Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Feb 1;277(2):e428-e438.
doi: 10.1097/SLA.0000000000004802. Epub 2023 Jan 10.

Symptom Assessment Following Surgery for Lung Cancer: A Canadian Population-based Retrospective Cohort Study

Dhruvin H Hirpara  1 , Natalie G Coburn  1   2   3   4 , Gail E Darling  1   5 , Biniam Kidane  6   7   8 , Mathieu Rousseau  9 , Vaibhav Gupta  1 , Mark Doherty  10 , Victoria Zuk  3 , Victoria Delibasic  3 , Wing Chan  4 , Julie Hallet  1   2   3   4
Affiliations

Symptom Assessment Following Surgery for Lung Cancer: A Canadian Population-based Retrospective Cohort Study

Dhruvin H Hirpara et al. Ann Surg. .

Abstract

Objective: To conduct a population-level analysis of temporal trends and risk factors for high symptom burden in patients receiving surgery for non-small cell lung cancer (NSCLC).

Background: A population-level overview of symptoms after curative intent surgery is necessary to inform decision making and supportive care for patients with lung cancer.

Methods: Retrospective cohort study of patients receiving surgery for stages I to III NSCLC between January 2007 and September 2018. Prospectively collection Edmonton Symptom Assessment System (ESAS) scores, linked to provincial administrative data, were used to describe the prevalence, trajectory, and predictors of moderate-to-severe symptoms in the year following surgery.

Results: A total of 5350 patients, with 28,490 unique ESAS assessments, were included in the analysis. Moderate-to-severe tiredness (68%), poor wellbeing (63%), and shortness of breath (60%) were the most common symptoms reported. The rise and fall in the proportion of patients experiencing moderate-to-severe symptoms after surgery coincided with the median time to first (58 days, interquartile range: 47-72) and last cycle of chemotherapy (140 days, interquartile range: 118-168), respectively. There was eventual stabilization, albeit above the preoperative baseline, within 6 to 7 months after surgery. Female sex (relative risk [RR] 1.09- 1.26), lower income (RR 1.08-1.23), stage III disease (RR 1.15-1.43), adjuvant therapy (RR 1.09-1.42), chemotherapy within 2 weeks of an ESAS assessment (RR 1.14-1.73), and pneumonectomy (RR 1.05-1.15) were associated with moderate-to-severe symptoms following surgery.

Conclusions: Knowledge of population-level prevalence, trajectory, and predictors of moderate-to-severe symptoms after surgery for NSCLC can be used to facilitate shared decision making and improve symptom management throughout the course of illness.

PubMed Disclaimer

Conflict of interest statement

J.H. has received speaking honoraria from Ipsen Biopharmaceuticals Canada and Advanced Accelerator Applications. N.C. receives salary support from Ontario Health (Cancer Care Ontario) as the Clinical Lead for Patient-Reported Outcomes and Symptoms Management. The other authors report no conflicts of interest.

Comment in

References

    1. Pei G, Zhou S, Han Y, et al. Risk factors for postoperative complications after lung resection for non-small cell lung cancer in elderly patients at a single institution in China. J Thorac Dis. 2014;6:1230–1238.
    1. Verma V, Simone C, Werner-Wasik M. Acute and late toxicities of concurrent chemoradiotherapy for locally-advanced non-small cell lung cancer. Cancers (Basel). 2017;9:120.
    1. Hirpara DH, Gupta V, Brown L, et al. Patient-reported outcomes in lung and esophageal cancer. J Thorac Dis. 2019;11(suppl 4):S509–S514.
    1. Lehto R. Symptom management in lung cancer: management update. Lung Cancer Manag. 2016;5:61–78.
    1. Slotman BJ, Mauer ME, Bottomley A, et al. Prophylactic cranial irradiation in extensive disease small-cell lung cancer: short-term health-related quality of life and patient reported symptoms—results of an international phase III randomized controlled trial by the EORTC Radiation Oncology and Lung Cancer Groups. J Clin Oncol. 2009;27:78–84.

Publication types

Grants and funding