Arents E; Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.
Haesevoets S; Van Overbeke M; Quadflieg K; et al

European Respiratory Review. 35(182), 2026 Oct.

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: Objective ly 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.