Lung cancer is highly prevalent, with approximately 46,363 new cases in 2018, accounting for 20.6% of cancer deaths in France. At diagnosis, 70% of patients have advanced or metastatic cancer, treatable only by palliative care. Respiratory rehabilitation aims to reduce symptoms, enhance performance, increase autonomy, and improve patients\' quality of life. While effective for COPD patients and other conditions causing dyspnea, its benefits in advanced, non-operable lung cancer are less studied. Some studies have shown the feasibility and safety of respiratory rehabilitation, but few have compared its impact on non-operable lung cancer patients or assessed its effect on quality of life. The main objective of the proposed study is to evaluate the impact of a respiratory rehabilitation program on the quality of life of patients with non-small cell lung cancer (NSCLC) undergoing maintenance chemotherapy and immunotherapy, compared to a control group receiving standard care.
Histologically proven stage IV non-small cell lung cancer patient
First-line treatment with chemotherapy combined with immunotherapy in the maintenance phase
Adenocarcinoma patient: maintenance with Alimta combined with pembrolizumab
Squamous cell carcinoma patient: maintenance with pembrolizumab alone
Small cell lung cancer, mesothelioma, neuroendocrine lung cancer
Patients with orthopedic disorders preventing respiratory rehabilitation that, in the investigator's opinion, could interfere with respiratory rehabilitation
Unresolved toxicity from previous treatment of grade > 1 (except alopecia) that, in the investigator's opinion, could interfere with respiratory rehabilitation
Symptomatic brain metastases (corticosteroid treatment is allowed if the doses administered are stable for at least one month before inclusion)
Parallel
Respiratory Rehabilitation
Procedure/SurgeryAn initial assessment is conducted upon admission to personalize the program. This includes: Clinical examination Spirometry Maximum Inspiratory Pressure (PImax) measurement Multidimensional Dyspnea Profile questionnaire at end of TM6 Exercise Functional Testing Measurement of quadriceps strength and endurance Blood gases Educational interview and shared educational assessment London Chest Activity of Daily Living (LCADL) Tobacco and/or dietary consultation The respiratory rehabilitation program, performed twice a week, includes: Exercise training on an ergocycle and treadmill (30 minutes at ventilatory threshold for the ergocycle; 30 minutes at 60-80% walking speed for the treadmill; or dyspnea rated 4-6 on the Borg scale after endurance exercise) Quadriceps muscle strengthening Therapeutic education program Group gymnastics Smoking cessation assistance Socio-psychological and nutritional support
Quality of Life Measurement Using EORTC QLQ-C30
The primary endpoint is the measurement of quality of life, assessed by the composite score from the sum of EORTC QLQ-C30. The evaluation will be conducted by filling out the quality of life questionnaires at inclusion (=Week 0) and at 8 weeks
Quality of Life Measurement Using EORTC QLQ-LC13
The primary endpoint is the measurement of quality of life, assessed by the composite score from the sum of EORTC QLQ-LC13. The evaluation will be conducted by filling out the quality of life questionnaires at inclusion (=Week 0) and at 8 weeks
Quality of Life Measurement Using EORTC QLQ-C30
The primary endpoint is the measurement of quality of life, assessed by the composite score from the sum of EORTC QLQ-C30. The evaluation will be conducted by filling out the quality of life questionnaires at inclusion (=Week 0) and at 8 weeks
Quality of Life Measurement Using EORTC QLQ-LC13
The primary endpoint is the measurement of quality of life, assessed by the composite score from the sum of EORTC QLQ-LC13. The evaluation will be conducted by filling out the quality of life questionnaires at inclusion (=Week 0) and at 8 weeks
Evaluation of quality of life using multiple modalities of the QLQ-C30.
Quality of life measurement using the functional scales and symptom scales of the QLQ-C30 questionnaire.
Evaluation of quality of life using multiple modalities of the QLQ-C30.
Quality of life measurement using the functional scales and symptom scales of the QLQ-C30 questionnaire.
Evaluation of quality of life using multiple modalities of the QLQ-C30.
Quality of life measurement using the functional scales and symptom scales of the QLQ-C30 questionnaire.
Evaluation of quality of life using multiple modalities of the QLQ-C30.
Quality of life measurement using the functional scales and symptom scales of the QLQ-C30 questionnaire.
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