Duc  M. Ha, MD, MAS

We are fortunate that the COVID-19 pandemic has not had an adverse impact on our work. Study activities are performed remotely by design as we are evaluating the effect of a telerehabilitation intervention compared with education alone for promoting physical activity and reducing dyspnea following curative intent therapy for lung cancer. Participants may complete all study activities remotely. The telerehabilitation intervention, which consists of motivational interviewing to increase step count and instruction on inspiratory muscle training to alleviate dyspnea, is delivered to participants via videoconference. Education on strategies to reduce breathlessness and increase physical activity is delivered to education arm participants by email. We have been able to capture complete participant baseline and follow-up measures by phone interview and REDCap for all participants enrolled thus far. The study team meets by videoconference on a weekly basis to discuss questions about potentially eligible patients, progress on enrollment and delivery of the telerehabilitation and education arm activities, analytic plans, and to troubleshoot obstacles to study implementation. These meetings are well attended and have facilitated efficiency of our work and group cohesion. Study team members visit our KPCO Institute for Health Research offices for as-needed in-person meetings and to mail participant study packages.

Update: We assembled a collaborative, expert, and dedicated research team that meets weekly. We developed an algorithm of electronic health data to identify lung cancer survivors. We also trained team members to confirm eligibility, in motivational interviewing, and inspiratory muscle training. We have chart reviewed 312 potentially eligible patients, confirmed eligibility on 66 patients, consented 17 participants, and completed baseline outcome including activPAL assessments and randomized 14 participants. Five participants in the telerehabilitation arm have completed two or more of the six telerehabilitation sessions and one has completed one session. In addition, we have published three original research articles, one abstract, and one book chapter on dyspnea, rehabilitation, physical activity and exercise, and quality of life in lung cancer survivorship.

Final Summary

Many lung cancer survivors experience increased shortness of breath (also known as breathlessness, or medically as dyspnea, pronounced disp-nee-uh) following lung cancer treatment aimed to achieve a cure, due to surgical removal or destruction of lung tissue and other changes within the chest associated with treatment, as well as pre-existing health conditions such as lung and heart disease. Over time, shortness of breath can lead to physical inactivity and other negative health consequences. We conducted a pilot randomized trial to assess the feasibility, acceptability, safety, and potential effects of inspiratory muscle training (IMT), a form of resistance training to strengthen breathing muscles and reduce shortness of breath, and walking promotion to improve lung cancer survivors’ physical activity levels following treatment.

We screened 751 patients from Kaiser Permanente Colorado, identified 124 patients who completed lung cancer treatment within 1-6 months as eligible, enrolled 31, and randomized 28 participants. Fourteen participants assigned to the treatment group received a 12-week intervention consisting of IMT + walking, education, and behavior change support delivered mostly via Microsoft Teams® and some via telephone. Fourteen participants assigned to the comparison or control group received emails containing educational materials on general exercise.

At the end of 12 weeks, we found that 79% (22/28) of participants completed the entire study. Participants also returned > 90% of self-reported activity logs, completed > 90% of study outcome measures, and attended > 90% of scheduled telemedicine visits; 75% of participants performed IMT at the recommended dose without difficulty. There was no difference in safety events between treatment and control participants. Compared with control participants, participants in the treatment group reported (statistically and clinically) significantly reduced symptom and improved health-related quality of life. On average, participants in the treatment group also walked 930 steps more per day than control participants; however, this difference was not (statistically) significant (meaning it could be due to chance), but if true, could be clinically meaningful.

Therefore, our project found that among lung cancer survivors who recently completed curative intent treatment, remotely delivered (via telemedicine) IMT + walking was feasible, acceptable, safe, and could reduce symptom burden, improve physical activity, and enhance health-related quality of life. Additional trials with a larger number of participants and longer follow-up are needed to determine these health effects.