Role of pulmonary rehabilitation in the management of patients with lung cancer

Purpose of review Over the last decade, evidence-based support for pulmonary rehabilitation in the management of patients with chronic lung disease has grown tremendously. A beneficial role of pulmonary rehabilitation has been largely shown among patients with chronic obstructive pulmonary disease and in patients with pulmonary emphysema enlisted for lung volume reduction surgery. In these settings, significant reductions in dyspnea, and improvements in exercise performance and health-related quality of life have been clearly demonstrated following a program of pulmonary rehabilitation. Pulmonary rehabilitation is often advocated as an adjunctive intervention in patients with cancer; however, the benefits of this intervention in the cancer setting, particularly in the perioperative setting for lung cancer, are only recently emerging. This review summarizes these investigations and highlights ongoing controversies regarding the utility of pulmonary rehabilitation in the surgical and medical management of patients with lung cancer. Recent findings Recent small studies suggest that pulmonary rehabilitation may favorably impact lung cancer management by improving a variety of clinically meaningful outcomes such as performance status, chemotherapy-related fatigue, oxygen consumption, exercise tolerance, and health-related quality of life. These findings, although intriguing, have not been investigated in any large, controlled trials to determine their impact, if any, on surgical resectability and outcome or on tolerance to aggressive chemoradiation therapy regimens. Summary Pulmonary rehabilitation shows promise as a therapeutic intervention in the management of lung cancer. Further, well designed, adequately powered studies, however, are urgently needed to address outstanding questions about its exact role in guiding lung cancer management.