Conclusions
- A meta-analysis indicates that healthy lifestyle interventions, such as promoting physical activity, improving psychological strategies, and introducing dietary changes, are effective in lung cancer patients, including those in the more advanced stages (stages III and IV) of the disease.
- Benefits include improved quality of life (QoL), reduced psychological distress, and fewer cancer-related symptoms (e.g., QoL).wheezing, coughing, chest tightness).
Why it matters
- GPs and specialists should encourage patients to benefit from healthy lifestyle interventions.
Study design
- Meta-analysis of 14 randomized clinical trials (RCTs) with 1,519 participants.
- The studies were selected through a literature search in the PubMed, Web of Science and Science Direct databases.
- Inclusion criteria: among others, lung cancer survivors; RCT; interventions focusing on healthy lifestyle programmes; patient-reported outcomes.
- Healthy lifestyle intervention had to be compared with no treatment, usual care, or no active role in the intervention.
- The components of the intervention varied, but the most common included offering information on the disease and/or its management, education in self-management of symptoms, education in practical self-management activities, and education in psychological strategies.
- Funding: Spanish Ministry of Education.
Main results
- Most studies involved patients with non-small cell lung cancer (NSCLC) and included patients with advanced disease (stages III and IV).
- Interventions improved QoL, with a significant aggregate mean difference (DM) between experimental and control groups (DM=0.73; 95% CI, 0.17–1.29; P=0.01).
- Outcome measures included the European Organization for Research and Treatment of Cancer’s Core 30 QoL questionnaire and the Functional Assessment of Cancer Therapy (FACT-Lung).
- The results showed a high heterogeneity (I2 = 92%; percentages above 50% are considered an indication of considerable heterogeneity).
- Interventions did not improve anxiety disorders (DM=0.61; 95% CI, 0.13 to 1.36; P=0.11) and depressive disorders (DM=0.49; 95% CI, 0.34 to 1.33; P=0.25).
- Interventions improved total psychosocial distress (DM=0.57; 95% CI, 0.01–1.13; P=0.05).
- Outcome measures included the State-Trait Anxiety Inventory (State-Trait Anxiety Inventory), Hospital Anxiety and Depression (HAD) HAD-anxiety, and HAD-depression questionnaires.
- The results showed a high heterogeneity (I2=93%).
- Interventions improved cancer-related symptoms (DM=0.77; 95% CI, 0.08–1.45; P=0.03).
- Outcome measures included the FACT-Lung Symptom Index (FACT) and the Symptom Distress Scale.
- The results showed a high heterogeneity (I2=90%).
- Applying the Cochrane bias risk assessment, 9 of the 14 studies were of poor quality, 4 studies were of acceptable quality, and the final study was of good quality.
- Outcome measures included the European Organization for Research and Treatment of Cancer’s Core 30 QoL questionnaire and the Functional Assessment of Cancer Therapy (FACT-Lung).
- The results showed a high heterogeneity (I2 = 92%; percentages above 50% are considered an indication of considerable heterogeneity).
- Outcome measures included the State-Trait Anxiety Inventory (State-Trait Anxiety Inventory), Hospital Anxiety and Depression (HAD) HAD-anxiety, and HAD-depression questionnaires.
- The results showed a high heterogeneity (I2=93%).
- Outcome measures included the FACT-Lung Symptom Index (FACT) and the Symptom Distress Scale.
- The results showed a high heterogeneity (I2=90%).
Limits
- High heterogeneity across studies, including timing of surgery, stage and therapeutic status of lung cancer patients.
- Most studies had a high risk of bias according to the Cochrane bias risk assessment.
- Small number of studies and small sample sizes.
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