Should pulmonary rehabilitation be a standard of care in lung cancer?

There are few therapeutic interventions as effective as pulmonary rehabilitation (PR) in the management of the chronic respiratory disease. The scientific evidence base demonstrating the clinical benefit of PR is incontestable, indeed the most recent iteration of the Cochrane systematic review summarising clinical trials of PR in chronic obstructive pulmonary disease (COPD) concluded that no further clinical trials testing effectiveness were needed.1 The gains in physical capacity and health-related quality of life conferred by PR in routine clinical practice are comparable to those seen in clinical trials2 and the available evidence suggests that completion of PR reduces subsequent healthcare costs through a reduction in the number of days spent in the hospital.3 This substantial body of evidence is derived largely from studies in people with COPD but, perhaps unsurprisingly, PR is also effective in other chronic respiratory diseases characterised by exercise limitation due to dyspnoea and muscle fatigue such as bronchiectasis, interstitial lung disease and pulmonary hypertension. This benefit, long understood by rehabilitation practitioners in the field, is increasingly now backed up by clinical trials of PR in these specific patient populations.4–6