Patient-Reported Symptom Interference as a Measure of Postsurgery Functional Recovery in Lung Cancer

Abstract

Context Few empirical studies have combined the patient’s perspective (patient-reported outcomes, or PROs) with clinical outcomes (risk for complications, length of hospital stay, return to planned treatment) to assess the effectiveness of treatment after thoracic surgery for early-stage non-small cell lung cancer (NSCLC). Objectives Quantitatively measure PROs to assess functional recovery postsurgery. Methods Treatment-naïve patients (N=72) with NSCLC who underwent either open thoracotomy or video-assisted thoracoscopic surgery (VATS) used the MD Anderson Symptom Inventory (MDASI) to report symptom interference with general activity, work, walking, mood, relations with others, and enjoyment of life for 3 months postsurgery. Functional recovery was defined as interference scores returning to presurgery levels. The MDASI’s sensitivity to change in functional recovery over time was evaluated via its ability to distinguish between surgical techniques. Results Interference scores increased sharply by day 3 postsurgery (all P<0.001), then returned to baseline levels via different trajectories. Patients who had unscheduled clinic visits during the study period reported higher scores on all 6 MDASI interference items (all P<0.05). Compared with the open-thoracotomy group, the VATS group returned more quickly to baseline interference levels for walking (18 vs 43 days), mood (8 vs 19 days), relations with others (4 vs 16 days) and enjoyment of life (15 vs 41 days) (all P<0.05). Conclusion Repeated measurement of MDASI interference characterized functional recovery after thoracic surgery for NSCLC and was sensitive to VATS’ ability to enhance postoperative recovery. Further study of the clinical applicability of measuring recovery outcomes using PRO-based functional assessment is warranted.

Validation of the Mandarin Chinese version of the Leicester Cough Questionnaire in non‐small cell lung cancer patients after surgery

“…Our study showed the suitability of an instrument for accurately assessing postoperative cough. This instrument can be used to guide effective treatment, accelerate recovery from postoperative cough, and achieve the objective of enhanced recovery after surgery …”

“…Enhanced recovery after surgery pathways have increasingly been applied to treat many patients who have undergone thoracic surgery, and symptomatic recovery after thoracic surgery has become increasingly important to assess quality of care and guide patient management . A cough, one of the most common respiratory symptoms after surgery, is an important determinant of quality of life .…”

Developing and validating utility parameters to establish patient-reported outcome-based perioperative symptom management in patients with lung cancer: a multicentre, prospective, observational cohort study protocol

“…The alert thresholds will be generated as cut-off points for the PSS with the method proposed by Serlin et al ,29 using the 6 MDASI-LC interference items as the anchor. The 6 MDASI interference items have been validated as a reliable and sensitive measure for functional status of patients undergoing cancer treatment19 30 and ‘functional recovery has been considered as the most important target’ for postoperative recovery by a large group of international professionals 31. Differences are considered statistically significant if the two-tailed p values of <0.05.…”

“…PRO-based symptom management is the key and ideal model for patient-centred care 15–19. However, there are still a few technical and methodological issues to be resolved before implementing PRO tools in perioperative symptom management in patients with lung cancer.…”

Physiotherapy management of patients undergoing thoracotomy procedure: A survey of current practice in Gauteng

“…The respective authors noted that physiotherapy services are most often offered to patients when in hospital but less so following hospital discharge. This is cause for concern as functional recovery following open thoracotomy is known to be slower compared with when a patient undergoes video-assisted thoracoscopic surgery (VATS) (Shi et al 2016 ). Shi et al ( 2016 ) noted that patients following open thoracotomy only return to preoperative walking ability after 43 days compared with 18 days in individuals who had undergone a VATS procedure.…”