| Abstract |
Background: The increase in the incidence of lung cancer and chronic obstructive pulmonary disease (COPD) in recent decades has been evident in the international bibliography. In fact, in many patients these two diseases coexist, having a very detrimental effect on their quality of life and their mental health. In recent years, there has been evidence that exercise, in the form of physiotherapy or any coordinated exercise, has had beneficial effects on the quality of life and thus on their mental health.
Aim: The purpose of this study was to examine the effects of therapeutic exercise in patients with lung cancer and COPD, and more specifically to assess the impact of therapeutic exercise on the levels of anxiety and depression and the quality of life of these patients. This is expected to open the dialog to improve the physical and respiratory function of people with lung cancer and COPD, promote better quality of life, reduce anxiety and the level of depression through exercise.
Methodology: A synchronic observational study with a control group was carried out as part of this postgraduate study. The study population was defined as patients with confirmed histological diagnosis of lung cancer, with co-existing condition of COPD, who are hospitalized at the Venizelio-Pananeio General Hospital of Heraklion. Sampling was occasional, non-probabilistic. Initially, a sample size assessment was performed and the sample consisted of 50 patients per group (sample total: 100). All participants were patients with stage I or II lung cancer. Also, with respect to COPD, staging according to the most recent spirometry (FEV1/FVC) was moderate and according to the guidelines of GOLD 2023, all participants were in Group A and B (GOLD 1 and 2). A questionnaire package was used (demographic and Clinical Health Profile sheet, European Organization for Research and treatment of Cancer QoL Questionnaire (EORTC QLQ-C30) and the Hospital anxiety and Depression scale (EORTC QLQ-C30). The statistical analysis was conducted on IBM SPSS 26, while all the tests were performed two-sided at a=0.05 statistical significance level.
Results: The study involved 50% women and 50% men, with an average age of 69.5 years (standard deviation, etc.=8.4), the majority were married (37% or widowed (28%), with an average number of family members 2.5 (t.a.=0.4). Regarding the educational level, most participants had completed the middle education (37%). Focusing on mental outcomes, all participants showed moderate to high levels of anxiety (15, 0.4) and depression (11,5, 0.2). However, there was a statistically significant difference (Pvalue=0.01) in anxiety levels, between those who did exercise (11,7, etc.=0.3) and those who did not (18,3, etc.=0.2). Similarly, statistically significant (Pvalue=0.01) higher levels of depression were observed again in the non-exercise group (AD=14,5, etc.=0.5) compared to those who exercised (AD=8.6, etc.=0.4). All participants showed low-medium levels of general health (1.5, 0.5) and total quality of life (2.2, 0.7). However, there was a statistically significant difference (Pvalue=0.03) in general health levels, between those who did exercise (2.3, 0.2) and those who did not (1.1, 0.1). Similarly, statistically significant (Pvalue=0.04) lower levels of total quality of life were observed in the non-exercise group (1.7, 0.3) compared to those who did the exercise (2.6, 0.2). It was found that all participants showed low-medium levels of physical function (2.3, 0.3), social function (2.1, etc.=0.4), while on the contrary they had high levels of symptomatology (3.5, 0.2). When a comparison was made between the two groups, there was a statistically significant difference (Pvalue=0.04) in the levels of physical functioning, between those who did exercise (2.8, 0.3) and those who did not (1.8, 0.3). Also, in social function there was statistically significant (Pvalue=0.03) higher levels for those who did exercise (2.5, 0.2) and those who did not (1.6, 0.1), while the symptomatology was significantly higher (Pvalue=0.03) in those who did not exercise (3.8, 0.2) compared to those who did not exercise (3.1, 0.3). Finally, it was found that there is a statistically significant effect of exercise on reducing stress levels (or=0.45, 95%CI=0.21-0.67) and depression (or=0.51, 95%CI-0.40-0.62). A corresponding tendency with reduced symptomatology occurs when exercised (or=0.94, 95%CI=0.52-1.21) but without a statistically significant difference. In contrast, therapeutic exercise has a beneficial effect on general health (or=1.72, 95%CI=1.60-1.83), total quality of life (or=1.69, 95%CI=1.43-1.91), physical (or=1.52, 95%CI=1.33-1.75) and social (or=1.23, 95%CI=1.09-1.38) functionality.
Conclusions: The contribution of therapeutic exercise seemed to be beneficial for the quality of life of these patients. Further studies are needed to establish their causal relationship, but the present evidence can help to design new studies and interventions in patients with lung cancer and COPD from the very early stages of the disease.
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