Pulmonary Rehabiltation before Lung Cancer Resection

描述(由申请人提供)：这项建议的总体目标是获得明确的证据，证明短期的术前肺康复对肺癌和严重慢性阻塞性肺疾病(COPD)患者根治性手术切除后的发病率和康复的有效性。这项研究议程的长期目标是创新肺功能低下患者肺癌切除术的术前护理，并最终将这些改进转化为所有胸部外科手术(如食道癌、冠状动脉旁路手术等)。并针对影响生活质量和体力活动轨迹，提出了影响肺癌生存的中介因素。需要这项研究的理由是，缺乏任何得到充分证实的降低风险干预措施，这些干预措施可以降低重症COPD患者肺癌切除术的发病率，或者可以改善他们的生活质量或体力活动轨迹，这些都是总体疾病进展中有意义的变量。拟议的干预措施是独一无二的，因为它结合了运动和行为干预措施，这些干预措施在拟议人群中进行了随机、单盲对照设计的试点测试，并被证明是可行的和潜在有效的。这项应用将坚实的初步数据与肺康复和胸部外科领域的卓越中心结合在一起，进行一项研究，将推动术前和慢性护理领域的发展。我们将深入描述康复和康复的过程，检验我们的假设，并通过追求以下特定目标来实现这一应用的目标：特定目标1：与匹配的对照组相比，前瞻性地确定10个定制的术前肺康复课程对接受肺癌切除并患有严重COPD的患者住院时间和术后并发症数量的影响。假设：10次个性化的术前肺康复治疗将显著减少住院时间和术后肺部并发症的数量。具体目标2：与对照组相比，前瞻性地确定10个疗程的术前肺康复对根治性切除后3、6和12个月的生活质量和体力活动的影响。假设：与对照组相比，10个定制的术前肺康复疗程将显著和有意义地(超过最小的临床重要差异)改善术后的体力活动和生活质量。

DESCRIPTION (provided by applicant): The overall objective of this proposal is to obtain definitive evidence for the effectiveness of a short preoperative Pulmonary Rehabilitation on the morbidity and recovery from a curative surgical resection in patients with Lung Cancer and severe Chronic Obstructive Pulmonary Disease (COPD). The long term goal of this research agenda is to innovate the preoperative care of lung cancer resection in patients with low lung function, and ultimately translate these improvements to all thoracic surgical procedures (such as esophageal cancer, coronary artery bypass surgery, etc.) and to impact on quality of life and physical activity trajectory, proposed mediators of lung cancer survival. The rationale for the need of this research is the lack any well proven risk-reducing intervention that may decrease the morbidity of lung cancer resection in patients with severe COPD or that may improve their quality of life or physical activity trajectory, meaningful variables in the overall disease progression. The proposed intervention is unique as it combines exercise and behavioral interventions that were pilot tested in a randomized single-blinded controlled design in the proposed population and proved feasible and potentially effective. This application brings together solid preliminary data with centers of excellence in Pulmonary Rehabilitation and thoracic surgery to conduct a study that will advance the field of preoperative and chronic care. We will describe the process of rehabilitation and recovery in-depth, test our hypotheses, and achieve the objective of this application by pursuing the following specific aims: Specific Aim 1: To prospectively determine the effect of 10 sessions of customized preoperative Pulmonary Rehabilitation on length of hospital stay and on the number of postoperative complications in patients that undergo a lung cancer resection and have severe COPD compared to a matched control group. Hypothesis: Ten sessions of customized preoperative Pulmonary Rehabilitation will significantly reduce the length of hospital stay and the number of postoperative pulmonary complications. Specific Aim 2: To prospectively determine the effect of a 10-session preoperative Pulmonary Rehabilitation on the trajectory of quality of life and measured physical activity at 3, 6 and 12 month after the curative resection compared to a matched control group. Hypothesis: Ten sessions of customized preoperative Pulmonary Rehabilitation will significantly and meaningfully (more than the minimal clinically important difference) improve physical activity and quality of life after surgery compared to a control group.