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Objective Patients with lung cancer experience significant declines in psychosocial and physical function during and after treatment that impact quality of life (QOL) and survival. Yoga is a potential strategy to mitigate functional decline among patients with lung cancer. Methods A single group 12-week pilot trial of low-moderate intensity yoga among patients with stage I-IV lung cancer and their partners (n = 46; 23 patient-partner dyads) during cancer treatment from two hospital systems. Feasibility, acceptability, descriptive statistics, and Cohen d effect sizes were calculated at 6 and 12-weeks for psychosocial and physical outcomes using validated questionnaires and assessments. Results At 6 and 12-weeks, retention was 65% and withdrawals were mainly due to disease progression. Among study completers (n = 26; 13 dyads) adherence was 80%. Comparing baseline to 12-week measurements, fatigue, depression symptoms, and sleep disturbance improved in 54% of participants for all three measures (Cohen's d = 0.40-0.53). QOL improved in 77% of participants (Cohen's d = 0.34). Upper and lower body flexibility, and lower body strength improved in 92%, 85% and 77% of participants, respectively (Cohen's d = 0.39-1.08). Six-minute walk test improved in 62% of participants an average of 32 meters (SD = 11.3; Cohen's d = 0.17). No serious adverse events were reported. Conclusions Among patients with stage I-IV lung cancer including active treatment, a 12-week partner-supported yoga program is feasible, acceptable, and improved psychosocial and physical function. Low-intensity yoga may be a complimentary approach to reduce the effects of cancer treatment, however, more research is needed to determine the efficacy of partner-supported yoga to mitigate functional decline.

Objective To determine the effectiveness of methylphenidate for depression treatment in patients with advanced cancer. Design An 18-day randomized, double-blind, placebo-controlled clinical trial of methylphenidate for treatment of depression in selective serotonin reuptake inhibitor-treated patients with advanced cancer in hospice or receiving palliative care. The primary outcome was depression remission, defined as a ≥50% reduction in score on the Montgomery-Asberg Depression Rating Scale. Results Among 47 enrolled participants, 34 were randomized. At study day 18, 85% of the methylphenidate and 60% of the placebo group were in depression remission (P = .22). Mean time to depression remission was 10.3 days [standard error (SE) 1.8] in the methylphenidate and 8.1 (SE 1.3) in the placebo group (P = .48). The mean baseline score for the Hospital Anxiety and Depression Scale (HADS) was 10.4 in each group and decreased by 3.6 (SE 1.1) in the methylphenidate and 2.3 (SE 1.2) in the placebo group (P = .51) by day 18. Once in remission, 1 methylphenidate and 5 placebo participants relapsed to depression (P = .18). There was no difference in mortality between the groups during the trial. Trial results were limited by small sample size attributed to difficulties in recruiting terminally ill patients. Conclusions This trial failed to demonstrate that methylphenidate treatment in selective serotonin reuptake inhibitor-treated patients had a significant effect on depression remission in patients with advanced cancer. This study underscores the difficulties in conducting trials for symptom management in patients with shortened life expectancy.

Lung cancer patients suffer considerable morbidity and mortality along with substantial psychological distress [1]. Lung cancer patients with diagnoses of depression experience greater mortality than their non-depressed peers [2], but the causes of this increased mortality are not well understood. For patients with advanced stage non-small cell lung cancer (NSCLC), platinum-based chemotherapy prolongs survival, improves symptom control, and yields superior quality of life compared to best supportive care [3]. The utilization of chemotherapy and patient factors impacting its receipt have not been characterized in depressed patients. The National Comprehensive Cancer Network (NCCN) has established Clinical Practice Guidelines for the treatment of lung cancer [3]. Previous studies have revealed that patients’ age and comorbidities affect receipt of recommended therapies [4], which is in accordance with guidelines. Other patient characteristics, such as black race, reduce the likelihood of chemotherapy receipt and represent an important treatment disparity [5–7]. It is unclear to what extent patients’ psychological comorbidities, such as a diagnosis of depression, influence utilization of guideline recommended chemotherapy. In addition, interactions between patient characteristics, such as race and depression, and their impact on chemotherapy receipt have not been explored. We examined chemotherapy receipt among lung cancer patients with a diagnosis of depression, including an analysis of patient risk factors associated with reduced receipt, in order to determine if differences in receipt may contribute to increased mortality.