Preoperative Respiratory Muscle Training to Prevent Postoperative Pulmonary Complications in Patients Undergoing Resection for Lung Cancer

术前呼吸肌训练预防肺癌切除患者术后肺部并发症

• 批准号: 10475188
• 负责人: Andrew Donald Ray
• 金额: $ 61.05万
• 依托单位: ROSWELL PARK CANCER INSTITUTE CORP
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-17 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10475188
• 关键词: Activities of Daily Living; Advanced Malignant Neoplasm; Aerobic; Atrophic; Biological; Biological Markers; Biology; Biopsy; Bypass; Cancer Patient; Cancer Survivor; Cardiopulmonary; Cardiopulmonary rehabilitation; Clinical; Complication; Continuity of Patient Care; Cost Savings; Data; Disease; Dyspnea; Evidence based program; Excision; Exercise; Forced expiratory volume function; Functional disorder; Gene Expression; Genomics; Goals; Habilitation; Health; Health Care Costs; Home; Hospitals; Impairment; Institutes; Insurance Carriers; Intervention; Intubation; Length of Stay; Lung; Malignant neoplasm of abdomen; Malignant neoplasm of esophagus; Malignant neoplasm of lung; Measures; Medical Care Costs; Medicare; Morbidity - disease rate; Muscle; Muscle Weakness; Muscle function; Neoadjuvant Therapy; Non-Small-Cell Lung Carcinoma; Operative Surgical Procedures; Outcome; Outpatients; Oxygen; Pathway interactions; Patients; Performance; Physical Function; Physical Rehabilitation; Pneumonia; Postoperative Complications; Postoperative Period; Proteins; Public Health; Pulmonary Function Test/Forced Expiratory Volume 1; Quality of life; Randomized Controlled Trials; Recovery; Rehabilitation Centers; Rehabilitation therapy; Research; Research Personnel; Resources; Respiratory Diaphragm; Respiratory Muscles; Risk; Running; Sample Size; Schedule; Secondary to; Services; Site; Stroke Volume; Structure; Subgroup; Supervision; Support System; Surgical complication; Survival Rate; Testing; Thoracic Surgical Procedures; Time; Training; Training Programs; United States National Institutes of Health; Visit; anxious; base; billing data; cancer recurrence; cancer rehabilitation; cancer surgery; chemotherapy; cohort; cost; cost effective intervention; cost effectiveness; cost-effectiveness evaluation; design; exercise capacity; exercise program; experience; health care delivery; high risk; improved; innovation; lung health; mortality; multimodality; muscle strength; novel; payment; prevent; programs; pulmonary function; readmission rates; rehabilitation service; responders and non-responders; sound; standard of care; surgical service; treatment as usual; treatment choice

PROJECT SUMMARY/ABSTRACT Surgical resection for stage I-III lung cancer is the treatment of choice and provides the highest rate of survival. Although surgery offers a potential cure, postoperative complications such as pneumonia, dyspnea, and reduced physical functioning are common and contribute to medical costs, reduced quality of life, length of stay, 30-day readmission rate, cancer recurrence, and mortality. Improving preoperative pulmonary health and aerobic capacity improves postoperative morbidity and mortality. However, preoperative exercise studies require a longer period of time (4-6 weeks) than is clinically available to demonstrate an impact, making them non-feasible for patients awaiting lung resection surgery. These programs also require multiple supervised visits/week, rigorous exercise, posing a strain on the social support system not available for most patients. In other disease sites, a 2-4 week respiratory muscle training (RMT) program performed prior to bypass, abdominal and esophageal cancer surgeries reduces postoperative complications. In lung cancer, respiratory muscle weakness (diaphragm) is associated with reduced exercise capacity and survival as well as increased surgical complications up to two years post-thoracic surgery. Therefore, interventions targeting respiratory muscle function prior to lung resection represent a more practical solution to prevent postoperative complications. RMT will also increase the number of surgically eligible patients as well as expedite recovery, reducing risk of long- term consequences in this high-risk cohort. Our long-term goal is to have a better understanding of biomarkers that will predict postoperative complications and quality of life in lung cancer survivors. The overall objective of this application is to determine how a home-based program designed around strengthening the respiratory muscles will improve postoperative health. This project will also study mechanisms contributing to respiratory muscle dysfunction as well as examine the financial sustainability of a prehabilitation program. The central hypothesis is that preoperative respiratory muscle weakness contributes to negative postoperative complications and RMT will mitigate these effects. The following specific aims will be tested: 1) Assess the impact of a preoperative RMT program on respiratory muscle strength, postoperative outcomes and quality of life compared to a usual care group; 2) Determine the extent of diaphragm anabolic/catabolic pathway activation between the RMT and standard of care group; and 3) Determine the financial sustainability of a transitional home-based program. In our opinion, this program is innovative because it will deliver prehabilitation services to advance the cancer care continuum in a group of patient who may not have received services due to the shortened period. It will quantify the direct effects of RMT and lung cancer on diaphragm structure and function, thus developing new biomarkers to predict postoperative complications. Finally, it will maximize preoperative cardiorespiratory performance and postoperative outcomes in the brief 2-4-weeks prior to surgery. The proposed research is significant because it will advance the delivery of rehabilitation services for surgically eligible cancer patients.

项目总结/文摘

项目成果

Effects of Preoperative Breathing Exercise on Postoperative Outcomes for Patients With Lung Cancer Undergoing Curative Intent Lung Resection: A Meta-analysis.

• DOI: 10.1016/j.apmr.2021.03.028
• 发表时间: 2021-12
• 期刊: ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION
• 影响因子: 4.3
• 作者: Pu, Chan Yeu;Batarseh, Hanan;Zafron, Michelle L.;Mador, M. Jeffery;Yendamuri, Sai;Ray, Andrew D.
• 通讯作者: Ray, Andrew D.