Physical Activity and Lung CancerHistory, Prevention, Treatment.By Derek Crowe, Nina PhamWhat is Lung Cancer?● Lung cancer is a progression that starts off with an abnormal cell growth and overtime grows into a tumor● Forms in one or both of the lungs and therefore one of the major complications it causes has to do with breathing ● It is the #1 cause of death from cancer (Waynes, M. 2015)Deaths from lung cancer ● 160,000 deaths each year in the U.S. alone ○ 1.4 million deaths worldwide● The 5 year survival rate is one of the lowest at 17%● There is a much greater risk of obtaining and dieing of lung cancer in smokers compared to non-smokers● Black men have the greatest risk of getting lung cancer followed by white men. Women have a generally lower risk than men(How Common is Lung Cancer, 2016)(Lung Cancer Facts, Figures & Factors, 2011)Incidence of Lung Cancer in different regions of the U.S. by race/ethnicity between 1998-2006(Racial/Ethnic Disparities and Geographic Differences in Lung Cancer Incidence in 38 States and the District of Columbia 1998-2006. 2010)Risk Factors of Lung CancerModifiable:-Smoking: Smoking and secondhand smoke are 2 of the biggest risks for lung cancer, the amount you smoke a day and time you have been smoking are what determines your risk-Exposure to asbestos: Asbestos, especially in the workplace, is also a very big risk factor especially when paired with smoking. Non modifiable: -Family History: If you have a family history of lung cancer you increase your risk -Age: ⅔ of all lung cancer diagnoses occur in older people age 65+ (Lung Cancer Risk Factors, 2015)Study Design and PopulationThe Impact of Physical Activity on Fatigue and Quality of Life in Lung Cancer Patients (Dhillon et al., 2012) ● Randomized Control Trial ● Study Population○ Patients who had lung cancer recruited from lung cancer clinics at 4 different hospitals ○ Had non-resectable, non-curable lung cancer○ About 102 patients, 18 years old or older, male and female participated ○ Medically fit ■ Have had treatment with chemotherapy or radiotherapy for at least 4 weeks before the studyHow was PA, fatigue, QOL measured, and Cancer measuredThe Impact of Physical Activity on Fatigue and Quality of Life in Lung Cancer Patients (Dhillon et al., 2012) ● PA questionnaire ○ Also provided a pedometer to keep track of activity ● Fatigue was assessed by the functional assessment of cancer therapy ○ Patient recorded outcome measures of how they are feeling● QOL was assessed by QOL questionnaire ● Lung Cancer measured by oncologist ○ People who were diagnosed with Stage 3 non-small cell lung cancer and/or limited small cell lung cancer○ People with advanced disease being treated palliatively may be receiving chemotherapy, biological agents and/or best supportive careStudy MethodsPA on Fatigue and QOL in Lung Cancer Patients (Dhillon et. al, 2012) ● Patients were randomized into 2 groups○ 2 month PA, generalized health care education and 8 weeks of PA program○ Usual care, were provided general health care education● Patients in PA group○ Supervised aerobic PA 30-45 mins and behavioral support sessions to enhance unsupervised PA (15-30 min) 1x/week ● Both groups had follow ups every 2, 4, 6 months on physical fitness and function○ Also had a follow up on survival - to death or 3 years of post interventionMain FindingsThe Impact of Physical Activity on Fatigue and Quality of Life in Lung Cancer Patients (Dhillon et al., 2012) ● Evidence that PA programs improve cancer fatigue and QOL in cancer population with high symptoms of lung cancer● Advanced lung cancer is incurable, but the goal of the PA treatment improved QOL and maintaining physical function● PA programs most effective in the early stages of lung cancer● The PA intervention has potential to improve standard care in a simple, fast, inexpensive wayImpact of PA on symptoms of lung cancer survivors: Study Design/Population(Lin, Y., Rau, K., & Lin, C. 2015)● Longitudinal Study ● Study Population ○ Patients were ≥ 18 years older, males and females■ Average age 68.76 years■ 185 patients participated, 143 continued participation until the second assessment time point (21 participants lost due to 6 deaths or 15 personal reasons - emotional stress or lack of motivation) ■ Final sample 122 patients totalImpact of PA on symptoms of lung cancer survivors: Study Methods(Lin, Y., Rau, K., & Lin, C. 2015)● Participants took different questionnaires to measure their PA and symptoms● 3 different assessment points after the patients were enrolled in the study ○ They did the questionnaires initial in the beginning of the study ○ Two follow ups after in increments of 3 months for a total of 3 month questionnaire, and 6 month questionnaire○ Took 10 mins to complete each questionnaireImpact of PA on symptoms of lung cancer survivors: How PA and Cancer were measured(Lin, Y., Rau, K., & Lin, C. 2015)● Godin Leisure-Time Exercise Questionnaire measured PA behaviors○ Determines the average frequency and duration patient engages in PA over a typical week of their leisure time■ with minimal effort■ moderate (not exhausting) ■ strenuous (rapid heartbeat)● Cancer in patients○ Initially enrolled lung cancer survivors treated through surgery at medical center in Taiwan○ Diagnosed with lung cancer by primary physician○ Had treatment with surgery, chemotherapy, radiation therapy, or targeted therapy○ Had no evidence of a recurrent or progressive diseaseImpact of PA on symptoms of lung cancer survivors: How symptoms were measured(Lin, Y., Rau, K., & Lin, C. 2015)● Taiwanese version of the Doctor of Medicine Anderson Symptom Inventory○ Measured severity of symptoms (Part 1) and the degree at which the symptoms interfered with daily living (Part 2)● Part 1: Different items such as: fatigue, disturbed sleep, pain, drowsiness, lack of appetite, nausea, vomiting, shortness of breath, numbness, difficulty remembering, dry mouth, distress (emotional), and sadness were used to get a total number of symptoms intensity○ Items are rated on a scale of 0 (not present) and 10 (as bad as you can imagine) ● Part 2:○ assesses the extent to which symptoms interfere with general activities, mood, normal work, relations with other people, walking ability, and enjoyment of life. ■ Items is rated on a scale of 0 (no interference) to 10 (interferes completely)Impact