Recommendations for Interventions to Improve Function in Patients With Lung Cancer: A Clinical Practice Guideline

Individuals with lung cancer frequently experience functional limitations, yet best practice to achieve functional recovery has not been synthesized. This Clinical Practice Guideline generates evidence-based recommendations to improve functional outcomes in this population.

A multispecialty expert workgroup completed a systematic review of the literature from 2010 to 2021 examining interventions for improving patient function at any stage or phase of disease. National Institutes of Health Quality Assessment standards were employed for bias assessment. Recommendations were generated per GRADE methodology, for mobility, physical activity, general function, and social function outcomes, during phases of prehabilitation, surgical post-operative acute (hospitalization), during-or-immediate post-treatment (first year), and survivorship.

Fifty-four studies were included. Combined exercise approaches should be used to improve mobility during the Prehabilitation and the During and Immediate Post-Treatment phases. For physical activity, combined interventions may be beneficial during the Surgical Post-Operative Acute phase, and multimodal interventions with exercise and education may improve function in the During and Immediate Post-Treatment phase. Combined exercise may improve general function in the During and Immediate Post-Treatment phase.

Current evidence emphasizes mobility outcomes, in prehabilitation and early post-treatment phases, with moderate level benefits of combined aerobic with resistance and/or breathing exercise. Further study is needed into sustainability of performing the interventions and durability of outcomes; increased breadth of interventions and functional outcome domains examined; and exploration of specific contexts including advanced disease, survivorship, high medical complexity and frailty, and caregiver-related factors. These recommendations are applicable for clinicians including oncologists, rehabilitation specialists, surgeons, primary and pulmonary care providers, nurses, and other supportive care personnel.