Grant R21CA164515

Managing Fatigue Using Virtual Reality for Post-Operative Lung Cancer Patients

DESCRIPTION (provided by applicant): Persons with early-stage (I-III) non-small cell lung cancer (NSCLC) report significantly more unmet supportive care needs than other cancer populations, yet they are among the most vulnerable and least studied. Two of the most prevalent unmet supportive care needs reported by the NSCLC population include the need to manage fatigue and attain adequate exercise to meet the physical demands of daily living. Cancer-related fatigue (CRF) is identified as a priority symptom because research shows CRF places the NSCLC population at risk for poor health outcomes. Evidence affirms exercise is the most effective intervention for the treatment of CRF in the general cancer population. Evidence also indicates that exercise in the post-operative phase of the NSCLC trajectory is feasible, safe, and efficacious. However, there are no guidelines for routine rehabilitative support for persons with NSCLC during the critical transition from hospital to home. Our objective is to determine the feasibility, acceptability, and preliminary efficacy of an innovative, home-based, virtual reality exercise intervention to enhance perceived self-efficacy (PSE) for CRF self-management for persons with NSCLC transitioning from hospital to home after surgery. Our proposed intervention was developed using a transdisciplinary approach and is novel in that it is the first to use self-efficacy theory to enhance a NSCLC patient's ability to manage their CRF by implementing a home-based exercise prescription after surgery. This innovative approach departs from the status quo by using a home-based, light-intensity exercise plan in an enjoyable virtual reality environment. This proposed study employs a six-week randomized control trial (RCT) with participants (N = 64) randomly assigned to either the exercise intervention or a usual care group. The exercise intervention uses the Nintendo Wii Fit-Plus and was designed to promote regular, light-intensity walking and balance exercises corresponding to levels of usual activities of daily living. Walking begins during the first week upon discharge from the hospital after surgery and builds in duration over a six- week period. Specific aims include: 1) Determine feasibility and acceptability by a) analyzing rates of recruitment, adherence, and retention;b) monitoring adverse events;c) identifying facilitators and barriers to recruitment, adherence, and retention. 2) Preliminary examination of efficacy by comparing both groups by age through the measurement of CRF severity, fatigability, PSE for CRF self-management, other symptoms severity, PSE for Walking, PSE for Balance, and functional performance. This research advances the science because it is the first study to use an in-home, light exercise intervention incorporating PSE enhancing strategies to target fatigue and its associated fatigability, in persons with NSCLC during the transition from hospitalization to home after surgery. Information gained from this RCT will be used to refine the design of future larger-scale studies targeting CRF and fatigability for the NSCLC population.