Pulmonary rehabilitation before lung cancer resection.

描述（由申请人提供）：本K23提案的目的是培养候选人成为独立研究者，能够设计，实施和获得高质量临床试验的资金，这些临床试验侧重于测量和改善慢性阻塞性肺疾病（COPD）和肺癌患者的结局和护理质量。 在拟议的研究期间，职业发展活动将包括（1）一对一的指导，（2）研究项目的开发和实施，（3）研究结果的演示和出版，以及（4）导致流行病学硕士学位的课程工作。 候选人提出了一个研究项目，该项目将重点展示一种新的方法，用于减少肺癌切除术后的肺部并发症和住院时间，这是发病率和死亡率的主要原因。 降低术后肺部并发症（PPC）的发生率将使更多的患者能够安全地接受手术并从手术中恢复，这是目前最有效的肺癌治疗方法。 目前，唯一能降低术后肺部并发症发生率的干预措施是戒烟。 肺切除术后肺部并发症的独立预测因子均为COPD的后果。 80%的肺癌患者患有COPD。 肺康复（PR）已被证明可有效减少COPD的症状、加重和住院时间。 该K奖的研究提案和具体目标包括一项随机对照试验（运动与常规护理），该试验将检查术前4周的上肢和下肢耐力训练对COPD和中度至高度手术风险患者肺癌切除术后肺部并发症和住院时间的影响。 出院后三个月将评估功能能力。 据推测，与常规护理相比，4周的术前运动训练将（1）减少住院天数，（2）导致重症监护和呼吸机天数显著减少，（3）降低主要术后肺部并发症的发生率，包括肺炎、呼吸衰竭、机械通气延长、肺不张，以及（4）改善恢复到活跃生活。

DESCRIPTION (provided by applicant): The purpose of this K23 proposal is to prepare the candidate to become an independent investigator, able to design, conduct, and acquire funding for, high-quality clinical trials that focus on measuring and improving outcomes and quality of care for patients with Chronic Obstructive Pulmonary Disease (COPD) and Lung Cancer. During the proposed study period, career development activities will include (1) one-on-one mentoring, (2) development and conduct of a research project, (3) presentation and publication of research findings, and (4) course work leading to a Masters degree in epidemiology. The candidate proposes a research project that will focus on demonstrating a novel approach for decreasing pulmonary complications and hospital stay after lung cancer resection, a major cause of morbidity and mortality. Decreasing the incidence of postoperative pulmonary complications (PPC) will allow more patients to safely undergo and recover from surgery, currently the most effective treatment for lung cancer. Currently, the only intervention shown to decrease the incidence of post-operative pulmonary complications is smoking cessation. Independent predictors of pulmonary complications after lung resection are all consequences of COPD. Eighty percent of patients with lung cancer have COPD. Pulmonary rehabilitation (PR) has been shown to effectively reduce symptoms, exacerbations and duration of hospitalization in COPD. The research proposal and specific aim of this K award includes a randomized controlled trial (exercise versus usual care) that will examine the effects of four weeks of preoperative upper and lower extremity endurance training on postoperative pulmonary complications and hospital stay after lung cancer resection in patients with COPD and moderate to high operative risk. It will evaluate functional capacity three month after discharge. It is hypothesized that four weeks of preoperative exercise training, when compared to usual care, will (1) decrease the number of hospital days, (2) result in significantly fewer intensive care and ventilator days, (3) decrease the incidence of major postoperative pulmonary complications, including pneumonia, respiratory failure, prolonged mechanical ventilation, atelectasis, and (4) improve recovery to active life.