Lung cancer is the most common cause of cancer-related death among both men and women in the United States. Individuals with early-stage lung cancer have markedly reduced exercise capacity caused by multiple mechanisms (e.g., disease pathophysiology, treatment, deconditioning, etc.). This is of critical importance since poor exercise capacity is associated with higher disease-related symptoms, poor health-related quality of life (HRQOL), increased susceptibility to common age-related diseases and likely, premature death. Despite its importance, effective interventions to improve exercise capacity among lung cancer patients are not available. Results from two uncontrolled pilot studies from our group have provided 'proof of principle'that aerobic training is a safe and feasible intervention associated with modest improvements in exercise capacity and HRQOL among early-stage lung cancer patients. The following two questions are now germane: (1) what is the most effective type of exercise training to improve exercise capacity;and (2) what are the mechanisms underlying this improvement? We propose a prospective, four-arm, randomized trial to compare the effects of three different exercise programs relative to a sedentary control group among 150 early-stage lung cancer patients who have completed cancer therapy. This grant will have the following primary and secondary aims: Primary aim: determine the effects of aerobic training and resistance training, relative to attention-control, on exercise capacity. Secondary aims: (1) to determine the effects on patient-reported outcomes, (2) to examine the physiological mediators of the exercise training - VO2peak relationship, (3) to examine the psychological mediators of the intervention - patient-reported outcomes relationship. This study will address several fundamental but, currently unanswered questions regarding the role of exercise training in the management of lung cancer. Information gained from this clinical trial will inform the design in future-planned studies further investigating the role of exercise training across the lung cancer survivorship continuum. Finally, the mechanistic findings will provide insight into how to refine exercise training interventions to maximize improvements in exercise capacity and associated outcomes in this underserved population.

Public Health Relevance

Lung cancer is the most common cause of cancer-related death among both men and women in the United States. Individuals with early-stage lung cancer have markedly reduced exercise capacity caused by multiple mechanisms (e.g., disease pathophysiology, treatment, deconditioning, etc.). This is of critical importance since poor exercise capacity is associated with higher disease-related symptoms, poor health-related quality of life (HRQOL), increased susceptibility to common age-related diseases and likely, premature death. Despite its importance, effective interventions to improve exercise capacity among lung cancer patients are not available.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Research Project (R01)
Project #
5R01CA138624-04
Application #
8301806
Study Section
Psychosocial Risk and Disease Prevention Study Section (PRDP)
Program Officer
O'Mara, Ann M
Project Start
2009-09-24
Project End
2014-07-31
Budget Start
2012-08-01
Budget End
2013-08-01
Support Year
4
Fiscal Year
2012
Total Cost
$400,379
Indirect Cost
$129,967
Name
Duke University
Department
Surgery
Type
Schools of Medicine
DUNS #
044387793
City
Durham
State
NC
Country
United States
Zip Code
27705
Jones, Lee W (2015) Precision Oncology Framework for Investigation of Exercise As Treatment for Cancer. J Clin Oncol 33:4134-7
Van Blarigan, Erin L; Gerstenberger, John P; Kenfield, Stacey A et al. (2015) Physical Activity and Prostate Tumor Vessel Morphology: Data from the Health Professionals Follow-up Study. Cancer Prev Res (Phila) 8:962-7
Scott, Jessica M; Jones, Lee W; Hornsby, Whitney E et al. (2014) Cancer therapy-induced autonomic dysfunction in early breast cancer: implications for aerobic exercise training. Int J Cardiol 171:e50-1
Jones, Lee W; Douglas, Pamela S; Khouri, Michel G et al. (2014) Safety and efficacy of aerobic training in patients with cancer who have heart failure: an analysis of the HF-ACTION randomized trial. J Clin Oncol 32:2496-502
Lakoski, Susan G; Barlow, Carolyn E; Koelwyn, Graeme J et al. (2013) The influence of adjuvant therapy on cardiorespiratory fitness in early-stage breast cancer seven years after diagnosis: the Cooper Center Longitudinal Study. Breast Cancer Res Treat 138:909-16
Betof, Allison S; Dewhirst, Mark W; Jones, Lee W (2013) Effects and potential mechanisms of exercise training on cancer progression: a translational perspective. Brain Behav Immun 30 Suppl:S75-87
Tonorezos, Emily S; Jones, Lee W (2013) Energy balance and metabolism after cancer treatment. Semin Oncol 40:745-56
Lakoski, Susan G; Eves, Neil D; Douglas, Pamela S et al. (2012) Exercise rehabilitation in patients with cancer. Nat Rev Clin Oncol 9:288-96
Koelwyn, Graeme J; Jones, Lee W; Hornsby, Whitney et al. (2012) Exercise therapy in the management of dyspnea in patients with cancer. Curr Opin Support Palliat Care 6:129-37
Jones, Lee W; Hornsby, Whitney E; Goetzinger, Amy et al. (2012) Prognostic significance of functional capacity and exercise behavior in patients with metastatic non-small cell lung cancer. Lung Cancer 76:248-52

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