Assessing Risk Factors Improved Functional Capacity Decline After Lung Cancer Resection

A decline in functional capacity is experienced by many patients with lung cancer who undergo resection. Routine screening of related factors could help clinicians identify those at risk and better allocate clinical resources, according to a systematic review published in Cancer Nursing.

Factors related to functional capacity decline in patients undergoing lung resection have not been systematically reviewed. Therefore, researchers conducted a systematic review of 21 studies to gather information about risk factors related to functional capacity deterioration after lung cancer surgery. Eleven of the studies were observational in nature. Twenty of the studies reported longitudinal capacity outcomes, with 6 reporting factors related to those outcomes.

The studies represented 1572 patients who had undergone lung cancer surgery.

Of the 5 unique functional capacity instruments reportedly used, the most commonly used tool was the 6-minute walking test (6MWT; 15 studies). The average 6MWT result was 659 meters in healthy adults aged 55 to 75 years.

The next most commonly used instrument was the cardiopulmonary exercise test (CPET; 4 studies). The incremental shuttle walk test (ISWT), stair-climbing test (SCT), and constant-load cycle endurance test (CCET) were reported once each.

Ten studies reported short-term (up to 1 month, postsurgery) functional capacity outcomes after surgery with 6 showing significant declines in the 6MWT. Thirteen studies showed medium-term (1 to 6 months) functional capacity outcomes postsurgery, and 9 reported nonsignificant changes in 6MWT.

The researchers identified 10 factors in 4 categories related to functional capacity deterioration after lung cancer surgery:

• Patient characteristics Age
• Preoperative clinical factors Vital capacity, diffusing capacity for carbon monoxide, quadriceps force, preoperative B-type natriuretic peptide level
• Surgical-related factors Surgical procedure, mediastinal lymph node resection, duration of chest tube drainage, presence of postoperative complications
• Postoperative clinical factor Change in C-reactive protein level

Other findings included the association between older patient age and loss of functional capacity, as noted in 2 studies, and a greater decline in postoperative functional capacity with longer duration of chest tube drainage. Additionally, the presence of postoperative complications significantly associated with functional capacity decline, explained the researchers.

This review suggests that functional capacity trajectories after lung cancer were significantly different from baseline levels in the short term, but the differences were not significant in the medium term. The 10 factors identified should be considered when designing future nursing interventions.

“There is a need for further research to be conducted in this population to investigate different patterns of functional capacity and more robust study design to confirm the factors related to functional capacity,” they wrote.

The researchers suggest further research be conducted to determine the most suitable functional capacity tests for patients with lung cancer undergoing surgery.

Reference

Xu X, Liu X, Ho MH, Chau PH, Cheung DST, Lin CC. Factors related to functional capacity deterioration in surgical lung cancer patients: a systematic review. Cancer Nurs. Published online July 11, 2023. doi:10.1097/NCC.0000000000001269