ORIGINAL ARTICLE   Free access

European Journal of Physical and Rehabilitation Medicine 2021 December;57(6):1002-11

DOI: 10.23736/S1973-9087.21.06789-7

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Rehabilitation for lung cancer patients undergoing surgery: results of the PUREAIR randomized trial

Sara TENCONI ¹, Carlotta MAININI ² ✉, Cristian RAPICETTA ¹, Luca BRAGLIA ³, Carla GALEONE ⁴, Silvio CAVUTO ³, Domenico F. MERLO ³, Stefania COSTI ^{5, 6}, Massimiliano PACI ¹, Roberto PIRO ⁴, Stefania FUGAZZARO ²

¹ Unit of Thoracic Surgery, AUSL Reggio Emilia, Reggio Emilia, Italy; ² Unit of Physical Medicine and Rehabilitation, AUSL Reggio Emilia, Reggio Emilia, Italy; ³ Unit of Research and Statistic Infrastructure, AUSL Reggio Emilia, Reggio Emilia, Italy; ⁴ Unit of Pulmonology, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy; ⁵ Department of Surgery, Medicine, Dentistry and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy; ⁶ Scientific Directorate, AUSL Reggio Emilia, Reggio Emilia, Italy

BACKGROUND: Surgery for non-small cell lung cancer is proven to be the most effective treatment in early stages, although concerns exist on its negative impact on patients’ overall fitness.
AIM: To establish whether intensive pulmonary rehabilitation, preoperative and postoperative, improves exercise capacity in patients undergoing lung resection.
DESIGN: Single center, unblinded, designed for superiority, 1:1 randomized controlled trial with two parallel arms.
SETTING: S. Maria Nuova Hospital of Reggio Emilia (Reggio Emilia, Italy).
POPULATION: Patients referred from local lung cancer multidisciplinary team for lung resection.
METHODS: Patients were randomized to either standard of care (SC) or SC + intensive perioperative pulmonary rehabilitation (SC+PR). The primary aim was to investigate the effectiveness of pulmonary rehabilitation in improving exercise capacity six months after surgery. Additionally, we wanted to investigate the same effect shortly after surgery (at one month), as well as the overall impact of rehabilitation on lung function, postoperative complications and length of stay, quality of life, mood disturbances and pain. Sample was sized based on the primary outcome assuming a minimal clinically significant difference of 25 meters in exercise tolerance, measured with 6 minutes walking test.
RESULTS: The exercise tolerance at 6 months after surgery was significantly higher in patients undertaking PR compared to SC (+48.9 meters vs. -7.5 meters respectively, difference: +56.4 meters, 95% CI: 29.6-83.0, P<0.001) and it showed significantly lower impairment at 1 month after surgery in the intervention group (-3.0 meters vs. -30.1 meters difference: +27.1 meters, 95% CI: 3.4-50.8, P=0.025). No other significant differences between groups were found.
CONCLUSIONS: Comparison between groups showed that pulmonary rehabilitation, administered pre and postoperatively, significantly improved exercise capacity at 6 months in patients undergoing lung resection; it also significantly reduced the decrease in exercise tolerance observed 1 month after surgery.
CLINICAL REHABILITATION IMPACT: The PUREAIR trial highlights the importance of combined preoperative and postoperative rehabilitation in reducing physical deconditioning in lung cancer patients undergoing surgery. Comprehensive pulmonary rehabilitation improves exercise capacity at 1 and 6 months after surgery. The PUREAIR trial results increase knowledge on comprehensive rehabilitation’s outcomes in the first six months after surgery.

KEY WORDS: Rehabilitation; Lung neoplasms; Exercise therapy; Patient education as topic; Breathing exercises