Cancer is a generic term for a large group of diseases. Cancer occurs when abnormal cells are not destroyed by normal bodily processes. Instead, these cells multiply and spread to other parts of the body. Cancer can affect any part of the body. Lung cancer is a tumour that grows in one or both lungs. Primary lung cancer starts growing in the lungs and can sometimes spread to other parts of the body. Secondary lung cancer, or metastatic lung cancer, starts growing in another part of the body and then spreads (metastasises) to the lungs. Common symptoms experienced by people with lung cancer are breathlessness, cough, pain and fatigue.
--How common is lung cancer?
Lung cancer is the leading type of cancer diagnosed in males around the world. In females, lung cancer is the fourth-most common cancer diagnosed after breast cancer, colorectal cancer and cancer of the cervix uteri. Cancer is the leading cause of death worldwide and lung cancer is the leading cause of cancer death. However, survival rates for cancer have significantly improved over recent decades, meaning there are many people who have survived cancer with particular needs for their quality of life.
--What causes lung cancer?
The most common cause of lung cancer is tobacco smoking, however, there is a small group of people with lung cancer who have never smoked. Lung cancer is usually caused by a combination of risk factors, including:
- exposure to second hand smoke
- exposure to asbestos
- exposure to other environmental or occupational dusts and chemicals
- being of an older age
- having other lung diseases
- a genetic preposition.
Lung cancer is usually seen in people over the age of 60.
--How do I know if I have lung cancer?
The early signs of lung cancer can be a new cough or change in an old cough, breathlessness, chest pain, coughing up blood, fatigue, weight-loss, wheeze and/or a hoarse voice. However, many of these symptoms are signs of other lung problems as well, and they do not necessarily mean you have lung cancer. If you have any of these symptoms and you are concerned, you should speak with your GP. Some early-stage lung cancers are diagnosed when a person has a routine test, such as a chest radiograph, for another problem and may not actually have any symptoms from the lung cancer.
A GP will help diagnose lung cancer. They may do a variety of tests to try to determine if you have lung cancer and send you to a specialist medical doctor (such as respiratory physician, thoracic surgeon or oncologist) for assessment and treatment. Your treatment will depend on the type of lung cancer, the location of the tumour and the stage of the lung cancer (progression and spread of the disease). It may include a combination of lung surgery (to remove the tumour), chemotherapy or radiotherapy. Physiotherapy is important before and after cancer treatment to help you stay fit and active.
--How can physiotherapy help with lung cancer?
Physiotherapy works alongside your cancer treatment (such as surgery, chemotherapy or radiotherapy) with the aim of keeping you fit, reducing your symptoms and maximising your quality of life. A thorough physiotherapy assessment aims to identify any problems you are having and treat them accordingly. The main treatment a physiotherapist will provide is exercise prescription, which is a program of exercises and physical activities individually tailored to you. Exercise aims to help keep you physically active and strong, and counteracts the side-effects of cancer and the treatments.
--When should I exercise?
People with cancer, including those with lung cancer, can be offered exercise before, during or after cancer treatment. However, it is strongly recommended that you undergo a thorough pre-exercise screening assessment to rule out any specific dangers to exercise. The assessment will also establish your baseline level of physical ability. Your physiotherapist can do this for you.
The aim of exercise is slightly different depending on the stage of your treatment:
- Before surgery, chemotherapy or radiotherapy, the aim is to maximise your physical fitness to help you tolerate treatment better and speed up your recovery. Exercise before surgery is often referred to as prehabilitation or prehab.
- During chemotherapy or radiotherapy, exercise aims to keep you fit, reduce symptoms, and maximise your quality of life and psychological status.
- After finishing surgery, chemotherapy or radiotherapy, exercise aims to restore any loss in fitness and muscle strength that occurred while having treatment, and maximise your functional abilities, psychological status and quality of life for the long-term.
--How much should I exercise?
The exercise recommendations for people with cancer include 30 minutes of aerobic exercise at least five days per week. Examples of aerobic exercise are brisk walking, jogging, riding on a stationary bike or swimming. It is also recommended to do strengthening exercises 2-3 days per week to keep your muscles strong. If you have had falls or poor balance, it is also recommended that you do balance exercises. Early after lung surgery there are some restrictions on the type of exercise you can do and the amount of heavy lifting and strengthening exercises. Your physiotherapist will incorporate the best exercises for your particular situation into your exercise program.
--Will exercise make my disease worse?
No, exercise will not make your disease worse. When you exercise, your lungs need to work harder to deliver more oxygen to your working muscles. Therefore, you may experience increased breathlessness when exercising; however, that is a good sign and quite normal when you are exercising. The breathlessness should go back to normal as soon as you stop the exercise. However, for safety, it is recommended that you consult your physiotherapist or GP before you start exercising for the first time after being diagnosed with lung cancer.
--What is pulmonary rehabilitation?
Pulmonary rehabilitation is a program for people with chronic lung disease, including lung cancer, that usually involves supervised group exercise, education and support. Joining a pulmonary rehabilitation program is a great way to learn how to exercise with lung cancer and how to best manage your disease. At the pulmonary rehabilitation program, a physiotherapist will measure your current abilities, your symptoms and your safety for exercise. They will teach you how to do the exercises and then usually supervise you exercising in the group environment once or twice a week for 6-8 weeks. The program will also include education, including how to understand your disease, how to best manage your symptoms, how to stop smoking or cut down (if you are a smoker), and how to eat a healthy diet. The programs are located at local hospitals or community centres around Australia. Speak to your doctor or physiotherapist for more information and to get a referral to your local program. There are also similar exercise programs available called cancer rehabilitation or oncology rehabilitation. Pulmonary, cancer or oncology rehabilitation is a great option for anyone diagnosed with lung cancer.
--What else can physiotherapy do?
You may also see a physiotherapist on the hospital ward while you are in hospital receiving treatment. Physiotherapy after surgery usually commences on the first day after surgery and involves helping you get out of bed and start walking early, as well as the prescription and supervision of exercise. Your physiotherapist will also give you advice on what to do and what not do after surgery, including some exercises to complete at home once you leave hospital.
Physiotherapists can also help with treatment of other complications that may arise from the cancer and cancer treatment. These can be pain and fatigue, as well as musculoskeletal injuries, osteoporosis, falls and balance problems, neurological problems or respiratory problems. It's recommended that you see a physiotherapist early after diagnosis in order to maximise your health.
--How effective is physiotherapy for lung cancer?
There is a large body of research to confirm the effectiveness of physiotherapy improving many aspects of life for people with lung cancer. The majority of evidence comes from breast, colorectal, prostate and haematological cancer, with rapidly growing evidence in lung cancer. The guidelines on exercise and cancer recommend patients with cancer do 150 minutes or more of moderate intensity aerobic exercise per week (eg, walking) and 2-3 sessions of resistance training per week, as well as avoiding sedentary time.
The evidence demonstrates that exercise is associated with strong and consistent benefits on many fronts, including:
- improving exercise capacity (fitness)
- improving muscle strength
- reducing cancer symptoms (including breathlessness and cancer-related fatigue)
- reducing depression
- reducing anxiety
- reducing cancer distress
- improving quality of life.
There is also growing evidence linking higher physical activity levels after diagnosis of certain types of cancer, with reduced rates of mortality. Exercise and cancer is a rapidly growing area of physiotherapy practice. There are now a number of private physiotherapy practices offering specific services to patients with cancer, as well as a number of cancer rehabilitation programs available in community centres and local hospitals.
Physical activity and exercise for people with cancer (international guidelines)
Physiotherapy management for people with lung cancer
--What can I do at home?
The best thing to do at home is to exercise daily and lead an active lifestyle. A good aim is to undertake at least 30 minutes of exercise on most days of the week. Brisk walking is a safe and easy way to achieve this if you are not used to exercising. In addition, avoiding too much sedentary time during the day is important (such as avoiding sitting down for too long, watching television). Some people wear activity trackers such as Fitbits, pedometers or smartphones to track the number of steps they take each day. This is a great way to monitor your activity levels and ensure you are keeping up an active lifestyle. Aim to do 10 000 steps every day. If you are starting exercise for the first time after being diagnosed with lung cancer, talk to your physiotherapist about what will work best for you.
--Factsheet on lung cancer
Click the image to download the factsheet.
