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. 2022 Sep;164(3):615-626.e3.
doi: 10.1016/j.jtcvs.2021.11.100. Epub 2022 Mar 12.

Long-term patient-reported outcomes after non-small cell lung cancer resection

Brendan T Heiden  1 , Melanie P Subramanian  2 , Jingxia Liu  3 , Angela Keith  2 , Kathryn E Engelhardt  2 , Bryan F Meyers  2 , Varun Puri  2 , Benjamin D Kozower  4
Affiliations

Long-term patient-reported outcomes after non-small cell lung cancer resection

Brendan T Heiden et al. J Thorac Cardiovasc Surg. 2022 Sep.

Abstract

Objectives: Patient-reported outcomes (PROs) are critical tools for evaluating patients before and after lung cancer resection. In this study, we assessed patient-reported pain, dyspnea, and functional status up to 1 year postoperatively.

Methods: This study included patients who underwent surgery for non-small cell lung cancer at a single institution (2017-2020). We collected PROs using the National Institutes of Health Patient Reported Outcome Measurement Information System (PROMIS). Data were prospectively collected and merged with our institutional Society of Thoracic Surgeons data. Using multivariable linear mixed effect models, we compared PROMIS scores for preoperative and several postoperative visits.

Results: From 2017 until 2020, 334 patients underwent lung cancer resection with completed PROMIS assessments. Pain interference, physical function, and dyspnea severity scores were worse 1 month after surgery (P < .001). Pain interference and physical function scores returned to baseline by 6 months after surgery. However, dyspnea severity scores remained persistently worse up to 1 year after surgery (1-month difference, 8.8 ± 1.9; 6-month difference, 3.6 ± 2.2; 1-year difference, 4.9 ± 2.8; P < .001). Patients who received a thoracotomy had worse physical function and pain interference scores 1 month after surgery compared with patients who received a minimally invasive operation; however, there were no differences in PROs by 6 months after surgery.

Conclusions: PROs are important metrics for assessing patients before and after lung cancer resection. Patients may report persistent dyspnea up to 1 year after resection. Additionally, patients undergoing thoracotomy initially report worse pain and physical function but these impairments improve by 6 months after surgery.

Keywords: dyspnea; lung cancer; pain; patient-reported outcomes; thoracic surgery.

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Conflict of interest statement

Conflict of Interest: None

Figures

Figure 1.
Figure 1.
Changes in PROMIS (a) dyspnea severity, (b) pain interference, and (c) physical function scores over time (pre-operative, 1-month, 6-months, and 12-months following surgery) for patients with NSCLC undergoing surgery. For dyspnea severity and pain interference, higher scores represent worse symptoms (arrows). For physical function, higher scores represent better symptoms (arrows). Error bars represent standard error. PROMIS, Patient Reported Outcomes Measurement Information System.
Figure 1.
Figure 1.
Changes in PROMIS (a) dyspnea severity, (b) pain interference, and (c) physical function scores over time (pre-operative, 1-month, 6-months, and 12-months following surgery) for patients with NSCLC undergoing surgery. For dyspnea severity and pain interference, higher scores represent worse symptoms (arrows). For physical function, higher scores represent better symptoms (arrows). Error bars represent standard error. PROMIS, Patient Reported Outcomes Measurement Information System.
Figure 1.
Figure 1.
Changes in PROMIS (a) dyspnea severity, (b) pain interference, and (c) physical function scores over time (pre-operative, 1-month, 6-months, and 12-months following surgery) for patients with NSCLC undergoing surgery. For dyspnea severity and pain interference, higher scores represent worse symptoms (arrows). For physical function, higher scores represent better symptoms (arrows). Error bars represent standard error. PROMIS, Patient Reported Outcomes Measurement Information System.
Figure 2.
Figure 2.
Changes in PROMIS (a) dyspnea severity, (b) pain interference, and (c) physical function scores over time (pre-operative, 1-month, 6-months, and 12-months following surgery) for patients with NSCLC undergoing minimally invasive versus open operations. For dyspnea severity and pain interference, higher scores represent worse symptoms (arrows). For physical function, higher scores represent better symptoms (arrows). Error bars represent standard error. PROMIS, Patient Reported Outcomes Measurement Information System.
Figure 2.
Figure 2.
Changes in PROMIS (a) dyspnea severity, (b) pain interference, and (c) physical function scores over time (pre-operative, 1-month, 6-months, and 12-months following surgery) for patients with NSCLC undergoing minimally invasive versus open operations. For dyspnea severity and pain interference, higher scores represent worse symptoms (arrows). For physical function, higher scores represent better symptoms (arrows). Error bars represent standard error. PROMIS, Patient Reported Outcomes Measurement Information System.
Figure 2.
Figure 2.
Changes in PROMIS (a) dyspnea severity, (b) pain interference, and (c) physical function scores over time (pre-operative, 1-month, 6-months, and 12-months following surgery) for patients with NSCLC undergoing minimally invasive versus open operations. For dyspnea severity and pain interference, higher scores represent worse symptoms (arrows). For physical function, higher scores represent better symptoms (arrows). Error bars represent standard error. PROMIS, Patient Reported Outcomes Measurement Information System.
Figure 3.
Figure 3.
Changes in PROMIS (a) dyspnea severity, (b) pain interference, and (c) physical function scores over time (pre-operative, 1-month, 6-months, and 12-months following surgery) for patients with NSCLC undergoing lobectomy versus sublobar resection. For dyspnea severity and pain interference, higher scores represent worse symptoms (arrows). For physical function, higher scores represent better symptoms (arrows). Error bars represent standard error. PROMIS, Patient Reported Outcomes Measurement Information System.
Figure 3.
Figure 3.
Changes in PROMIS (a) dyspnea severity, (b) pain interference, and (c) physical function scores over time (pre-operative, 1-month, 6-months, and 12-months following surgery) for patients with NSCLC undergoing lobectomy versus sublobar resection. For dyspnea severity and pain interference, higher scores represent worse symptoms (arrows). For physical function, higher scores represent better symptoms (arrows). Error bars represent standard error. PROMIS, Patient Reported Outcomes Measurement Information System.
Figure 3.
Figure 3.
Changes in PROMIS (a) dyspnea severity, (b) pain interference, and (c) physical function scores over time (pre-operative, 1-month, 6-months, and 12-months following surgery) for patients with NSCLC undergoing lobectomy versus sublobar resection. For dyspnea severity and pain interference, higher scores represent worse symptoms (arrows). For physical function, higher scores represent better symptoms (arrows). Error bars represent standard error. PROMIS, Patient Reported Outcomes Measurement Information System.
Figure 4.
Figure 4.
Long-term patient reported outcomes following lung cancer resection. Patients undergoing thoracotomy initially report worse pain and physical function compared to minimally invasive approaches but these impairments improve by 6 months after surgery. Additionally, patients may report persistent dyspnea for at least 1 year after resection.
See this image and copyright information in PMC

Comment in

  • Commentary: Never PROMIS more than you can deliver.
    Wang SX, Kim S, Marshall MB. Wang SX, et al. J Thorac Cardiovasc Surg. 2022 Sep;164(3):627-628. doi: 10.1016/j.jtcvs.2021.12.009. Epub 2021 Dec 8. J Thorac Cardiovasc Surg. 2022. PMID: 34930580 No abstract available.

References

    1. Subramanian M, Kozower BD, Brown LM, Khullar OV., Fernandez FG. Patient-Reported Outcomes in Cardiothoracic Surgery. Ann Thorac Surg. 2019;107(1):294–301. doi: 10.1016/j.athoracsur.2018.06.005 - DOI - PMC - PubMed
    1. Lipscomb J, Gotay CC, Snyder CF. Patient-reported Outcomes in Cancer: A Review of Recent Research and Policy Initiatives. CA Cancer J Clin. 2007;57(5):278–300. doi: 10.3322/ca.57.5.278 - DOI - PubMed
    1. Basch E, Torda P, Adams K. Standards for patient-reported outcome-based performance measures. JAMA - J Am Med Assoc. 2013;310(2):139–140. doi: 10.1001/jama.2013.6855 - DOI - PubMed
    1. ColG, Murgu SD, Korst RJ, Slatore CG, Unger M, Quadrelli S. Follow-up and surveillance of the patient with lung cancer after curative-intent therapy: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013;143(5 Suppl):e437S–e454S. doi: 10.1378/chest.12-2365 - DOI - PubMed
    1. Khullar OV, Rajaei MH, Force SD, et al. Pilot Study to Integrate Patient Reported Outcomes After Lung Cancer Operations Into The Society of Thoracic Surgeons Database. Ann Thorac Surg. 2017;104(1):245–253. doi: 10.1016/j.athoracsur.2017.01.110 - DOI - PubMed

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