title: Trajectories of Symptom Occurrence and Severity From Before Through Five Months After Lung Cancer Surgery.
abstract: BACKGROUND
  Limited information is available about lung cancer patients' symptoms in the pre- and postoperative periods.
  
  
  OBJECTIVE
  Study purposes were to evaluate for changes in symptom occurrence and severity from the preoperative period to five months after surgery and to evaluate for predictors of the occurrence and trajectories of these symptoms.
  
  
  METHODS
  Patients completed the Memorial Symptom Assessment Scale before and at one and five months after surgery. Changes in the six most common physical symptoms and the most common psychological symptom were evaluated using multilevel growth mixture modeling. Age, gender, comorbidity, and receipt of adjuvant chemotherapy were included as covariates in the conditional models for symptom occurrence and severity.
  
  
  RESULTS
  The total number of symptoms increased significantly from the preoperative to the one month assessment. At five months, the number of symptoms was lower than at one month but significantly higher than at the preoperative assessment. The occurrence of five of the symptoms (i.e., pain, lack of energy, shortness of breath, feeling drowsy, and worrying) increased significantly from before through the first month after surgery and then decreased over time. Cough and difficulty sleeping persisted over the five months of the study. In general, the effect of the four covariates was to increase patients' overall symptom burden.
  
  
  CONCLUSIONS
  Changes in the occurrence and severity of these seven symptoms were variable. All seven symptoms occurred at relatively high rates and were of moderate severity. Findings can be used to identify patients who are at higher risk for more severe symptoms.
authors.affiliation: Division of Emergencies and Critical Care, Ullevål, Oslo University Hospital, Oslo, Norway; Department of Respiratory Medicine, Oslo University Hospital, Oslo, Norway. Electronic address: trine.oksholm@rr-research.no.
authors.forename: Trine
authors.initials: T
authors.lastname: Oksholm
authors.affiliation: Division of Emergencies and Critical Care, Ullevål, Oslo University Hospital, Oslo, Norway; Department of Nursing Science, University of Oslo, Oslo, Norway.
authors.forename: Tone
authors.initials: T
authors.lastname: Rustoen
authors.affiliation: School of Nursing, University of California, San Francisco, California, USA.
authors.forename: Bruce
authors.initials: B
authors.lastname: Cooper
authors.affiliation: School of Nursing, University of California, San Francisco, California, USA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Paul
authors.affiliation: Department for Thoracic and Cardiovascular Surgery, Rikshospitalet, Oslo University Hospital, Oslo, Norway.
authors.forename: Steinar
authors.initials: S
authors.lastname: Solberg
authors.affiliation: Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway.
authors.forename: Kari
authors.initials: K
authors.lastname: Henriksen
authors.affiliation: Department of Respiratory Medicine, Oslo University Hospital, Oslo, Norway; Institute of Health and Society and Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Johny Steinar
authors.initials: JS
authors.lastname: Kongerud
authors.affiliation: School of Nursing, University of California, San Francisco, California, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Miaskowski
mesh_terms: D000368:Aged; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008175:Lung Neoplasms / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology* / Q000601:surgery*; D008297:Male; D011184:Postoperative Period; D057234:Preoperative Period; D012720:Severity of Illness Index; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Lung cancer; postoperative; predictors; preoperative; surgery; symptoms