Deterioration in physical activity and function differs according to treatment type in non-small cell lung cancer - future directions for physiotherapy management

Objectives To investigate in non-surgically and surgically treated non-small cell lung cancer (NSCLC): (1) changes in physical activity, function, health-related quality of life (HRQoL) and symptoms after diagnosis; and (2) the association between physical activity and outcomes. Design Prospective observational study. Setting Three acute tertiary hospitals. Participants Sixty-nine individuals (43 male, median [IQR] age 68 [61 to 74] years) with stage I-IV NSCLC. Main outcome measures The primary outcome (Physical Activity Scale for the Elderly) and secondary outcome (six-minute walk test and questionnaires assessing HRQoL, function, symptoms, mood) were measured at diagnosis (pre-treatment), and eight to ten weeks post-diagnosis (post-operative and/or during chemotherapy/radiotherapy). Results Individuals treated surgically (n = 27) experienced a deterioration in physical activity levels (baseline median [IQR] = 74 [51 to 135]; follow-up median [IQR] = 29 [24 to 73]; median difference = 45, effect size = 0.3). At follow-up physical activity was inversely related to depression, pain and appetite loss (rho > 0.5, p < 0.05). In contrast non-surgical individuals (n = 42) did not experience a change in physical activity, however did experience deterioration in function, functional capacity, global HRQoL, fatigue and dyspnoea. Physical activity levels were low in this group and at follow-up the strongest relationships with physical activity levels were global HRQoL, function, fatigue and mood (inverse, rho > 0.5, p < 0.05). Conclusions Surgically treated individuals experienced a reduction in physical activity levels after diagnosis, which was not seen in the non-surgical group. Lower physical activity levels were associated with poorer outcomes, particularly in non-surgically treated individuals. Further research is required to establish the optimal intervention to improve physical activity levels in these cohorts. (C) 2015 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.