title: A randomized controlled trial of postthoracotomy pulmonary rehabilitation in patients with resectable lung cancer.
abstract: BACKGROUND
  Little is known about the effects of rehabilitation for patients with lung cancer after thoracotomy. The primary objective of this study was to evaluate the effect of a multidisciplinary rehabilitation program on quality of life (QOL) and secondary objectives were to determine its effects on pain and exercise capacity and the feasibility of combining rehabilitation with adjuvant chemotherapy.
  
  
  METHODS
  Patients who had undergone a thoracotomy for lung cancer were randomized between rehabilitation and usual care. Rehabilitation consisted of twice-weekly training for 12 weeks starting 1 month after hospital discharge, scheduled visits to pain specialists, and medical social work. QOL and pain were measured with validated questionnaires at baseline and after 1, 3, 6, and 12 months. Exercise tolerance was assessed at baseline and after 3 months with a 6-minute walking distance test.
  
  
  RESULTS
  The study closed prematurely because of the introduction of video-assisted thoracoscopic surgery. Of 57 randomized patients, 49 patients (23 active and 26 control) were analyzed. QOL was not significantly different between groups, although, the active group reported more pain after 3 and 6 months and more limitations because of physical problems after 3 months. In the active group, 6-minute walking distance improved by 35 m from preoperative baseline, as opposed to the control group that showed a decline by 59 m (p = 0.024 for difference). Patients treated with adjuvant chemotherapy showed decreased attendance at training sessions.
  
  
  CONCLUSIONS
  Rehabilitation did not result in a better QOL. Exercise tolerance improved at the cost of more pain and more limitations because of physical problems. We suggest that rehabilitation is better postponed for 3 to 4 months after hospital discharge.
authors.affiliation: Department of Pulmonology, Isala Klinieken, Zwolle, The Netherlands. j.a.stigt@isala.nl
authors.forename: Jos A
authors.initials: JA
authors.lastname: Stigt
authors.forename: Steven M
authors.initials: SM
authors.lastname: Uil
authors.forename: Susanne J H
authors.initials: SJ
authors.lastname: van Riesen
authors.forename: Frans J N A
authors.initials: FJ
authors.lastname: Simons
authors.forename: Monique
authors.initials: M
authors.lastname: Denekamp
authors.forename: Ghada M
authors.initials: GM
authors.lastname: Shahin
authors.forename: Harry J M
authors.initials: HJ
authors.lastname: Groen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D005081:Exercise Therapy; D017079:Exercise Tolerance; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000534:rehabilitation* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011182:Postoperative Care; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D012129:Respiratory Function Tests; D011795:Surveys and Questionnaires; D020775:Thoracic Surgery, Video-Assisted; D013908:Thoracotomy; D016138:Walking; D055815:Young Adult