What Happens to Patients Undergoing Lung Cancer Surgery?: Outcomes and Quality of Life Before and After Surgery

doi:10.1378/chest.122.1.21

Chest

Volume 122, Issue 1, July 2002, Pages 21-30

https://doi.org/10.1378/chest.122.1.21 Get rights and content

Objective

To compare baseline preoperative and 6-month postoperative functional health status and quality of life in patients undergoing lung cancer resection.

Methods

Lung cancer surgery patients from three hospitals were administered the Short-Form 36 Health Survey (SF-36) and the Ferrans and Powers’ quality-of-life index (QLI) before surgery and 6 months after surgery. Preoperative, intraoperative, hospital stay, and 6-month postoperative clinical data were collected. All p values ≤ 0.05 were considered significant.

Results

One hundred thirty-nine patients were studied; 131 patients were discharged and 8 patients (5.8%) died. One hundred three patients (78.6%) who survived underwent an evaluation at 6 months, 16 patients (12.2%) died during follow-up, 2 patients refused follow-up, 4 patients were unavailable for follow-up, and 6 patients are awaiting an evaluation at 6 months. Compared with matched healthy subjects, preoperative lung cancer patients had worse results on the SF-36 physical functioning, role–emotional, mental health, and energy subscales. At 6 months, SF-36 subscales for physical functioning, role–physical, bodily pain, and mental health were significantly worse than preoperative values. The visual analog pain scale was significantly worse at follow-up. The QLI with all subscales and SF-36 for role–emotional, energy, and general health subscales were unaffected by lung cancer resection. Whereas preoperative FEV₁ and 6-min walk results did not predict postoperative functional health status or QLI, a low preoperative diffusion capacity of the lung for carbon monoxide (Dlco) predicted poor postoperative QLI. Preoperative chemoradiation, extent of resection, postoperative complications, or adjuvant therapy did not negatively affect the results of the 6-month QLI or SF-36.

Conclusions

Preoperative functional health status in patients who undergo lung cancer surgery is significantly impaired. A significant number of patients die during the 6 months after surgery. Pain and impairment of functional health status persists for 6 months after lung cancer resection. Dlco, not FEV₁, predicts postoperative quality of life. Preoperative chemoradiation, extent of resection, postoperative complications, or adjuvant therapy do not adversely affect functional health status or quality of life 6 months after surgery. Future studies should focus on risk prediction, technical improvements, and postoperative intervention to improve the functional outcomes and quality of life after lung cancer surgery.

Section snippets

Materials and Methods

We collected preoperative demographics, comorbidities, respiratory variables, and intraoperative and postoperative variables for patients referred for lung cancer resection. Functional assessment included Karnofsky performance status, American Society of Anesthesiology classification, and a 6-min walk. Respiratory variables included room air arterial blood gas analysis, complete spirometry, lung volumes and diffusion capacity of the lung for carbon monoxide (Dlco) measurement, Medical Research

Patient Population

One hundred thirty-nine patients were studied. Sixty-two patients were enrolled at the academic medical center, 16 patients were enrolled at the VA medical center, and 61 patients were enrolled at the community tertiary care medical center. The mean ± SD age was 62.05 ± 10.62 years (range, 31 to 86 years). Fifty-nine percent of the patients were male, 32.4% of the patients were actively employed at the time of surgery, 40.3% of the patients were active smokers within 8 weeks of surgery, and

Discussion

This study prospectively examined preoperative and postoperative functional health status and quality of life after pulmonary resection for lung cancer in 139 patients and analyzed these scores relative to multiple clinical characteristics and outcomes. We demonstrated impaired preoperative physical and emotional functioning, mental health, and energy in lung cancer surgery patients compared with a healthy, age-matched control population. After lung cancer resection, these patients had further

Conclusion

In summary, lung cancer surgery patients are sicker than the general population as documented by poorer functional status results. This depressed functional status persists for at least 6 months after surgery. Pain is a persistents postoperative complication of lung cancer surgery. A low preoperative Dlco is the only predictor of postoperative quality of life. A significant number of patients die following hospital discharge after lung cancer surgery. Preoperative chemoradiation, extent of

Appendix

Abbreviations: SSN = social security number; Y = yes; N = no; Ht = height; Wt = weight; Hx = history; CABG = coronary artery bypass graft surgery; MI = myocardial infarction; vasc dis = vascular disease; RA = room air; TLC = total lung capacity; MRC = Medical Research Council; preop = preoperative; pul = pulmonary; rehab = rehabilitation; resect = resection; pneumonect = pneumonectomy; LN = lymph node; EBL = estimated blood loss; Path = pathologic; req = requiring; Rx = therapy; LOS = length of

References (29)

S Cykert et al.
Patient preferences regarding possible outcomes after lung resection: what outcomes should preoperative evaluations target?
Chest
(2000)
MS Reif et al.
Evidence-based medicine in the treatment of non-small cell lung cancer
Clin Chest Med
(2000)
DJ Kearney et al.
Assessment of operative risk in patients undergoing lung resection: importance of predicted pulmonary function
Chest
(1994)
GL Walsh et al.
Resection of lung cancer is justified in high-risk patients selected by exercise oxygen consumption
Ann Thorac Surg
(1994)
J Wang et al.
Diffusing capacity predicts operative mortality but not long-term survival after resection of lung cancer
Thorac Cardiovasc Surg
(1999)
G Rocco et al.
Outcome of lung surgery: what patients don't like
Chest
(2000)
JW Asaph et al.
Median sternotomy vs thoracotomy to resect primary lung cancer: analysis of 815 cases
Ann Thorac Surg
(2000)
M Ferguson et al.
Diffusion capacity predicts morbidity and mortality after pulmonary resection
J Thorac Cardiovas Surg
(1988)
J Whittle et al.
Use of Medicare claims data to evaluate outcomes in elderly patients undergoing lung resection for lung cancer
Chest
(1991)
PS Romano et al.
Patient and hospital characteristics related to in-hospital mortality after lung cancer resection
Chest
(1992)

DM Lanuza et al.

Prospective study of functional status and quality of life before and after lung transplantation

Chest

(2000)

ME Kurtz et al.

Loss of physical functioning among geriatric cancer patients: relationships to cancer site, treatment, comorbidity and age

Eur J Cancer

(1997)

KL Yun et al.

Time related quality of life after elective cardiac operation

Ann Thorac Surg

(1999)

RE Dales et al.

Preoperative prediction of pulmonary complications following thoracic surgery

Chest

(1993)

Cited by (253)

The fatigue-inducing effects of cancer and its therapy are characterized by decreased physical activity in the absence of any motivational deficit
2024, Brain, Behavior, and Immunity
Although cancer and its therapy are well known to be associated with fatigue, the exact nature of cancer-related fatigue remains ill-defined. We previously reported that fatigue-like behavior induced independently by tumor growth and by the chemotherapeutic agent cisplatin is characterized by reduced voluntary wheel running and an intact motivation to expand effort for food rewards. The present set of experiments was initiated to characterize the functional consequences of fatigue induced by chemoradiotherapy in tumor-bearing mice and relate them to changes in the expression of genes coding for inflammation, mitochondria dynamics and metabolism. Two syngeneic murine models of cancer were selected for this purpose, a model of human papilloma virus-related head and neck cancer and a model of lung cancer. In both models, tumor-bearing mice were submitted to chemoradiotherapy to limit tumor progression. Two dimensions of fatigue were assessed, the physical dimension by changes in physical activity in mice trained to run in wheels and the motivational dimension by changes in the performance of mice trained to nose poke to obtain a food reward in a progressive ratio schedule of food reinforcement. Chemoradiotherapy reliably decreased wheel running activity but had no effect on performance in the progressive ratio in both murine models of cancer. These effects were the same for the two murine models of cancer and did not differ according to sex. Livers and brains were collected at the end of the experiments for qRT-PCR analysis of expression of genes coding for inflammation, mitochondria dynamics, and metabolism. The observed changes were mainly apparent in the liver and typical of activation of type I interferon and NF-κB-dependent signaling, with alterations in mitochondrial dynamics and a shift toward glycolysis. Although the importance of these alterations for the pathophysiology of cancer-related fatigue remains to be explored, the present findings indicate that fatigue brought on by cancer therapy in tumor-bearing mice is more physical than motivational.
Implementing a virtual mind-body prehabilitation program for patients undergoing thoracic surgery: A quality improvement project
2023, JTCVS Open
Prehabilitation before thoracic surgery has been found to improve outcomes in patients with cancer; however, COVID-19 presented challenges to access on-site programs. We describe the development, implementation, and evaluation of a synchronous, virtual mind-body prehabilitation program developed in response to COVID-19.
Eligible participants were patients seen at a thoracic oncology surgical department of an academic cancer center, aged 18 years or older with a diagnosis of thoracic cancer and referred at least 1 week before surgery. The program offered 2 45-minute preoperative mind-body fitness classes each week delivered via Zoom (Zoom Video Communications, Inc). We collected data for referrals, enrollment, participation, and evaluated patient-reported satisfaction and experience. We conducted brief semistructured interviews about participants’ experience.
Among 278 patients referred, 260 were approached, and of those 197 (76%) patients agreed to participate. Among participants, 140 (71%) attended at least 1 class, with an average of 11 attendees per class. The majority of participants reported being extremely satisfied (97.8%), extremely likely to recommend the classes to others (91.2%), and indicated that classes were very much helpful in preparing for surgery (90.8%). Patients also reported that the classes helped reduce anxiety/stress (94.2%), fatigue (88.5%), pain (80.7%), and shortness of breath (86.5%). Qualitative data further suggest that the program made participants feel stronger, more connected to their peers, and better prepared for surgery.
This virtual mind-body prehabilitation program was well received with high satisfaction and benefits and is highly feasible to implement. This approach may help overcome some of the challenges to in-person participation.
Quality of Life in Octogenarians After Lung Resection Compared to Younger Patients
2022, Clinical Lung Cancer
To evaluate postoperative outcome and quality of life (QOL), comparing patients <80 years old to patients ≥ 80.
EORTC questionnaires, QLQ-C30 and QLQ-LC13 was used to assess QOL, in patients after surgery. Results were evaluated according to 3 age groups: <70, 70 to 79, and ≥80.
106 patients were enrolled with 33 (<70), 25 (70-79), and 48 (≥80) patients per group. The median age was 74 years. 79% of patients had minimally invasive procedures, including 91% of those ≥80. Fifteen patients underwent wedge resections. Complication rates (18%, 32%, and 29%, P = .4) and median length of stay (4, 6, and 5 days, P = .2) were similar in all age groups, with no hospital mortality. One hundred one patients completed the questionnaires. Global QOL was highest among octogenarians. Overall functional and role QOL was higher among octogenarians than 70- to 79-year-olds, with emotional QOL higher than those <70 (P < .05). Social QOL in octogenarians was marginally lower than younger patients. Lung-specific symptom scores were at least 1.5 times lower than those <80 (P = .052). Patients aged 70 to 79 had the worst symptomatic and emotional effect on QOL. Surgical access and preoperative performance status did not affect final QOL across all age groups (P = .9 and P = .065). Among anatomical lung resections, QOL was higher in octogenarians than those 70 to 79 in all domains, and similar or higher than those <70 in most domains.
Quality of life among octogenarians after surgery remains similar to younger patients even after anatomical lung resection. Surgery in octogenarians is safe, with minimal impact on postoperative QOL.
Postoperative exercise training improves the quality of life in patients receiving pulmonary resection: A systematic review and meta-analysis based on randomized controlled trials
2022, Respiratory Medicine
To evaluate whether postoperative exercise training is effective in improving clinical outcomes such as the quality of life (QoL), exercise capacity and respiratory function of patients receiving pulmonary resection.
The PubMed, EMBASE, Web of Science and PEDro electronic databases were comprehensively searched to identify eligible randomized controlled trials (RCTs).
The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. The primary outcome was postoperative QoL and secondary outcomes were exercise capacity and respiratory function.
A total of eight studies involving 691 participants were enrolled in this systematic review and meta-analysis. For the postoperative QoL measured by 36-Item Short Form Health Survey (SF-36), the pooled results demonstrated that postoperative exercise training could significantly improve the SF-36 physical domain score [weighted mean difference (WMD) = 5.87, 95% confidence interval (CI): 3.96 to 7.78, P＜0.001] and SF-36 mental domain score (WMD = 8.15, 95% CI: 0.13 to 16.16, P = 0.05). The results of further analysis for the eight dimensions of SF-36 were similar to the overall results. However, for secondary outcomes, no significant effects of postoperative exercise training on exercise capacity and respiratory function were observed.
Postoperative exercise training could significantly improve the QoL of patients undergoing lung surgery. However, more RCTs with large samples are still needed to verify the effects of postoperative exercise rehabilitation on clinical outcomes of patients who receive pulmonary resection.
Exercise and Lung Cancer
2022, Lung Cancer Rehabilitation
Engaging in exercise or physical activity has been found to be safe and strongly recommended, as well as beneficial, in patients with lung cancer at any stage of the disease and its treatment. Factors that may affect the exercise tolerance or capacity and functional Independence in patients with lung cancer include prediagnosis fitness level, normal aging, comorbidities, tumor burden, cancer-related, and treatment-related side effects. Tailoring cancer rehabilitation and exercise programs for this population may alleviate some of the current barriers including low adherence and high dropout rates. Optimized clinical and research collaboration between oncologists, cancer rehabilitation physicians, and exercise specialists may aid in creating these programs while emphasizing on specific considerations related to lung cancer and its treatments.
Modifiable factors associated with health-related quality of life among lung cancer survivors following curative intent therapy
2022, Lung Cancer
The number of lung cancer survivors is increasing along with advances in screening, diagnosis, and treatment. Following curative intent therapy, many lung cancer survivors experience significant health-related quality of life (HRQL) impairments. We sought to identify potentially modifiable factors that contribute to the HRQL of these patients.
In this cross-sectional observational study of disease-free, stage I-IIIA lung cancer survivors following curative intent therapy, we used a conceptual model to examine factors that included behavioral, objective functional and physiologic, self-rated function and symptom burden, specific comorbidities, and non-modifiable demographic and clinical lung cancer-related characteristics. We assessed HRQL using the valid and prognostic European Organization for Research and Treatment of Cancer Quality of Life (QoL) Core 30 global health/QoL subscale. We used univariable and multivariable linear regression modeling with backward elimination of potentially modifiable and non-modifiable factors, and interpreted clinically and statistically significant, consistent, and independent modifiable factors as meaningful.
Among 75 participants at a median of 12 months since treatment completion, the mean (standard deviation) C30 global health/QoL score was 62.7 (23.3) points (0–100 scale range). In multivariable analysis, with and without non-modifiable factors, we identified three clinically and statistically significant, consistent, and independent factors (unstandardized β range) associated with global health/QoL: 1) abnormal exercise-induced dyspnea (−9.23 to −10.0 points); 2) impaired self-rated role function (or inability to perform work or daily activities and pursuing leisure-time activities) (−12.6 to −16.4 points); and 3) abnormal insomnia (or trouble sleeping) (−12.6 to −16.4 points).
We identified meaningful modifiable factors associated with the HRQL of disease-free, stage I-IIIA lung cancer survivors following curative intent therapy. Interventions to improve the HRQL of these patients should aim to reduce exercise-induced dyspnea, improve role function – the ability to perform work and other daily including leisure-time activities, and control insomnia.

View all citing articles on Scopus

View full text

Chest

Clinical InvestigationsSurgeryWhat Happens to Patients Undergoing Lung Cancer Surgery?: Outcomes and Quality of Life Before and After Surgery

Objective

Methods

Results

Conclusions

Section snippets

Materials and Methods

Patient Population

Discussion

Conclusion

Appendix

Chest

Clin Chest Med

Chest

Ann Thorac Surg

Thorac Cardiovasc Surg

Chest

Ann Thorac Surg

J Thorac Cardiovas Surg

Chest

Chest

Chest

Eur J Cancer

Ann Thorac Surg

Chest

Clinical Investigations
Surgery
What Happens to Patients Undergoing Lung Cancer Surgery?: Outcomes and Quality of Life Before and After Surgery