Effect of pulmonary rehabilitation exercise on postoperative quality of life and symptom cluster in patients with lung cancer: a systematic review and meta-analysis

This study aimed to evaluate the efficacy of pulmonary rehabilitation exercise on postoperative quality of life (QoL) and symptom cluster (pain, fatigue, shortness of breath) in lung cancer survivors, meanwhile, to explore the interrelationships among these symptoms. Randomized controlled trials (RCTs) were retrieved from six databases. Pooled standardized mean difference (SMD) was calculated using random-effects models. Subgroup analyses stratified by intervention duration, multiple sensitivity tests and trim-and-fill analysis were performed. Study-level correlation and regression analyses investigated symptom associations. Evidence certainty was assessed via GRADE. Ten RCTs with 852 participants were included. Perioperative pulmonary rehabilitation modestly improved QoL (standardized mean difference [SMD] = 0.91; 95% confidence interval [CI] 0.23 to 1.58), 6-minute walk distance (SMD = 0.21; 95% CI 0.00 to 0.43) and full vital capacity (SMD = 1.16; 95% CI 0.44 to 1.89), and alleviated the postoperative symptom cluster (pain (SMD = -0.49; 95% CI -0.92 to -0.07), fatigue (SMD = -0.65; 95% CI -0.87 to -0.42) and shortness of breath (SMD = -0.71; 95% CI -1.10 to -0.32)). Moderate-to-strong positive pairwise correlations were detected among symptoms, with pain identified as the core correlated symptom within the symptom cluster. Perioperative pulmonary rehabilitation may improve functional recovery and relieve postoperative symptoms in lung cancer patients. Preoperative intervention and structured rehabilitation lasting at least two months are worthy of attention. As substantial heterogeneity and limited evidence certainty exist, conclusions should be interpreted cautiously. Large standardized RCTs are required to confirm optimal rehabilitation protocols.