Quality of life after preoperative home-based exercise training in patients with lung cancer: a secondary analysis

A preoperative home-based exercise training (PHET) program appeared to improve health-related quality of life (HRQoL) in patients undergoing lung cancer surgery. However, inter-individual variability in response was observed. This secondary analysis aimed to identify characteristics of responders/non-responders to PHET, determine predictors of response, and examine whether preoperative HRQoL response to PHET is associated with postoperative HRQoL maintenance.

This was a secondary analysis of pooled data from a feasibility study and a randomized controlled trial, including sociodemographic/clinical data, physical performance and HRQoL (EORTC-QLQ-C30). Responders/non-responders were classified based on a change of ≥5 points in Global QoL score (EORTC QLQ-C30) from baseline to pre-surgery time point. Between-group differences and predictors of PHET response (logistic regression) were analysed.

32 patients (63% male, 67.1±7.8 years) were included, from which 56% (n=18) were responders to PHET in Global QoL. Responders had lower baseline scores in Global QoL, Emotional Function and Summary Score compared to non-responders (P<0.05), and 50% of responders had chronic obstructive pulmonary disease (COPD) (P=0.02). No other between-group differences were found (P>0.05). In the regression model including the Summary Score (EORTC-QLQ-C30) and COPD (Nagelkerke R2=0.511), COPD was a significant predictor of response: COPD patients were 13.4 times more likely to be responders (odds ratio =13.4; 95% confidence interval: 1.4; 132.2). 65% of PHET-responders maintained/improved HRQoL 1-month post-surgery.

Most patients awaiting lung cancer surgery responded in HRQoL to a PHET, however, a considerable proportion did not. Further research is needed to identify characteristics of non-responders and optimize prehabilitation strategies accordingly.