Perioperative Rehabilitation and Initiation of Adjuvant Chemotherapy in Resected Non-Small Cell Lung Cancer

Adjuvant chemotherapy can improve outcomes for patients who have undergone lung cancer resection, and perioperative rehabilitation may help maintain the physical condition necessary to receive adjuvant chemotherapy. This observational cohort study investigated the impact of perioperative rehabilitation on the administration of postoperative adjuvant chemotherapy, focusing on platinum-based chemotherapies, using a proprietary database of health claims and administrative data from over 450 acute care hospitals in Japan. Patients with Stage II-IIIB non-small cell lung cancer (NSCLC) who underwent surgery between 2017 and 2023 within 180 days of a record of lung cancer diagnosis were eligible. Primary outcome was the proportion of patients who initiated adjuvant platinum-based chemotherapy within 90 days after surgery. Adjusted risk differences were estimated using inverse probability of treatment weighted modified least-squares regression. A total of 8111 patients with Stage II-IIIB NSCLC were included in this study, of whom 5158 (median age: 73.0 years; 72.0% male) received perioperative rehabilitation and 2953 (72.0 years; 69.8% male) did not. Adjuvant chemotherapy (within 90 days of surgery; primary outcome) was initiated in 31.1% (1489/4794) of patients with rehabilitation versus 29.1% (788/2708) in patients without rehabilitation. The adjusted risk difference was 4.1% (adjusted risk difference estimate: 0.041 [95% confidence interval: 0.021, 0.062]; p < 0.001). This study demonstrated that perioperative rehabilitation was associated with more frequent initiation of adjuvant platinum-based chemotherapy within 90 days after surgery in patients with Stage II-IIIB NSCLC. Additional research is warranted to confirm the clinical benefits of the broader implementation of perioperative rehabilitation.