Crandall, K., Maguire, R., Campbell, A., & Kearney, N. (2014). Exercise intervention for patients surgically treated for Non-Small Cell Lung Cancer (NSCLC): A systematic review. Surgical Oncology, 23, 17–30. 

DOI Link


STUDY PURPOSE: To examine the literature regarding exercise interventions for patients who were surgically treated for non-small cell lung cancer (NSCLC) focusing on three key areas: methodological quality, intervention design (e.g., duration, frequency, type), and outcomes measured
TYPE OF STUDY: Systematic review

Search Strategy

KEYWORDS: A figure in the article outlines the keywords and derivations used to conduct the search.
  • Study Design: Both randomized and nonrandomized studies were considered to acquire a complete understanding of the topic area. The key inclusion criterion was that all studies, regardless of design, had to include some form of physical exercise training for patients surgically treated for NSCLC. This review intended to include quantitative, qualitative, and mixed-method study designs.
  • Participants: Studies that included participants diagnosed with resectable NSCLC were included in this review. Exercise interventions were defined as supervised or unsupervised inpatient, outpatient, community- or home-based interventions that included any type of exercise training applied to patients surgically treated for NSCLC. Some studies included additional components. Four studies included education, four included smoking cessation, and three used phone calls.
  • Outcome measures: All outcomes measured were recorded in this review. 
  • Study Design: All poster abstracts and non-English full-text articles were excluded.  
  • Participants: Studies with < 65% of the patient population were excluded to ensure a consistent sample.

Literature Evaluated

TOTAL REFERENCES RETRIEVED: Thirty-six full-text journals were reviewed after various methods were employed to get to this sample size of 25 that met the inclusion criteria. Then 19 were original studies and one article reported two studies for a final number of 20 studies.
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: The reasons that 11 articles were excluded from included that they were not a published study (e.g., abstract from conference or study protocol [n = 8]), the intervention did not include exercise training (n = 1), or the study included < 65 % of the patient population (n = 2). Ten studies included control groups.

Sample Characteristics

  • TOTAL PATIENTS INCLUDED IN REVIEW = 575 (not including the 246 historical controls, making the average study size 28.75 participants)
  • KEY SAMPLE CHARACTERISTICS: The mean cohort age was 64.07 years across 17 of the studies. Three studies did not report age. All studies that reported gender recruited both male and female participants, and the average male percentage of recruitment was 57.29% (range = 29%–95.5%). Five studies did not report gender. All stages of cancer were included, but mainly stages I–III were present. 


Phase of Care and Clinical Applications

PHASE OF CARE: Multiple phases of care


There were multiple outcomes measured with fatigue being one of the outcomes. Fatigue was measured using various instruments in five different ways that were not comparable. For example, fatigue was reported as an issue of severity/intensity in one study, and another reported it as the self-efficacy (ability) to manage fatigue. Also, it appears this was not taken into account by the authors of this article. The perceptions of fatigue as a symptom with severity to be reduced as compared to the perception of fatigue to be managed are two different concepts, and this distinction has not been pointed out by the authors of the article.
  • Fatigue increase was noted in studies presurgery to immediately postsurgery, yet the authors did not cite which studies.  
  • Fatigue reduction was found from baseline to postintervention in three out of five studies. The authors note that in two studies, fatigue severity from baseline to postintervention was not reduced and that each of these studies were of a different type of exercise (resistance) with different intervention timing (preoperative).
  • Fatigue reduction was noted to be sustained in two participants who did not receive adjuvant therapy as compared to those who underwent adjuvant treatment.


Preliminary findings from the review suggest that intervention via exercise compared with usual care pre- and postsurgery may reduce fatigue. The results from the systematic review show the infancy of this particular field of study with very few studies included for analysis, with the majority of studies being of observational methodology. In addition, studies included a wide range of exercise prescriptions.


The field of treatment for fatigue in the surgical NSCLC population is in its infancy. In one study of the reviewer’s expertise, it is noted that the article was labeled as an unsupervised intervention when the article discusses the actual supervision of subjects participating in the exercise intervention.

Nursing Implications

Additional study of the best exercise prescription for fatigue management is needed related to patients undergoing surgery. The best timing for such interventions is not clear.

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