The prognostic value of physical functioning on survival in patients with nonsmall cell lung cancer: a systematic review and meta-analysis.
12 affiliations
- 1Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.
- 2Shared first authors.
- 3REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium.
- 4BIOMED-Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium.
- 5MOVANT Research Group, Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium.
- 6Department of Experimental-Health Psychology, Faculty of Health Psychology, Ghent University, Ghent, Belgium.
- 7Centre of Expertise in Care Innovation, Department of PXL - Healthcare, PXL University of Applied Sciences and Arts, Hasselt, Belgium.
- 8Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium.
- 9Faculty of Medicine and Life Sciences, Hasselt University, Genk, Belgium.
- 10Department of Lung Diseases, Hospital Oost-Limburg, Genk, Belgium.
- 11Shared last authors.
- 12Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium [email protected].
Abstract
Background
Physical functioning has emerged as a potentially valuable prognostic indicator in patients with nonsmall cell lung cancer (NSCLC). This systematic review and meta-analysis aimed to evaluate the prognostic value of objectively measured components of physical functioning on survival outcomes across treatment modalities.Methods
Medline, Web of Science and Scopus were searched up to May 2025. Eligible studies included adult patients with NSCLC and assessed at least one objectively measured physical functioning indicator in relation to survival outcomes. Indicators were categorised using the International Classification of Functioning, Disability and Health (ICF) framework into "body functions and structures", "activities" and "participation" and studies were stratified into "surgery" and "nonsurgery" groups. Meta-analyses were conducted when data permitted it.Results
58 studies (19 436 patients) were included. Most assessments were performed before treatment. In the surgical group, only "activities"-based measures were evaluated. A meta-analysis restricted to this group showed that survivors had substantially higher (functional) exercise capacity, measured through cardiopulmonary exercise testing and field tests (standardised mean difference 0.79). In nonsurgical cohorts, prognostic value extended across all ICF domains, with low handgrip strength (hazard ratio (HR) 1.27), low (functional) exercise capacity (HR 2.11) and physical inactivity (HR 2.86) associated with significantly higher mortality. Notably, no studies in surgical cohorts evaluated "body functions" or "participation". Heterogeneity and varying thresholds were noted across studies.Conclusions
Objectively measured physical functioning is a significant prognostic indicator of survival in NSCLC. Routine assessment could enhance risk stratification and guide personalised care. Future research should address longitudinal changes, standardisation of measures and targeted interventions.
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BibTeX
@article{arents2026prognostic,
title = {{The prognostic value of physical functioning on survival in patients with nonsmall cell lung cancer: a systematic review and meta-analysis.}},
author = {Eva Arents and Sarah Haesevoets and Marthe Van Overbeke and Kirsten Quadflieg and Francesca Van Hulle and Bihiyga Salhi and Maarten Criel and Dieter Stevens and David Ruttens and Veerle Surmont and Marc Daenen and Eric Derom and Chris Burtin and Heleen Demeyer},
journal = {European respiratory review : an official journal of the European Respiratory Society},
year = {2026},
month = oct,
doi = {10.1183/16000617.0230-2025},
url = {https://europepmc.org/article/MED/42906942},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - The prognostic value of physical functioning on survival in patients with nonsmall cell lung cancer: a systematic review and meta-analysis.
AU - Eva Arents
AU - Sarah Haesevoets
AU - Marthe Van Overbeke
AU - Kirsten Quadflieg
AU - Francesca Van Hulle
AU - Bihiyga Salhi
AU - Maarten Criel
AU - Dieter Stevens
AU - David Ruttens
AU - Veerle Surmont
AU - Marc Daenen
AU - Eric Derom
AU - Chris Burtin
AU - Heleen Demeyer
PY - 2026
DA - 2026/10/21
JO - European respiratory review : an official journal of the European Respiratory Society
DO - 10.1183/16000617.0230-2025
UR - https://europepmc.org/article/MED/42906942
AB - Background Physical functioning has emerged as a potentially valuable prognostic indicator in patients with nonsmall cell lung cancer (NSCLC). This systematic review and meta-analysis aimed to evaluate the prognostic value of objectively measured components of physical functioning on survival outcomes across treatment modalities.Methods Medline, Web of Science and Scopus were searched up to May 2025. Eligible studies included adult patients with NSCLC and assessed at least one objectively measured physical functioning indicator in relation to survival outcomes. Indicators were categorised using the International Classification of Functioning, Disability and Health (ICF) framework into "body functions and structures", "activities" and "participation" and studies were stratified into "surgery" and "nonsurgery" groups. Meta-analyses were conducted when data permitted it.Results 58 studies (19 436 patients) were included. Most assessments were performed before treatment. In the surgical group, only "activities"-based measures were evaluated. A meta-analysis restricted to this group showed that survivors had substantially higher (functional) exercise capacity, measured through cardiopulmonary exercise testing and field tests (standardised mean difference 0.79). In nonsurgical cohorts, prognostic value extended across all ICF domains, with low handgrip strength (hazard ratio (HR) 1.27), low (functional) exercise capacity (HR 2.11) and physical inactivity (HR 2.86) associated with significantly higher mortality. Notably, no studies in surgical cohorts evaluated "body functions" or "participation". Heterogeneity and varying thresholds were noted across studies.Conclusions Objectively measured physical functioning is a significant prognostic indicator of survival in NSCLC. Routine assessment could enhance risk stratification and guide personalised care. Future research should address longitudinal changes, standardisation of measures and targeted interventions.
SN - 0905-9180
SN - 1600-0617
ER -