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. 2022 Aug 30;23(1):224.
doi: 10.1186/s12931-022-02149-9.

Longitudinal changes in pulmonary function and patient-reported outcomes after lung cancer surgery

Sumin Shin #  1   2 , Sunga Kong #  3   4 , Danbee Kang #  3   5 , Genehee Lee  3   4 , Jong Ho Cho  2 , Young Mog Shim  2   4 , Juhee Cho  3   4   5   6 , Hong Kwan Kim #  7   8   9 , Hye Yun Park #  10   11
Affiliations

Longitudinal changes in pulmonary function and patient-reported outcomes after lung cancer surgery

Sumin Shin et al. Respir Res. .

Abstract

Background: Surgery is the mainstay of treatment for non-small cell lung cancer, but the decline in pulmonary function after surgery is noticeable and requires attention. This study aimed to evaluate longitudinal changes in pulmonary function and integrated patient-reported outcomes (PROs) after lung cancer surgery.

Methods: Data were obtained from a prospective cohort study, the Coordinate Approach to Cancer Patients' Health for Lung Cancer. Changes in forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) at 2 weeks, 6 months, and 1 year after surgery, and the corresponding modified Medical Research Council (mMRC) dyspnea scale and chronic obstructive lung disease assessment test (CAT) scores were evaluated. Mixed effects model was used to investigate changes in pulmonary function and PROs.

Results: Among 620 patients, 477 (76.9%) underwent lobectomy, whereas 120 (19.4%) and 23 (3.7%) were treated with wedge resection/segmentectomy and bilobectomy/pneumonectomy, respectively. Both FVC and FEV1 markedly decreased 2 weeks after surgery and improved thereafter; however, they did not recover to baseline values. The corresponding mMRC dyspnea scale and CAT scores worsened immediately after surgery. The dyspnea scale of the mMRC was still higher, while CAT scores returned to baseline one year after surgery, although breathlessness and lack of energy persisted. Compared to the changes from baseline of FVC and FEV1 in patients who underwent lobectomy, patients who underwent bilobectomy/pneumonectomy showed a greater decrease in FVC and FEV1, while wedge resection/segmentectomy patients had smaller decreases in FVC and FEV1 at 2 weeks, 6 months, and 1 year after surgery. Bilobectomy/pneumonectomy patients had the highest mMRC dyspnea grade among the three groups, but the difference was not statistically significant one year after surgery.

Conclusions: After lung cancer surgery, pulmonary function and PROs noticeably decreased in the immediate post-operative period and improved thereafter, except for dyspnea and lack of energy. Proper information on the timeline of changes in lung function and symptoms following lung cancer surgery could guide patient care approaches after surgery.

Trial registration: ClinicalTrials.gov; No.: NCT03705546; URL: www.

Clinicaltrials: gov.

Keywords: Non-small cell lung cancer; Patients reported outcomes; Pulmonary function; Surgery.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of study participants. a. pulmonary metastasis of cancer in other organs. b. patients who were simultaneously diagnosed with cancer in other organs. CATCH –LUNG Coordinate Approach to Cancer Patient’s Health for Lung Cancer, NSCLC non-small cell lung cancer
Fig. 2
Fig. 2
Change in pulmonary function and patient-reported outcomes by postoperative time. (A) FVC (mL), (B) FVC (percent of the predicted value), (C) FEV1 (mL), (D) FEV1 (percent of the predicted value) (E), mMRC dyspnea scale, (F) CAT CAT chronic obstructive pulmonary disease assessment test, FEV1 forced expiratory volume in 1 s, FVC forced expiratory vital capacity, mMRC dyspnea scale modified Medical Research Council dyspnea scale
Fig. 3
Fig. 3
Change in pulmonary function and patient-reported outcomes by type of surgery and postoperative time. (A) FVC (mL), (B) FVC (percent of the predicted value), (C) FEV1(mL), (D) FEV1 (percent of the predicted value), (E) mMRC dyspnea scale, (F) CAT according to type of surgery and postoperative time CAT chronic obstructive pulmonary disease assessment test, FEV1 forced expiratory volume in 1 s; FVC forced expiratory vital capacity, mMRC dyspnea scale modified Medical Research Council dyspnea scale. *P for interaction (P < 0.01) between type of surgery (reference: lobectomy) and time after adjustment for age, sex, smoking status, obesity, stage, cell type, type of surgery, video-assisted thoracic surgery, postoperative pulmonary complications, and adjuvant treatment
See this image and copyright information in PMC

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