Trajectory and profile of quality of life in patients undergoing lung resection for lung cancer during hospitalization according to the EQ-5D

Analysis of the changes in health-related quality of life and employment status after surgery in patients with lung cancer: a single-center longitudinal study

OBJECTIVE

This study analyzed the changes in health-related quality of life (HRQOL) and employment status of patients undergoing lung cancer surgery in Japan.

METHODS

This was a single-center, prospective study on patients who underwent lung anatomical resection. The eligible patients completed self-reported HRQOL and employment surveys at baseline and 6 and 12 months postoperatively. HRQOL was assessed using questionnaires including the European Organization for Research and Treatment of Cancer Core Quality of Life questionnaire (EORTC QLQ-C30) and EORTC QLQ and Lung Cancer module and additional social engagement and work-related stress evaluation tools.

RESULTS

In total, 93 patients completed the baseline survey, and 80 provided survey data at 6 months postoperatively. The HRQOL scores of several factors significantly declined immediately after the surgery and then gradually improved. The EORTC global health score, which represents overall health status, returned to baseline levels at 12 months postoperatively. However, symptoms such as fatigue, dyspnea, and coughing did not return to baseline levels at 12 months postoperatively. Approximately 68% of the patients who were employed preoperatively continued to work at 12 months postoperatively.

CONCLUSIONS

Lung cancer surgery significantly affected the HRQOL and employment status of the patients within the first 6 months after surgery. For patients who decide to return to work before full recovery of QOL, we consider the need for enhanced support to assist them as they can reintegrate into work and activities of daily living.

Relationship between changes in pulmonary function and patient-reported outcomes of lung cancer surgery

PURPOSE

To investigate the relationship between changes in pulmonary function (PF) and patient-reported outcomes (PROs) of lung cancer surgery.

METHODS

We recruited 262 patients who underwent lung resection for lung cancer, to evaluate the PROs, using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ)-C30 and the Lung Cancer 13-question supplement (LC13). The patients underwent PF tests and PRO assessments preoperatively (Pre) and 1 year after surgery (Y1). Changes were calculated by subtracting the value at Pre from the value at Y1. We set two cohorts: patients under the ongoing protocol (Cohort 1) and patients who were eligible for lobectomy with clinical stage I lung cancer (Cohort 2).

RESULTS

Cohorts 1 and 2 comprised 206 and 149 patients, respectively. In addition to dyspnea, changes in PF were also correlated with scores for global health status, physical and role function scores, fatigue, nausea and vomiting, pain, and financial difficulties. Absolute correlation coefficient values ranged from 0.149 to 0.311. Improvement of emotional and social function scores was independent of PF. Sublobar resection preserved PF more than lobectomy did. Wedge resection mitigated dyspnea in both cohorts.

CONCLUSION

The correlation between PF and PROs was found to be weak; therefore, further studies are needed to improve the patient's postoperative experience.

Preoperative state anxiety predicts postoperative health-related quality of life: A prospective observational study on patients undergoing lung cancer surgery

Objective

Improving quality of life (QOL) after surgery is very important. Recently, preoperative anxiety has been suggested to predict postoperative health-related (HR) QOL, however the accuracy of anxiety measurement remains problematic. We examined the relationship between preoperative anxiety level and postoperative HRQOL using qualitative and quantitative assessment of anxiety.

Method

We used a detailed anxiety assessment to quantitatively investigate preoperative anxiety as a predictor of postoperative HRQOL in lung cancer patients. Fifty one patients who underwent surgery for lung cancer were included. They were assessed four times: on admission, on discharge, 1 month after surgery, and 3 months after surgery. Anxiety was measured separately as "state anxiety" and "trait anxiety" using the State-Trait Anxiety Inventory, and HRQOL was measured using the EuroQol 5 dimension 5-level.

Results

The HRQOL decreased at discharge and gradually recovered over time, reaching the same level at 3 months after surgery as at admission. HRQOL score was lower at discharge than at pre-surgery and 3 months after the surgery (p < 0.0001 each), and the score at 1 month after the surgery was lower than at pre-surgery (p = 0.007). In addition, multiple regression analysis showed that HRQOL at discharge was associated with "state anxiety" rather than "trait anxiety" at admission (p = 0.004).

Conclusion

This study identifies the types of anxiety that affect postoperative HRQOL. We suggest that postoperative HRQOL on discharge may be improved by interventions such as psychological or medication treatment for preoperative state anxiety if identified preoperative state anxiety can be managed appropriately.

Dynamic Changes and Influencing Factors for the Quality of Life in Nursing Care after Lung Cancer Resection

To investigate the dynamic changes and influencing factors for the quality of life in nursing care in patients with lung cancer after resection. Totally, 136 patients undergoing lung cancer resection in our hospital from January 2019 to January 2022 were prospectively enrolled as subjects. The quality of life was measured before and 1 and 2 weeks and 1, 3, 6, and 12 months after the operation to analyze the dynamic changes in the quality of life in nursing care. Clinical data of patients were collected at the time of discharge. The patients were divided into high-quality and low-quality groups according to the median level of quality of life in nursing care at the final follow-up. The logistic regression equation was applied to analyze the influencing factors for the quality of life in nursing care after lung cancer resection. Of 136 patients receiving lung cancer resection, 32 were lost to follow-up until the final follow-up, so 104 patients were finally included. According to the median level of quality of life in nursing care at the final follow-up, the patients were divided into high-quality and low-quality groups (n = 52 per group). The quality of life in nursing care first decreased, then increased, and then stabilized after lung cancer resection. The comparison of clinical data between the two groups exhibited that albumin level was higher in the high-quality group than that in the control group. The age, proportion of living alone, S-AI score, and FoP-Q-SF score were lower in the high-quality group than those in the low-quality group ( $P<0.05$ ). Univariate logistic regression analysis demonstrated that high albumin (OR = 0.884) was a protective factor for the quality of life in nursing care after lung cancer resection ( $P<0.05$ ). Living alone (OR = 1.333), high S-AI score (OR = 1.211), high FoP-Q-SF score (OR = 1.221), and advanced age (OR = 1.209) were the risk factors for the quality of life in nursing care after lung cancer resection ( $P<0.05$ ). Multivariate logistic regression analysis demonstrated that high albumin (OR = 0.861) was a protective factor for the quality of life in nursing care after lung cancer resection ( $P<0.05$ ). Living alone (OR = 1.144), high S-AI score (OR = 1.170), high FoP-Q-SF score (OR = 1.161), and advanced age (OR = 1.181) were the risk factors for the quality of life after lung cancer resection ( $P<0.05$ ). The quality of life in nursing care first decreased, then increased, and then stabilized after lung cancer resection. Albumin, age, living alone, and S-AI and FoP-Q-SF scores were the influencing factors for the quality of life in nursing care after lung cancer resection. In the nursing care process after lung cancer resection, we should focus on elderly patients living alone who are affected by anxiety and fear of recurrence to improve the quality of life of these patients.

Effect of coronary artery bypass grafting on quality of life: a meta-analysis of randomized trials

AIMS

We conducted a systematic review and meta-analysis to evaluate temporal trends in quality of life (QoL) after coronary artery bypass grafting (CABG) surgery in randomized clinical trials, and a quantitative comparison from before surgery to up to 5 years after surgery.

METHODS AND RESULTS

We searched MEDLINE, CINAHL, EMBASE, Cochrane Library, and PsycINFO from 2010 to 2020 to identify studies that included the measurement of QoL in patients undergoing CABG. The primary outcome was the Seattle Angina Questionnaire (SAQ), and secondary outcomes were the 36-item Short Form Health Survey (SF-36) and EuroQol Questionnaire (EQ-5D). We pooled the means and the weighted mean differences over the follow-up period. In the meta-analysis, 2586 studies were screened and 18 full-text studies were included. There was a significant trend towards higher QoL scores from before surgery to 1 year post-operatively for the SAQ angina frequency (AF), SAQ QoL, SF-36 physical component (PC), and EQ-5D, whereas the SF-36 mental component (MC) did not improve significantly. The weighted mean differences from before surgery to 1 year after was 24 [95% confidence interval (CI): 21.6-26.4] for the SAQ AF, 31 (95% CI: 27.5-34.6) for the SAQ QoL, 9.8 (95% CI: 7.1-12.8) for the SF-36 PC, 7.1 (95% CI: 4.2-10.0) for the SF-36 MC, and 0.1 (95% CI: 0.06-0.14) for the EQ-5D. There was no evidence of publication bias or small-study effect.

CONCLUSION

CABG had both short- and long-term improvements in disease-specific QoL and generic QoL, with the largest improvement in angina frequency.

Comparison of Postoperative Quality of Life and Pain with and without a Metal Rib Spreader in Patients Undergoing Lobectomy through Axillary Mini-Thoracotomy for Stage I Lung Cancer

Purpose: To evaluate postoperative patient-reported quality of life (QOL) and pain with and without a metal rib spreader (MRS) in patients with stage I lung cancer who underwent lobectomy through axillary mini-thoracotomy (AMT).

Methods: This single-institution prospective observational study enrolled patients between January 2015 and April 2018. Their QOL and pain were evaluated using the EQ-5D and the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire 30 items (QLQ-C30). The EQ-5D was completed preoperatively (Pre) and on days 1/3/5/7 (D1/3/5/7), at 1 month (M1), and at 1 year postoperatively (Y1). The EORTC QLQ-C30 was completed at Pre, M1, and Y1.

Results: The data of 140 patients were analyzed (video-assisted without MRS: VA/noMRS: 67, AMT with MRS: AMT/MRS: 73). Although the AMT/MRS group had more preoperative comorbidities, longer operative times, and more blood loss than the VA/noMRS group, the EQ-5D visual analog scale scores were not significantly different at any assessment point (Pre/D1/D3/D5/D7/M1/Y1) (VA/noMRS: 82/48/60/67/73/77/85, AMT/MRS: 80/46/60/66/73/76/85). Postoperative pain in the EQ-5D descriptive system and the EORTC QLQ-C30 was comparable between the groups.

Conclusion: VA/noMRS and AMT/MRS showed similar postoperative QOL and pain scores, indicating that MRS negligibly impacts the postoperative QOL and pain.