You Want Me to Do What?

Exercise Benefits Lung Cancer Patients, Study Shows

A typical patient of Vickie Shannon, M.D., is on oxygen and confined to a wheelchair. Often a family member is there, too, to offer information.

"'Mom can't walk from here to the bathroom. She struggles to get out of bed,'" is a common theme of these family members, according to Shannon.

"'She doesn't go to the store anymore. She's not cooking. She's not doing any kind of cleaning,' they say."

Shannon, a professor in the Department of Pulmonary Medicine, listens carefully and takes notes. When she suggests putting the patient in rehab -- which includes some exercise -- she gets startled looks.

"You want her to do what? Have you listened to a word I've said?"

According to Shannon, much is now known about the pulmonary rehabilitation of patients with chronic obstructive pulmonary disease (COPD).

Still in question is whether patients with COPD and cancer, or cancer patients who may have lung disease due to other causes, benefit from pulmonary rehabilitation during their treatments.

Old school of thought
Shannon says physicians used to believe that they couldn't rehab patients during their treatment.

To test this, Shannon initiated a study of 361 patients with moderate-to-severe COPD who'd undergone nonsurgical treatment for lung cancer.

"Patients getting cancer therapy for solid tumors typically have fewer toxic side effects to their treatment regimens," she says. They tolerate exercise better than the patient who is being treated with immunosuppressive therapy and/or stem cell transplantation for hematologic malignancies. That's why we looked at that group of patients. "

Timing is everything
Another important question, she says, is when to begin rehabilitation.

"In cancer patients, you have to finesse their rehabilitation program around their cancer treatment," Shannon says. "Many of them are just too debilitated, or so it was thought, to undergo pulmonary rehabilitation while getting cancer treatment."

The group was split, with 132 patients receiving pulmonary rehabilitation during cancer treatment; the other 229 patients underwent pulmonary rehabilitation after completing their cancer therapy.

During the 12-week program, patients worked one-on-one with an occupational therapist and a physical therapist for 1 1/2 hours, three times a week.

"Initially, the patient sees me, or one of the other pulmonologists, for a baseline evaluation that includes exercise physiology testing, a six-minute walk examination, and pulmonary function studies," Shannon explains.

"After getting an idea of what they're capable of, we set up a program based on what the test results showed."

Results showed that patients undergoing pulmonary rehabilitation during their cancer treatment overwhelmingly did better than those in which pulmonary rehabilitation was started six months or more after completion of their cancer therapy.  

"It's hard to swallow the pill initially," Shannon says with a chuckle, "but it makes a huge difference and it doesn't take months for improvement to occur. Often you see some improvement in a matter of weeks."

Only those who completed the program were included in the assessment. Some participants dropped out because they received more toxic treatment.

'Butt out' smoking
Most patients had stopped smoking before undergoing cancer treatment and pulmonary rehabilitation, Shannon says. Those who hadn't were enrolled in MD Anderson's Tobacco Cessation Program.

"Most patients who are interested in pulmonary rehabilitation really are interested in stopping the smoking habit," she says.

Shannon says that pulmonary rehabilitation is a growing practice in the management of MD Anderson's patients with shortness of breath due to chronic respiratory illness.

"If you can't breathe, getting out of bed is like climbing Mount Everest," she says. "When patients can easily get out of bed and take a shower within the first couple of weeks of rehab, they want to stick with it."

Of course, Shannon says, there are dropouts --patients who never come, or who come once or twice and don't return.

"But once patients see the benefits of the program," she says, "we have to make them leave.

"After all, the whole purpose of cancer care is not only to treat and cure the cancer,  but to restore patients to their fullest physical function after cancer treatment."