Resiliency among older adults receiving lung cancer treatment (ROAR-LCT): A novel supportive care intervention for older adults with advanced lung cancer

Abstract

Introduction: Novel supportive care interventions designed for an aging population with lung cancer are urgently needed. We aimed to determine the feasibility of a novel supportive care physical therapy (PT) plus progressive muscle relaxation (PMR) intervention delivered to older adults with advanced lung cancer in the United States (US).

Materials and methods: This clinical trial, Resiliency Among Older Adults Receiving Lung Cancer Treatment (ROAR-LCT: NCT04229381), recruited adults aged ≥60 years with unresectable stage III/IV non-small cell (NSCLC) or small cell lung cancer (SCLC) receiving cancer treatment at The James Thoracic Oncology Center (planned enrollment, N = 20). There were no exclusion criteria pertaining to performance status, laboratory values, prior cancer diagnoses, comorbidities, or brain metastases. Participants were evaluated by PT and psychology and given an exercise pedaler, resistance bands, a relaxation voice recording, and instructions at study initiation. Participants were evaluated in-person by PTs and psychologists at the start and end of the 12-session intervention, with the intervening sessions conducted via virtual health. Participants completed self-reported measures of functional status, symptoms, and mood longitudinally with the following instruments: EQ-5D-5L, Patient Health Questionnaire-9, and General Anxiety Disorder-7. PT assessments included the Short Physical Performance Battery (SPPB) and the two-minute walk test. Feasibility was defined as at least 60% of participants completing at least 70% of all intervention sessions. Optional gut microbiome samples and activity monitoring data (ActiGraph®) were also collected.

Results: The ROAR-LCT study concluded after consenting 22 patients. Among the 22 consented, 18 (81.8%) started the intervention; 11 participants (61.1%) completed at least 70% of all study sessions. All participants with SCLC completed the intervention. Reasons for withdrawal included progression of disease or hospitalization. The majority (88.9%) of patients who started were able to complete at least one virtual health session. Participants' functional status, SPPB, depression, and anxiety scores were stable from pre- to post-intervention. Participants who withdrew had worse baseline scores across domains. Seven microbiome and six ActiGraph® samples were collected.

Discussion: This is one of the first PT + PMR supportive care interventions using virtual health among older adults with advanced lung cancer to achieve feasibility in the US.

Keywords: Functional resiliency; Functional status; Lung cancer; Older adults; Physical therapy; Progressive muscle relaxation; Supportive care intervention.

Figure 1:. Study Schema

Abbreviations: VH – virtual health visit; PMR – progressive muscle relaxation; SPPB – Short Physical Performance Battery; QoL – quality of life

Figure 2:. CONSORT Diagram

Abbreviations: ROAR-LCT--Resiliency Among Older Adults Receiving-Lung Cancer Treatment *No longer ineligible = participant received home health physical therapy referral while inpatient that took precedent to the ROAR intervention.

Figure 3:. Summary Timeline for Each Participant of the ROAR-LCT Intervention Pilot Trial (N= 18)*

*Successful recruitment and implementation of longitudinal physical activity measurements, gut microbiome, and accelerometer-based activity tracking demonstrate the feasibility of implementing an exercise intervention in the Thoracic Oncology Clinic. In total, 18 patients received a variety of treatments and participated in primarily telehealth-based study visit interventions.