Lung cancer is the most common type of cancer with a poor prognosis, which ranks first in cancer-related deaths. The incidence of lung cancer per 100,000 people in the United States is 60.1 deaths per year for men and women, and 48.4 for both sexes. It is the most common type of cancer in our country in total and in men, and the incidence of lung cancer in women is in the 5th place. According to the International Cancer Agency’s estimations of newly diagnosed cancer for 2012, the most diagnosed cancer in the world was lung cancer (13.0%), while lung cancer (19.4%) caused the most deaths from cancer. It has been stated that if the cancer increase rate continues in this way, there will be a total of 19.3 million new cancer cases in 2025 due to the increase in the world population and the aging of the population. About half of patients with lung cancer are diagnosed at an advanced stage. 5-year life expectancy in lung cancer is 15%. If early diagnosis is made, this rate can increase to 52.6%. However, only 15% of patients can be diagnosed at an early stage.More than 55% of patients presenting with lung cancer have distant metastases at diagnosis, 25% have regional nodal involvement, and only about 15% have localized disease suitable for surgery (Fauci 1998). Non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) are the main histological subtypes of lung cancer, accounting for approximately 85% of all cases. Despite recent significant diagnostic and therapeutic advances, the overall prognosis for patients with lung cancer remains poor. The most important risk factor for lung cancer (constituting approximately 90% of cases) is smoking. Increases in tobacco use over the past few decades, particularly among women and youth, are now reflected in the increasing incidence of lung cancer in many countries.
Fatigue is one of the most common and distressing patient-reported symptoms associated with cancer and its treatment. People with lung cancer report that fatigue lasts longer and more severely than patients with other cancers, leading to more functional impairment. In addition, various cancer and treatment-related complications such as shortness of breath, muscle wasting, pain, loss of appetite and deterioration of physical fitness and lung function may further deteriorate the patient’s condition.
Cancer rehabilitation ; It is defined as aiming and helping a patient with cancer to gain maximum physical, social, psychological and occupational functions in line with the limits determined by his disease and treatments. Pulmonary rehabilitation methods have a place in every stage of diagnosis and treatment of cancer patients. One of the treatment goals is to improve the quality of life in lung cancer because there is no long-term survival expectation. Another treatment goal is to increase functional capacity. Functional capacity is a measure of baseline performance in patients diagnosed with lung cancer, therefore, treatment with exercise is a very reasonable approach in patients with cancer. Physical activity to lung cancer improves pulmonary function and perfusion. It is hypothesized that physical activity can upregulate antioxidants and free scavengers to help counteract the effects of cigarette smoke. Physical activity also reduces the risk of pneumonia and venothrombotic events, thereby improving overall survival and quality of life in patients with unresectable lung cancer. Pulmonary rehabilitation services; It can be given in outpatient, inpatient, home rehabilitation and palliative care centers. The success of pulmonary rehabilitation is possible if it can be organized individually. Pulmonary rehabilitation tries to help strengthen individual skills by motivating behavior change.
Benefits of pulmonary rehabilitation in lung cancer;
- Improving lung resection results, accelerating of post-surgical recovery
- Providing risk modification for surgery
- Improving cancer-related disability and quality of life
- Improving performance in the chemotherapy process
- Providing symptom control by motivating individual competence
PULMONARY REHABILITATION BEFORE AND AFTER LUNG CANCER SURGERY
Postoperative complications are common after lung cancer surgery. After surgery, limited physical activity is common, which is associated with an increased length of hospital stay. Causes of low physical activity include varying respiratory mechanics, pain, and dyspnea. Compared to healthy individuals who underwent surgery, the number of daily steps measured 6-10 weeks after surgery is lower, they also spend more time in long and uninterrupted periods of sedentary behavior, and they spend less time in light-intensity physical activity. A study in the USA reported that only 25% of patients were active enough, on average four years after surgery for lung cancer. According to the NETT (National Emphysema Treatment Trial) studies, it has been shown that the application of pulmonary rehabilitation before surgery in cases with severe emphysema provides changes in the risk category. According to the results reported by Wilson from the cancer center, it has been shown that preoperative 3-week pulmonary rehabilitation applications provide an improvement in surgical results in cases with COPD who will undergo lung cancer surgery. The basic principles of pre- or postoperative pulmonary rehabilitation in patients who will undergo lung cancer surgery are not much different from those who do not undergo surgery. One of the important components of preoperative pulmonary rehabilitation is smoking cessation. In this period, one of the lung secretion cleaning techniques; Methods such as incentive spirometry, deep breathing, coughing should be taught.
At various centers in the United Kingdom, Australia and New Zealand, more than 90% of physiotherapists routinely treat patients who have undergone post-operative thoracic surgery. Treatment typically consists of mobilization, shoulder exercises , pain control methods, and breathing exercises. Physiotherapy treatment in the hospital after lung cancer surgery has been shown to reduce pain.
APPLICATIONS OF PULMONARY REHABILITATION DURING CANCER-RELATED FATIGUE AND CHEMOTHERAPY
Cancer-related fatigue syndrome is characterized by weakness, sleep disturbance, depression, cognitive dysfunction, social isolation, and persistent burnout. Pulmonary rehabilitation practices, which are a multidisciplinary treatment approach, should definitely be included in the treatment.
Endurance exercise training provides increase in muscle mass, strength and endurance, improvement in ventilation / perfusion ratio, increase in cardiac reserve and oxidative enzyme capacity in muscles. Strengthening exercises are also an effective exercise method for muscle mass loss due to corticosteroid use. Studies have shown that even moderate-intensity walking exercise at home can increase the quality of life. It is recommended to exercise every day. A good way to start exercising is in small increments of ten minutes at a time, depending on the person’s level of fatigue. Going slow, setting goals, and being aware of the effects on the body are smart points, but it can take time to improve an individual’s level of fitness. At first, the patient may suffer from fatigue and low endurance and may only exercise for a short time. Each day sessions can be extended.
Patients with shortness of breath and limited breathing capacity due to cancer should do upper body stretching exercises daily to increase lung capacity. The stretch program allows the lungs and diaphragm to move more freely, restoring mobility in the chest and back. Stretching and lengthening the muscle and fascia improves circulation, increases muscle elasticity, increases oxygen to the muscles and helps the body repair. By increasing blood circulation to the muscles, it prevents the muscles with less blood flow from tensing and reduces inflammation. After radiation, it is very important to do stretching exercises to help the body stay flexible. Radiation typically causes additional tightening. Radiation may be active on the affected area for at least one year following completion of treatment.
Low-intensity walking is a safe way to start aerobic exercise. Lung cancer patients should participate in an enjoyable activity, for this aerobic exercise is one of the effective ways. Aerobic exercise not only improves heart function but also improves oxygen capacity. Examples of aerobic exercise include walking, dancing, cycling ergometer, arm ergometer, or any activity that increases heart rate.
Breathing helps reduce stress and anxiety. It is important to use the full lung capacity and to breathe slowly and deeply. Relaxation breathing can be used immediately after surgery as it allows the patient to focus all their energy on healing.
Pursed Lip Breathing
Body composition evaluation is an important point in determining how well or how bad cancer patients are. Cancer is a disease initiated by abnormal cells, characterized by increased metabolic rate, and suppression of the immune system, dehydration, changes in eating habits and activity, neurological disorders are just a few of the side effects of treatment. Therefore, it is important to approach patients with lung cancer with a multidisciplinary study.
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