Safety and feasibility of cardiopulmonary exercise testing in patients with advanced cancer

The use of cardiopulmonary exercise testing (CPET) is increasing in many areas of disease management, the clinical utility of this procedure in patients with advanced cancer remains to be determined. Accordingly, we conducted a pilot study to comprehensively evaluate the safety and feasibility of CPET in 85 patients diagnosed with inoperable non-small cell lung cancer (NSCLC) or metastatic breast cancer (MBC).

Using a cross-sectional design, consecutive patients with histologically or cytologically confirmed inoperable NSCLC or MBC were screened for eligibility by their attending oncologist. All consenting patients performed complete pulmonary function tests (NSCLC only) and a symptom-limited CPET on a cycle ergometer with gas exchange analysis.

A total of 85 patients (NSCLC, n=46; MBC, n=39) were recruited and tested. Overall, there were a total of three (3.5%) positive exercise tests [NSCLC, n=2 (4.3%); MBC, n=1 (2.6%)]; 68 (80.0%) negative tests [NSCLC, n=33 (71.7%); MBC, n=35 (89.7%)]; and 14 (16.5%) indeterminate tests [NSCLC, n=11 (23.3%); MBC, n=3 (7.7%)]. Two patients experienced an adverse event during exercise testing. Mean VO(2peak) was 17.0mlkg(-1)min(-1) and 16.5mlkg(-1)min(-1) for NSCLC and MBC patients, respectively. The mean percentage of age and sex-predicted VO(2peak) maximum for both groups was 67%.

A symptom-limited, individualized CPET appears to be a relatively safe and feasible assessment tool to objectively evaluate physical functioning in selected patients with advanced cancer. This study provides important information to future investigations examining the potential role of exercise training in this patient population.