Functional and quality-of-life outcomes following structured exercise in palliative lung cancer care: A meta-analysis and meta-regression.

322 Background: Exercise interventions have emerged as a supportive care strategy in lung cancer (LC). Evidence remains fragmented, particularly in palliative settings where functional decline and symptom burden are pronounced. Methods: A systematic search was conducted on June 9, 2025, using PubMed, Cochrane, and oncology conference proceedings. Eligible studies included randomized controlled trials and controlled cohort studies evaluating structured exercise interventions in adults with LC. Data on population characteristics, intervention type, delivery mode, frequency, duration, and outcomes were extracted. Primary outcomes were functional capacity (6-minute walk test [6MWT]) and health-related quality of life (EORTC QLQ-C30/LC13). Pooled effect sizes were calculated using random-effects models (Hedges’ [g]) with 95% confidence intervals (CIs). Subgroup analyses were conducted by therapy intent (palliative, adjuvant), and meta-regression was used to assess outcome domain (QoL, physical function, dyspnea) as a moderator. Statistical heterogeneity was quantified using I² and τ². Results: Eight studies (N = 706) were included. Median age was 67.0 years (IQR: 61.4-76.8). Majority of participants had non-small cell LC (86.1%), with 4.0% small cell LC and 9.9% unclassified. 95.0% studies involved patients with advanced/palliative disease. Intervention durations were typically 8-12 weeks (78.2%) or ≥16 weeks (32.0%), with sessions most often lasting 60-90 minutes (94.6%). Delivery modes were primarily supervised (61.8%) or mixed with home-based components (47.9%). The overall dropout rate in intervention arms was 24.2%. Meta-analysis showed that exercise interventions significantly improved 6MWT performance (g = 0.20, 95% CI: 0.01-0.38, p = 0.039, I² = 0%). Subgroup effects by therapy intent (palliative, adjuvant) were not statistically different (p = 0.55). For health-related quality of life (EORTC QLQ-C30/LC13), the pooled effect was moderate and significant (g = 0.50, 95% CI: 0.11–0.89, p = 0.012; I² = 63.1%). Meta-regression revealed that outcome domain significantly moderated effect size (QM = 13.53, p = 0.001), fully accounting for between-study heterogeneity (R² = 100%). Large benefits were observed for global QoL (g = 1.01) and physical functioning (g = 0.79), but not for dyspnea (g = –0.16). Conclusions: Structured exercise interventions yield meaningful gains in functional capacity and quality of life, especially in global and physical domains. These findings support incorporating exercise into routine care for LC patients, particularly in palliative settings.