Association between Pulmonary Function and Stair-Climbing Test Results after Lung Resection: A Pilot Study.

Background: The stair-climbing test was used to assess the exercise capacity before lung resection in subjects with lung cancer. However, few studies have systematically evaluated the role of this exercise methodology as a postoperative test. The aim of the present study was to assess whether the stair-climbing test findings reflect the postoperative decrease in pulmonary function. Methods: Twenty subjects with non-small-cell lung cancer who underwent lung resection were enrolled in the study. Perioperative functional evaluation comprised the pulmonary function test, stair-climbing test, and 6-min walk distance test (6MWD). A correlation analysis was performed between the postoperative percentages of pulmonary function with respect to preoperative values and the exercise capacity. Results: No correlation was noted between the percentage changes in pulmonary function and those in 6MWD. However, there was a significant correlation between the percentage changes in forced expiratory volume in 1 s and those in the altitude reached in the stair-climbing test (r=0.46, p < 0.05) and between the percentage changes in carbon monoxide lung diffusion capacity and those in the altitude (r=0.54, p < 0.05). Conclusions: The stair-climbing test findings might be effective at detecting changes in exercise capacity induced by postoperative decrease in pulmonary function.

A self-efficacy enhancing intervention for pulmonary rehabilitation based on motivational interviewing for postoperative lung cancers patients: modeling and randomized exploratory trial.

The objective of this study was to evaluate the feasibility and preliminary efficacy of a self-efficacy enhancing intervention designed for pulmonary rehabilitation based on motivational interviewing (MI) for postsurgical non-small cell lung cancer (NSCLC) patients. This study was a 2-arm pilot randomized controlled trial and was conducted in two cardiothoracic surgery departments, a tertiary hospital in Fuzhou, China. 28 postsurgical NSCLC patients were randomized to a 3 month (6 session) self-efficacy enhancing intervention based on MI or usual care (UC). Data were measured at baseline and after intervention. The MI based self-efficacy enhancing intervention group was superior to the UC group for reducing anxiety and depression, improving self-efficacy, quality of life, confrontational coping, social support and functional capacity. However, no statistically significant difference was observed in subjective well-being, posttraumatic growth, body mass index and pulmonary function between the two groups. This pilot study demonstrated the feasibility of MI based self-efficacy enhancing intervention for postsurgical NSCLC patients. A larger randomized trial would demonstrate a more rigorous test of efficacy.

[Impact of pulmonary rehabilitation after lung resection for cancer on patients' level of anxiety and depression]. / Impact de la réhabilitation respiratoire sur l'anxiété et la dépression après chirurgie thoracique pour cancer.

INTRODUCTION: Pulmonary rehabilitation (PR) for patients undergoing lung resection for cancer remains controversial. We studied the effects of PR, its impact on quality of life and the level of anxiety and depression. METHODS: In 2011 and 2012, PR was offered to all patients referred to our institution after lung resection for cancer. Patients were evaluated between admission and discharge by a 6 minutes walking test (6MWD), a Visual Analogue Pain Intensity Scale, a quality of life questionnaire (EORTC QLQ C30) and by the Hospital Anxiety and Depression Scale (HAD). The same questionnaires were mailed 6 months after completing PR. RESULTS: Between early 2011 and late 2012, 133 patients were admitted to our institution following lung resection for cancer. Of these, 59 (44%) patients completed PR and returned their questionnaires 6 months after discharge. During PR of these 59 patients, the mean quality of life score increased from 56.3 to 65.9 (P<0.05), the median anxiety score decreased from 5.5 to 4 (P<0.05) and that of depression from 3 to 2 (P<0.05). At 6 months post-discharge, the mean quality of life score remained stable at 66.3 (P=0.8), the median anxiety score reverted to 6 (P<0.05) and the median depression score reverted to 4.5 (P<0.05). CONCLUSION: This observational study during PR, showed that quality of life and the levels of anxiety and depression were improved at the end of the course. After returning home, the average quality of life score remained stable but the level of anxiety and depression increased.

[The role of the nurse in lung cancer surgery]. / Le rôle infirmier dans la chirurgie du cancer du poumon.

The surgical period of the treatment of lung cancer is gruelling for the patient. Close to the patient from the pre-operative care onwards, nursing teams take turns in listening and providing technical care through to the patient's discharge. The optimal treatment of pain favours the early rehabilitation of the patient.

Incentive spirometry does not enhance recovery after thoracic surgery.

OBJECTIVE: To investigate the additional effect of incentive spirometry to chest physiotherapy to prevent postoperative pulmonary complications after thoracic surgery for lung and esophageal resections. DESIGN: Randomized controlled trial. SETTING: University hospital, intensive care unit, and surgical department. PATIENTS: Sixty-seven patients (age, 59 +/- 13 yrs; forced expiratory volume in 1 sec, 93% +/- 22% predicted) undergoing elective thoracic surgery for lung (n = 40) or esophagus (n = 27) resection. INTERVENTIONS: Physiotherapy (breathing exercises, huffing, and coughing) (PT) plus incentive spirometry (IS) was compared with PT alone. MEASUREMENTS AND MAIN RESULTS: Lung function, body temperature, chest radiograph, white blood cell count, and number of hospital and intensive care unit days were all measured. Pulmonary function was significantly reduced after surgery (55% of the initial value) and improved significantly in the postoperative period in both groups. However, no differences were observed in the recovery of pulmonary function between the groups. The overall score of the chest radiograph, based on the presence of atelectasis, was similar in both treatment groups. Eight patients (12%) (three patients with lobectomy and five with esophagus resection) developed a pulmonary complication (abnormal chest radiograph, elevated body temperature and white blood cell count), four in each treatment group. Adding IS to regular PT did not reduce hospital or intensive care unit stay. CONCLUSIONS: Pulmonary complications after lung and esophagus surgery were relatively low. The addition of IS to PT did not further reduce pulmonary complications or hospital stay. Although we cannot rule out beneficial effects in a subgroup of high-risk patients, routine use of IS after thoracic surgery seems to be ineffective.