title: Symptom recovery after thoracic surgery: Measuring patient-reported outcomes with the MD Anderson Symptom Inventory.
abstract: OBJECTIVE
  Measuring patient-reported outcomes (PROs) has become increasingly important for assessing quality of care and guiding patient management. However, PROs have yet to be integrated with traditional clinical outcomes (such as length of hospital stay), to evaluate perioperative care. This study aimed to use longitudinal PRO assessments to define the postoperative symptom recovery trajectory in patients undergoing thoracic surgery for lung cancer.
  
  
  METHODS
  Newly diagnosed patients (N = 60) with stage I or II non-small cell lung cancer who underwent either standard open thoracotomy or video-assisted thoracoscopic surgery lobectomy reported multiple symptoms from before surgery to 3 months after surgery, using the MD Anderson Symptom Inventory. We conducted Kaplan-Meier analyses to determine when symptoms returned to presurgical levels and to mild-severity levels during recovery.
  
  
  RESULTS
  The most-severe postoperative symptoms were fatigue, pain, shortness of breath, disturbed sleep, and drowsiness. The median time to return to mild symptom severity for these 5 symptoms was shorter than the time to return to baseline severity, with fatigue taking longer. Recovery from pain occurred more quickly for patients who underwent lobectomy versus thoracotomy (8 vs 18 days, respectively; P = .022). Patients who had poor preoperative performance status or comorbidities reported higher postoperative pain (all P < .05).
  
  
  CONCLUSIONS
  Assessing symptoms from the patient's perspective throughout the postoperative recovery period is an effective strategy for evaluating perioperative care. This study demonstrates that the MD Anderson Symptom Inventory is a sensitive tool for detecting symptomatic recovery, with an expected relationship among surgery type, preoperative performance status, and comorbid conditions.
authors.affiliation: Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, Tex.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Fagundes
authors.affiliation: Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Tex.
authors.forename: Qiuling
authors.initials: Q
authors.lastname: Shi
authors.affiliation: Department of Thoracic & Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Tex.
authors.forename: Ara A
authors.initials: AA
authors.lastname: Vaporciyan
authors.affiliation: Department of Thoracic & Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Tex.
authors.forename: David C
authors.initials: DC
authors.lastname: Rice
authors.affiliation: Department of Anesthesiology & Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Tex.
authors.forename: Keyuri U
authors.initials: KU
authors.lastname: Popat
authors.affiliation: Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Tex.
authors.forename: Charles S
authors.initials: CS
authors.lastname: Cleeland
authors.affiliation: Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Tex. Electronic address: xswang@mdanderson.org.
authors.forename: Xin Shelley
authors.initials: XS
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000601:surgery*; D015897:Comorbidity; D005260:Female; D006304:Health Status; D006801:Humans; D008137:Longitudinal Studies; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000503:physiopathology; D011013:Pneumonectomy / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis* / Q000503:physiopathology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020127:Recovery of Function; D012307:Risk Factors; D057566:Self Report; D012720:Severity of Illness Index; D013781:Texas; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects*; D013908:Thoracotomy / Q000009:adverse effects*; D013997:Time Factors; D016896:Treatment Outcome
keywords: MDASI; VATS; enhanced recovery; patient-reported outcome (PRO); postoperative care; symptoms