Health-related quality of life after surgical treatment in patients with non-small cell lung cancer: a systematic review

Abstract

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.