Self-reported exercise capacity among current smokers eligible for lung cancer screening: Distribution and association with key comorbidities

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One concern: as lung cancer screening (LCS) is implemented is that patients will be screened who are too ill to benefit. Poor exercise capacity (EC) predicts adverse outcomes following lung resection. Objective: Describe the distribution of EC among smokers eligible for LCS and examine associations with comorbidities. Methods: Cross-sectional analysis of baseline data from a randomized controlled trial of tobacco treatment in the context of LCS. Participants responded regarding limitations in moderate activities, ability to climb stairs, and frequency of dyspnea on a scale from never/almost never to all or most of the time. Responses were assigned a numeric score and summed to categorize exercise limitation. Associations between poor EC and key comorbidities were examined using adjusted logistic regression. Results: 660 participants completed a survey with the following characteristics: 64.4% male, 89.5% white, mean age 64.5. Overall EC categories were: good 39.0%, intermediate 41.6%, and poor 19.4%. Prevalence of poor EC was higher among patients with COPD (OR 4.62 95%CI 3.05–7.02), heart failure (OR 3.07 95%CI 1.62–5.82) and cardiovascular disease (OR 2.24, 95%CI 1.45–3.47), and was highest among patients with multimorbidity. Among patients with COPD and heart failure, 57% had poor and 0% had good EC. In adjusted logistic regression, only COPD and Charlson comorbidity index remained significantly associated with poor EC. Conclusions: Many patients eligible for LCS reported poor EC, with increased odds of poor EC among patients with comorbidities. More research is needed to determine how to best integrate EC and comorbidity into eligibility and shared decision-making conversations.

Original languageEnglish (US)
Article number100443
JournalCancer Treatment and Research Communications
StatePublished - Jan 1 2021

Bibliographical note

Funding Information:
Work was funded by NCI R01CA141527 (Adaptive Interventions for Smoking Cessation in Lung Cancer Screening Programs). Dr. Melzer is supported by a VA HSR&D CDA HX003067–01A1. Work was also supported by resources from the Minneapolis VA Health Care System.

Publisher Copyright:
© 2021


  • Cancer screening
  • Comorbidity
  • Exercise capacity
  • Functional capacity
  • Lung cancer
  • Lung cancer screening
  • Multimorbidity


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