Nurse-supported hybrid home-based pulmonary rehabilitation improves psychological distress, quality of life, and functional performance in advanced lung cancer: A randomized controlled trial

PURPOSE This study aimed to evaluate the effectiveness and safety of a nurse-supported hybrid home-based pulmonary rehabilitation program (PRP) in reducing psychological distress and preserving quality of life (QoL) and functional performance in patients with advanced lung cancer. METHODS A randomized controlled trial was conducted with 104 patients with stage III-IV lung cancer randomly assigned to an intervention group (n = 52) or a control group (n = 52). The intervention group received home-based aerobic, resistance, and breathing exercises three times weekly after an initial supervised session. Anxiety and depression were primary outcomes, while QoL and functional performance were secondary outcomes. Outcomes were assessed at baseline, week 4, and week 8 and analyzed using generalized estimating equations under an intention-to-treat approach. RESULTS Groups were comparable at baseline. At week 8, the intervention group showed significantly greater reductions in anxiety (β = -1.72, 95% CI -3.04, -0.40, p = .01) and depression (β = -1.21, 95% CI -2.35, -0.07, p = .04) compared with the control group. QoL and functional performance were maintained in the intervention group but declined in the control group. Program adherence was 63.5%, and no exercise-related serious adverse events occurred, including among participants with bone metastases. CONCLUSIONS A nurse-supported hybrid PRP is an effective intervention for reducing psychological distress and preserving functional status in patients with advanced lung cancer. The observed safety profile further supports its clinical applicability, including for high-risk populations. TRIAL REGISTRATION Clinical trial ID: NCT05279521; First patient enrolled: April 14, 2022.