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Yusuke Yonenaga,1 Tateaki Naito,2 Taro Okayama,1 Midori Kitagawa,1 Noriko Mitsuhashi,1 Takeshi Ishii,1 Hiroshi Fuseya,1 Toshimi Inano,3 Ayumu Morikawa,4 Miwa Sugiyama,4 Keita Mori,5 Akifumi Notsu,5 Takanori Kawabata,5 Akira Ono,2 Hirotsugu Kenmotsu,2 Haruyasu Murakami,2 Akira Tanuma,6 Toshiaki Takahashi2 1Division of Rehabilitation Medicine, Shizuoka Cancer Center, Nagaizumi-cho, Shizuoka, Japan; 2Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho, Shizuoka, Japan; 3Division of Nutrition, Shizuoka Cancer Center, Nagaizumi-cho, Shizuoka, Japan; 4Division of Nursing, Shizuoka Cancer Center, Nagaizumi-cho, Shizuoka, Japan; 5Clinical Research Center, Shizuoka Cancer Center, Nagaizumi-cho, Shizuoka, Japan; 6Department of Rehabilitation Medicine, Juntendo Shizuoka Hospital, Juntendo University School of Medicine, Izunokuni-shi, Shizuoka, JapanCorrespondence: Tateaki NaitoDivision of Thoracic Oncology, Shizuoka Cancer Center, 1007, Shimonagakubo, Nagaizumi-cho, Shizuoka, 411-8777, JapanTel +81-55-989-5222Fax +81-55-989-5783Email t.naito@scchr.jpPurpose: This prospective observational study aimed to explore the influence of physical inactivity during initial chemotherapy on the risk of disability and hospitalization in later life among older patients with advanced non-small-cell lung cancer (NSCLC).Patients and Methods: Patients aged 70 or above who were scheduled to receive first-line chemotherapy for newly diagnosed advanced NSCLC were recruited for the study. An electronic pedometer was used to measure daily steps; based on the change rate (cutoff: − 12.5%) from pretreatment to 12 ± 4 weeks after enrolment, patients were classified as active or inactive. The Barthel Index estimated activities of daily living. We compared disability-free survival time, mean cumulative functions of hospital stays, and medical costs, between the active and inactive groups.Results: Among the 29 patients enrolled, 21 were evaluable. Compared with active patients (n = 11), inactive patients (n = 10) showed shorter disability-free survival (6.4 vs 19.9 months, p < 0.05) and tended to have longer hospital stays (23.7 vs 6.3 days/person) and higher inpatient care cost (¥ 1.6 vs ¥ 0.3 million/person [US$16,000 vs US$3000/person]) during the first year.Conclusion: Physical inactivity during initial chemotherapy may be a risk factor for developing disability and requiring hospitalization in later life for older patients with advanced NSCLC. Our findings may indicate the need for lifestyle interventions with multidisciplinary teams, which include physicians, nurses, and physiotherapists, for older patients with advanced lung cancer during an active cancer treatment. A large-sample-sized study is needed to validate our findings.Keywords: non-small-cell lung cancer, older patients, physical activity, disability-free survival, medical cost, length of hospital stay

Little is known about the impact of decreased walking capacity on clinical outcomes in elderly patients with cancer. This prospective observational study aimed to investigate the impact of walking capacity on the risk of disability and hospitalization in elderly patients with advanced lung cancer. This study prospectively enrolled 60 patients aged ≥ 70 years with advanced non-small-cell lung cancer (NSCLC) scheduled to receive first-line chemotherapy or radical radiotherapy between January 2013 and December 2014 (trial registration number: UMIN000009768). Patients were classified into the mobile or less mobile group based on the median incremental shuttle walking distance (ISWD) before initial treatment. Assessments included the Barthel index, disability-free survival time, mean cumulative lengths of hospital stay, and inpatient medical costs. The median ISWD was 290 m (interquartile range, 245–357.5 m). The mobile group (ISWD ≥ 290 m) had a longer disability-free survival time than the less mobile group (ISWD < 290 m, 24.6 months vs. 8.4 months, p < 0.05). During the first year from study entry, the mobile group had shorter cumulative lengths of hospital stay (41.3 vs. 72.9 days/person, p < 0.05) and lower inpatient medical costs (¥1.9 vs. ¥2.9 million/person, p < 0.05) than the less mobile group. Elderly NSCLC patients with adequate walking capacity showed lower risks of disability, shorter hospitalizations, and lower inpatient medical costs than patients with reduced walking capacity. Further prospective research is needed to validate these findings. The trial was registered with the University Hospital Medical Information Network as trial number UMIN000009768 on January 13, 2013. UMIN000009768