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. 2024 May 31;16(5):2776-2789.
doi: 10.21037/jtd-23-1929. Epub 2024 May 10.

Multimodal prehabilitation in patients with non-small cell lung cancer: a feasibility study

David W G Ten Cate  1   2 , Rosaline van den Berg  3 , Maaike Scholten-Bakker  4 , Charlotte J L Molenaar  1 , Erik M von Meyenfeldt  5 , Gerrit D Slooter  1 , Frank J C van den Broek  1 , Geertruid M H Marres  5
Affiliations

Multimodal prehabilitation in patients with non-small cell lung cancer: a feasibility study

David W G Ten Cate et al. J Thorac Dis. .

Abstract

Background: Anatomic pulmonary resection is the preferred curative treatment in operable non-small cell lung cancer (NSCLC) but is associated with postoperative complications and inevitable compromise in functional capacity. Preoperative enhancement of functional capacity can be achieved with prehabilitation, yet the window of opportunity in NSCLC patients is small because patients are required to undergo surgery within 3 weeks from diagnosis. The goal of this study was to assess the feasibility of a prehabilitation programme in NSCLC within a 3-week timeframe and its effect on functional capacity-although the study was not powered to confirm improvements in functional capacity.

Methods: Prehabilitation consisted of six interventions: exercise programme, nutritional support, mental support, smoking cessation, patient empowerment, and optimisation of respiratory status and was executed in two large teaching hospitals in the Netherlands. Assessments were scheduled at baseline (T0), end of program preoperatively (T1), and 6 weeks postoperatively (T2). Feasibility was defined as ≥80% of participants completing ≥80% of the programme. Functional capacity [6-minute walk test (6MWT), steep ramp test (SRT), one repetition maximum (1RM), maximal inspiratory pressure (MIP), and hand grip strength (HGS)] was evaluated on T1 and T2 compared to T0 using mixed model analyses.

Results: In total, 24 patients were included. In 95.8% of patients, the program proved feasible and preoperative functional capacity significantly improved in all pre-specified tests on T1. 1RM sustained improved at T2.

Conclusions: Multimodal prehabilitation for lung surgery is feasible within a timeframe of 3 weeks. Even though this study was not powered to confirm it, prehabilitation may improve preoperative functional capacity.

Keywords: Prehabilitation; feasibility; functional capacity; lung surgery.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-23-1929/coif). M.S.B. received stipendium, speerpuntengelden from the Albert Schweitzer ziekenhuis. E.M.v.M. received speaker fees and financial support for the Organization of Educational Events from Johnson & Johnson. G.M.H.M. received the stipendium from the Albert Schweitzer Hospital Fund. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flowchart on the screening process. NSCLC, non-small cell lung cancer; ASz, Albert Schweitzer Hospital; MMC, Maxima Medical Centre; COVID, coronavirus disease.
Figure 2
Figure 2
Change in functional capacity in patients participating in a prehabilitation programme prior to NSCLC. Differences between time points per functional capacity test. (A) SRT (W); (B) 6MWT (m); (C) MIP (cmH2O); (D) HGS (kg); (E) 1RM LP (kg); (F) 1RM LR (kg); (G) 1RM LPD (kg); (H) 1RM CP (kg). *, P<0.001; **, P<0.05. Light grey: T0; dark grey: T1; gray: T2. X-axis: three different timepoints (T0, T1, T2); Y-axis: outcome of specific test. T0: baseline; T1: end of program preoperatively; T2: 6 weeks postoperatively. NSCLC, non-small cell lung cancer; SRT, steep ramp test; 6MWT, 6-minute walk test; MIP, maximal inspiratory pressure; HGS, hand grip strength; 1RM, one repetition maximum; LP, leg press; LR, low row; LPD, lateral pull down; CP, chest press.
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