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Open Access Publications from the University of California

The Utility of Exercise Testing in Patients with Lung Cancer

  • Author(s): Ha, D
  • Mazzone, PJ
  • Ries, AL
  • Malhotra, A
  • Fuster, M
  • et al.

The harms associated with lung cancer treatment include perioperative morbidity and mortality and therapy-induced toxicities on various organs, including the heart and lungs. Optimal treatment, therefore, entails a need for risk-assessment to weigh the probabilities of benefits versus harms. Exercise testing offers an opportunity to evaluate a patient's physical fitness/exercise capacity objectively. In lung cancer, it is most often used to risk-stratify patients undergoing evaluation for lung cancer resection surgery. In recent years, its use outside of this context has been described, including in non-surgical candidates and lung cancer survivors. In this article we review the physiology of exercise testing and lung cancer. Then, we assess the utility of exercise testing in lung cancer patients in 4 contexts (preoperative evaluation for lung cancer resection surgery, following lung cancer surgery, lung cancer prognosis, and assessment of efficiency of exercise training programs) after systematically identifying original studies involving the most common forms of exercise tests in this patient population: laboratory cardiopulmonary exercise testing and simple field testing with the six-minute walk test, shuttle walk test, and/or stair climbing test. Lastly, we propose a conceptual framework for risk-assessment of lung cancer patients being considered for therapy and identify areas of further studies in this patient population.

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