title: Prognostic significance of functional capacity and exercise behavior in patients with metastatic non-small cell lung cancer.
abstract: BACKGROUND
  To investigate the prognostic importance of functional capacity and exercise behavior in patients with metastatic non-small cell lung cancer (NSCLC).
  
  
  METHODS
  Using a prospective design, 118 consecutive participants with histologically confirmed metastatic (inoperable) NSCLC and Eastern Cooperative Oncology group (ECOG) 0-3 completed a six-minute walk test to assess functional capacity and questionnaire that assessed self-reported exercise behavior. Cox proportional models were used to estimate the risk of all-cause mortality according to six-minute walk distance (6MWD) (<358.5m, 358.5-450 m, ≥450 m) and exercise behavior (MET-hrswk(-1)) categories with adjustment for important covariates.
  
  
  RESULTS
  Median follow-up was 26.6 months; 77 deaths were reported during this period. Functional capacity was an independent predictor of survival (P(trend)=0.003) and added incremental prognostic value beyond that provided by PS plus other traditional markers of prognosis (P(trend)=0.025). Compared with patients achieving a 6MWD <358.5m, the adjusted hazard ratio (HR) for all-cause mortality was 0.61 (95% CI, 0.34-1.07) for a 6MWD of 358.5-450 m, and 0.48 (95% CI, 0.24-0.93) for a 6MWD >450 m. In unadjusted analysis, there was a borderline significant effect of exercise behavior on survival (p=0.052). Median survival was 12.89 months (95% CI, 9.11-21.05 months) for those reporting <9MET-hrswk(-1) compared with 25.63 months (95% CI, 11.28 to ∞ months) for those reporting ≥9MET-hrswk(-1).
  
  
  CONCLUSIONS
  Functional capacity is a strong independent predictor of survival in advanced NSCLC that adds to the prediction of survival beyond traditional risk factors. This parameter may improve risk stratification and prognostication in NSCLC.
authors: Duke Cancer Institute, Durham, NC 27710, USA. lee.w.jones@duke.edu
authors: Lee W
authors: LW
authors: Jones
authors: Whitney E
authors: WE
authors: Hornsby
authors: Amy
authors: A
authors: Goetzinger
authors: Lindsay M
authors: LM
authors: Forbes
authors: Emily L
authors: EL
authors: Sherrard
authors: Morten
authors: M
authors: Quist
authors: Amy T
authors: AT
authors: Lane
authors: Miranda
authors: M
authors: West
authors: Neil D
authors: ND
authors: Eves
authors: Margaret
authors: M
authors: Gradison
authors: April
authors: A
authors: Coan
authors: James E
authors: JE
authors: Herndon
authors: Amy P
authors: AP
authors: Abernethy
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology* / Q000503:physiopathology*; D003430:Cross-Sectional Studies; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D016138:Walking / Q000502:physiology