Cardio-oncology rehabilitation is a critical intervention for lung cancer survivors, particularly those diagnosed at an early stage and under-going lobectomy, as maximal oxygen up-take peak (VO2PEAK) is a strong prognostic predictor. In a paper published in the Journal of Clinical Oncology, Guangqi Li and colleagues explored the use of digital therapeutics for telerehabilitation in this patient population.
Slow Uptake of Telerehabilitation
According to Li and colleagues, “Home-based cardiac telerehabilitation serves as a substitute for traditional center-based rehabilitation, demonstrating higher participation and completion rates.”
Authors of another article recently published in European Heart Journal Supplements emphasized that cardio-oncology rehabilitation is beneficial but “still underused in patients with cancer, and we are still at the dawning of remote models of rehabilitation. Telehealth has been described by cancer survivors as a convenient and reassuring modality of care, reducing the subjective impact of cancer treatment,” Irma Bisceglia, MD, and co-authors explained. They added that some patients “benefit the most from rehabilitation; this principle holds true for telerehabilitation, too, which has been proven to be as effective as face-to-face rehabilitation.” Li and co-investigators noted that technological innovations, such as wearable devices and mobile apps, offer benefits, including tailored video guides, real-time monitoring, custom safety alerts, and feedback. However, these devices have not been widely adopted in clinical practice. To address these gaps, the researchers conducted a randomized controlled trial to determine the efficacy, safety, and compliance of a 3-month digital therapeutics-based cardiooncology rehabilitation program for lung cancer survivors.
Benefits for Lung Cancer Survivors
The study included early-stage lung cancer survivors post-lobectomy who did not require radiotherapy or chemotherapy. The researchers randomly assigned patients to either a cardiac telerehabilitation group or a usual care group for 5 months.
The telerehabilitation group utilized the R Plus Health app, which provided exercise prescriptions with video guides and real-time heart rate monitoring, driven by AI and modified by physiologists. The usual care group received routine exercise instructions.
Primary and secondary outcomes included VO 2PEAK, FEV 1, diffusing capacity for carbon monoxide, cardiac function, safety, compliance, and various symptom, psychology, sleep, fatigue, and QOL scales.
Out of 47 participants, 40 (85%) completed the trial: 24 in the telerehabilitation group and 16 in the usual care group. Patients in the telerehabilitation group exercised an average of 3.6 times per week, totaling 168.3 minutes per week, with 106.3 minutes of effective exercise duration (reaching the required heart rate). Cardiac telerehabilitation significantly improved VO2PEAK (3.660 ±3.232 vs 1.088 ±3.230 mL/kg/min; P=0.023), alleviated affective interference (-1.091 ±1.788 vs 0.310 ±1.330; P=0.017), and reduced anxiety (-0.377 ±0.584 vs -0.020 ±0.321; P=0.045) compared with usual care. Other efficacy outcomes did not significantly differ between the groups.
The researchers noted that no exercise-related AEs occurred during the intervention. Given their findings, Li and colleagues noted that digital therapeutics-based cardio-oncology rehabilitation effectively improved cardiorespiratory fitness and reduced affective interference and anxiety in lung cancer survivors. The researchers observed high compliance and safety rates, suggesting that digital therapeutics offer a viable and beneficial alternative to traditional rehabilitation methods. When selecting patients for cardio-oncology rehabilitation, Dr. Bisceglia and co-authors noted that clinicians should screen patients carefully to optimize outcomes.
