The role of pulmonary rehabilitation in the lung cancer patient.

Lung cancer is the most common deadly malignancy in the United States. It is estimated that 219,440 men and women in the United States will be diagnosed with lung cancer and 159,390 will die of lung cancer in 2009. The overall 5-year survival rate is 15.6%; however, survival rates are much higher (52.6%) for patients who are diagnosed when the cancer is confined to the primary site. Unfortunately, a minority of patients (15%) are diagnosed at this stage. Although the most effective treatment for lung cancer is surgical resection, many patients have significant underlying chronic lung disease as well as other comorbidities, which may increase perioperative risk and possibly exclude them from undergoing surgery. Preoperative assessment is essential for proper risk stratification, but there are important questions that remain to be answered as to (1) whether preoperative or postoperative pulmonary rehabilitation can result in less perioperative morbidity and mortality, (2) whether the institution of preoperative pulmonary rehabilitation can allow more patients to undergo potentially curative surgical resection, and (3) whether pulmonary rehabilitation can play a role in those patients not eligible for surgery.