title: Predictors of nursing home admission, severe functional impairment, or death one year after surgery for non-small cell lung cancer.
abstract: OBJECTIVE
  To assess factors associated with nursing home admission, severe functional impairment, or death 1 year after surgery for stage I-IIIa non-small cell lung cancer.
  
  
  BACKGROUND
  Patients perceive long-term disability to be one of the most undesirable complications of lung cancer treatment.
  
  
  METHODS
  A multiregional cohort was surveyed 12 months after surgery. Logistic regression was used to determine adjusted predictors of long-term disability. Recursive partitioning was used to create a risk index based on preoperative factors.
  
  
  RESULTS
  Of the 1007 patients, 146 (15%) were admitted to a nursing home or died by 1 year after surgery, with higher risk among patients 80 years or older, those with severe comorbidities, and those with stage II-IIIa disease (all Ps ≤ 0.01). Among 759 survivors who completed the follow-up survey, 51 (7%) were admitted to a nursing home or reported inability to get out of bed, dress or wash themselves, or perform usual activities. Patients with moderate comorbidities (P < 0.001) or lack of high school diploma (P = 0.03) were more likely to experience nursing home admission or severe functional impairment. The risk of nursing home admission, severe functional impairment, or death was low (16%) for patients younger than 75 years and for those 75 years or older with stage I disease, intermediate (33%) for patients 75 years or older with stage II-IIIa disease and no or mild comorbidities, and high (60%) for those 75 years or older with stage II-IIIa disease and moderate or severe comorbidities.
  
  
  CONCLUSIONS
  Patients' risk of long-term disability should be incorporated in preoperative counseling.
authors: Department of Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA. sbillmeier@partners.org
authors: Sarah E
authors: SE
authors: Billmeier
authors: John Z
authors: JZ
authors: Ayanian
authors: Yulei
authors: Y
authors: He
authors: Michael T
authors: MT
authors: Jaklitsch
authors: Selwyn O
authors: SO
authors: Rogers
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000534:rehabilitation* / Q000601:surgery; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000534:rehabilitation* / Q000601:surgery; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D009735:Nursing Homes / Q000706:statistics & numerical data*; D011013:Pneumonectomy; D011184:Postoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends