With the support of a $379,741 grant from the National Cancer Institute and the Nintendo Wii game system, nursing researcher Amy Hoffman aims to help lung cancer patients reduce fatigue and get more exercise as they transition from the hospital to the home after surgery.
The most common type of lung cancer - affecting 85 percent of those diagnosed - is non-small cell lung cancer, or NSCLC, said Hoffman of Michigan State University's College of Nursing. Patients face significant, life-limiting health issues from the disease and its treatment.
Additionally, patients with acute and chronic illness, particularly cancer, report that self-management of symptoms are a common challenge.
"Nearly half of all Americans live with at least one chronic illness, and nearly a quarter of Americans having multiple chronic illnesses," Hoffman said. "The needs of the chronically ill are not being met, and a common challenge noted by patients with cancer is self-management of symptoms."
While surgery is the most common treatment for earlier-stage NSCLC, no formal guidelines currently exist for routine rehabilitative support following lung cancer surgery. Research shows that designing services for the hospital to home transition provides health care continuity and avoids preventable poor outcomes.
A rehabilitation program created by Hoffman incorporates the use of the Nintendo Wii-Fit Plus as a way to promote light-intensity, self-paced walking and balance exercise to address cancer-related fatigue. The Wii-Fit program provides patients with a home-based exercise alternative without the barriers of travel or weather.
Two of the most common NSCLC post-operative complications occurring within the first 30 days of surgery are lung collapse and pneumonia. Hoffman's program aims to help protect the patient's recovery by pre-empting postoperative complications.
"This is where my research team is making a difference, by transforming the current standard of care and providing an innovative, rehabilitative, home-based exercise intervention for postsurgical lung cancer patients," she said.
The exercise intervention is designed to build on successes, gradually increasing in duration while allowing patients to set their own exercise goals. The format helps patients focus on the fun in exercise while limiting the focus on the unpleasant symptoms typical of persons after undergoing surgery for lung cancer.
Hoffman said a pilot study successfully recruited and retained persons to participate.
"The virtual exercise intervention was found to be safe and highly acceptable, with patients stating they would recommend the program to others like themselves undergoing surgery for NSCLC," she said.
Results showed excellent improvement in cancer-related fatigue levels over time, with fatigue decreasing from presurgery levels through 16 weeks of exercise after surgery while most patients also were undergoing chemotherapy and/or radiation therapy.
Since persons with NSCLC are among the most vulnerable patient populations, should this intervention prove to be effective in the clinical trial, it could be applicable across similar vulnerable populations with chronic illnesses that currently have few or no rehabilitation options Hoffman said.
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