Evaluating the Feasibility and Preliminary Effects of a Remotely Delivered Dyad-Based Intervention Incorporating Resistance Training to Improve Fitness in Individuals With Non-Small-Cell Lung Cancer and in Their Partners

Lung cancer is the second-most diagnosed malignancy, accounting for more annual deaths than breast, prostate, and colorectal cancers combined. Approximately 80% of lung cancer diagnoses are non-small-cell lung cancer (NSCLC), 42% will present with localized disease and 58% will present with advanced disease. Scientific advances have led to improved 5-year survival rates. These advances are projected to improve, meaning that survivors of NSCLC will live longer. However, the extent of thoracic resection, radiation, chemotherapy, and immunotherapy treatment; common comorbid conditions like COPD (chronic obstructive pulmonary disease); and health behaviors exacerbate physical and emotional health burdens. Research has yet to address the management of physical deconditioning and unresolved symptoms (e.g., dyspnea, fatigue) in long-term survivors of lung cancer, both of which negatively impact health-related quality of life (HRQL). Self-management interventions that target lifestyle behaviors such as physical activity and stress reduction have demonstrated meaningful benefit in managing symptom burden. Additionally, scientific consensus supports the use of resistance training (RT) to mitigate functional decline from physical deconditioning by increasing muscular strength and endurance. However, frequently NSCLC survivors are sedentary or insufficiently active.

Lifestyle behaviors tend to cluster in families and social networks; thus, family members and friends of survivors are also at risk of poor health. An emerging consensus corroborates the inclusion of family and friends ("partners") of cancer survivors in self-management interventions. In this proposal, a partner is anyone the survivor considers a supportive person. Partners are critical sources of all types of social support across the cancer continuum. Importantly, partners must cope with their own concerns, including uncertainty surrounding the survivor's illness, fear of losing their partner, and the impact of their own health behaviors. Together, survivors and their partners may benefit significantly from a dyad-based lifestyle behavior intervention that supports physical and emotional health.

This research team has conducted extensive formative and preliminary research to develop a dyad-based intervention for NSCLC survivors and their partners. Early on, participants clearly indicated a preference for home-based, family- and safety-oriented interventions. Most recently, participants demonstrated the feasibility and preliminary effectiveness of a 12-week, dyad-based, telephone-delivered, self-management intervention known as Breathe Easier (BE), featuring mindfulness-based breathing exercises, meditation, and a walking program for dyads (N = 40; 20 dyads). Another study involved testing an RT program tailored to survivors only (n = 14). Feasibility and acceptability were strong and indicated positive improvements involving symptom burden and physical functioning.

Recognizing that evidence supports a multimodal approach, our research team aims to expand the BE intervention by integrating home-based RT via digital technology. The revised intervention will be known as BE+ and will include stage IV survivors to better understand the feasibility of this subgroup.

Theoretical Approach: The ORBIT model, which is a systematic framework for developing behavioral interventions, was used to develop a chain of evidence for the BE+ intervention program. BE+ is also built on the individual and family self-management theory (IFSMT), which proposes that successful change in health behavior self-management after a diagnosis of lung cancer requires active involvement by the survivor coupled with partner support. IFSMT encompasses three broad dimensions (context, process, outcomes) and promotes self-regulation, self-efficacy, and social support. The context dimension may impact individual and partner engagement in the self-management process and, therefore, the outcomes. Within the process dimension, self-regulation of the self-management of behaviors requires active involvement. Social support enhances the capacity to change and influences collaboration among dyads. The program components of BE+ enhance these three factors-leading to improved health behaviors. The behaviors of individuals in close, personal relationships are interdependent, and the actions of one person continuously affect the other's actions.