The value of perioperative physical activity in older patients undergoing surgery for lung cancer

ABSTRACT

Introduction

With a median age at diagnosis of 70, lung cancer represents an enormous public health problem among older Americans. An estimated 19,000 people age 65 and older undergo lung cancer surgery annually in the US. Older adults undergoing lung cancer surgery are often frail with limited physiologic reserves, multi-morbidities, and functional impairments. Physical function, dyspnea, and quality of life return to baseline slower in older adults compared with younger adults after lung surgery.

Areas covered

In this review, we summarize available data about perioperative physical activity interventions that may improve outcomes for older adults undergoing lung cancer surgery. We also review the limitations of existing studies and discuss emerging data on the roles of telehealth and family caregiver inclusion in peri-operative physical activity interventions.

Expert opinion

We propose that future perioperative physical activity interventions in older adults undergoing lung cancer surgery should include a comprehensive geriatric assessment to guide personalized interventions. Interventions should be conceptually based, with a focus on enhancing self-efficacy, motivation, and adherence through classic behavior change strategies that are proven to impact outcomes. Finally, interventions should be designed with attention to feasibility and scalability. Exercise programs delivered via telehealth (telephone or tele-video) may improve access and convenience for patients.

KEYWORDS:

• Lung cancer surgery
• older adults
• physical activity
• pulmonary rehabilitation
• geriatric oncology
• prehabilitation

Article highlights

• A number of physical activity interventions have been described to improve outcomes of people undergoing lung cancer surgery, and the majority of those populations were older adults.

• Many studies reported an improvement in functional activity through measurement of objective endpoints including 6-minute walk test (6MWT), and many studies reported that physical activity prevented complications and reduced length of stay after surgery.

• Few studies focused specifically on older adults and utilize a geriatric assessment to prescribe physical activity. In addition, almost no studies included family caregivers.

• Prehabilitation studies that require postponement of surgery are not feasible in the United States. Studies that require intensive supervised exercise programs multiple times per week are not feasible in many healthcare settings, particularly in older adults who may have barriers to transportation and may be a burden on family caregivers.

• Telehealth-based physical activity interventions and incorporation of pedometers and other wearable technologies are promising modalities for use in perioperative physical activity interventions but require additional study.

Declaration of interest

D Raz has received grant funding from AstraZeneca (unrelated to the content of this manuscript). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.