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: 10249221
• 负责人: Andrew Donald Ray
• 金额: $ 62.3万
• 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 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10249221
• 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; 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/摘要 手术切除I-III期肺癌是治疗的选择，并提供最高的生存率。 虽然手术提供了一个潜在的治愈，术后并发症，如肺炎，呼吸困难，并减少 身体功能是常见的，并有助于医疗费用，降低生活质量，住院时间，30天 再入院率、癌症复发率和死亡率。改善术前肺部健康和有氧运动 提高了术后发病率和死亡率。然而，术前运动研究需要 比临床上可用于证明影响的时间更长（4-6周），使其不可行 等待肺切除手术的患者。这些项目还需要每周多次监督访问， 剧烈的运动，对大多数患者无法获得的社会支持系统造成压力。其他疾病 研究中心，在旁路手术前进行2-4周呼吸肌训练（RMT）计划，腹部和 食管癌手术减少术后并发症。在肺癌中，呼吸肌无力 （横膈膜）与运动能力和存活率降低以及手术次数增加有关。 胸外科手术后两年的并发症。因此，针对呼吸肌的干预措施 肺切除术前功能恢复是预防术后并发症的更实用的解决方案。RMT 这也将增加符合手术条件的患者数量，并加快康复，降低长期 在这一高风险队列中的长期后果。我们的长期目标是更好地了解生物标志物 预测肺癌幸存者的术后并发症和生活质量。的总体目标 这个应用程序是为了确定如何以家庭为基础的计划设计围绕加强呼吸 肌肉将改善术后健康。该项目还将研究有助于呼吸的机制。 肌肉功能障碍，以及检查财务可持续性的一个prehistorical计划。中央 假设术前呼吸肌无力导致阴性术后并发症 而RMT将减轻这些影响。将对以下具体目标进行测试：1）评估 术前RMT方案对呼吸肌肌力、术后疗效及生活质量的影响比较 2）确定横膈膜合成代谢/分解代谢途径激活的程度， RMT和标准护理组;以及3）确定过渡性家庭为基础的财务可持续性 程序.在我们看来，这一计划是创新的，因为它将提供优先服务，以促进 癌症护理连续性的一组病人谁可能没有得到服务，由于缩短时间。它 将量化RMT和肺癌对膈肌结构和功能的直接影响，从而开发新的 生物标志物来预测术后并发症。最后，它将最大限度地提高术前心肺 在手术前2-4周内的性能和术后结局。拟议的研究是 意义重大，因为它将促进为符合手术条件的癌症患者提供康复服务。