Veterans Affairs-based Multi-modal Lung Cancer Survivorship Program: A 12-month Follow-up Study on Effectiveness and Durability

Rationale: Despite completing treatment, lung cancer survivors frequently experience symptoms of dyspnea, fatigue, depression and anxiety. We previously demonstrated that a comprehensive 12-week survivorship program, that included home-based pulmonary rehabilitation, mental health interventions, smoking cessation, and optimization of respiratory medications, provided clinically meaningful improvements for lung cancer survivors. We sought to update this initial work by including additional program enrollees, as well as to examine the durability of the intervention with 1-year follow-up data. Methods: Individuals at the Durham Veterans Affairs Medical Center with confirmed lung cancer and Karnofsky score ≥ 60 were eligible for participation. At enrollment, respiratory medications were optimized, smoking cessation pharmacotherapy was offered, and those with a Hospital Anxiety and Depression Scale (HADS) >8 were offered a mental health referral. Participants completed in-home exercises with a goal of 1 hour/day, 5 days/week with a weekly check-in by phone. Functional and mental health data were collected at enrollment, program completion at 12 weeks, and 1-year post-completion. Data were summarized and analyzed using repeated measures ANOVA with Tukey HSD post-hoc analysis for pairwise comparisons. Results: Of 112 lung cancer survivors (95% males, mean age 69.5) who enrolled, 63 (56.2%) completed the program and 22 (35% of completers) were re-evaluated one year later. Median months from cancer diagnosis to program enrollment was 6.8. Least square means of each score (95% confidence interval) from enrollment (0 mo) to program completion (3 mo) and to 1 year follow-up (12 mo) were as follows (Figure 1): Duke Activity Status Index (DASI: 18.14 (15.1-21.45) to 23.98 (20.48-27.75) to 20.77 (16.59-25.41) ), modified Medical Research Council dyspnea scale (mMRC: 1.77 (1.45-2.08) to 1.35 (1.04-1.66) to 1.18 (0.72-1.64)), Hospital Anxiety and Depression total score (HADS-T: 12.02 (9.88-14.38) to 10.16 (8.19-12.33) to 9.08 (6.72-11.81)), Functional Assessment of Cancer Therapy-Lung Emotional subscale score (FACT-EWB: 14.95 (13.86-16.03) to 15.14 (14.06-16.22) to 16.46 (14.87-18.05)). Statistically significant differences (p<0.05) were present in the DASI score between 0 and 3 months, the HADS-T score between 0 and 12 months, and the mMRC scores between 0 and 3 months and 0 and 12 months, with a trend towards significance in all other pairwise comparisons. Conclusions: Participation in a 12-week comprehensive home-based lung cancer survivorship program is associated with both immediate and sustained improvement in dyspnea, functional status, and mental health. Continued study is needed to understand optimal delivery of these programs.

Duke Scholars

Author Neelima Navuluri Medicine, Pulmonary, Allergy, and Critical Care Medicine