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Paula Jane Agostini

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    MA 08 - Supportive Care and Communication (ID 669)

    • Event: WCLC 2017
    • Type: Mini Oral
    • Track: Nursing/Palliative Care/Ethics
    • Presentations: 1
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      MA 08.09 - Postoperative Mobilisation and Rehabilitation Requirements for Lung Cancer Patients Undergoing Minimally Invasive Surgery (ID 10064)

      11:00 - 12:30  |  Presenting Author(s): Paula Jane Agostini

      • Abstract
      • Presentation
      • Slides

      Video-assisted thoracoscopic surgery (VATS) is now increasingly performed and recommended in early-stage NSCLC resection. Early postoperative mobilisation, rehabilitation and physiotherapy can improve subsequent reduction in lung volumes, aid clearance of secretions and independent mobility, although there is much variation in how lung cancer patients are currently managed in this respect. The objective of this study was to observe capability for early mobility and frequency of issues potentially amenable to physiotherapy rehabilitation following VATS lobectomy for lung cancer. Any preoperative factors associated with increased rehabilitation needs were also identified, thus enabling early recognition of lung cancer patients needing rehabilitation.

      A prospective observational study was performed including all consecutive cancer patients undergoing VATS lobectomy in a regional centre over 4 years (2012-2016). Standard postoperative care included early mobilisation where patients were sat out by nursing staff from postoperative day 1 (POD1) and assisted to mobilise as able. Physiotherapy assessment of all patients on POD1 determined presence of issues potentially amenable to rehabilitation, and this was commenced as deemed necessary. Outcome measures included development of postoperative pulmonary complication (PPC), hospital and high dependency unit (HDU) length of stay (LOS) and intensive therapy unit admission (ITU).

      285 lung cancer patients were observed; 76 (27%) patients did not requiring specialised rehabilitation or physiotherapy, and engaged with nursing staff successfully in early mobility and becoming independently mobile. These patients had a significantly lower hospital and HDU length of stay (p<0.001), reflecting uncomplicated recovery. The remaining 209 patients (73%) received physiotherapy rehabilitation to assist/improve reduced mobility. Of these patients 23 (8%) also received chest physiotherapy for sputum clearance and 65 (23%) for lung volume loss. amongst those requiring this therapy were all patients who developed PPC, and all those admitted to the ITU. Despite surgery being non-invasive the frequency of development of PPC was higher than that for other VATS surgery at 7%, and this was associated with poorer outcomes. Logistic regression identified that COPD, BMI, preoperative mobility and age were associated with increased postoperative rehabilitation needs for mobility or respiratory issues (p=0.013).

      We recommend that all lung cancer patients receive early mobilisation and routine postoperative rehabilitation following this surgery ensuring issues amenable to physiotherapy and the need for rehabilitation is detected early. Associated preoperative baseline factors included COPD, poor preoperative mobility, and increasing BMI and age; such patients may benefit from preoperative rehabilitation as well as routine physiotherapy for better postoperative outcome.

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