Prospective study of quality of life after lung cancer resection (original) (raw)
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Clinical Lung Cancer, 2019
Very long-term health-related quality of life (HRQoL) is an important end point in operated early stage non esmall-cell lung cancer with good prognosis. The results for very long-term HRQoL after minimally invasive video-assisted thoracoscopic surgery (VATS) has not been evaluated and compared to thoracotomy. Surprisingly, inferior overall HRQoL was evident for patients operated with VATS, independent of preoperative factors including age, comorbidities, and pulmonary function tests. Background: As a result of routine low-dose computed tomographic screening, lung cancer is more frequently diagnosed at earlier, operable stages of disease. In treating local nonesmall-cell lung cancer, video-assisted thoracoscopic surgery (VATS), a minimally invasive surgical approach, has replaced thoracotomy as the standard of care. While short-term quality-of-life outcomes favor the use of VATS, the impact of VATS on long-term health-related quality of life (HRQoL) is unknown. Patients and Methods: We studied patients who underwent lobectomy for the treatment of nonesmall-cell lung cancer from January 2006 to January 2013 at a single institution (n ¼ 456). Patients who underwent segmentectomy (n ¼ 27), who received neoadjuvant therapy (n ¼ 13), or who were found to have clinical stage > T2 or > N0 disease (n ¼ 45) were excluded from analysis. At time of HRQoL assessment, 199 patients were eligible for study and were mailed the generic HRQoL instrument 15D. Results: A total of 180 patients (90.5%) replied; 92 respondents underwent VATS while 88 underwent open thoracotomy. The VATS group more often had adenocarcinoma (P ¼ .006), and lymph node stations were sampled to a lesser extent (P ¼ .004); additionally, hospital length of stay was shorter among patients undergoing VATS (P ¼ .001). No other clinical or pathologic differences were observed between the 2 groups. Surprisingly, patients who underwent VATS scored significantly lower on HRQoL on the dimensions of breathing, speaking, usual activities, mental function, and vitality, and they reported a lower total 15D score, which reflects overall quality of life (P < .05). Conclusion: In contrast to earlier short-term reports, long-term quality-of-life measures are worse among patients who underwent VATS compared to thoracotomy.
Quality of Life Following Lung Cancer Resection
Chest, 2002
Study objectives: Quality of life (QOL) following video-assisted thoracic surgery (VATS) major lung resection has not been systematically studied. This study was designed to evaluate the intermediate to long-term QOL in patients with lung cancer following resection, comparing VATS with thoracotomy. Design: Cross-sectional study, telephone survey. Methods: Of 136 disease-free surviving patients with non-small cell lung cancer operated on between 1994 and 2000, 45 patients were excluded because of large tumors (> 5 cm) or locally advanced disease, and another 27 patients were excluded because of adjuvant therapy, coexisting cancer from another source, or psychiatric illness. At the time of the survey, 13 patients were found to be either unsuitable or unwilling to participate. This left a total of 51 patients, with 27 patients in the VATS group and 24 patients in the thoracotomy group (open group), for the final analysis. QOL was assessed using Chinese versions of the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ)-C30 and the EORTC QLQ-LC13, supplemented with nine self-developed surgery-related questions. Results: Mean follow-up time was 33.5 months in the VATS group (median, 20.8 months; range, 6.0 to 84.2 months) and 39.4 months in the open group (median, 37.7 months; range, 7.0 to 75.1 months). Both groups had good QOL and high levels of functioning despite a fairly high incidence of symptoms. There was a trend for VATS patients to score higher on the QOL and functioning scales and to report fewer symptoms. However, these differences did not lead to statistical significance. Conclusions: This study showed that lung cancer patients with resectable disease following surgical treatment without recurrence have good QOL and high levels of functioning on intermediate to long-term follow-up, with no significant differences between the VATS and open groups.
European Journal of Cardio-Thoracic Surgery, 2020
OBJECTIVES The aim of this study was to assess whether quality of life (QoL) scales are associated with postoperative length of stay (LoS) following video-assisted thoracoscopic surgery (VATS) lobectomy for lung cancer. METHODS This is a single-centre retrospective analysis on 250 consecutive patients submitted to VATS lobectomies (233) or segmentectomies (17) over a period of 3 years. QoL was assessed in all patients by the self-administration of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 questionnaire. The individual QoL scales were tested for possible association with LoS along with other objective baseline and surgical parameters using univariable and multivariable analyses. RESULTS Thirty-day cardiopulmonary and mortality rates were 22% and 2.4%. The median LoS was 4 days [interquartile range (IQR) 3–7]. Fifty-one (20%) patients remained in hospital longer than 7 days after surgery (upper quartile). General health [global he...
Symptom severity 1 to 4 months after thoracotomy for lung cancer
American Journal of Critical Care an Official Publication American Association of Critical Care Nurses, 2008
Background Information about the severity of symptoms during recovery from surgery for lung cancer can be useful in planning and anticipating needs for recovery. Objectives To describe symptom severity during the first 4 months after thoracotomy for non-small cell lung cancer and factors associated with overall symptom severity at 1 and 4 months. Methods Ninety-four patients were assessed at 1, 2, and 4 months after thoracotomy by using the Lung Cancer Symptom Scale, Brief Pain Inventory, Schwartz Fatigue Scale, Dyspnea Index, and Center for Epidemiology Studies-Depression Scale (CES-D). Clinically meaningful changes, decrease in the proportion of patients with severe symptoms, and relationships among symptoms were determined. Mixed effects models for repeated measures were used to evaluate changes in severity. Multiple regression models were used to examine correlates of overall symptoms. Results Mean symptom severity significantly decreased over time for most symptoms. Only disrupted appetite, pain, and dyspnea had clinically meaningful improvement at 4 months. Severe symptoms included fatigue (57%), dyspnea (49%), cough (29%), and pain (20%). Prevalence of depressed mood decreased at 4 months. Most patients (77%) had comorbid conditions. Number of comorbid conditions and CES-D explained 54% of the variance in symptom severity at 1 month; comorbid conditions, male sex, neoadjuvant treatment, and CES-D score explained 50% of the variance at 4 months. Conclusions Severe symptoms continued 4 months after surgery for some patients, indicating the need for support during recovery, especially for patients with multiple comorbid conditions and depressed mood.
A Systematic Review and Meta-Analysis to Assess Patient-Reported Outcomes after Lung Cancer Surgery
The Scientific World Journal, 2013
The main objective of this review was to systematically review, assess, and report on the studies that have assessed health related quality of life (HRQOL) after VATS and thoracotomy for resection of lung cancer. We performed a systematic review of six databases. The Downs and Black tool was used to assess the risk of bias. Five studies were included. In general, patients undergoing VATS have a better HRQOL when compared to thoracotomy; however, there was a high risk of bias in the included studies. The consistent use of a lung cancer specific questionnaire for measuring HRQOL after surgery is encouraged.
Lung Cancer, 2013
Introduction: Surgical resection currently is the best available treatment to enhance long-term survival after non-small cell lung cancer (NSCLC). With the anticipated growth in the number of NSCLC survivors diagnosed through computed tomography screening, health-related quality of life (HR-QOL) as an endpoint of treatment will become increasingly important. This article is a systematic review of the literature regarding HR-QOL in patients after surgical treatment. Methods: Three computerized databases (PubMed, Medline, and CINHAL) were used to identify relevant articles. Inclusion criteria were: empirical studies English language, assessment of HR-QOL after surgical treatment for stage I, II, or III NSCLC, and publication prior to January 2012. Data were abstracted and content analyses were used to synthesize the findings. Results: Nineteen out of 337 studies were reviewed. The majority of participants (67%) had stable or improved mental HR-QOL at 6-months after surgery. Compared with the general population, however, NSCLC survivors have poorer mental HR-QOL. Compared to pre-surgical status, participants had worse physical function at 6-months after surgery and had decreased physical function up to 2-years after surgery. Pain, fatigue, dyspnea and coughing were the most prevalent symptoms. Increased levels of dyspnea and fatigue persisted for at least 2-years after surgery. Continued smoking, presence of comorbidities, extensive surgical resection, and use of adjuvant therapy were associated with lower HR-QOL. Conclusions: New interventions focused on smoking cessation, improving symptom control and physical function are needed to enhance HR-QOL after lung cancer surgery.
Mini-invasive Surgery , 2020
The recent improvement in surgical techniques for non-small cell lung cancer enables evident better results in term of postoperative recovery with lower adverse events. Even though the interest in minimally invasive procedures has increased, more subjective advantages are not always so apparent in the literature. There is indeed a growing interest in the daily life of patients including their management of physical and emotional pain, the perception of quality of life, and pulmonary function recovery. This review aims to highlight the advantages of minimal invasive surgery on pain, quality of life, and functional pulmonary recovery after lobectomy alone for early stage non-small cell lung cancer. Minimal invasive techniques or limited sparing open techniques offer better results in term of postoperative pain than open non-sparing techniques, allowing a lighter analgesia protocol. However, these clear benefits seem to disappear in the mid-term postoperative period. Studies suggest that minimal invasive surgery is non-inferior to thoracotomy in terms of quality of life, and seems to give patients at least a better vision of their health, but larger-scale studies are needed to demonstrate its superiority. Data show clear advantages in the postoperative pulmonary function recovery for minimal invasive surgery compared to that of open procedures, although sparing and anterior incisions can show equivalence. That benefit does not seem to persist in the mid and long term. Nevertheless, the posterolateral thoracotomy appears to have the worse effect on the loss of pulmonary function.
European Journal of Cardio-Thoracic Surgery, 2014
The aim of this prospective study was to compare the effects of axillary thoracotomy (AT) and video-assisted thoracoscopic surgery (VATS) on acute-phase responses, pain, performance status and quality of life in patients undergoing pulmonary resection. METHODS: Fifty-five patients with peripherally located lung lesions were enrolled into this study. Surgery was done by VATS or AT. Forced expiratory volume, smoking habits, complications, Charlson comorbidity index, sex, age, length of incision, length of operation, length of hospital stay, length of drainage, length of air leakage, preoperative and postoperative C-reactive protein (CRP) values, visual analogue scale, quality of life and performance status of the patients were measured and compared. RESULTS: Twenty-five patients had lung resection with VATS and 30 patients had lung resection with AT. The demographic variables were similar. The differences between the two groups' postoperative serum CRP levels were significantly lower for the VATS group. The length of postoperative stay was significantly shorter for the VATS group. There were no other statistical significance between the two groups in terms of operative variables, complications, pain, quality of life and performance status. CONCLUSIONS: AT is a technique equivalent to VATS in terms of early complications, pain, performance status and quality of life; VATS provided a shorter postoperative stay.
Current thoracic surgery, 2019
Background: Video-assisted thoracoscopic surgery (VATS) is more advantageous than open surgery. In particular, VATS is superior in terms of pain, physical functioning, and overall patient satisfaction. The aim of this study was to evaluate factors affecting early postoperative pain and quality of life in patients who underwent VATS for benign or malignant disease. Materials and Methods: Seventy-seven patients who underwent VATS in our hospital between March 1 and June 30, 2018 were evaluated retrospectively. Postoperative pain was assessed at 2, 6, and 24 hours postoperatively using Visual Analogue Scale (VAS). The short-form 36 (SF-36) quality of life questionnaire was used to assess early quality of life. Results: Of the 74 patients in the study, 50 were male (67.6%) and 24 were female (32.4%). Mean VAS score was 6.84 ± 1.63 at postoperative hour 2, 4.19 ± 1.36 at postoperative hour 6, and 2.58 ± 1.20 at postoperative day 1. Geriatric patients had significantly higher VAS pain scores at postoperative hour 6 and day 1 (p = 0.011, p = 0.013). Patients with benign disease had significantly higher quality of life compared to patients with malignancy (p < 0.001). The presence of complications and advanced age were associated with lower postoperative quality of life. Conclusions: Although VATS patients have less severe pain and better quality of life in the early postoperative period, patients with malignancy had worse physical, psychological, and emotional state. In addition, geriatric patients and patients with early postoperative complications showed larger decreases in early postoperative quality of life.