Primary aim: To determine if prior research findings of improvement in patient outcomes with exercise during adjuvant chemotherapy would be maintained at six-month follow-up

Secondary aim: To determine if patients who reported regular exercise during the follow-up period would report better outcomes at six-month follow-up

Participants who had initially been in a three-armed randomized controlled trial were recruited to participate in this study. Prior study groups were aerobic exercise, resistance exercise, and control. Exercise groups were supervised. Participants were mailed questionnaires to determine the frequency of exercise and to rate their quality of life, self-esteem, fatigue, anxiety, and depression. Participants were asked to recall their exercise of the past six months using a questionnaire, and were then categorized into meeting or not meeting current guidelines for aerobic exercise (>/= 60 minutes of vigorous or 150 minutes of moderate exercise per week).

• The study reported on a sample of 201 female patients with breast cancer.
• Mean patient age was 49 years, with a range of 25–78 years.
• Patients received adjuvant chemotherapy with or without radiation therapy.
• Of the sample, 21% were obese, 61% had stage II disease, 59% had breast-conserving surgery, 31% received taxane-based chemotherapy, and 25% had reported recent exercise in the initial study.

• Multisite
• Other setting
• Alberta, Ottawa, and British Columbia, Canada

Patients were undergoing the transition phase of care after initial treatment.

This was a descriptive study for follow-up from a previous randomized controlled trial.

• Functional Assessment of Cancer Therapy–Anemia scale (FACT-A)
• Rosenberg Self-Esteem Scale
• Center for Epidemiologic Studies–Depression scale (CES-D)
• Spielberger State-Trait Anxiety Inventory
• Godin Leisure-Time Exercise Questionnaire

Of the sample, 20.9% reported meeting both aerobic and resistance exercise guidelines, 8% reported meeting only resistance exercise guidelines, 28.9% reported meeting only aerobic guidelines, and 42.3% reported not meeting any exercise guidelines. Those who originally were in a group given supervised aerobic exercise training (AET) had fewer reporting that they met exercise guidelines during follow-up (p = 0.034). Those who had received resistance exercise training (RET) reported higher self-esteem at six months (p = 0.032). The AET group reported significantly lower anxiety at six months than either the control or RET group members (p = 0.049). All other changes in self-reported outcomes at six months favored the exercise groups, but were not statistically significant. Those who reported that they met exercise guidelines reported higher quality of life (p = 0.025) and less fatigue (p = 0.013). They also reported less anxiety, but this difference was not significant. At six months, those in the AET group reported that anxiety was lower by 4.7 points and depression was reduced by 2.7 points.

Exercise training during chemotherapy treatment may have longer-term effects on anxiety and self-esteem. Consistent exercise meeting recommended guidelines appears to benefit patients in terms of a positive effect on symptoms of fatigue and general quality of life.

• There was a higher loss to follow-up in the original study’s control group, which may have skewed study results comparing exercise groups to controls.
• Findings are based on self-report only, which may have affected findings related to consistency of exercise.

Findings suggest that ongoing exercise according to guidelines appears to have positive effects on patients’ quality of life, fatigue, anxiety, and self-esteem. Nurses can educate patients about these potential benefits.

To compare the effects and doses of a three-arm exercise trial to improve sleep quality in patients with breast cancer receiving active chemotherapy

The three-group design of the CARE trial compared the standard dose of 25–30 minutes of aerobic exercise (STAN) to higher doses of activity that included 50–60 minutes of aerobic exercise (HIGH) and 50–60 minutes of combined-dose of aerobic and resistance exercise (aerobic and strength training three times per week) (COMB). COMB strength training was part of the 50–60 minute session and included two sets of 10–12 repetitions of nine different strength exercises at 60%–75% of the estimated one-repetition max (RM). All groups received three weekly treatments with outcomes measures to determine primary and secondary outcomes. Interventions continued for the duration of chemotherapy. Data were collected at baseline, midpoint 1, midpoint 2, and postintervention.

• N = 296
• MEAN AGE = > 18 years M = 50 (SD = 8.7 years)
• FEMALES: 100%
• KEY DISEASE CHARACTERISTICS: Patients with breast cancer receiving active chemotherapy
• OTHER KEY SAMPLE CHARACTERISTICS: English or French speaking; not pregnant; stages I–IIIc

• SITE: Multi-site    
• SETTING TYPE: Multiple settings    
• LOCATION: Canada

• PHASE OF CARE: Active antitumor treatment

Blinded, randomized, controlled trial

• Primary outcomes were measured using the Pittsburgh Sleep Quality Index (PSQI).
• Secondary outcomes for moderators for plausibility included clinical utility, support for previous research used, age, aerobic exercise guidelines, strength exercise guidelines, comorbidities, body mass index, aerobic fitness (treadmill and gas exchange), and medical moderators from records (stage, surgery, and chemotherapy).

296 patients completed the study with complete data. Baseline global sleep scores were M = 6.2 (SD = 4.1) with 52% of participants reporting poor sleep at baseline (PSQI > 5). The main effects of the study showed that the HIGH group had statistically better outcomes compared to the STAN group for primary sleep global scores (d = 0.22; p = 0.039), sleep quality (d = 0.26; p = 0.028), and sleep latency (d = 0.18; p = 0.049). The COMB group barely scored significantly higher than the STAN group for global sleep quality, sleep duration, and sleep efficiency (d = 0.24; p = 0.04)  and percent of poor sleepers (d = 0.20; p = 0.045). The HIGH group was statistically better than COMB for sleep latency only (d = 0.20; p = 0.04) . Significant moderators included surgery, baseline aerobic fitness, baseline aerobic exercise guidelines, baseline strength guidelines, and number of comorbid conditions. The effect size for the HIGH group compared to the STAN group was larger for global sleep quality for lumpectomy patients with no comorbid conditions, those meeting aerobic exercise guidelines, and those who were fitter at baseline. Scores in the COMB group were higher than those of the STAN group for lumpectomy patients meeting strength exercise guidelines. The overall effect for each arm was small.

Higher doses of exercise and the combination of exercise and strength training were associated with better overall sleep quality compared to the standard dose of 50–60 minutes of aerobic exercise. Different sleep components appeared to be most affected by the type of exercise intervention, and no single intervention impacted all the sleep components measured.

• Measurement validity/reliability questionable
• Findings not generalizable
• Intervention expensive, impractical, or training needs
• Other limitations/explanation: There were no noted statistics to compare the three intervention groups as reported in the manuscript, so it is unclear whether group differences were present. The findings of this study only are generalizable to breast cancer and cannot be generalized to other active patients with cancer. The intervention assumes that patients have access to exercise support and gyms with the COMB part of the intervention. This might not be realistic for some areas with rural populations. The PSQI was validated using all 19 items, but this study eliminated nine (sleep disturbance) questions without a validation of the questionnaire, thus reducing the overall validity and reliability of the findings that were based on the global sleep quality index.

Nurses often suggest maintaining activity during treatment, but there is little information about the effectiveness of this recommendation on sleep-wake disturbances. This study provided a large sample of patients with breast cancer that narrowed down the doses needed to affect sleep. The overall results of this study suggest that exercise can improve sleep during chemotherapy treatment. However, the limitations of this study need to be taken into consideration before recommending the actual interventions used.

To test the hypothesis that aerobic exercise would be better than usual care for improving sleep quality, and to examine potential moderators of intervention effects

Patients were stratified by lymphoma type and whether the patient was receiving chemotherapy and then randomized to receive the exercise intervention or usual care. The intervention consisted of supervised aerobic sessions three days per week for 12 weeks. Prescriptions for unsupervised exercise were provided for patients who were unable or unwilling to attend supervised sessions, and these sessions were not counted in adherence evaluation. Usual care patients were asked to not change baseline exercise habits and were offered supervised exercise after final study assessments.

• N = 117
• AGE: 32.5% were younger than 50 years, and the rest were older than 50 years. No other age information is provided.
• MALES: 59%, FEMALES: 41%
• KEY DISEASE CHARACTERISTICS: All had non-Hodgkin lymphoma, 54.7% were off treatment, and 45.3% were in active treatment.  
• OTHER KEY SAMPLE CHARACTERISTICS: At baseline, 71.8% were not meeting recommended activity guidelines. At baseline, overall, 47% were poor sleepers. The prevalence of poor sleepers was higher in the intervention group (57.9% compared to 36.7%, p = .021).

• SITE: Not stated/unknown  
• SETTING TYPE: Outpatient  
• LOCATION: Canada

• PHASE OF CARE: Multiple phases of care

• RCT

• Pittsburgh Sleep Quality Index

Aerobic exercise resulted in a small (d = -0.19) but not significant improvement in global sleep quality. In the intervention group, the exercise program improved global sleep quality in patients receiving chemotherapy (p = .013), but not for those who were off therapy. Exercise improved global sleep quality in those who were poor sleepers at baseline (p = .007), but not in those who were good sleepers at baseline.  Analysis further showed that positive effects of exercise were seen in patients with shorter time since diagnosis, patients who were obese, and patients who had less aggressive disease.

Aerobic exercise did not significantly improve sleep quality in this study of patients with lymphoma. Exercise appeared to have some benefits for sleep quality in individuals who were in active treatment.

• Risk of bias (no blinding)
• Risk of bias (no appropriate attentional control condition)
• Key sample group differences that could influence results
• Other limitations/explanation: Findings showed that those with poor sleep quality had a greater effect with aerobic exercise, and, at baseline, more poor sleepers were in the intervention group. This suggests that actual effects may be even lower for exercise than shown here. No statement is provided of how many patients did not participate in the supervised exercise sessions and how this was handled in overall analysis of group differences.

Findings show that overall, participation in aerobic exercise does not improve overall sleep quality in patients with lymphoma. Some benefit may exist for patients during chemotherapy treatment and for individuals who have baseline poor sleep quality. For these types of patients, nurses should consider suggesting aerobic exercise or providing exercise prescriptions.

Patients were randomized to receive either 10 weeks of group psychotherapy and exercise (home-based, moderate intensity, 20 to 30 minutes, three to five times per week, and tailored across the intervention to promote progression toward the goal of achieving a heart rate during exercise of 65% to 75% of the estimated heart rate maximum) or group psychotherapy only. The group psychotherapy intervention consisted of stress management and relaxation training or expressive supportive therapy. Both group psychotherapy interventions had a psychoeducational focus. Patients in the group psychotherapy only arm received a personalized exercise plan after study completion. To control for possible contamination between the experimental conditions, groups of patients who had registered for a group psychotherapy program at a large cancer center, rather than individual patients, were randomized.

• The study included 96 patients (group psychotherapy and exercise group, n = 51; group psychotherapy only, n = 45).
• Mean age was 51.55 years (range 25–74).
• Of the patients, 84% were female, 50% had stage I or II disease, and 50% had stage III or IV disease.
• Most patients were Caucasian and had an annual income of $40,000 per year.
• All patients were screened for participation restrictions for a moderate exercise program using the revised Physical Activity Readiness Questionnaire (PAR-Q) and a submaximal fitness assessment.
• Diagnoses included breast cancer (40.9%), colon cancer (9.4%), lymphoma (6.2%), ovarian cancer (5.2%), gastric cancer (4.2%), melanoma, and mixed solid tumors (21.8%).

• Single site
• Outpatient comprehensive cancer center

Patients were undergoing the active treatment and long-term follow-up phases of care.

This was a randomized, controlled trial with a crossover for the control group receiving group psychotherapy alone.

Functional Assessment of Cancer Therapy–Fatigue (FACT-F)

No difference existed between expressive supportive therapy and stress management and relaxation therapy in group psychotherapy effect in either group. Group psychotherapy and exercise improved quality of life beyond group psychotherapy only in cancer survivors (active treatment and long-term follow-up). The group psychotherapy intervention did not significantly reduce fatigue; however, the addition of moderate-intensity exercise resulted in a statistically significant improvement in fatigue.

• The group was relatively homogeneous with regard to race (most were Caucasian), educational level (59% had completed university), and socioeconomic status (67% had a median annual family income greater than $40,000).
• The exercise program was only 10 weeks in length and provided no long-term follow-up because of the control group crossover design.
• Some exercise, adherence, and contamination problems were noted; about 20% of the patients in the exercise condition did not meet the minimum cut point of 60 minutes per week of moderate or strenuous exercise, and 20% of patients in the control group met this cut point.
• Contamination may have resulted from having the control condition monitor patients and report their exercise on a weekly basis or because previous exercisers were allowed to participate.
• All patients were selected from among patients who declared themselves interested in a group psychotherapy intervention; thus, the results are generalizable to patients who voluntarily join group psychotherapy classes.
• The authors did not differentiate outcomes achieved by patients who were receiving active treatment and those on long-term follow-up.
• Nontolerance of exercise and safety parameters for exercise in the group psychotherapy and exercise groups was not described.
• For group psychotherapy, a therapist experienced in stress management, relaxation therapy, and expressive-supportive therapy is required. A certified fitness appraiser must appraise and design each individual program.
• Skills and equipment for performing a submaximal cardiovascular treadmill test are needed to evaluate the fitness level of patients prior to having them commence an exercise program.

Databases searched were MEDLINE, CANCERLIT, CINAHL, HERACLES, PsycINFO, and SPORTDiscus through 1997. Studies restricted solely to movement therapy and/or stretching/flexibility exercises for rehabilitation of range of motion were excluded. Studies were also excluded if they presented insufficient detail to allow for critical review.

Eighteen intervention studies (10 quasiexperimental and eight experimental designs) of physical exercise designed to improve cardiovascular and/or muscular fitness were included.

Outcomes were fatigue, health-related quality of life, symptom distress, immune function, physical exercise capacity (maximal oxygen consumption), and other physical performance measures.

Treatment evaluated cycle ergometer (eight studies), walking either alone or in combination with some other exercise mode (six studies), resistance training (one study), and unspecified (three studies).

Length of the intervention was 12 weeks or less in 14 studies, between four and six months in three studies, and one year in one study. Exercise was supervised (13 studies), unsupervised home-based (three studies), and partially supervised (two studies).

• The sample sizes ranged from eight to 70 participants.
• Most of the studies were conducted in patients with or survivors of breast cancer or those who were predominantly stage I and II.
• A few studies evaluated exercise in patients with leukemia following allogeneic stem cell transplantation and in patients with solid tumors following autologous stem cell transplantation.
• Single studies were found for survivors of head and neck, colorectal, and childhood cancer.

The reviewed studies indicated promising effects on both physiological and psychological outcomes. Three studies reported a significant reduction in fatigue. Although effect sizes could not be summarized across studies due to the diversity of outcomes with small numbers of effect sizes, the effects appeared to be robust and clinically significant.

• Small convenience samples were used.
• The study design lacked appropriate control groups.
• The range of cancer sites was restricted. 
• The intervention period was short (the exercise treatment lasted 12 weeks or less in most studies).

Additional studies are needed to examine the effect of exercise, specifically on the endpoint of fatigue.

To examine the effects of exercise dose and type on psychosocial distress in patients with breast cancer receiving chemotherapy

Patients were computer-stratified by center and protocol and randomly assigned in a 1:1:1 ratio to standard (STAN), combination (COMB), or high-volume (HIGH). Participants exercised for the duration of their chemotherapy schedules. STAN treatment followed the Physical Activity Guidelines for Americans. The guidelines recommend a minimum of 75 minutes per week of vigorous aerobic exercise over three days per week. HIGH followed double the minimum guidelines of 150 minutes per week, and COMB followed the STAN guideline with the addition of a standard strength training program for three days per week. Exercise was supervised, and attendance, duration, and the intensity of aerobic exercise, weight, sets, and repetitions of strength training were recorded.

• N = 301  
• AGE RANGE = 45–55 years
• FEMALES: 100%
• KEY DISEASE CHARACTERISTICS: Breast cancer stages I–III initiating adjuvant chemotherapy

• SITE: Multi-site    
• SETTING TYPE: Multiple settings    
• LOCATION: Canada

• PHASE OF CARE: Active antitumor treatment

Randomized trial

• Short version of Center for Epidemiological Studies-Depression Scale (CES-D)
• Short form of the Spielberger State-Trait Anxiety Inventory (STAI)
• Perceived Stress Scale (PSS)
• Rosenberg Self-Esteem Scale (RSES)

There were no significant differences in managing depressive symptoms with HIGH and COMB exercises compared to the STAN exercise. COMB and HIGH exercises were effective in managing depressive symptoms in patients with clinical levels of depressive symptoms at baseline. There were no differences between the groups in anxiety scores.

Compared to standard exercise, higher volumes of exercise did not improve depressive symptoms, but it was effective in managing depressive symptoms in patients with clinical levels of depressive symptoms at baseline.

• Risk of bias (no blinding)

Depression is the most common psychological symptom in patients with cancer. Oncology nurses should encourage patients to perform standard aerobic exercise to improve depressive symptoms. Exercise also has been shown to be beneficial for anxiety and fatigue.

The three-armed study reported on an exercise intervention with supervised aerobic exercise (AET) and supervised resistance exercise (RET) versus usual care (UC). The exercise sessions were started one to two weeks after starting chemotherapy and ended three weeks after completion of chemotherapy. Exercise trainers administered the intervention.

• AET group participants (n = 78) exercised three times per week on a cycle, a treadmill, or an elliptical machine, beginning at 60% of their maximal oxygen consumption for weeks 1–6 and then progressing to 70% during weeks 7–12, and 80% beyond week 12. Exercise duration began at 15 minutes for weeks 1–3 and increased by five minutes every three weeks until the duration reached 45 minutes at week 18.
• RET group participants (n = 82) exercised three times per week, performing two sets of 8–12 repetitions of nine different exercises at 60%–70% of their estimated one-repetition maximum. Resistance was increased by 10% when participants completed more than 12 reps.
• UC group participants (n = 82) were asked not to initiate an exercise program and were offered a one-month exercise program after postintervention assessments.

Data were collected at three time points: baseline (one to two weeks after starting chemotherapy), midpoint (three to four weeks after starting chemotherapy), and at six-month follow-up.

The study reported on a sample of 242 women with breast cancer receiving adjuvant chemotherapy.

Multiple centers in Canada

A randomized controlled trial (RCT) design was used.

• Functional Assessment of Cancer Therapy–Anemia scale (FACT-A)
• Rosenberg Self-Esteem Scale
• Center for Epidemiologic Studies–Depression scale (CES-D)
• Spielberger State Anxiety Inventory (STAI)
• Peak oxygen consumption
• Expired gases
• Body weight and height
• Dual x-ray absorptiometry scan for assessment of whole body fat and lean tissue
• Lymphedema measurements
• Chemotherapy completion rate assessed as the average relative dose intensity for the originally planned regimen based on standard formulas

Mixed-model analysis measured at three time points compared the differences across groups in changes over time. Neither AET nor RET interventions significantly improved cancer-specific quality of life, fatigue, depression, or anxiety, although the trends favored the exercise groups. AET improved self-esteem, aerobic fitness, and percent of body fat. RET improved self-esteem, muscle strength, lean body mass, and chemotherapy completion rates.

The study is an RCT with an adequate sample size but null findings for anxiety levels.

The intervention required exercise trainers.

To determine if oral synthetic tetrahydrocannabinol (THC) and smoked marijuana are effective in the treatment of chemotherapy-induced nausea and vomiting (CINV), and to evaluate the side effects and patient preferences for treatment

Databases searched were MEDLINE (1966–present), CINAHL (1982–present), and the Cochrane Library.  A search of article reference lists also was performed.

Search keywords were nausea, vomiting, cancer, chemotherapy, cannabis, marijuana, and dronabinol.

Studies were included in the review if they

• Reported on human clinical trials.
• Involved treatment with smoked marijuana or oral synthetic THC for CINV.
• Were in English.

The author retrieved 18 relevant citations, 10 of which were clinical trials and included in the review. The author evaluated the quality of the reference based on strength of evidence, study design, sample size, and purpose. Specific criteria were not described.

• A total of 929 patients were involved across the 10 included studies.
• Sample sizes ranged from 15 to 214.
• Subjects had a variety of diagnoses and were receiving various types of chemotherapy.
• Six studies involved the use of chemotherapy that was of moderate to high emetogenic potential.

• Two studies evaluated the efficacy of oral synthetic THC versus placebo. In both studies, THC was significantly better than placebo at reducing CINV (p < 0.001).
• A one-group study tested crude marijuana; 78% of patients reported it to be moderately or highly effective. However, 18 patients dropped out of the study because they did not accept the smoking route of administration.
• Three studies examined oral synthetic THC versus phenothiazines. Two of these studies found that THC was significantly more effective in controlling CINV (p < 0.05) while the third found no difference. Timing and dosages differed across studies. In one study, patients who took THC reported significantly more sedation, incoordination, and feelings of being high than those receiving compazine or placebo.
• One study found that the combination of THC and antiemetics was most successful in mitigating severity and duration of CINV.
• In one study of smoked marijuana versus phenothiazines, no differences were found between groups.
• In a comparison of oral THC versus smoked marijuana, both were found to be effective with no significant differences found between these approaches.
• One study compared oral THC versus 5-HT₃ receptor antagonists (RAs) in a randomized, controlled, double-blind design. All patients received a standard antiemetic protocol of dexamethasone and ondansetron prior to chemotherapy and then were randomly assigned to also receive THC, placebo, or other drugs alone or in combination. All drugs were more effective than placebo, but no significant differences were found between those who took the THC and the other medication groups.
• A number of these studies had small sample sizes, and one lacked a control group.

• Both oral THC and smoked marijuana were found to be more effective than placebo and as equally effective as other commonly used antiemetics in controlling CINV.
• Oral THC appears to be as effective as smoked marijuana.
• THC was associated with more side effects (sedation, lack of coordination, and feeling “high”).
• Some patients found the inhalation route for marijuana use to be unacceptable.
• Some patients may not be able to tolerate the harsh smoke, and, because crude marijuana may contain bacteria or fungi, concerns exist for immunocompromised patients.
• Cannabinoids appear to have value as adjuvant medication, and the evidence supports their use for mitigation of CINV. They appear to be most effective in combination with other antiemetics.

Nurses need to review potential sides effects. Individual patients can have differing concerns as a result of other problems or preferences. Oral THC may be the best option for use among patients with cancer.

To evaluate the effect of ¹⁵³Sm–ethylenediamine tetramethylene phosphonate (Sm-EDTMP) for relief of pain from bone metastases

Consecutive patients referred to nuclear medicine who met eligibility criteria (life expectancy greater than six months, no chemotherapy within the previous four weeks, and acceptable blood values) were entered into the study. Each patient was asked to evaluate his or her pain daily using a visual analog and a verbal rating scale. Pain palliation was assessed using the patient’s mean scores. Sm-EDTMP was given intravenously in a solution of 37 MBq per kilogram body weight. Patients had blood work daily, and a TcMDP bone scan was done on the fifth day.

• N = 277  
• MEAN AGE = 64 years (range = 24–92 years)
• MALES: Not reported, FEMALES: Not reported
• KEY DISEASE CHARACTERISTICS: The majority of patients had prostate cancer.

• SITE: Single-site    
• SETTING TYPE: Not specified    
• LOCATION: Mexico

• PHASE OF CARE: Late-effects and survivorship
• APPLICATIONS: Palliative care

Observational

• Visual Analogue Scale (VAS)
• Verbal Rating Scale (VRS)

Pain was reduced in patients with prostate cancer by 74%, in breast by 67%, in renal by 78%, in thyroid by 67%, in lung by 75%, in cervical by 80%, in colon and rectum by 73%, and by 100% in patients with osteosarcoma. There were no significant changes in blood work values of leukocyte counts, hemoglobin, or platelets at 3 or 12 weeks after treatment. Pain scores were significantly reduced at 3 and 12 weeks (p = .001). There was a relatively high variability in pain score differences.

Sm-EDTMP was effective in reducing pain from bone metastases from multiple tumor types over a 12-week period.

• Risk of bias (no control group)
• Unintended interventions or applicable interventions not described that would influence results
• Measurement/methods not well described
• Other limitations/explanation: No information was provided regarding other medications, etc., used for pain control or any changes in medications during the study. It is not clear if the VRS or VAS was used for analysis, and it was not stated whether the scale was a 10-point or 100-point VAS. The study duration was relatively brief. The sample sizes of patients with various tumor types were not stated.

Radiopharmaceuticals such as Sm-EDTMP may be effective for the management of pain from bone metastases. Further research comparing various pain control approaches is warranted with longer follow-up.

The intervention included weekly sessions with a nurse research practitioner, lasting one hour, using counseling, breathing retraining, relaxation, and the teaching of alternate coping and adaptation strategies. The interventions are the same as those commonly used to treat patients with chronic pulmonary disease. Patients were randomized either to an intervention group or control group. The intervention group met over a three- to six-week period. Additional follow-up sessions were available if necessary. The number of sessions was not stated. The control group received usual nursing care such as breathing assessment with documentation in the medical record.

The study reported on a sample of 20 patients with lung cancer. The patients had completed either chemotherapy or radiotherapy and were experiencing breathlessness.

The study was conducted in a nurse-led clinic in a specialist cancer center.

Randomized, controlled pilot study

• A 10-point VAS measuring three time frames (best, worst, and usual) to rate breathlessness over the previous week
• Distress caused by breathlessness
• Functional Capacity Scale
• HADS

Median scores on all measures were improved. Distress from breathlessness improved 53%, breathlessness at worst improved 35%, and functional capacity improved by 21%. Distress in the control group worsened by a median of 10%. Significant improvements compared with the control group were observed in breathlessness at best (p < 0.02) and at worst (p < 0.5), distress caused by breathlessness (p < 0.01), and functional capacity (p < 0.02). Improvements were not observed for anxiety or depression.

The study demonstrates that patients with lung cancer and breathlessness benefit from a rehabilitative approach.

The effect of time and attention on a weekly basis independent of intervention is unknown. The contribution of each component of the intervention is unknown. Are all components needed to achieve the same outcome, or was one aspect of the intervention most significant? The study had a small sample, and baseline data show that the intervention group rated distress caused by breathlessness higher than did the control group.

The study is valuable as a pilot study with an aim to test feasibility.