治療肺癌時最好有高強度運動


【24drs.com】研究者在CHEST 2011:美國胸腔科醫學會年會中報告指出,治療非小細胞肺癌時的高強度運動可以比癌症治療後再進行相同的運動更有效。
  
  德州大學安德森癌症中心醫學教授Vickie R. Shannon醫師發表研究結果時表示,這篇研究顯示了兩件事情,其一,可以在病患的癌症治療中轉診,其二,這些病患可以從復健中獲益。
  
  Shannon醫師等人回顧探討361名非小細胞肺癌、中度到重度慢性阻塞性肺病患者的資料,這些患者完成個別的肺部復健計畫;他們參與了一個為期12週的門診病患肺部復健計畫,每週2至3次,這個計畫包括了以最大運動功率之60%-80%的運動,強度訓練以及有氧運動。
  
  每週這些病患還進行2次個人職能訓練與1次團體教育課程,也被轉診進行戒菸課程與提供營養計畫;整體而言,132名病患在癌症治療時進行了復健,229人在完成癌症治療後進行復健。
  
  研究人員在開始時與完成復健計畫後2週、3個月、6個月和12個月時對病患進行評估。研究結束時,癌症治療時進行復健組剩下76個病患,完成癌症治療後進行復健組剩下113人。
  
  兩組都有改善,但是,治療時進行復健組的改善較多,復健計畫一結束時,病患的柏格量表,呼吸困難降低3.5分(±1.3),疲勞降低2.4分(±1.1)。
  
  相較之下,治療後才進行復健組的呼吸困難分數降低1.2分(±0.06),疲勞降低1.2分(±0.7)(兩組之間的差異達統計上的顯著意義;呼吸困難之P<.001,疲勞之P< .01)。
  
  同樣地,復健後6個月,治療時進行復健組的慢性呼吸道疾病問卷分數改善8.4分(±4.5),治療後才進行復健組則是2.4分(±3.2)(P= .001)(6個月後,差異不再達統計上的顯著意義)。
  
  治療時進行復健組在6分鐘行走距離、作工負荷、最大氧氣攝取量、氧氣量、氧脈都顯著高於治療後才進行復健組,一般而言,治療時進行復健組的改善比較大且較持久。
  
  Shannon醫師表示,病患滿意這些結果;我們不容易說動他們參加這個計畫,但一旦他們接受,就會愛上它。這些病患相當虛弱,離開椅子自己梳頭髮對他們而言都是大事。
  
  俄亥俄州立大學睡眠醫學、重症照護、過敏與肺部醫學助理教授Michael Ezzie醫師表示,許多醫師對於是否要完成癌症治療後才轉診病患進行肺部復健有所猶豫。
  
  未參與這次研究的Ezzie醫師表示,多數癌症專家會擔心,讓接受癌症治療的病患接近其他可能有呼吸道疾病的患者。他指出,Shannon醫師的研究團隊沒有分析有關呼吸道疾病的資料。雖然有這顧慮,但他認為,這篇研究和其他幾篇小型研究顯示,治療中轉診病患進行復健是有其價值的。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=6637&x_classno=0&x_chkdelpoint=Y
  

High-Intensity Exercise Best During Lung Cancer Therapy

By Laird Harrison
Medscape Medical News

October 24, 2011 (Honolulu, Hawaii) — High-intensity exercise during treatment for nonsmall-cell lung cancer can be more effective than the same program after cancer treatment, researchers reported here at CHEST 2011: American College of Chest Physicians Annual Meeting.

"This [study] shows 2 things," said Vickie R. Shannon, MD, professor of medicine at the University of Texas M.D. Anderson Cancer Center in Houston, who presented the results. "One is that you can refer patients during their cancer treatment, and 2 is that those patients get some benefit from the rehabilitation."

Dr. Shannon and her colleagues looked retrospectively at the records of 361 patients with nonsmall-cell lung cancer and moderate to severe chronic obstructive pulmonary disease who completed an individualized program of pulmonary rehabilitation.

The patients participated in a 12-week outpatient pulmonary rehabilitation program 2 to 3 times a week. The program included exercising at 60% to 80% of their maximal work rate, strength training, and aerobic exercises.

Each week, the patients also had 2 individual sessions with an occupational therapist and 1 group-education session. They were also given referrals to tobacco-cessation and nutrition programs.

Overall, 132 patients underwent rehabilitation during their cancer therapy and 229 underwent rehabilitation after they completed cancer therapy.

The researchers evaluated the patients at baseline, at 2 weeks, and at 3, 6, and 12 months after completing the rehabilitation program. Seventy-six of the patients who underwent rehabilitation during cancer therapy and 113 of those who underwent rehabilitation after cancer therapy remained in the study until its completion.

Both groups improved, but the improvement was greater in the during-therapy group. Immediately after rehabilitation, the Borg scores of those patients had dropped 3.5 points (±1.3) for dyspnea and 2.4 points (±1.1) for fatigue.

By comparison, the after-therapy group dropped 1.2 points (±0.06) for dyspnea and 1.2 points (±0.7) for fatigue. (The between-group differences were statistically significant; P < .001 for dyspnea and P < .01 for fatigue.)

Likewise, 6 months after rehabilitation, Chronic Respiratory Disease Questionnaire scores had improved 8.4 points (±4.5) in the during-therapy group, compared with 2.4 points (±3.2) in the after-therapy group (P = .001). (Six months later, the difference was no longer statistically significant.)

The during-therapy group's improvements in 6-minute walk distance, work load, maximal oxygen intake, oxygen, and oxygen pulse were all statistically greater than those of the after-therapy group. In general, the improvements were more durable and greater for the during-therapy group.

Patients are pleased with the results, said Dr. Shannon. "We do have a hard time getting them into the program, but once they are in, they love it.... Those patients are very debilitated, so to be able to get out of a chair and comb their hair is a very big deal."

Many clinicians have hesitated to refer their patients for pulmonary rehabilitation until after cancer therapy is completed, panel comoderator Michael Ezzie, MD, assistant professor of pulmonary medicine, allergy, critical care, and sleep medicine at Ohio State University, Columbus, told Medscape Medical News.

"Most cancer specialists have concerns about putting patients undergoing cancer therapy near other patients who might have respiratory diseases," said Dr. Ezzie, who was not involved in this study. Dr. Shannon's group has not yet analyzed data on respiratory diseases, he pointed out.

Despite that concern, "I think this study and a couple of other small studies show that it's valuable to refer patients during therapy," he said.

Dr. Shannon and Dr. Ezzie have disclosed no relevant financial relationships.

CHEST 2011: American College of Chest Physicians Annual Meeting: Abstract 855A. Presented October 23, 2011.

    
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