Exercise and physical activity should be considered as therapeutic options for lung cancer as they have been shown to reduce symptoms, increase exercise tolerance, improve quality of life, and potentially reduce length of hospital stay and complications following surgery for the disease. These findings were published in the Journal of Thoracic Oncology (2015; doi:10.1097/JTO.0000000000000536).

Lung cancer is the leading cause of cancer deaths in the United States with an estimated 160,000 deaths each year, and worldwide there are 1.4 million deaths. In the last two decades lung cancer therapy has improved, but the overall 5-year survival rate is still quite low at 17%.

Lung cancer patients experience many debilitating symptoms including difficulty breathing, cough, fatigue, anxiety, depression, insomnia, and pain. One-third of long term survivors, those more than 5 years from diagnosis, experience reduced quality of life and report lower physical and health scores compared to healthy patients.

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Given the incidence of lung cancer and its associated costs, an inexpensive and relatively easy therapy that reduces symptoms and improves quality of life, such as physical activity, could be beneficial. Clinicians underutilize exercise as a therapy, in part due to the lack of evidence-based consensus as to how and when to implement increasing physical activity.

Gerard A. Silvestri, MD, Brett Bade, MD, and colleagues at Medical University of South Carolina, in Charleston, reviewed the safety, benefits, and application of increasing physical activity and exercise in lung cancer with the goal to summarize the effect on improved lung cancer outcomes.

The authors found that most patients with lung cancer, regardless of stage, want physical activity advice directly from a physician at a cancer center before cancer treatment. Exercise guidance may increase adherence to a dedicated program.

Multiple trials have shown that increased activity reduces symptom burden and that exercise interventions may have beneficial effects on quality of life, physical function, social function, and fatigue.

Perioperative exercise in lung cancer patients appears to be safe. It improves operability, operative risk, postoperative complications, and increases exercise capacity.

Preoperative interventions may be more beneficial than postoperative ones. Patients with nonsurgical, advanced-stage lung cancer may benefit from increased physical activity by improving exercise tolerance and symptom burden. However, the location, duration, and intensity to be recommended are not clear.

Chronically ill patients with cancer have different exercise limitations than their healthy counterparts. Other concurrent diseases and high symptom burden add challenges in how best to study and implement physical activity programs in patients with lung cancer. Low-intensity regimens such as daily walking or step counting may provide a safe mechanism to increase physical activity while identifying an individual patient’s activity limits. Both supervised and self-directed programs have potential benefit, though how to choose one versus the other is not yet clear.

The same benefits of increased activity observed in patients with lung cancer, especially improved symptoms and quality of life, appear to apply to lung cancer survivors as well.

The authors concluded “clinicians should (at minimum) consider physical activity early, counsel against inactivity, and encourage physical activity in patients with all stages of lung cancer and lung cancer survivors.”