Advanced treatments have changed lung cancer from a quickly fatal disease into one that, in some metastatic cases, can be lived with for years. But doctors and patient advocates say that longer survival also means a greater need to address day-to-day functioning, side effects, fatigue, muscle loss, anxiety and depression, not just the tumor itself.
Dr. Shani Shila, founder and CEO of the Israeli Lung Cancer Association, said patients who live longer with the disease must cope for extended periods with treatment toxicity and frequent monitoring. She also said the burden reaches families, after personally accompanying her husband, Elad, through 11 years of metastatic lung cancer until his death about three years ago. Physiotherapist Helena Silman-Cohen, who works in Rambam’s oncology system, said rehabilitation is meant to treat functional decline caused by the illness and that exercise can reduce side effects, improve physical capacity and ease depression and anxiety.
The Health Ministry backed this view in May, issuing updated physiotherapy recommendations that describe rehabilitation as an integral part of medical care. The guidelines call for personalized treatment, continuity, early intervention and combined physical, educational and family support. Still, Shila said metastatic patients often cannot access respiratory rehab at all, even when they qualify, because of a severe shortage of appointments. Silman-Cohen said the field is still new in Israel, noting that only two years ago an oncology rehabilitation program opened at Loewenstein Hospital.
Against that backdrop, the association launched “Breathing Easy” with AstraZeneca, under the global Lung Ambition initiative. The pilot enrolled 50 metastatic lung cancer patients, 25 in each round, recruited through the Facebook group “Friends for a Breath,” and was professionally supported by Dr. Damian Urban, Prof. Alona Zer, and Dr. Amir Bar-Shai. Each participant received four one-on-one physiotherapy sessions, a tailored booklet, equipment, and three online emotional-support meetings for patients and caregivers.
The pilot’s results, presented at ASCO and ESMO, showed improved physical function and overall health, along with less fatigue, nausea, vomiting and loss of appetite. Patients were assessed with sit-to-stand and 10-meter walk tests, plus quality-of-life questionnaires before treatment, after it, and again two months later. Shila said some gains faded after two months, so the next step is to build a digital version to reach more patients and sustain the benefits longer.
