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Preoperative Respiratory Muscle Training to Prevent Postoperative Pulmonary Complications in Patients Undergoing Resection for Lung Cancer

Award Number: R01CA222382
ORGANIZATION: NATIONAL CANCER INSTITUTE
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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Preoperative Respiratory Muscle Training to Prevent Postoperative Pulmonary Complications in Patients Undergoing Resection for Lung Cancer - PROJECT SUMMARY/ABSTRACT Surgical resection for stage I-III lung cancer is the treatment of choice and provides the highest rate of survival. Although surgery offers a potential cure, postoperative complications such as pneumonia, dyspnea, and reduced physical functioning are common and contribute to medical costs, reduced quality of life, length of stay, 30-day readmission rate, cancer recurrence, and mortality. Improving preoperative pulmonary health and aerobic capacity improves postoperative morbidity and mortality. However, preoperative exercise studies require a longer period of time (4-6 weeks) than is clinically available to demonstrate an impact, making them non-feasible for patients awaiting lung resection surgery. These programs also require multiple supervised visits/week, rigorous exercise, posing a strain on the social support system not available for most patients. In other disease sites, a 2-4 week respiratory muscle training (RMT) program performed prior to bypass, abdominal and esophageal cancer surgeries reduces postoperative complications. In lung cancer, respiratory muscle weakness (diaphragm) is associated with reduced exercise capacity and survival as well as increased surgical complications up to two years post-thoracic surgery. Therefore, interventions targeting respiratory muscle function prior to lung resection represent a more practical solution to prevent postoperative complications. RMT will also increase the number of surgically eligible patients as well as expedite recovery, reducing risk of long- term consequences in this high-risk cohort. Our long-term goal is to have a better understanding of biomarkers that will predict postoperative complications and quality of life in lung cancer survivors. The overall objective of this application is to determine how a home-based program designed around strengthening the respiratory muscles will improve postoperative health. This project will also study mechanisms contributing to respiratory muscle dysfunction as well as examine the financial sustainability of a prehabilitation program. The central hypothesis is that preoperative respiratory muscle weakness contributes to negative postoperative complications and RMT will mitigate these effects. The following specific aims will be tested: 1) Assess the impact of a preoperative RMT program on respiratory muscle strength, postoperative outcomes and quality of life compared to a usual care group; 2) Determine the extent of diaphragm anabolic/catabolic pathway activation between the RMT and standard of care group; and 3) Determine the financial sustainability of a transitional home-based program. In our opinion, this program is innovative because it will deliver prehabilitation services to advance the cancer care continuum in a group of patient who may not have received services due to the shortened period. It will quantify the direct effects of RMT and lung cancer on diaphragm structure and function, thus developing new biomarkers to predict postoperative complications. Finally, it will maximize preoperative cardiorespiratory performance and postoperative outcomes in the brief 2-4-weeks prior to surgery. The proposed research is significant because it will advance the delivery of rehabilitation services for surgically eligible cancer patients.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2025 ( Subtotal = $0 )
2025	2022	HEALTH RESEARCH, INC.	665 ELM ST	BUFFALO	NY	14203	ERIE	USA	Cancer Cause and Prevention Research	000	5	3/12/2025	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2022 ( Subtotal = $610,513 )
2022	2022	HEALTH RESEARCH, INC.	ELM AND CARLTON ST	BUFFALO	NY	14263	ERIE	USA	Cancer Cause and Prevention Research	000	5	9/1/2022	NON-COMPETING CONTINUATION	$610,513
														Subtotal = $610,513

Issue Date FY: 2021 ( Subtotal = $622,974 )
2021	2021	HEALTH RESEARCH, INC.	ELM AND CARLTON ST	BUFFALO	NY	14263	ERIE	USA	Cancer Cause and Prevention Research	000	4	8/25/2021	NON-COMPETING CONTINUATION	$622,974
														Subtotal = $622,974

Issue Date FY: 2020 ( Subtotal = $661,363 )
2020	2020	HEALTH RESEARCH, INC.	ELM AND CARLTON ST	BUFFALO	NY	14263	ERIE	USA	Cancer Cause and Prevention Research	000	3	8/27/2020	NON-COMPETING CONTINUATION	$661,363
														Subtotal = $661,363

Issue Date FY: 2019 ( Subtotal = $527,709 )
2019	2019	HEALTH RESEARCH, INC.	ELM AND CARLTON ST	BUFFALO	NY	14263	ERIE	USA	Cancer Cause and Prevention Research	001	2	8/9/2019	NON-COMPETING CONTINUATION	$527,709
2019	2018	HEALTH RESEARCH, INC.	ELM AND CARLTON ST	BUFFALO	NY	14263	ERIE	USA	Cancer Cause and Prevention Research	000	1	11/16/2018	NEW	$0
														Subtotal = $527,709

Issue Date FY: 2018 ( Subtotal = $585,953 )
2018	2018	HEALTH RESEARCH, INC.	ELM AND CARLTON ST	BUFFALO	NY	14263	ERIE	USA	Cancer Cause and Prevention Research	000	1	9/17/2018	NEW	$585,953
														Subtotal = $585,953

Grand Total All Awards = $3,008,512

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Preoperative Respiratory Muscle Training to Prevent Postoperative Pulmonary Complications in Patients Undergoing Resection for Lung Cancer

Award Number: R01CA222382

ORGANIZATION: NATIONAL CANCER INSTITUTE

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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