title: The Utility of Exercise Testing in Patients with Lung Cancer.
abstract: The harm associated with lung cancer treatment include perioperative morbidity and mortality and therapy-induced toxicities in various organs, including the heart and lungs. Optimal treatment therefore entails a need for risk assessment to weigh the probabilities of benefits versus harm. Exercise testing offers an opportunity to evaluate a patient's physical fitness/exercise capacity objectively. In lung cancer, it is most often used to risk-stratify patients undergoing evaluation for lung cancer resection. In recent years, its use outside this context has been described, including in nonsurgical candidates and lung cancer survivors. In this article we review the physiology of exercise testing and lung cancer. Then, we assess the utility of exercise testing in patients with lung cancer in four contexts (preoperative evaluation for lung cancer resection, after lung cancer resection, lung cancer prognosis, and assessment of efficiency of exercise training programs) after systematically identifying original studies involving the most common forms of exercise tests in this patient population: laboratory cardiopulmonary exercise testing and simple field testing with the 6-minute walk test, shuttle walk test, and/or stair-climbing test. Lastly, we propose a conceptual framework for risk assessment of patients with lung cancer who are being considered for therapy and identify areas for further studies in this patient population.
authors.affiliation: Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, La Jolla, California. Electronic address: d5ha@ucsd.edu.
authors.forename: Duc
authors.initials: D
authors.lastname: Ha
authors.affiliation: Respiratory Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Mazzone
authors.affiliation: Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, La Jolla, California.
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Ries
authors.affiliation: Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, La Jolla, California.
authors.forename: Atul
authors.initials: A
authors.lastname: Malhotra
authors.affiliation: Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, La Jolla, California; Pulmonary and Critical Care Medicine Section, Veterans Administration San Diego Healthcare System, San Diego, California.
authors.forename: Mark
authors.initials: M
authors.lastname: Fuster
mesh_terms: D005080:Exercise Test; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery; D010101:Oxygen Consumption; D010806:Physical Education and Training; D011013:Pneumonectomy; D011379:Prognosis; D018570:Risk Assessment
keywords: Cardiopulmonary exercise testing; Exercise testing; Lung cancer; Shuttle walk test; Six-minute walk test; Stair-climbing test