| Background:Lung cancer has an increasing burden of symptoms during and after cancer treatment and a high level of unmet need for rehabilitation.Exercise for lung cancer patients is safe and feasible and is supported by evidence-based evidence.Exercise plays an important role in the full cycle of lung cancer treatment,but only a minority of lung cancer patients participate in exercise regularly in clinical practice,and there is an urgent need to further explore a "patient-centered" and more acceptable form of exercise.Part 1: Global Estimates of Rehabilitation Needs and Disease Burden in Tracheal,Bronchus,and Lung Cancer from 1990 to 2019 and Projections to 2045 Based on the Global Burden of Disease Study 2019Objective:This study aims to provide up-to-date insights into the rehabilitation needs and the burden of Tracheal,Bronchus,and Lung cancer(TBL cancer)from 1990 to 2019,and attributable risk factors by gender and age.We also attempt to make projections to 2045,which will help guide the allocation of rehabilitation resources and the formation of a multidisciplinary model of cancer care,as well as precise control and full life-cycle management of TBL cancer.Methods:To estimate the need for rehabilitation,we used data from the Global Burden of Disease Study 2019 to calculate the prevalence,years lived with disability(YLDs)and the attributable risk factors of TBL cancer.To reflect trends in the disease burden of TBL cancer over the past three decades,this study calculated the estimated annual percentage change(EAPC)in age-standardized rates of relevant indicators from 1990 to 2019.Bayesian age-period-cohort model and Auto-Regressive Integrated Moving Average model were established to forecast the future health burden.All analyses were done at the global level and then some in the aggregation with the seven World Bank regions.All data analysis and charting by R software(x64 version 4.2.1)and Microsoft Excel(version 2019).Results:1.Globally in 2019,3,212,307 cases of TBL cancer(95% UI 2,937,037-3,488,346)could have benefitted from rehabilitation,contributing to 544,215(95% UI 396,134-700,099)YLDs.Over the past 30 years,the age-standardized rate(ASR)of prevalence(EAPC=0.51)and YLDs(EAPC=0.03)increased.Throughout this period,the global prevalence and YLDs counts were greater in males than females.2.According to the predictions,the ASR of prevalence and YLDs are projected to show a slight downward trend by 2045 on the global scale,the overall prevalence and YLDs due to TBL cancer are likely to increase further,but all indicators show a growing trend in females.3.This study also identified modifiable risk factors for TBL cancer YLDs,with smoking being the number one risk factor,as well as the need for concern about high fasting plasma glucose.Part 2: Analysis of the effectiveness and acceptability of a tele-guided functional movement matrix intervention on body function & structure,activity and participation in patients with non-small cell lung cancer: a mixed methods study Objective:The aim of this study was to apply a mixed methods study to evaluate the feasibility,intervention effectiveness and acceptability of a tele-guided functional movement matrix at the body function&structure,activity and participation levels in patients with non-small cell lung cancer.Methods:This study used an explanatory sequential analysis in a mixed-methods study,in which a quantitative study of a single-arm clinical trial was conducted followed by a qualitative study of a semi-structured interview with subjects participating in this trial,and the two were jointly presented to validate and complement each other’s efforts to jointly demonstrate the feasibility,effectiveness,and acceptability of the exercise program,respectively.Quantitative study component: Seventy-nine subjects were recruited for this study,17 of whom met the inclusion criteria,and were given a remotely guided functional exercise matrix intervention for a total of 24 sessions of 45-60 minutes on alternate days(no intervention during hospitalization for cancer treatment).Subjects completed the essential information prior to the intervention,completed questionnaires,and participated in assessments before and after the 24 intervention sessions.Feasibility assessment indicators included: recruitment rate,retention rate,compliance,and adverse event rate.Intervention outcome indicators include: grip strength,appendicular skeletal muscle mass index(ASMI),6m walking speed and time up and go(TUG)tests,Short Physical Performance Battery(SPPB),Six Minute Walk Test and European Organization for Research and Treatment of Cancer Quality of Life-Core 30 Questionnaire Version 3.0(EORTC QLQ-C30 V3.0).The SPSS 25.0 statistical software was used to analyze the test data,and the paired-samples t-test was used if the count data conformed to a normal distribution,and the Wilcoxon signed rank sum test was used if they did not conform to a normal distribution,and the comparison of the initial,final and improved values before and after the intervention was performed with a significance level of P < 0.05.Qualitative study part: purposive sampling was used,and 17 subjects who entered the trial had semi-structured qualitative interviews conducted,and traditional content analysis was selected for data analysis with a view to generalizing and summarizing the advantages of the functional movement matrix.Results:1.The results of the quantitative study showed that 79 subjects were recruited to participate in the eligibility screening of the study,17 met the inclusion criteria,a total of 12 adhered to the full trial,the recruitment rate of this study was 21.52%,the retention rate was 70.59%,the exercise protocol was safe,the patients had high compliance(79.2%-100%)and the exercise protocol was feasible.Comparing the differences in the indicators assessed before and after the 24 exercise interventions,patients had statistically significant differences in grip strength(the difference was 1.85 kg,95% CI 0.82-2.88,P=0.002),TUG(the difference was-0.69 s,95% CI-1.34--0.37,P=0.04)and 6-minute walking distance(the difference was 21.11 m,95% CI 15.69-26.52,P<0.001)had differences in change,all of which were statistically significant.Still,patients’ ASMI,gait speed,and SPBB were not statistically different.A pre-postintervention comparison revealed that in terms of health-related quality of life,the patient’s physical function and fatigue,emotional function,cognitive function,social function,overall health,and insomnia all improved significantly after the intervention(p<0.05).However,there was no statistical difference in role function.2.The qualitative findings from 16 patients add that the exercise program does not cause excessive fatigue when performed,and the movements are varied,challenging,and can also be integrated into daily life in a convenient and economical way;the exercise facilitators were supervising,encouraging support and guidance from professionals,the convenience of home,increased sense of belonging,and support from family and friends;barriers to exercise were lack of motivation,lack of time,and side effects of treatment;the exercise program enhances the brain’s ability to perceive the body,improves patients’ willpower and health consciousness of active exercise.3.The combined results of the mixed-methods studies suggest that the exercise training program is highly sustainable and that most patients will continue to adhere to the exercise program after the end of the trial,consistent with higher adherence.Conclusion:Lung cancer remains one of the major global public health problems.According to the forecast results,lung cancer’s disease burden and rehabilitation needs will continue to rise,and the increment is higher for women than men.Cancer rehabilitation should intervene early in the clinical management of TBL cancer.In the future,an increasing number of patients worldwide will benefit from rehabilitation services to help achieve precise control and management of TBL cancer patients throughout the cycle.Functional movement matrix intervention programs are feasible,effective and acceptable during cancer treatment for NSCLC patients.In the future,large-scale,multi-center,and randomized controlled trials are needed to validate its effectiveness further so that it can be further promoted for use in clinical settings. |
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