Determinants of completion of a home-based rehabilitation program in patients awaiting lung surgery for lung cancer : a prospective observational multicenter study

Abstract

Introduction: Home-based rehabilitation programs (H-RP) could facilitate the implementation of pulmonary rehabilitation prior resection for non-small cell lung cancer (NSCLC), but their feasibility has yet to be demonstrated. Our aims were to identify the determinants associated with the non-completion of H-RP and the factors associated with 30-days postoperative events.

Methods: Patients with proven or suspected NSCLC were involved prior to surgery in an H-RP containing four components: i)a minimum of three ergocycle sessions/week; ii)one physiotherapy session/week; iii)initiation of smoking cessation; iv)nutritional support. The H-RP was defined "completed" when the four components were performed. If smoking cessation and nutritional supports were not necessary, they were considered as already completed.

Results: Out of 50 patients included, 42 were finally operated (80% men, median age 69(IQR 25%-75% 60-74) years; 64% COPD; 29% type-2 diabetes). 20 patients (48%) completed 100% of the program. In univariate analysis, BMI>26.5 kg/m2, diabetes, polymedication (≥ 5 drugs), living alone and a long delay in starting H-RP were associated with the risk of non-completion. In multivariate analysis, polymedication (OR=12.2 95%CI: 2.0;74.2), living alone (single vs couple OR=21.5 95%CI: 1.4;324.4) and a long delay in starting H-RP (OR=6.24 95%CI: 1.1;36.6) were independantly associated with the risk of non-completion. H-RP non completion, diabetes, polymedication, social precariousness and female gender were associated with events at 30 days.

Conclusion: Being isolated and polymedicated increases the risk of not completing H-RP.