Characterizing and optimizing physical function in lung cancer survivors Public Deposited

Lung cancer is the second most common cancer in men and women in the United States and survival rates are starting to rise. Improving survival rates creates a need for studies of lung cancer survivors that focus on improving the chronic management of lung cancer, including offsetting declines in physical function and mitigating persistent treatment related symptoms, in order to optimize quality of life. The purpose of this dissertation was to understand how physical function changes among lung cancer survivors and how exercise may serve as a possible rehabilitative strategy to restore independence. Four specific aims were set to achieve this purpose: 1) Describe inter-individual differences in the pattern and rate of change of self-reported physical functioning and associated symptoms over one year in lung cancer survivors; 2) Describe the application of exercise as a strategy to improve outcomes in lung cancer patients and specifically summarize the methodology and reporting of exercise interventions in controlled trials; 3) Describe the application of yoga as a strategy to improve outcomes in all cancer types and specifically summarize the methodology and reporting of yoga interventions in controlled trials; 4) Determine the feasibility and preliminary efficacy of a progressive yoga exercise training program to improve physical function during lung cancer treatment. For aim 1, a secondary analysis of self-reported physical function and symptoms over one year in lung cancer survivor was conducted. For aim 2, a systematic review of randomized controlled exercise trials conducted in lung cancer survivors was performed with attention to principles of exercise training. For aim 3, a systematic review of randomized controlled trials employing yoga as the intervention in all cancer types was performed with attention to principles of exercise training. For aim 4, a single group 12-week, supervised yoga intervention in lung cancer survivors was conducted. The results from this dissertation work indicate that significant interindividual variability in trajectories of self-reported physical functioning exist. Though the number of exercise trials for lung cancer patients is growing, the principles of exercise training are not consistently applied. The components of the exercise prescription were well reported, whereas adherence to each was not. In studies of yoga across all cancer types the principles of exercise training were not well applied, and the reporting of the FITT components and adherence to each were not consistently reported. Yoga is a feasible and safe modality of exercise for lung cancer survivors who are medically well enough to attend supervised classes with potential benefits for improving physical function. This dissertation has made meaningful contributions to the fields of symptom science, application of yoga as a modality of exercise in the cancer population and exercise oncology in lung cancer survivors. This dissertation has immediate implications for the design and selection of exercise interventions to optimize rehabilitation in lung cancer survivors and points to the need for more research to improve the lives of lung cancer survivors.

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