Lung cancer is an enormous public health problem among older Americans. The most effective treatment option for people diagnosed with early-stage lung cancer is surgery, and the average age of people undergoing lung cancer surgery is 70. Lung cancer surgery often takes a greater toll on older adults. In general, older adults take a longer time to recover from surgery with respect to their endurance and their ability to participate in everyday activities like they did before surgery. In addition, older adults are more likely than younger adults to have complications after lung cancer surgery. In addition, there has been a trend to shorten hospital stays after lung and other cancer surgeries in order to reduce costs. This has meant that family caregivers (FCGs) have had to take on a larger role in the recovery of patients undergoing lung cancer surgery. Older adults may have greater caregiving needs due to frailty and other medical conditions, and family caregivers often feel overwhelmed at the prospect of assisting in the recovery of their loved ones after cancer surgery. Physical activity helps older adults with lung cancer recover faster from lung cancer surgery, reduces surgical complications, and also helps FCGs have a better sense of well-being. The benefits of physical activity in cancer patients is well recognized. Walking and strengthening programs have been shown to help people recover their exercise endurance faster after lung surgery, improves quality of life, and reduces complications from lung surgery. There is a critical need to develop interventions specifically for older adults that improve quality of life and reduce complications from lung cancer surgery. Prior studies of physical activity before and after lung surgery have focused largely on “one size fits all” physical activity interventions administered by rehabilitation experts. This approach has limitations because older adults have a range of physical impairments and traditionally FCGs have not been included in this approach. The purpose of this study is to test a telephone-based, personalized perioperative physical activity intervention to improve recovery for older adults with lung cancer and to improve well-being of older adults and their FCGs after lung surgery.

To test which strategy is best for improving surgical recovery care, a randomized trial will be completed. The trial will be completed at multiple hospitals through the SWOG cooperative network. Patients will be randomly assigned to two groups: 1) intervention group, which involves a personalized walking program and lower extremity strengthening exercises developed based on preoperative assessments, goal setting, and self-monitoring using a pedometer worn on the patient’s wrist, and FCG coaching to serve as “walking buddies;” or 2) control group, which involves receiving a booklet about the importance of physical activity and receiving a pedometer for self-monitoring. This study has the potential to improve the care of older adults undergoing lung cancer surgery by providing a personalized physical activity program and through leveraging patients’ FCGs to support them through their recovery. This is the first study of its kind to deliver a centralized exercise program for older adults undergoing lung cancer surgery, and the first of its kind to involve FCGs as coaches for the patients’ recovery.