What happens to patients undergoing lung cancer surgery? Outcomes and quality of life before and after surgery.
OBJECTIVE
To compare baseline preoperative and 6-month postoperative functional health status and quality of life in patients undergoing lung cancer resection.


METHODS
Lung cancer surgery patients from three hospitals were administered the Short-Form 36 Health Survey (SF-36) and the Ferrans and Powers' quality-of-life index (QLI) before surgery and 6 months after surgery. Preoperative, intraoperative, hospital stay, and 6-month postoperative clinical data were collected. All p values <or= 0.05 were considered significant.


RESULTS
One hundred thirty-nine patients were studied; 131 patients were discharged and 8 patients (5.8%) died. One hundred three patients (78.6%) who survived underwent an evaluation at 6 months, 16 patients (12.2%) died during follow-up, 2 patients refused follow-up, 4 patients were unavailable for follow-up, and 6 patients are awaiting an evaluation at 6 months. Compared with matched healthy subjects, preoperative lung cancer patients had worse results on the SF-36 physical functioning, role-emotional, mental health, and energy subscales. At 6 months, SF-36 subscales for physical functioning, role-physical, bodily pain, and mental health were significantly worse than preoperative values. The visual analog pain scale was significantly worse at follow-up. The QLI with all subscales and SF-36 for role-emotional, energy, and general health subscales were unaffected by lung cancer resection. Whereas preoperative FEV(1) and 6-min walk results did not predict postoperative functional health status or QLI, a low preoperative diffusion capacity of the lung for carbon monoxide (DLCO) predicted poor postoperative QLI. Preoperative chemoradiation, extent of resection, postoperative complications, or adjuvant therapy did not negatively affect the results of the 6-month QLI or SF-36.


CONCLUSIONS
Preoperative functional health status in patients who undergo lung cancer surgery is significantly impaired. A significant number of patients die during the 6 months after surgery. Pain and impairment of functional health status persists for 6 months after lung cancer resection. DLCO, not FEV(1), predicts postoperative quality of life. Preoperative chemoradiation, extent of resection, postoperative complications, or adjuvant therapy do not adversely affect functional health status or quality of life 6 months after surgery. Future studies should focus on risk prediction, technical improvements, and postoperative intervention to improve the functional outcomes and quality of life after lung cancer surgery.
Division of Cardiothoracic Surgery, The Oregon Clinic, Portland, OR 97213, USA. jhandy@orclinic.com
John R
JR
Handy
James W
JW
Asaph
Laurie
L
Skokan
Carolyn E
CE
Reed
Sydney
S
Koh
Gladney
G
Brooks
E Charles
EC
Douville
Andrew C
AC
Tsen
Gary Y
GY
Ott
Gerard A
GA
Silvestri
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003131:Combined Modality Therapy; D005260:Female; D006304:Health Status; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000523:psychology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011183:Postoperative Complications; D011184:Postoperative Period; D011788:Quality of Life; D020775:Thoracic Surgery, Video-Assisted; D016896:Treatment Outcome