<p>STANDARDS AND GUIDELINES FOR REHABILITATION IN LUNG CANCER PATIENTS. MERSEYSIDE AND CHESHIRE PALLIATIVE CARE AUDIT GROUP</p><p>Guidelines </p><p>. For lung cancer patients, rehabilitation needs may include the following symptoms or issues:[1] (Level 4) </p><p> o Pain</p><p> o Dyspnoea </p><p> o Fatigue</p><p> o Dysphagia</p><p> o Anorexia and cachexia</p><p> o Anxiety / stress</p><p> o Impaired mobility</p><p> o Reduction in independence for activities of daily living</p><p> o Need for specific equipment</p><p> o Communication difficulties</p><p> o Difficulties with work and leisure activities</p><p>. Ideally, for all lung cancer patients, their rehabilitation needs should be reviewed at the following different stages of their illness.[2] (Level 4):</p><p>1. Diagnosis</p><p>1 2. Treatment</p><p>3. Post treatment</p><p>4. Monitoring and survivorship</p><p>5. Palliative care</p><p>6. End of life</p><p>. A key worker for each individual patient should be identified to provide continuity of care throughout the patient pathway.[3] (Level 4) </p><p>. Exercise is a simple low-risk intervention and should be considered to help patients suffering from cancer-related fatigue both during and after treatment. [4] (Level 1+)</p><p>. A referral for more intensive non-pharmacological and psychological intervention should be considered for lung cancer patients to help improve both their dyspnoea and functioning level.[5](Level 1+)</p><p>. Simple measures like the use of walking aids and breathing re-training should be considered to help lung cancer patients manage their breathlessness.[6] (Level 2+)</p><p>. Relaxation therapy should be considered as an intervention not only to help lung cancer patients with psychological symptoms but to also help with somatic symptoms such as pain.[7] (Level 1-)</p><p>. Although the evidence for acupuncture and massage is more limited, these can still be beneficial interventions for some lung cancer patients.[7,8] (Level 4) </p><p>2 Standards</p><p>. All lung cancer patients at the palliative or end-of-life care stage of their illness should have their need for rehabilitation services assessed.[9,10] (Grade D)</p><p> o use of a holistic assessment tool (e.g. distress thermometer, SPARC)</p><p>. Lung cancer patients with palliative and end-of-life care needs should be able to access the rehabilitation services they need in a timely manner, as and when they need it.[11] (Grade D) </p><p> o generally < 2 weeks for most patients</p><p> o < 48 hours for certain clinical situations e.g. patient at high risk of falls, hospital admission likely without intervention, patient in at the end of life. </p><p>. A cancer rehabilitation team should consist of, but not be limited to, the following five key Allied Health Professionals:[11]</p><p> o Physiotherapist</p><p> o Occupational therapist</p><p> o Speech and language therapist</p><p> o Dietician</p><p> o Lymphoedema specialist (Grade D) </p><p>3 . There should be clear contact points for referral to general rehabilitation services and specialist AHP services (who can deliver rehabilitation interventions) for all healthcare professionals.[11] (Grade D)</p><p>4 REFERENCES</p><p>(1) NHS National Cancer Action Team. Rehabilitation Care Pathway Lung. Crown </p><p>Copyright 2009. </p><p>(2) Dietz. Rehabilitation in Cancer Care. Oxford: Wiley-Blackwell 1981.</p><p>(3) Merseyside and Cheshire Cancer Network. Key worker guideline 2010. </p><p>(4) Cramp F, Daniel J. Exercise for the management of cancer-related fatigue in adults. </p><p>Cochrane Database Syst Rev 2008;2:CD006145.</p><p>(5) Bredin M, Corner J, Krishnasamy M et al. Multicentre randomised controlled trial of </p><p> nursing intervention for breathlessness in patients with lung cancer. BMJ </p><p>1999;318:901-4.</p><p>(6) Bausewein C, Booth S, Gysels M et al. Non-pharmacological interventions for </p><p> breathlessness in advanced stages of malignant and non-malignant diseases. </p><p>Cochrane Database Syst Rev 2008;2:CD005623.</p><p>(7) Luebbert K, Dahme B, Hasenbring M. The effectiveness of relaxation training in </p><p> reducing treatment-related symptoms and improving emotional adjustment in acute </p><p> non-surgical cancer treatment: a meta-analytical review. Psychooncology </p><p>2001;10:490-502.</p><p>5 (8) Wilkinson S, Barnes K, Storey L. Massage for symptom relief in patients with cancer: </p><p> systematic review. J Adv Nurs 2008;63:430-9.</p><p>(9) National Institute for Clinical Excellence. Guidance on Cancer Services: Improving </p><p>Supportive and Palliative Care for Adults with Cancer 2004. </p><p>(10) National End of Life Care Programme. Holistic Common Assessment of supportive </p><p> and palliative care needs for adults requiring end-of-life care 2010. </p><p>(11) NHS National Cancer Action Team. National Cancer and Palliative Care Rehabilitation </p><p>Workforce Project: project overview report 2010. </p><p>6</p>