Feasibility of an early versus delayed rehabilitation intervention in patients with lung cancer on cancer-related fatigue: a pilot RCT

Cancer-related fatigue (CRF) reduces physical performance and quality of life (QoL). Some authors suggest including moderate-intensity physical exercise to manage CRF; however, the optimal timing to offer rehabilitation remains unclear. The primary aim is to investigate the feasibility of a pulmonary rehabilitation (PR) program, including physical exercise and educational sessions, for lung cancer patients undergoing cancer treatments; secondary objectives are to investigate its effect on CRF, physical performance, and QoL. This randomized controlled trial enrolls 40 patients with stage II or III non-small-cell lung cancer undergoing chemotherapy, radiotherapy, or immunotherapy. Patients are randomly assigned to one of two groups: Group A (early-PR) begins PR after enrollment, at the beginning of non-surgical therapies, while Group B (delayed-PR) begins PR for 3 months after enrollment. The PR program consists of two education sessions focused on CRF management and eight supervised exercise sessions, including aerobic, strengthening, stretching, and breathing exercises, combined with home exercises. CRF, QoL, activity level, and endurance are assessed at the baseline (T0) and at 3 and 6 months (T1–T2). One year after T0, survival is assessed along with the CRF, QoL, and activity level (T3). Feasibility will be assessed at 3 and 6 months. Clinical Trial Registration:www.clinicaltrials.gov identifier is NCT06051136. What is this article about? Many patients with lung cancer experience severe exhaustion (cancer-related fatigue, CRF), which makes it difficult to perform daily activities and lowers their quality of life. Physical exercise is an effective way to manage this fatigue, but it is not yet clear what is the best time to begin a rehabilitation program during cancer treatment. This study investigates whether a pulmonary rehabilitation (PR) program, which includes physical exercise and practical advice, is feasible and safe to implement for lung cancer patients undergoing treatment. What are the expected results of this study? This clinical trial involves 40 patients with non-small-cell lung cancer receiving anticancer therapies. Patients are divided into two groups: one starts rehabilitation immediately, while the other starts 3 months later. The program consists of eight supervised exercise sessions (aerobic, strength, breathing exercises) and two informational sessions focused on managing fatigue. We expect to demonstrate that the program is feasible (i.e. patients can complete it) and that by comparing the two groups, we will identify which timing of rehabilitation (early versus delayed) leads to better outcomes. What do the results of this study mean? The findings of the study regarding the feasibility and effect of PR will provide crucial information for clinical practice. The results will help doctors and rehabilitation specialists understand when and how to offer rehabilitation support to patients with lung cancer. This knowledge is essential for developing evidence-based intervention to improve patients’ energy levels, physical function, and quality of life during their cancer treatment.