER ) registry , we identified 2,090 patients with stage I NSCLC≤1 cm in size who underwent lobectomy or limited resection ( segmentectomy or wedge resection ) .  We used propensity score analysis to adjust for potential differences in the baseline characteristics of patients in the two treatment groups . Overall and lung cancer-specific survival rates of patients undergoing lobectomy vs limited resection were compared in stratified and adjusted analyses , controlling for propensity scores . RESULTS Overall , 688 ( 33 % ) patients underwent limited resection . For the entire cohort , we were not able to identify a difference in outcomes among patients treated with lobectomy vs limited resection , as demonstrated by an adjusted hazard ratio ( HR ) for overall survival ( 1.12 ; 95 % CI , 0.93 - 1.35 ) and lung cancer-specific survival ( HR , 1.24 ; 95 % CI , 0.95 - 1.61 ) . Similarly , when the cohort was divided into propensity score quintiles , we did not find a difference in survival rate between the two groups . CONCLUSIONS Limited resection and lobectomy may lead to equivalent survival rates among patients with stage I NSCLC tumors≤1 cm in size . If confirmed in prospect i ve studies , limited resection may be preferable for the treatment of small tumors because it may be associated with fewer complications and better postoperative lung function Background The optimal form of exercise for individuals with cancer has yet to be identified , but there is evidence that exercise improves their quality of life . The aim of this study is to assess the efficacy and efficiency of an innovative physical exercise programme , for individuals undergoing chemotherapy for breast , gastrointestinal or non-small cell lung tumours , for improving quality of life , reducing level of fatigue , and enhancing functional capacity over time . Design / Methods We will conduct a clinical trial in 66 patients with stage IV breast , gastrointestinal or non-small cell lung cancer , recruited by the Department of Oncology of the referral hospital from 4 primary care health centres of the Basque Health Service ( Osakidetza ) . These patients will be r and omised to one of two groups . The treatment common to both groups will be the usual care for cancer : optimized usual drug therapies and strengthening of self-care ; in addition , patients in the intervention group will participate in a 2-month exercise programme , including both aerobic and strength exercises , supervised by nurses in their health centre . The principal outcome variable is health-related quality of life , measured blindly with the 30-item European Organization for the Research and Treatment of Cancer Core Quality of Life Question naire and Short Form-36 four times : at baseline , and 2 , 6 and 12 months later . The secondary outcome variables are fatigue ( Functional Assessment of Chronic Illness Therapy-Fatigue question naire ) , functional capacity ( 6-Minute Walk Test and cardiorespiratory test ) , muscle strength ( h and -held dynamometry and sit-to-st and test ) , radiological response to treatment ( Response Evaluation Criteria In Solid Tumors ) and progression-free and overall survival . Age , sex , diagnosis , chemotherapy regimen , Eastern Cooperative Oncology Group performance status and smoking status will be considered as predictive variables . Data will be analysed on an intention-to-treat basis , comparing changes at each time point between groups , adjusting for baseline values by analysis of covariance . Discussion As well as achieving the objectives set , this study will provide us with information on patient perception of the care received and an opportunity to develop a project based on collaborative action between the primary care and oncology professionals . Trial registration Clinical Trials.gov Identifier : NCT01786122 Registration date : 02/05/2013 Micro‐ Abstract : OAK , a phase III advanced non – small‐cell lung cancer ( NSCLC ) trial , compared the investigational drug atezolizumab with the st and ard chemotherapy agent docetaxel . The patient‐reported outcomes data revealed that atezolizumab prolonged the time to the worsening of disease‐related symptoms , such as chest pain , and maintained patients ’ health‐related quality of life . These data further support the use of atezolizumab in the treatment of advanced NSCLC . Background : The r and omized phase III OAK ( a study of atezolizumab compared with docetaxel  in participants with locally advanced or metastatic non – small‐cell lung cancer [ NSCLC ] who have failed platinum‐containing therapy ) trial investigated the anti – programmed cell death lig and 1 ( PD‐L1 ) antibody atezolizumab for advanced or metastatic , previously treated , NSCLC . Atezolizumab significantly improved overall survival ( OS ) compared with docetaxel ( hazard ratio [ HR ] , 0.73 ; 95 % confidence interval [ CI ] , 0.62–0.87 ; P = .0003 ; median OS , 13.8 vs. 9.6 months , respectively ) . Patient‐reported outcomes ( PROs ) were collected to evaluate disease‐related symptoms and health‐related quality of life ( HRQoL ) to support the finding of a survival benefit . Patients and Methods : The first 850 patients were r and omized to receive atezolizumab ( 1200 mg every 3 weeks ) or docetaxel  ( 75 mg/m2 every 3 weeks ) . PROs were collected on day 1 of cycle 1 , day 1 of every subsequent cycle , and at the end‐of‐treatment visit for patients who completed ≥ 1 baseline and 1 postbaseline PRO assessment . The European Organisation for the Research and Treatment of Cancer QoL question naire and lung cancer module were used to assess PROs . Results : Atezolizumab delayed the time to deterioration ( TTD ) in physical function ( HR , 0.75 ; 95 % CI , 0.58–0.98 ) and role function ( HR , 0.79 ; 95 % CI , 0.62–1.00 ) and numerically improved patients ’ HRQoL from baseline compared with docetaxel . Atezolizumab also prolonged the TTD in chest pain ( HR , 0.71 ; 95 % CI , 0.49–1.05 ; P = .0823 ) , although both arms showed an objective reduction relative to baseline . Overall , the patients had no clinical ly significant worsening in treatment‐related symptoms , although the scores favored atezolizumab . Conclusion : These PRO data support the clinical benefit of atezolizumab in patients with previously treated advanced or metastatic NSCLC .  Atezolizumab prolonged the TTD of patients ’ limitations in role and physical functions compared with docetaxel Objective The objective of this pilot study was to describe the effects of a 16-week home-based rehabilitative exercise program on cancer-related fatigue ( CRF ) , other symptoms , functional status , and quality of life ( QOL ) for patients with non-small cell lung cancer ( NSCLC ) after thoracotomy starting within days after hospital discharge and continuing through the initiation and completion of chemotherapy .  Material s and methods Five patients with NSCLC completed the Brief Fatigue Inventory ( measuring CRF severity ) and the MD And erson Symptom Inventory ( measuring symptom severity ) before and after thoractomy , and at the end of each week of the 16-week exercise program . Additionally , the Medical Outcomes Study Short Form-36 ( measuring physical and mental functional status ) and the Quality of Life Index ( measuring QOL ) were completed before and after thoracotomy , after weeks 3 , 6 , 12 , and 16 ( the end of the exercise program ) . Further , the 6-minute walk test  ( measuring functional capacity ) was administered before thoracotomy , prior to the initiation of chemotherapy and /or radiation therapy , and at the end of the 16-week exercise program , after completion of chemotherapy . Results Participants had a mean age of 63 years and a mean of five comorbid conditions ; the exercise program was initiated within 4 days after hospital discharge . Participants ’ CRF severity scores were reduced to mild levels , while the mean number of symptoms decreased from 9 postthoracotomy to 6 after the exercise program , with mean levels of severity and interference decreasing to below prethoracotomy levels . Likewise , participants ’ functional status and QOL after completing the exercise program improved to near or above prethoracotomy levels . Conclusion The home-based , light-intensity exercise program for NSCLC patients receiving and completing adjuvant chemotherapy postthoracotomy showed promising trends in improving CRF severity , other symptom severity , functional status , and QOL . Further testing via a two-arm r and omized controlled trial is being conducted BACKGROUND The National Institute for Health and Clinical Excellence has issued guidelines on the treatment of non-small cell lung cancer ( NSCLC ) and recommends that patients with stage IIIA-IIIB disease who are not amenable to surgery be treated with potentially curative chemoradiation ( CTX-RT ) . This review was conducted as part of a larger systematic review of all first-line chemotherapy ( CTX ) and CTX-RT treatments for patients with locally advanced or metastatic NSCLC . However , it was considered that patients with potentially curable disease ( e.g. stage IIIA ) are different from those with advanced disease , who are suitable for palliative treatment only , and therefore the results should be reported separately . OBJECTIVE To evaluate the clinical effectiveness of first-line CTX in addition to radiotherapy ( RT ) ( CTX-RT vs CTX-RT ) for adult patients with locally advanced NSCLC who are suitable for potentially curative treatment . DATA SOURCES Three electronic data bases ( MEDLINE , EMBASE and The Cochrane Library ) were search ed from January 1990 to September 2010 . REVIEW METHODS Inclusion criteria comprised adult patients with locally advanced NSCLC , trials that compared any first-line CTX-RT therapy ( induction , sequential , concurrent and consolidation ) and outcomes of overall survival ( OS ) and /or progression-free survival ( PFS ) . The results of clinical data extraction and quality assessment were summarised in tables and with narrative description . Direct meta-analyses using OS data were undertaken where possible : sequential CTX-RT compared with concurrent CTX-RT ; sequential CTX-RT compared with concurrent/consolidation CTX-RT ; and sequential CTX-RT compared with concurrent CTX-RT with or without consolidation . There were not sufficient data to perform meta- analysis on PFS . RESULTS Of the 240 potentially relevant studies that were published post 2000 , 19 met the inclusion criteria and compared CTX-RT with CTX-RT . The results from the OS meta- analysis comparing sequential CTX-RT with concurrent CTX-RT appear to show an OS advantage for concurrent CTX-RT arms over sequential arms ; this result is not statistically significant [ hazard ratio ( HR ) 0.79 ; 95 % confidence interval ( CI ) 0.50 to 1.25 ) ] . The results from the OS meta- analysis comparing sequential CTX-RT with concurrent/consolidation CTX-RT appear to show a statistically significant OS advantage for concurrent/consolidation CTX-RT treatment over sequential treatment ( HR 0.68 ; 95 % CI 0.55 to 0.83 ) . The results from the OS meta- analysis comparing sequential CTX-RT with concurrent CTX-RT with or without consolidation appear to show a statistically significant OS advantage for concurrent CTX-RT with or without consolidation over sequential treatment ( HR 0.72 ; 95 % CI 0.61 to 0.84 ) . LIMITATIONS This report provides a summary and critical appraisal of a comprehensive evidence base of CTX-RT trials ; however , it is possible that additional trials have been reported since our last literature search . It is disappointing that the quality of the research in this area does not meet the accepted quality st and ards regarding trial design and reporting . CONCLUSIONS This review identified that the research conducted in the area of CTX-RT was generally of poor quality and suffered from a lack of reporting of all important clinical findings , including OS . The 19 trials included in the systematic review were too disparate to form any conclusions as to the effectiveness of individual CTX agents or types of RT . The focus of primary research should be good method ological quality ; appropriate allocation of concealment and r and omisation , and comprehensive reporting of key outcomes , will enable meaningful synthesis and conclusions to be drawn . FUNDING The National Institute for Health Research Health Technology Assessment programme BACKGROUND Multiple sclerosis ( MS ) is a major cause of chronic , neurological disability , with a significant long-term disability burden , often requiring comprehensive rehabilitation . OBJECTIVES To systematic ally evaluate evidence from published Cochrane Review s of clinical trials to summarise the evidence regarding the effectiveness and safety of rehabilitation interventions for people with MS ( pwMS ) , to improve patient outcomes , and to highlight current gaps in knowledge . METHODS We search ed the Cochrane Data base of Systematic Review s up to December 2017 , to identify Cochrane Review s that assessed the effectiveness of organised rehabilitation interventions for pwMS . Two review ers independently assessed the quality of included review s , using the Revised Assessment of Multiple Systematic Review s ( R-AMSTAR ) tool , and the quality of the evidence for reported outcomes , using the GRADE framework . MAIN RESULTS Overall , we included 15 review s published in the Cochrane Library , comprising 164 r and omised controlled trials ( RCTs ) and four controlled clinical trials , with a total of 10,396 participants . The included review s evaluated a wide range of rehabilitation interventions , including : physical activity and exercise therapy , hyperbaric oxygen therapy ( HBOT ) , whole-body vibration , occupational therapy , cognitive and psychological interventions , nutritional and dietary supplements , vocational rehabilitation , information provision , telerehabilitation , and interventions for the management of spasticity . We assessed all review s to be of high to moderate method ological quality , based on R-AMSTAR criteria .Moderate- quality evidence suggested that physical therapeutic modalities ( exercise and physical activities ) improved functional outcomes ( mobility , muscular strength ) , reduced impairment ( fatigue ) , and improved participation ( quality of life ) . Moderate- quality evidence suggested that inpatient or outpatient multidisciplinary rehabilitation programmes led to longer-term gains at the levels of activity and participation , and interventions that provided information improved patient knowledge . Low-qualitty evidence suggested that neuropsychological interventions , symptom-management programmes ( spasticity ) , whole body vibration , and telerehabilitation improved some patient outcomes . Evidence for other rehabilitation modalities was inconclusive , due to lack of robust studies . AUTHORS ' CONCLUSIONS The evidence suggests that regular specialist evaluation and follow-up to assess the needs of patients with all types of MS for appropriate rehabilitation interventions may be of benefit , although the certainty of evidence varies across the different types of interventions evaluated by the review s. Structured , multidisciplinary rehabilitation programmes and physical therapy ( exercise or physical activities ) can improve functional outcomes ( mobility , muscle strength , aerobic capacity ) , and quality of life . Overall , the evidence for many rehabilitation interventions should be interpreted cautiously , as the majority of included review s did not include data from current studies . More studies , with appropriate design , which report the type and intensity of modalities and their cost-effectiveness are needed to address the current gaps in knowledge BACKGROUND Non-small-cell lung cancer ( NSCLC ) harboring the anaplastic lymphoma kinase gene ( ALK ) rearrangement is sensitive to the ALK inhibitor crizotinib , but resistance invariably develops . Ceritinib ( LDK378 ) is a new ALK inhibitor that has shown greater antitumor potency than crizotinib in pre clinical studies . METHODS In this phase 1 study , we administered oral ceritinib in doses of 50 to 750 mg once daily to patients with advanced cancers harboring genetic alterations in ALK . In an expansion phase of the study , patients received the maximum tolerated dose . Patients were assessed to determine the safety , pharmacokinetic properties , and antitumor activity of ceritinib . Tumor biopsies were performed before ceritinib treatment to identify resistance mutations in ALK in a group of patients with NSCLC who had had disease progression during treatment with crizotinib .  RESULTS A total of 59 patients were enrolled in the dose-escalation phase . The maximum tolerated dose of ceritinib was 750 mg once daily ; dose-limiting toxic events included diarrhea , vomiting , dehydration , elevated aminotransferase levels , and hypophosphatemia . This phase was followed by an expansion phase , in which an additional 71 patients were treated , for a total of 130 patients overall . Among 114 patients with NSCLC who received at least 400 mg of ceritinib per day , the overall response rate was 58 % ( 95 % confidence interval [ CI ] , 48 to 67 ) . Among 80 patients who had received crizotinib  previously , the response rate was 56 % ( 95 % CI , 45 to 67 ) . Responses were observed in patients with various resistance mutations in ALK and in patients without detectable mutations . Among patients with NSCLC who received at least 400 mg of ceritinib per day , the median progression-free survival was 7.0 months ( 95 % CI , 5.6 to 9.5 ) . CONCLUSIONS Ceritinib was highly active in patients with advanced , ALK-rearranged NSCLC , including those who had had disease progression during crizotinib treatment , regardless of the presence of resistance mutations in ALK . ( Funded by Novartis Pharmaceuticals and others ; Clinical Trials.gov number , NCT01283516 . ) BACKGROUND Current staging methods are inadequate for predicting the outcome of treatment of non-small-cell lung cancer ( NSCLC ) . We developed a five-gene signature that is closely associated with survival of patients with NSCLC . METHODS We used computer-generated r and om numbers to assign 185 frozen specimens for microarray analysis , real-time reverse-transcriptase polymerase chain reaction ( RT-PCR ) analysis , or both . We studied gene expression in  frozen specimens of lung-cancer tissue from 125 r and omly selected patients who had undergone surgical resection of NSCLC and evaluated the association between the level of expression and survival . We used risk scores and decision-tree analysis to develop a gene-expression model for the prediction of the outcome of treatment of NSCLC . For validation , we used r and omly assigned specimens from 60 other patients . RESULTS Sixteen genes that correlated with survival among patients with NSCLC were identified by analyzing microarray data and risk scores . We selected five genes ( DUSP6 , MMD , STAT1 , ERBB3 , and LCK ) for RT-PCR and decision-tree analysis . The five-gene signature was an independent predictor of relapse-free and overall survival . We vali date d the model with data from an independent cohort of 60 patients with NSCLC and with a set of published microarray data from 86 patients with NSCLC . CONCLUSIONS Our five-gene signature is closely associated with relapse-free and overall survival among patients with NSCLC Background The Lung Cancer Exercise Training Study ( LUNGEVITY ) is a r and omized trial to investigate the efficacy of different types of exercise training on cardiorespiratory fitness ( VO2peak ) , patient-reported outcomes , and the organ components that govern VO2peak in post-operative non-small cell lung cancer ( NSCLC ) patients . Methods / Design Using a single-center , r and omized design , 160 subjects ( 40 patients / study arm ) with histologically confirmed stage I-IIIA NSCLC following curative-intent complete surgical resection at Duke University Medical Center ( DUMC ) will be potentially eligible for this trial . Following baseline assessment s , eligible participants will be r and omly assigned to one of four conditions : ( 1 ) aerobic training alone , ( 2 ) resistance training alone , ( 3 ) the combination of aerobic and resistance training , or ( 4 ) attention-control ( progressive stretching ) . The ultimate goal for all exercise training groups will be 3 supervised exercise sessions per week an intensity above 70 % of the individually determined VO2peak for aerobic training and an intensity between 60 and 80 % of one-repetition maximum for resistance training , for 30 - 45 minutes/session . Progressive stretching will be matched to the exercise groups in terms of program length ( i.e. , 16 weeks ) , social interaction ( participants will receive one-on-one instruction ) , and duration ( 30 - 45 mins/session ) . The primary study endpoint is VO2peak . Secondary endpoints include : patient-reported outcomes ( PROs ) ( e.g. , quality of life , fatigue , depression , etc . ) and organ components of the oxygen cascade ( i.e. , pulmonary function , cardiac function , skeletal muscle function ) . All endpoints will be assessed at baseline and postintervention ( 16 weeks ) . Sub studies will include genetic studies regarding individual responses to an exercise stimulus , theoretical determinants of exercise adherence , examination of the psychological mediators of the exercise - PRO relationship , and exercise-induced changes in gene expression . Discussion VO2peak is becoming increasingly recognized as an outcome of major importance in NSCLC . LUNGEVITY will identify the optimal form of exercise training for NSCLC survivors as well as provide insight into the physiological mechanisms underlying this effect . Overall , this study will contribute to the establishment of clinical exercise therapy rehabilitation guidelines for patients across the entire NSCLC continuum . Trial Registration AIM To investigate the safety and feasibility of a six-week supervised structured exercise and relaxation training programme on estimated peak oxygen consumption , muscle strength and health related quality of life ( HRHRQOL ) in patients with inoperable lung cancer , undergoing chemotherapy . METHODS A prospect i ve , single-arm intervention study of supervised , hospital based muscle and cardiovascular group training and individual home-based training . Peak oxygen consumption ( VO(2peak ) ) was assessed using an incremental exercise test . Muscle strength was measured with one repetition maximum test ( 1RM ) . HRQOL was assessed using the Functional Assessment of Cancer Therapy-Lung ( FACT-L ) scale . RESULTS Twenty-five patients with non-small cell cancer ( NSCLC ) stage III-IV and four patients with extensive disease small cell lung cancer ( SCLC-ED ) were recruited . Six patients ( 20.7 % ) dropped out leaving 23 patients for analysis .  Exercise adherence in the group training was 73.0 % and 8.7 % in the home-based training . There were improvements in estimated VO(2peak ) and six-minute walk distance ( 6 MWD ) as well as increased muscle strength measurements ( p<0.05 ) . There was significant improvement in the " emotional well-being " parameter ( FACT-L ) while there were no significant changes in HRQOL . CONCLUSION Exercise training produces significant improvements in physiological indices and emotional HRQOL and is safe and feasible in patients with advanced stage lung cancer , undergoing chemotherapy .  No analysis on home-based training was done because of low adherence
Criterion validity for three of these measures was established in NSCLC but not the reliability or responsiveness .
Background The measurement properties of instruments used to assess functional capacity , physical activity and muscle strength in participants with non-small cell lung cancer ( NSCLC ) have not been systematic ally review ed .
Method Objectives : To identify outcome measures used to assess these outcomes in participants with NSCLC ; and to evaluate , synthesis e and compare the measurement properties of the outcome measures identified .