IMPAIRMENT OF THE FUNCTIONAL CAPACITY OF PATIENTS WITH ADVANCED LUNG CANCER: A PROPOSAL FOR PRACTICING PHYSICAL EXERCISES AT HOME

Abstract

Introduction/Justification: Lung cancer (LC) is a disease with high incidence, morbidity, and mortality in Brazil and around the world. Smoking plays a relevant role in the pathogenesis of CP. LC and tobacco limit lung mechanics and, consequently, gas exchange, leading to dyspnea and fatigue. The association of these symptoms with loss of weight and muscle mass secondary to protein catabolism, comorbidities and the effects of treatment limit the functional capacity of patients with LC. In turn, the reduction in patients' functional capacity favors the adoption of a sedentary lifestyle, resulting in a reduction in quality of life. Outpatient and home physical exercise protocols based on functional capacity have been successfully applied to LC patients from developed countries, but not to patients from developing countries. Objectives: The present study aimed to evaluate the functional capacity of patients with advanced stage LC at the Pneumology outpatient clinic of the General Hospital of the University of Campinas and propose a program of comfort measures and home physical exercises. Materials and Methods: The study was a cross-sectional clinical trial, approved by the Local Ethics Committee. Patients with stage III or IV non-small cell lung cancer (NSCLC), with ECOG less or equal to 2, without significant morbidities, and seen at diagnosis at the General Hospital of University of Campinas were invited to participate in the study. Patients previously treated by surgical tumor resection, chemo and/or radiotherapy or who did not want to participate in the study were excluded. Data relating to the clinical aspects of patients and pathological aspects of the tumor were obtained from medical records by the researcher responsible for the study. The functional capacity of the patients was assessed using of the six-minute walk test (6MWT) and lung function by spirometry. Comparison between groups was performed using the Mann-Whitney or Kruskal-Wallis's test. The association between categorical variables was assessed using Fisher's exact test. The linear regression test was used for multivariate analyses. Results: Sixty-three patients with a mean age of 65 years and a mean body mass index (BMI) of 24.4 kg/m2 were enrolled in the study. Most patients were smokers or ex-smokers. Systemic arterial hypertension and chronic obstructive pulmonary disease were the most common comorbidities, identified in near half and a quarter of the sample, respectively. Almost 60% of the patients reported pain before the test and were medicated with analgesics before the start of the 6MWT. The patients had an average distance covered of 362.9 meters, 30% lower than the distance predicted (p < 0.0001). Forced vital capacity, forced expiratory volume in the first second and peak expiratory flow were also lower than predicted values (p < 0.05) and were indicative of ventilatory disorders. Habits, clinical and pathological aspects, such as smoking, patient's clinical condition, pain intensity, pre-existing comorbidities and tumor stage influenced the patients' functional capacity. Conclusion: Our patients with advanced NSCLC had a less satisfactory functional capacity than patients from developed countries. Therefore, we have created a booklet with comfort measures and recommendations for practicing physical exercises at home adapted to them. Acknowledgements: Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES).

Keywords

• Comfort measures
• Home physical exercises
• Lung cancer