Pulmonary rehabilitation in lung cancer management : an investigative study on health-related quality of life of patients and the perceived views of healthcare professionals

Abstract

Background: Lung cancer is one of the most commonly diagnosed cancer and is the leading cause of mortality worldwide. It is a major challenge to global healthcare, making it an important public health issue. Patients suffering from lung cancer experience an array of symptoms that may include dyspnoea, fatigue, cough, and pain. All these symptoms can negatively influence the patients’ physical function and impair their daily living activities. Pulmonary rehabilitation is a multidisciplinary intervention that is tailored to the individual patients’ needs. It aims to assist patients to improve their respiratory function, exercise tolerance, physical capacity, and overall health-related quality of life. This research seeks to assess the impact of Pulmonary Rehabilitation on the health-related quality of life of patients with lung cancer and to understand its influence on the overall health system performance.

Methodology: A mix-method research design was employed. Patient reported outcome measures (EORTC QLQ-C30 and QLQ-LC29) were used to evaluate the effects of an 8-week pulmonary rehabilitation programme in patients diagnosed with lung cancer. Outcome measures were assessed pre and post the intervention. Structured interviews were used to explore perceptions of healthcare professionals on the impact of pulmonary rehabilitation within the oncology setting. Interviews were transcribed verbatim and analysed thematically.

Result: A total of 14 patients with lung cancer were eligible for data analysis: mean age 69; male 78.6%; disease stage n (%), I = 3 (21.4), III = 4 (28.6), IV = 7 (50.0%). All patients were receiving systemic anti-cancer treatment and/or radiotherapy except for one patient. Significant improvements were demonstrated in global health status/QoL (p=0.03), and lessening of symptoms including fatigue (p=0.044), dyspnoea (p=0.018) and pain (p=0.013) were observed following an 8-week pulmonary rehabilitation programme. In the qualitative part of the study 10 healthcare professionals were recruited. Five major themes were generated: holistic care approach; education and prevention; perceived physical and psychological benefits; impact on the healthcare sector; and maximising the efficacy of the intervention. Most findings of this study are consistent with existing literature.

Discussion: Health-related quality of life is recognised as a valuable outcome measure in cancer care management. Healthcare professionals perceived pulmonary rehabilitation to have a central role in maintaining and/or improving health-related quality of life through patient education of physical activity, symptom management, and behavioural strategies. This was shown to contribute to a positive effect on the patient’s anxiety levels and hospital admissions. Pulmonary rehabilitation has been demonstrated as an important healthcare service in lung cancer management. Promoting physical activity and healthy behaviours are crucial in today’s ageing population and increased cancer incidence. Such health services facilitate integration back into the community and act as a tool for the work-age cohort to remain economically viable.

Conclusion: This study suggests that pulmonary rehabilitation should be promoted to improve physical/cognitive function as well as health-related quality of life throughout the disease trajectory in patients with lung cancer and other cancer diagnosis experiencing oncology-related pulmonary insufficiency. Based on the findings of this study, recommendations were suggested. These may inform future strategies to further improve patient experience and quality of care, ensuring better standards of care for all.