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Turan GB, Özer Z, Sariköse A. The effects of progressive muscle relaxation exercise applied to lung cancer patients receiving chemotherapy on dyspnea, pain and sleep quality: A randomized controlled trial. Eur J Oncol Nurs 2024; 70:102580. [PMID: 38636116 DOI: 10.1016/j.ejon.2024.102580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 03/20/2024] [Accepted: 03/25/2024] [Indexed: 04/20/2024]
Abstract
PURPOSE The aim of the present study is the analysis of how progressive muscle relaxation exercise affects dyspnea, pain and sleep quality in patients with lung cancer receiving chemotherapy. METHODS Seventy-four patients diagnosed with lung cancer were included in this randomized controlled study. A total of 16 sessions of progressive muscle relaxation exercises were applied to the patients in the intervention group for a duration of 30 min, 2 days a week for 8 weeks. Patient Information Form, Medical Research Council Dyspnea Scale (MRC dyspnea scale), Pitssburg Sleep Quality Index (PSQI), Visual Analog Scale- Pain (VAS-P) were used to collect data. RESULTS Socio-demographic and disease characteristics were found to be similar in control and intervention groups. Final scores indicated significant differences between the experimental and control groups in all variables. The experimental group showed significantly more favorable results in dyspnea (p < 0.001), pain (p < 0.003) and sleep (p < 0.001) symptoms. When the effect size values (Cohen's d) of these findings were analyzed, PMR exercise was found to have a moderate effect on mean VAS-P scores (0.548) and a large effect on mean MRC dyspnea scale (1.073) and PSQI (0.970) scores. These results indicated significant differences in pre and post intervention mean scores. CONCLUSION Progressive muscle relaxation exercise applied to lung cancer patients receiving chemotherapy was found to be effective in reducing dyspnea and pain severity and improving sleep quality. Clinical trial registration at ClinicalTrials.gov. NCT04978805.
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Affiliation(s)
| | - Zülfünaz Özer
- Department of Nursing, Istanbul Sabahattin Zaim University, Istanbul, Turkey.
| | - Ayşegül Sariköse
- Fırat University Institute of Health Sciences, Department of Internal Medicine Nursing, Elazig, Turkey.
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Okuyama A, Mizutani T, Tachibana K, Higashi T, Ogawa A. Treatment Patterns and Postoperative Activities of Daily Living in Patients with Non-small Cell Lung Cancer: A Retrospective Study Using Nationwide Health Services Utilization Data in Japan. Ann Surg Oncol 2024; 31:3409-3416. [PMID: 38127217 DOI: 10.1245/s10434-023-14798-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The number of older patients with cancer has been increasing. This study aimed to determine the proportion of postoperative decline in activities of daily living (ADL), hospital mortality rate, home healthcare services use, and adjuvant chemotherapy treatment patterns of patients with early-stage non-small cell lung cancer (NSCLC) across age groups. METHODS We analyzed health service utilization data of patients aged ≥ 40 years diagnosed with clinical stage I or II NSCLC in 2015 who underwent thoracoscopy or thoracotomy. The Barthel index was used to determine the proportions of patients aged 40-64, 65-74, ≥ 75 years who experienced a decline in the ADL of ≥ 10 points at postoperative discharge compared to the ADL at admission. RESULTS Overall, 19,780 patients were analyzed. The proportion of patients with ADL decline slightly increased with increasing age: 1.1%, 1.6%, and 3.5% after thoracoscopic surgery, and 1.4%, 2.8%, and 4.8% after thoracotomy among those aged 40-64, 65-74, and ≥ 75 years, respectively. The hospital mortality rate and proportion of home healthcare services use was fewer than 10 cases, or < 2%. The unexpected readmission rate was slightly higher among those aged ≥ 75 years (3.7% for thoracoscopic surgery, 4.7% for thoracotomy) than among those aged 40-64 years (1.8% for thoracoscopic surgery, 2.5% for thoracotomy). CONCLUSION The difference in the proportion of patients with ADL decline between those aged 40-64 and ≥ 75 years was approximately 3%. This study provides practical information for clinicians involved in the care of older patients who undergo thoracic surgery.
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Affiliation(s)
- Ayako Okuyama
- Graduate School of Nursing, St. Luke's International University, Tokyo, Japan.
- National Cancer Center Institute for Cancer Control, Tokyo, Japan.
| | - Tomonori Mizutani
- Department of Medical Oncology, Kyorin University Faculty of Medicine, 6-20-2 Shinkawa, Mitakashi, Tokyo, Japan
| | - Keisei Tachibana
- Department of Thoracic and Thyroid Surgery, Kyorin University Faculty of Medicine, 6-20-2 Shinkawa, Mitakashi, Tokyo, 181-8611, Japan
| | - Takahiro Higashi
- National Cancer Center Institute for Cancer Control, Tokyo, Japan
- Department of Public Health, The University of Tokyo, Tokyo, Japan
| | - Asao Ogawa
- Psycho-Oncology Division, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Chiba, Japan
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3
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Jovanoski N, Abogunrin S, Di Maio D, Belleli R, Hudson P, Bhadti S, Jones LG. Health State Utility Values in Early-Stage Non-small Cell Lung Cancer: A Systematic Literature Review. PHARMACOECONOMICS - OPEN 2023; 7:723-738. [PMID: 37289325 PMCID: PMC10471534 DOI: 10.1007/s41669-023-00423-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/10/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Non-small cell lung cancer (NSCLC) is the predominant histological subtype of lung cancer and is the leading cause of cancer-related deaths globally. Quality of life is an important consideration for patients and current treatments can adversely affect health-related quality of life (HRQoL). OBJECTIVE The objectives of this systematic literature review (SLR) were to identify and provide a comprehensive catalogue of published health state utility values (HSUVs) in patients with early-stage NSCLC and to understand the factors impacting on HSUVs in this indication. METHODS Electronic searches of Embase, MEDLINE and Evidence-Based Medicine Reviews were conducted via the Ovid platform in March 2021 and June 2022 and were supplemented by grey literature searches of conference proceedings, reference lists, health technology assessment bodies, and other relevant sources. Eligibility criteria were based on patients with early-stage (stage I-III) resectable NSCLC receiving treatment in the adjuvant or neoadjuvant setting. No restriction was placed on interventions or comparators, geography, or publication date. English language publications or non-English language publications with an English abstract were of primary interest. A validated checklist was applied to conduct quality assessment of the full publications. RESULTS Twenty-nine publications (27 full publications and two conference abstracts) met all eligibility criteria and reported 217 HSUVs and seven disutilities associated with patients with early NSCLC. The data showed that increasing disease stage is associated with decreasing HRQoL. It was also indicated that utility values vary by treatment approach; however, the choice of treatment may be influenced by the patients' disease stage at presentation. Few studies aligned with the requirements of health technology assessment (HTA) bodies, indicating a need for future studies to conform to these preferences, making them suitable for use in economic evaluations. CONCLUSIONS This SLR found that disease stage and treatment approach were two of several factors that can impact patient-reported HRQoL. Additional studies are warranted to confirm these findings and to investigate emerging therapies for early NSCLC. In collecting a catalogue of HSUV data, this SLR has begun to identify the challenges associated with identifying reliable utility value estimates suitable for use in economic evaluations of early NSCLC.
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Detterbeck FC, Mase VJ, Li AX, Kumbasar U, Bade BC, Park HS, Decker RH, Madoff DC, Woodard GA, Brandt WS, Blasberg JD. A guide for managing patients with stage I NSCLC: deciding between lobectomy, segmentectomy, wedge, SBRT and ablation-part 2: systematic review of evidence regarding resection extent in generally healthy patients. J Thorac Dis 2022; 14:2357-2386. [PMID: 35813747 PMCID: PMC9264068 DOI: 10.21037/jtd-21-1824] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 05/05/2022] [Indexed: 11/06/2022]
Abstract
Background Clinical decision-making for patients with stage I lung cancer is complex. It involves multiple options (lobectomy, segmentectomy, wedge, stereotactic body radiotherapy, thermal ablation), weighing multiple outcomes (e.g., short-, intermediate-, long-term) and multiple aspects of each (e.g., magnitude of a difference, the degree of confidence in the evidence, and the applicability to the patient and setting at hand). A structure is needed to summarize the relevant evidence for an individual patient and to identify which outcomes have the greatest impact on the decision-making. Methods A PubMed systematic review from 2000-2021 of outcomes after lobectomy, segmentectomy and wedge resection in generally healthy patients is the focus of this paper. Evidence was abstracted from randomized trials and non-randomized comparisons with at least some adjustment for confounders. The analysis involved careful assessment, including characteristics of patients, settings, residual confounding etc. to expose degrees of uncertainty and applicability to individual patients. Evidence is summarized that provides an at-a-glance overall impression as well as the ability to delve into layers of details of the patients, settings and treatments involved. Results In healthy patients there is no short-term benefit to sublobar resection vs. lobectomy in randomized and non-randomized comparisons. A detriment in long-term outcomes is demonstrated by adjusted non-randomized comparisons, more marked for wedge than segmentectomy. Quality-of-life data is confounded by the use of video-assisted approaches; evidence suggests the approach has more impact than the resection extent. Differences in pulmonary function tests by resection extent are not clinically meaningful in healthy patients, especially for multi-segmentectomy vs. lobectomy. The margin distance is associated with the risk of recurrence. Conclusions A systematic, comprehensive summary of evidence regarding resection extent in healthy patients with attention to aspects of applicability, uncertainty and effect modifiers provides a foundation on which to build a framework for individualized clinical decision-making.
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Affiliation(s)
- Frank C. Detterbeck
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Vincent J. Mase
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Andrew X. Li
- Department of General Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Ulas Kumbasar
- Department of Thoracic Surgery, Hacettepe University School of Medicine, Ankara, Turkey
| | - Brett C. Bade
- Department of Pulmonary Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Henry S. Park
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Roy H. Decker
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - David C. Madoff
- Department of Radiology & Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Gavitt A. Woodard
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Whitney S. Brandt
- Department of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Justin D. Blasberg
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
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Zeng J, Mao WM, Chen QX, Luo TB, Wu YL, Zhou Q, Yang XN, Yan HH, Zhong WZ, Wang Q, Xu ST, Wu L, Shen Y, Liu YY, Chen C, Cheng Y, Xu L, Wang J, Fei K, Li XF, Li J, Huang C, Liu ZD, Xu S, Chen KN, Xu SD, Liu LX, Yu P, Wang BH, Ma HT. Quality of life with adjuvant gefitinib versus vinorelbine plus cisplatin in patients with completely resected stage II-IIIA (N1-N2) EGFR-mutant non-small-cell lung cancer: Results from the ADJUVANT (CTONG1104) study. Lung Cancer 2020; 150:164-171. [PMID: 33186858 DOI: 10.1016/j.lungcan.2020.09.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 09/12/2020] [Accepted: 09/22/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Health-related quality of life (HRQoL) data complement conventional clinical endpoints when comparing adjuvant gefitinib with chemotherapy in patients with early-stage non-small-cell lung cancer (NSCLC) and epidermal growth factor receptor (EGFR) mutations. This study aimed to assess changes in HRQoL with adjuvant gefitinib vs chemotherapy in this patient group. MATERIALS AND METHODS In the phase III ADJUVANT trial, patients with completely resected, stage II-IIIA (N1-N2), EGFR-mutant NSCLC were randomized (1:1) to receive either gefitinib for 24 months or vinorelbine plus cisplatin (VP) every 3 weeks for four cycles. HRQoL was assessed as a secondary endpoint using the Functional Assessment of Cancer Therapy-Lung Cancer (FACT-L), Lung Cancer Symptom Scale (LCSS) questionnaires, and Trial Outcome Index (TOI) composite score. HRQoL dynamics, improvements, and time to deterioration were compared between groups. RESULTS At baseline, 104 of 106, and 80 of 87 patients receiving gefitinib and VP, respectively, completed two questionnaires (FACT-L and LCSS). Baseline scores were balanced between groups. Although HRQoL fluctuated and gradually improved in both groups, longitudinally higher scores were reported with gefitinib than VP (FACT-L, odds ratio 418.16, 95 % confidence interval [CI] 2.75-63509.05, p = 0.019; LCSS, 1.13, 1.04-1.22, p = 0.003; TOI, 88.39, 4.40-1775.05, p = 0.003). Time to deterioration in HRQoL was delayed with gefitinib compared with VP (FACT-L, median 69 vs 6 weeks, hazard ratio 0.62, 95 % CI 0.42-0.90, p = 0.013; LCSS, median 45 vs 6 weeks, 0.63, 0.43-0.93, p = 0.020; TOI, median 164 vs 9 weeks, 0.51, 0.33-0.77, p = 0.001). CONCLUSION Adjuvant gefitinib is associated with improved HRQoL over VP, supporting its use in patients with stage II-IIIA (N1-N2), EGFR-mutant NSCLC.
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Affiliation(s)
- Jian Zeng
- Department of Thoracic Surgery, Zhejiang Cancer Hospital, University of Chinese Academy of Sciences, Hangzhou, China
| | - Wei-Min Mao
- Department of Thoracic Surgery, Zhejiang Cancer Hospital, University of Chinese Academy of Sciences, Hangzhou, China.
| | - Qi-Xun Chen
- Department of Thoracic Surgery, Zhejiang Cancer Hospital, University of Chinese Academy of Sciences, Hangzhou, China
| | - Tao-Bo Luo
- Department of Thoracic Surgery, Zhejiang Cancer Hospital, University of Chinese Academy of Sciences, Hangzhou, China
| | - Yi-Long Wu
- Department of Pulmonary Cancer, Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Qing Zhou
- Department of Pulmonary Cancer, Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xue-Ning Yang
- Department of Pulmonary Cancer, Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hong-Hong Yan
- Department of Pulmonary Cancer, Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wen-Zhao Zhong
- Department of Pulmonary Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Qun Wang
- Department of Thoracic Surgery, Fudan University Affiliated Zhongshan Hospital, Shanghai, China
| | - Song-Tao Xu
- Department of Thoracic Surgery, Fudan University Affiliated Zhongshan Hospital, Shanghai, China
| | - Lin Wu
- Department of Pulmonary Medicine, Hunan Cancer Hospital, Changsha, China
| | - Yi Shen
- Department of Thoracic Surgery, The Affiliated Hospital of Medical College Qingdao University, Qingdao, China
| | - Yong-Yu Liu
- Department of Thoracic Surgery, Liaoning Cancer Hospital, Shenyang, China
| | - Chun Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Ying Cheng
- Department of Oncology, Jilin Provincial Tumor Hospital, Changchun, China
| | - Lin Xu
- Department of Thoracic Surgery, Jiangsu Cancer Hospital, Nanjing, China
| | - Jun Wang
- Department of Thoracic Surgery, The People's Hospital of Peking University, Beijing, China
| | - Ke Fei
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China
| | - Xiao-Fei Li
- Department of Thoracic Surgery, Tangdu Hospital, Xi'an, China
| | - Jian Li
- Department of Thoracic Surgery, Peking University First Hospital, Beijing, China
| | - Cheng Huang
- Department of Pulmonary Oncology, Fujian Cancer Hospital, Fuzhou, China
| | - Zhi-Dong Liu
- Department of Thoracic Surgery, Beijing Chest Hospital, Beijing, China
| | - Shun Xu
- Department of Thoracic Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Ke-Neng Chen
- Department of Thoracic Surgery, Beijing Cancer Hospital, Beijing, China
| | - Shi-Dong Xu
- Department of Thoracic Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Lun-Xu Liu
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Ping Yu
- Department of Thoracic Oncology, Sichuan Cancer Hospital, Chengdu, China
| | - Bu-Hai Wang
- Department of Oncology, The Northern Jiangsu People's Hospital, Yangzhou, China
| | - Hai-Tao Ma
- Department of Thoracic Surgery, The First Affiliated Hospital of Suzhou University, Suzhou, China
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Ha D, Ries AL, Lippman SM, Fuster MM. Effects of curative-intent lung cancer therapy on functional exercise capacity and patient-reported outcomes. Support Care Cancer 2020; 28:4707-4720. [PMID: 31965306 PMCID: PMC7371511 DOI: 10.1007/s00520-020-05294-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 01/03/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE Lung cancer treatment can lead to negative health consequences. We analyzed the effects of curative-intent lung cancer treatment on functional exercise capacity (EC) and patient-reported outcomes (PROs). METHODS We performed a prospective, observational cohort study of consecutive patients with stage I-IIIA lung cancer undergoing curative-intent therapy and assessed functional EC (primary outcome, six-minute walk distance (6MWD)), cancer-specific quality of life (QoL) (secondary outcome, European Organization for Research and Treatment of Cancer QoL Questionnaire Core 30 (EORTC-QLQ-C30) summary score), and exploratory outcomes including dyspnea (University of California San Diego Shortness of Breath Questionnaire (UCSD SOBQ)) and fatigue Brief Fatigue Inventory (BFI)) symptoms before and at 1 to 3 months post-treatment. We analyzed the time effect of treatment on outcomes using multivariable generalized estimating equations. RESULTS In 35 enrolled participants, treatment was associated with a clinically meaningful and borderline-significant decline in functional EC ((mean change, 95% CI) 6MWD = - 25.4 m (- 55.3, + 4.47), p = 0.10), clinically meaningful and statistically significant higher dyspnea (UCSD SOBQ = + 13.1 (+ 5.7, + 20.6), p = 0.001) and fatigue (BFI = + 10.0 (+ 2.9, + 17.0), p = 0.006), but no clinically meaningful or statistically significant change in cancer-specific QoL (EORTC-QLQ-C30 summary score = - 3.4 (- 9.8, + 3.0), p = 0.30). CONCLUSIONS Among the first prospective analysis of the effect of curative-intent lung cancer treatment on functional EC and PROs, we observed worsening dyspnea and fatigue, and possibly a decline in functional EC but not cancer-specific QoL at 1 to 3 months post-treatment. Interventions to reduce treatment-related morbidities and improve lung cancer survivorship may need to focus on reducing dyspnea, fatigue, and/or improving functional EC.
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Affiliation(s)
- Duc Ha
- Institute for Health Research, Kaiser Permanente Colorado, 2550 S. Parker Rd Suite 200, Aurora, CO, 80014, USA.
- Pulmonary, Critical Care, and Sleep Medicine, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA.
- Department of Medicine, University of California San Diego, La Jolla, CA, USA.
| | - Andrew L Ries
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Scott M Lippman
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
- Moores Cancer Center, University of California San Diego Health, La Jolla, CA, USA
| | - Mark M Fuster
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
- Pulmonary and Critical Care Medicine, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
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Ijsseldijk MA, Shoni M, Siegert C, Wiering B, van Engelenburg AKC, Tsai TC, Ten Broek RPG, Lebenthal A. Oncologic Outcomes of Surgery Versus SBRT for Non-Small-Cell Lung Carcinoma: A Systematic Review and Meta-analysis. Clin Lung Cancer 2020; 22:e235-e292. [PMID: 32912754 DOI: 10.1016/j.cllc.2020.04.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/21/2020] [Accepted: 04/25/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The optimal treatment of stage I non-small-cell lung carcinoma is subject to debate. The aim of this study was to compare overall survival and oncologic outcomes of lobar resection (LR), sublobar resection (SR), and stereotactic body radiotherapy (SBRT). METHODS A systematic review and meta-analysis of oncologic outcomes of propensity matched comparative and noncomparative cohort studies was performed. Outcomes of interest were overall survival and disease-free survival. The inverse variance method and the random-effects method for meta-analysis were utilized to assess the pooled estimates. RESULTS A total of 100 studies with patients treated for clinical stage I non-small-cell lung carcinoma were included. Long-term overall and disease-free survival after LR was superior over SBRT in all comparisons, and for most comparisons, SR was superior to SBRT. Noncomparative studies showed superior long-term overall and disease-free survival for both LR and SR over SBRT. Although the papers were heterogeneous and of low quality, results remained essentially the same throughout a large number of stratifications and sensitivity analyses. CONCLUSION Results of this systematic review and meta-analysis showed that LR has superior outcomes compared to SBRT for cI non-small-cell lung carcinoma. New trials are underway evaluating long-term results of SBRT in potentially operable patients.
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Affiliation(s)
- Michiel A Ijsseldijk
- Division of Surgery, Slingeland Ziekenhuis, Doetinchem, The Netherlands; Division of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Melina Shoni
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Charles Siegert
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA; Division of Thoracic Surgery, West Roxbury Veterans Administration, West Roxbury, MA
| | - Bastiaan Wiering
- Division of Surgery, Slingeland Ziekenhuis, Doetinchem, The Netherlands
| | | | - Thomas C Tsai
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Richard P G Ten Broek
- Division of Surgery, Slingeland Ziekenhuis, Doetinchem, The Netherlands; Division of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Abraham Lebenthal
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA; Division of Thoracic Surgery, West Roxbury Veterans Administration, West Roxbury, MA; Harvard Medical School, Boston, MA
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8
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Nestle U, Adebahr S, Kaier K, Gkika E, Schimek-Jasch T, Hechtner M, Momm F, Gaertner J, Becker G, Grosu AL. Quality of life after pulmonary stereotactic fractionated radiotherapy (SBRT): Results of the phase II STRIPE trial. Radiother Oncol 2020; 148:82-88. [PMID: 32339780 DOI: 10.1016/j.radonc.2020.03.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 02/21/2020] [Accepted: 03/16/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Preserving health related quality of life (HRQOL) plays an important role in considering stereotactic body fractionated radiotherapy (SBRT). The prospective monocenter phase II STRIPE trial investigated long-term HRQOL after SBRT, efficacy and toxicity. MATERIALS AND METHODS Patients with ≤2 pulmonary lesions ≤5 cm were treated with 4DPET/CT-based SBRT (3 × 12.5 Gy or risk-adapted 5 × 7 Gy, to 60% isodose). Follow up (FU) was performed 2 and 7 weeks after SBRT, then 3-monthly for 2 years with assessment of response (primary endpoint: 2-year cumulative incidence of local progression (LP); secondary endpoints: local progression free survival (LPFS), overall survival (OS) and toxicity (CTCAE)). Impact of predefined patient and treatment related factors on HRQOL (EORTC QLQ-C30 and EORTC QLQ-LC13) was evaluated. RESULTS Between 02/2011 and 11/2014, 100 patients were given SBRT for 56 NSCLC and 44 pulmonary metastases (M1). Long-term FU overall revealed stable Quality of Life (QoL)/Global health status (GHS), functions-scores and symptoms. For QoL/GHS, patients with low (<median) initial QoL/GHS-Score revealed significantly stronger improvement than those with good QoL/GHS-scores (p < 0.001). Probability for LP, LPFS and OS 2 years after SBRT was 8.1% (NSCLC: 7.3%, M1:9.2%), 53.3% (NSCLC: 50.7%, M1: 56.0%) and 62.2% (NSCLC: 57.2%, M1: 68.4%). ≥G3-Toxicity was <4%, but ≥G3 dyspnea was 6% at baseline and 14.5% 2 years after SBRT. CONCLUSIONS These prospective data on representative pulmonary SBRT patients confirm stable preservation of HRQOL after SBRT and demonstrate a QoL/GHS-benefit for patients with low initial QoL/GHS-scores, the regimen of 3 × 12.5 Gy SBRT being efficient and well tolerated. This result may inform shared decision making when discussing SBRT for frail patients.
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Affiliation(s)
- Ursula Nestle
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Germany; Department of Radiation Oncology, Kliniken Maria Hilf GmbH Mönchengladbach, Germany
| | - Sonja Adebahr
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Germany; German Cancer Consortium (DKTK) Partner Site Freiburg, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Klaus Kaier
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Germany
| | - Eleni Gkika
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Germany
| | - Tanja Schimek-Jasch
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Germany
| | - Marlene Hechtner
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Germany; German Cancer Consortium (DKTK), Partner Site Mainz, Germany
| | - Felix Momm
- Department of Radio-oncology, Ortenau Klinikum Offenburg-Kehl, Germany
| | - Jan Gaertner
- Palliative Care Center Hildegard, Basel, Switzerland
| | - Gerhild Becker
- Clinic for Palliative Care, Medical Center, Faculty of Medicine, University of Freiburg, Germany
| | - Anca-Ligia Grosu
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Germany; German Cancer Consortium (DKTK) Partner Site Freiburg, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany
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9
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Dean GE, Weiss C, Jungquist CR, Klimpt ML, Alameri R, Ziegler PA, Steinbrenner LM, Dexter EU, Dhillon SS, Lucke JF, Dickerson SS. Nurse-Delivered Brief Behavioral Treatment for Insomnia in Lung Cancer Survivors: A Pilot RCT. Behav Sleep Med 2020; 18:774-786. [PMID: 31672070 PMCID: PMC7190424 DOI: 10.1080/15402002.2019.1685523] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Objective/Background: Insomnia occurs in 50 to 80% of lung cancer survivors. Cognitive behavioral therapy is the standard treatment for insomnia (CBTI); however, treatment length and lack of psychologists trained in CBTI limits access. Brief Behavioral Treatment for Insomnia (BBTI), a nurse-delivered modified CBTI, is proposed. This feasibility pilot study sought to compare the BBTI intervention to attention control Healthy Eating Program (HEP) for insomnia in lung cancer survivors. Participants: The participants comprised adults, 21 years of age or older with insomnia and stage I/II non-small cell lung cancer, more than 6 weeks from surgery and living in Western NY. Methods: Participants (n = 40) were randomly assigned to an experimental (BBTI) or attention control condition (Healthy Eating Program). Thirty participants completed the study. Results: Participants were 66 years of age (± 7.6; range 53-82), 40% (n = 16) male, 87.5% (n = 35) Caucasian, 50% (n = 20) married, BMI 27.7 (± 5.8), and 12% (n = 5) never smokers. Baseline sleep diary sleep efficiency, ISI and other baseline covariates were balanced between the groups. Sleep efficiency improved ≥85% in BBTI group (p = .02), but not in HEP control group (p = 1.00). Mean ISI for BBTI and attention control were 6.40 ± 4.98 and 14.10 ± 4.48 (p = .001) respectively. In addition, BBTI group mean total FACT-L score improved by 6.66 points from baseline while HEP group score worsened (p = .049). Conclusions: BBTI is a practical, evidence-based, clinically relevant intervention that improved sleep and quality of life in lung cancer survivors with insomnia. Additional research to evaluate efficacy, duration, and implementation strategies are essential.
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Affiliation(s)
- Grace E. Dean
- University at Buffalo, State University of New York, School
of Nursing, Buffalo, NY
| | - Carleara Weiss
- University at Buffalo, State University of New York, School
of Nursing, Buffalo, NY
| | - Carla R. Jungquist
- University at Buffalo, State University of New York, School
of Nursing, Buffalo, NY
| | - Michelle L. Klimpt
- University at Buffalo, State University of New York, School
of Nursing, Buffalo, NY
| | - Rana Alameri
- Department of Fundamental Nursing, College Nursing, Imam
Abdulrahman Bin Faisal University, Saudi Arabia
| | | | - Lynn M. Steinbrenner
- Jacobs School of Medicine, Buffalo, NY,VA Western New York Health Systems and Department of
Medicine, Buffalo, NY
| | - Elisabeth U. Dexter
- Jacobs School of Medicine, Buffalo, NY,Thoracic Oncology, Roswell Park Cancer Institute, Buffalo,
NY
| | - Samjot S. Dhillon
- Jacobs School of Medicine, Buffalo, NY,Thoracic Oncology, Roswell Park Cancer Institute, Buffalo,
NY
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10
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Phillips JD, Wong SL. Patient-Reported Outcomes in Surgical Oncology: An Overview of Instruments and Scores. Ann Surg Oncol 2020; 27:45-53. [PMID: 31463699 PMCID: PMC6925633 DOI: 10.1245/s10434-019-07752-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Indexed: 12/19/2022]
Abstract
Traditional measures of quality and effectiveness in surgical oncology have focused on morbidity, mortality, and when available, recurrence rates. Measuring patient-reported outcomes (PROs) has become more widely accepted during the last decade. This article reviews instruments commonly used in the surgical treatment of cancer patients to evaluate PROs. In addition, it discusses the linkage of PROs and health-related quality of life measures with traditional surgical complications and highlights future directions related to the expanding use of PROs in the surgical care of cancer patients.
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Affiliation(s)
- Joseph D Phillips
- Department of Surgery, Dartmouth-Hitchcock Medical Center, The Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Sandra L Wong
- Department of Surgery, Dartmouth-Hitchcock Medical Center, The Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
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11
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Hoeffkes D, Welcker K, Hendrix H, Kamlak V, Prisadov G, Noack F, Meyer A. [Health-Related Quality of Life in Patients with Non-Small Cell Lung Cancer before and after Surgery - a Comparison between Thoracotomy and Video-Assisted Thoracoscopic Surgery]. Zentralbl Chir 2019; 145:574-580. [PMID: 31791091 DOI: 10.1055/a-1039-1694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Earlier studies have proven that in patients with non-small cell lung cancer video-assisted thoracoscopic surgery is functionally superior to thoracotomy in terms of perioperative and postoperative complications. The objective of this work was to determine whether there is a difference in health-related quality of life (HRQoL) of patients with non-small cell lung cancer - compared to the German normal population - before and after surgery. Moreover, HRQoL after thoracotomy was compared to HRQoL after video-assisted thoracoscopic surgery (VATS). MATERIAL AND METHODS Based on retrospective data generated during a 7-year period (2010 - 2017), 327 patients with non-small cell lung cancer who underwent therapy were examined. Patients either underwent thoracotomy or video-assisted thoracoscopic surgery. 456 of short form 12 questionnaires were analysed. Via norm-based scoring, and physical and mental component summaries (PCS and MCS) were calculated before and 6, 12, and 24 months after treatment. Using t tests, potential differences in physical and mental component summaries were evaluated between patients and the German normal population as well as between patients after thoractomy and after VATS. RESULTS Up to 24 months after surgery, the physical dimension of HRQoL is significantly reduced, while the mental component summary does not significantly differ from the German population. Moreover, thoracotomy and VATS gave equivalent values for health-related quality of life. CONCLUSION With respect to health-related quality of life, thoracotomy and video-assisted thorascopic surgery are equivalent in the long term. But there was a trend to improvement with both summary scores that might indicate superiority of video-assisted thoracoscopic surgery.
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Affiliation(s)
- Daniel Hoeffkes
- Klinik für Pneumologie, Kliniken Maria Hilf GmbH Mönchengladbach, Deutschland
| | - Katrin Welcker
- Klinik für Thoraxchirurgie, Kliniken Maria Hilf GmbH Mönchengladbach, Deutschland
| | - Holger Hendrix
- Klinik für Thoraxchirurgie, Kliniken Maria Hilf GmbH Mönchengladbach, Deutschland
| | - Vladimir Kamlak
- Klinik für Thoraxchirurgie, Kliniken Maria Hilf GmbH Mönchengladbach, Deutschland
| | - Georgi Prisadov
- Klinik für Thoraxchirurgie, Kliniken Maria Hilf GmbH Mönchengladbach, Deutschland
| | - Frank Noack
- Klinik für Thoraxchirurgie, Kliniken Maria Hilf GmbH Mönchengladbach, Deutschland
| | - Andreas Meyer
- Klinik für Pneumologie, Kliniken Maria Hilf GmbH Mönchengladbach, Deutschland
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12
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[Postoperative complications after major lung resection]. Rev Mal Respir 2019; 36:720-737. [PMID: 31208887 DOI: 10.1016/j.rmr.2018.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 09/08/2018] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The advent of the minimally invasive techniques has allowed an expansion of the indications for thoracic surgery, particularly in older patients and those with more comorbidities. However, the rate of postoperative complications has remained stable. STATE OF THE ART Postoperative complications are defined as any variation from the normal course. They occur in 30% but majority of them are minor. The 30-day mortality rate for lung resection varies range between 2 % and 3% in the literature. Complications can be classified as: (1) early (occurring in the first 24hours) including both "generic" surgical complications (especially postoperative bleeding) and complications more specific to lung surgery (Acute respiratory syndrome, atelectasis); (2) in-hospital complications and those occurring during the first 3 months; these are dominated by infectious events in particular pneumonia but also bronchial (bronchopleural fistula), pleural (pneumothorax, hydrothorax) or cardiac complications; (3) late complications are dominated by chronic pain, affecting 60% of patients having a thoracotomy at three months. Lobectomy is the most common lung resection. Pneumonectomy is a distinct procedure requiring a specific peri- and postoperative management. Right pneumonectomy is associated with a higher risk with a treatment related-mortality ranging between 7 and 10%. CONCLUSION Major lung resection has benefited from minimally invasive approaches and fast track to surgery. However, it is important to note the occurrence of new and specific complications related to those news surgical access.
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13
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Kyte K, Ekstedt M, Rustoen T, Oksholm T. Longing to get back on track: Patients' experiences and supportive care needs after lung cancer surgery. J Clin Nurs 2019; 28:1546-1554. [PMID: 30589147 DOI: 10.1111/jocn.14751] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 12/13/2018] [Accepted: 12/17/2018] [Indexed: 12/13/2022]
Abstract
AIMS AND OBJECTIVES This study aims to describe surgically treated lung cancer patients' experiences of coming home after discharge from hospital to expand the knowledge about their supportive care needs. BACKGROUND Existing research reports that patients suffer from a high symptom burden after lung cancer surgery. Such burden has negative impacts on their physical, emotional and social wellbeing. Few studies have explored the surgically treated patients' supportive care needs after being discharged from hospital. DESIGN This study used a qualitative descriptive design, following the EQUATOR guidelines (COREQ). METHODS The information about 14 patients' experiences was collected from semi-structured interviews. The interviews were conducted in their homes within three weeks after their discharge from hospital. The data were analysed using qualitative content analysis. RESULTS The main theme of the study, "Longing to get back on track with their lives", consisted of four categories: "Burdened with problems related to postoperative symptoms and treatment", "Struggling for the needed support", "A pendulum between being in need of support and being independent", and "Striving to adapt to a new way of life". The participants experienced many problems related to postoperative symptoms and treatment. Information and support from healthcare professionals were deficient. Life was characterised by striving to be independent and adapting to a new lifestyle. CONCLUSIONS The findings demonstrate the supportive care needs of surgically treated lung cancer patients. Nurses and other healthcare professionals could offer more individualised support during the first few weeks after the patients' discharge by including them and their caregivers in the discharge planning. RELEVANCE TO CLINICAL PRACTICE Knowledge of patients' perspectives and experiences of everyday life at home after lung cancer surgery can provide hospital nurses with a better understanding of what is important for such patients beyond hospitalisation. This knowledge should be included in discharge planning.
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Affiliation(s)
| | - Mirjam Ekstedt
- Department of Health and Caring Sciences, Linnaeus University Kalmar, Sweden.,Department of Learning, Informatics, Management, and Ethics, Karolinska Institute, Stockholm, Sweden
| | - Tone Rustoen
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
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14
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Schwartz RM, Alpert N, Rosenzweig K, Flores R, Taioli E. Changes in quality of life after surgery or radiotherapy in early-stage lung cancer. J Thorac Dis 2019; 11:154-161. [PMID: 30863584 PMCID: PMC6384341 DOI: 10.21037/jtd.2018.12.30] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 11/05/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Although surgical resection is considered the standard of care for early-stage non-small cell lung cancer, radiotherapy [stereotactic body radiation therapy (SBRT)] has been proposed as a minimally invasive treatment alternative. Studies have not examined differences in quality of life (QoL) between surgery and radiotherapy, despite important implications for patient and provider decision making. METHODS The Surveillance, Epidemiology, and End Results Medicare Health Outcomes Survey (1998-2014) was used to assess changes in physical QoL score [Physical Component Summary (PCS)] and mental health QoL score [Mental Component Summary (MCS)] from baseline (prior to cancer diagnosis) to follow-up after treatment with surgery only or radiotherapy only. QoL was measured using the 36-item Short Form Health Survey (SF-36) until 2006, when it was replaced by the Veterans RAND 12-Item Health Survey (VR-12). RESULTS Data from 184 patients (28 SBRT, 156 surgery) was included. There was a significant decline in PCS score from baseline to follow-up (surgery: -4.81; 95% CI: -6.31, -3.30; P<0.0001; SBRT: -5.6; 95% CI: -9.96, -1.24; P=0.0137). Similarly, MCS scores declined for both groups although the change was significant for surgery patients only (surgery: -2.96; 95% CI: -4.55, -1.37; P=0.0003; SBRT: -1.86; 95% CI: -5.4, 1.68; P=0.2902). Surgical patients had higher baseline PCS (P=0.0061) and MCS (P=0.0056) than SBRT patients. There was no significant difference in the change over time between the two treatment options for PCS or MCS. CONCLUSIONS Although both treatments negatively impact QoL, the impact of SBRT on QoL may be comparable to surgery and therefore SBRT should be given consideration as an alternative treatment, especially when surgery is not an option.
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Affiliation(s)
- Rebecca M. Schwartz
- Department of Occupational Medicine, Epidemiology and Prevention, Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY 11021, USA
- Institute for Translational Epidemiology and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Naomi Alpert
- Institute for Translational Epidemiology and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Kenneth Rosenzweig
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Raja Flores
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Emanuela Taioli
- Institute for Translational Epidemiology and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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15
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Liu X, Xu S, Liu B, Xu W, Ding R, Wang T, Li B, Wang X, Wu Q, Teng H, Wang S. [Survival Analysis of Stage I Non-small Cell Lung Cancer Patients Treated with
Da Vinci Robot-assisted Thoracic Surgery]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2018; 21:849-856. [PMID: 30454547 PMCID: PMC6247004 DOI: 10.3779/j.issn.1009-3419.2018.11.07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
背景与目的 达芬奇机器人手术系统在胸外科的应用日益广泛,本研究旨在探讨经达芬奇机器人手术治疗Ⅰ期非小细胞肺癌(non-small cell lung cancer, NSCLC)患者的疗效。 方法 回顾2012年1月-2017年12月于我科行手术治疗的Ⅰ期NSCLC患者347例,依据手术方式分为机器人(robot-assisted thoracic surgery, RATS)组134例及腔镜(video-assisted thoracic surgery, VATS)组213例。比较两组患者围术期一般指标(术中出血量、术后引流量、术后带管时间、术后住院时间、淋巴结清扫状况),分析患者生存状况(overall survival, OS)、无进展生存状况(disease free survival, DFS)及相关影响因子。 结果 机器人组与腔镜组术中出血量[(49±39) mL vs (202±239) mL]、术后引流量[Day 1: (248±123) mL vs (350±213) mL; Day 2: (288±189) mL vs (338±189) mL]比较,机器人组均少于腔镜组(P < 0.05);术后带管时间[(10±5) d vs (11±8) d]及住院时间[(13±6) d vs (14±9) d]两组患者无明显差异(P > 0.05)。机器人组与腔镜组的淋巴结清扫组数[(5±2)组vs(4±2)组]及淋巴清扫数量[(18±9)枚vs(11±8)枚]比较,机器人组均优于腔镜组(P < 0.05)。机器人组与腔镜组生存状况比较[1年生存率:97.3% vs 96%、3年生存率:89.8% vs 83.1%、5年生存率:87.5 % vs 70.3%,平均生存时间(month):61 vs 59],两组无统计学差异(P > 0.05)。无进展生存状况:机器人组与腔镜组比较[1年无进展生存率:93.7% vs 91.3%、3年无进展生存率:87.7% vs 68.4%、5年无进展生存率:87.7% vs 52.5%,平均无进展生存时间(month):61 vs 50],机器人组明显优于腔镜组(P < 0.05)。单因素分析显示,淋巴结清扫数量是患者生存状况的影响因子;肿瘤直径、手术方式、淋巴结清扫组数、淋巴结清扫数量为患者无进展生存状况的影响因子。多因素分析显示生存状况无独立影响因子,肿瘤直径及手术方式为无进展生存状况的独立影响因子。 结论 达芬奇机器人Ⅰ期非小细胞肺癌患者术后生存状况与腔镜手术无差异,但无进展生存状况优于腔镜手术;达芬奇机器人手术淋巴结清扫更彻底,同时术中出血量更少。
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Affiliation(s)
- Xingchi Liu
- Department of Thoracic Surgery, General Hospital of Shenyang Military Command, Shenyang 110016, China
| | - Shiguang Xu
- Department of Thoracic Surgery, General Hospital of Shenyang Military Command, Shenyang 110016, China
| | - Bo Liu
- Department of Thoracic Surgery, General Hospital of Shenyang Military Command, Shenyang 110016, China
| | - Wei Xu
- Department of Thoracic Surgery, General Hospital of Shenyang Military Command, Shenyang 110016, China
| | - Renquan Ding
- Department of Thoracic Surgery, General Hospital of Shenyang Military Command, Shenyang 110016, China
| | - Tong Wang
- Department of Thoracic Surgery, General Hospital of Shenyang Military Command, Shenyang 110016, China
| | - Bo Li
- Department of Thoracic Surgery, General Hospital of Shenyang Military Command, Shenyang 110016, China
| | - Xilong Wang
- Department of Thoracic Surgery, General Hospital of Shenyang Military Command, Shenyang 110016, China
| | - Qiong Wu
- Department of Thoracic Surgery, General Hospital of Shenyang Military Command, Shenyang 110016, China
| | - Hong Teng
- Department of Thoracic Surgery, General Hospital of Shenyang Military Command, Shenyang 110016, China
| | - Shumin Wang
- Department of Thoracic Surgery, General Hospital of Shenyang Military Command, Shenyang 110016, China
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Adebahr S, Hechtner M, Schräder N, Schimek-Jasch T, Kaier K, Duncker-Rohr V, Gkika E, Momm F, Gaertner J, Becker G, Grosu AL, Nestle U. Early Impact of Pulmonary Fractionated Stereotactic Body Radiotherapy on Quality of Life:Benefit for Patients With Low Initial Scores (STRIPE Trial). J Thorac Oncol 2018; 14:408-419. [PMID: 30521969 DOI: 10.1016/j.jtho.2018.10.170] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 09/26/2018] [Accepted: 10/31/2018] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Quality of life (QoL) of comorbid patients with pulmonary malignancies is a key issue in considering fractionated stereotactic body radiotherapy (SBRT) indication. This study investigates the early impact of SBRT on QoL. METHODS One hundred patients with pulmonary lesions were treated with SBRT from February 2011 to December 2014 within the prospective, monocenter, phase II STRIPE trial. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core module (EORTC QLQ-C30) and the QLQ-LC13 lung cancer-specific questionnaire were used to evaluate QoL before, 2 and 7 weeks after SBRT, then every 3 months for 2 years. We report on the analysis of early changes from baseline to 7-week follow-up exam. Impact of patient- and treatment-related factors on the change in QoL was analyzed. RESULTS QoL was assessed in 97 patients; compliance was 92% and 85% at baseline and 7 weeks after SBRT, respectively. No clinically relevant changes greater than or equal to 10 in the QoL/global health status (GHS), function scores and inquired symptoms were observed. Patients with baseline QoL below the median showed clinically relevant improvement in QoL/GHS (Δ16.7 ± 25.3, p = 0.003), emotional function (Δ14.4 ± 25.4, p = 0.013), and fatigue (Δ -10.1 ± 26.5, p = 0.089) in contrast to patients with high initial scores. No changes were observed in the dichotomized subgroups of initial Karnofsky index, Charlson Comorbidity Index, age, diagnosis, and tumor localization. CONCLUSIONS In short-term follow-up, QoL is well maintained after pulmonary SBRT. Especially patients with low initial QoL/GHS scores show benefit from SBRT with respect to QoL.
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Affiliation(s)
- Sonja Adebahr
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK) Partner Site Freiburg, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Marlene Hechtner
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; German Cancer Consortium (DKTK), Partner Site /Mainz, Germany
| | - Nele Schräder
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tanja Schimek-Jasch
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Klaus Kaier
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
| | - Viola Duncker-Rohr
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Radio-oncology, Ortenau Klinikum Offenburg-Gengenbach, Offenburg, Germany
| | - Eleni Gkika
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Felix Momm
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Radio-oncology, Ortenau Klinikum Offenburg-Gengenbach, Offenburg, Germany
| | - Jan Gaertner
- Clinic for Palliative Care, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Palliative Care Center Hildegard, Basel, Switzerland
| | - Gerhild Becker
- Clinic for Palliative Care, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Anca-Ligia Grosu
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK) Partner Site Freiburg, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ursula Nestle
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK) Partner Site Freiburg, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Radiation Oncology, Kliniken Maria Hilf GmbH Mönchengladbach, Mönchengladbach, Germany
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17
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Nicastri DG, Alpert N, Liu B, Wolf A, Taioli E, Tran BV, Flores R. Oxygen Use After Lung Cancer Surgery. Ann Thorac Surg 2018; 106:1548-1555. [PMID: 29928852 DOI: 10.1016/j.athoracsur.2018.05.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 04/18/2018] [Accepted: 05/14/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND There are no published reports on predictors of oxygen (O2) use after lung cancer surgery. The prospect of O2 use after lung cancer surgery may affect a patient's therapy choice. METHODS The Surveillance, Epidemiology, and End Results (SEER)-Medicare data set was queried to identify patients diagnosed with primary lung cancer (stage I/II) who underwent surgical resection from 1994 to 2010. Patients with a second resection within 6 months of their first and those with preoperative O2 use were excluded. Multivariable logistic regression was performed to evaluate the odds ratios and 95% confidence intervals of O2 use (defined as being billed for home O2) after discharge for lung cancer surgery. RESULTS Of 21,245 eligible patients from 1994 to 2010, 3,255 (15.3%) were billed for O2 use in the first month of discharge. Of these, 13.7% (447 of 3,255) stopped using within 1 month, and 1.47% died. By 6 months, an additional 6.7% died, and 46.27% (1,384 of 2,991) were still alive and using O2. Discharge on O2 was associated with higher odds of death within 6 months (odds ratio, 1.35; 95% confidence interval, 1.17 to 1.55). The significant, independent risk factors for O2 use at discharge were procedure, sex, race, histology, pulmonary comorbidities, obesity, length of stay, pulmonary complications, and discharge mode. CONCLUSIONS Home O2 use after lung cancer surgery comprises a sizable portion of this population and is correlated with death in the first 6 months. Various predictors significantly increased the risk of O2 use at discharge. However, 49.3% of those originally discharged on O2 were alive and off O2 at 6 months.
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Affiliation(s)
- Daniel G Nicastri
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Naomi Alpert
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Bian Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Andrea Wolf
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Emanuela Taioli
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York; Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Benjamin V Tran
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Raja Flores
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
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Halle IH, Westgaard TK, Wahba A, Oksholm T, Rustøen T, Gjeilo KH. Trajectory of sleep disturbances in patients undergoing lung cancer surgery: a prospective study. Interact Cardiovasc Thorac Surg 2017; 25:285-291. [PMID: 28486702 DOI: 10.1093/icvts/ivx076] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 02/15/2017] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Patients with lung cancer report sleep difficulties to be frequent and bothersome symptoms. This study describes the trajectory of sleep from before and up to 12 months after surgery for lung cancer. Further, it investigates possible associations between sleep disturbance, demographic and clinical characteristics before surgery. METHODS This study is part of a longitudinal multicentre study. Sleep disturbance was measured by The General Sleep Disturbance Scale (GSDS) that investigates frequencies of sleep difficulties (21 items) and a total sum score ≥43 indicates a clinically meaningful level of sleep disturbance (score range 0-147). Linear mixed models were used to study changes in sleep from baseline to 1, 5, 9 and 12 months after surgery. RESULTS The percentage of patients (n = 264) reporting sleep disturbances was 60.9% at baseline, 68.5% at Month 1, 55.4% at Month 5, 51.3% at Month 9 and 49.7% at Month 12. The increase to and decrease from Month 1 was the only significant alteration in the occurrence of sleep disturbance. The patients reported most problems within the subscales sleep quantity, early awakenings and sleep quality. Factors associated with sleep disturbance were lower age, use of pain medication and psychotropic medication and higher comorbidity score. CONCLUSIONS Lung cancer patients sleep poorly, before as well as after surgery. There is a need to address sleeping disturbance routinely in clinical practice and screening for sleeping problems is indicated. Further studies are warranted concerning factors that contribute to sleep disturbance and how they best can be treated.
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Affiliation(s)
- Ingrid Helene Halle
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Therese Krystad Westgaard
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Alexander Wahba
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Cardiothoracic Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Trine Oksholm
- VID Specialized University, Haraldsplass, Bergen, Norway.,Department of Respiratory Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Tone Rustøen
- Department of Nursing Science, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Kari Hanne Gjeilo
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Cardiothoracic Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Cardiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,National Competence Centre for Complex Symptom Disorders, St. Olavs Hospital, Trondheim, Norway
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Schwartz RM, Gorbenko K, Kerath SM, Flores R, Ross S, Taylor TN, Taioli E, Henschke C. Thoracic surgeon and patient focus groups on decision-making in early-stage lung cancer surgery. Future Oncol 2017; 14:151-163. [PMID: 29231095 DOI: 10.2217/fon-2017-0254] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
AIM To investigate medical decision-making from the thoracic surgeons' and patients' perspectives in early-stage lung cancer. PATIENTS & METHODS We conducted one focus group with thoracic surgeons (n = 15) and one with a group of early-stage lung cancer patients treated with surgery (n = 7). Focus groups were recorded, transcribed and coded for themes. RESULTS For surgeons, surgical procedure choice was a primary concern, followed by the surgical treatment plan decision-making process. Survivors focused primarily on the physical and mental health-related postsurgical burden for which they felt they were not well prepared and placed less emphasis on surgical decision-making. CONCLUSION As early-stage lung cancer mortality rates are improving, surgeons and patients can prioritize surgical approaches and postsurgical care that enhance quality of life.
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Affiliation(s)
- Rebecca M Schwartz
- Department of Occupational Medicine, Epidemiology & Prevention, Hofstra Northwell School of Medicine, Great Neck, NY 11201, USA.,Department of Population Health Science & Policy & Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Ksenia Gorbenko
- Department of Population Health Science & Policy & Institute for Health Care Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Samantha M Kerath
- Department of Biomedical Science, Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Raja Flores
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Sheila Ross
- Lung Cancer Alliance, Washington DC, 20006, USA
| | - Tonya N Taylor
- Department of Medicine, State University of New York Downstate Medical Center, Brooklyn, NY 11203, USA
| | - Emanuela Taioli
- Department of Population Health Science & Policy & Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.,Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Claudia Henschke
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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Shi Q, Wang XS, Vaporciyan AA, Rice DC, Popat KU, Cleeland CS. Patient-Reported Symptom Interference as a Measure of Postsurgery Functional Recovery in Lung Cancer. J Pain Symptom Manage 2016; 52:822-831. [PMID: 27521528 PMCID: PMC5154813 DOI: 10.1016/j.jpainsymman.2016.07.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 06/14/2016] [Accepted: 07/29/2016] [Indexed: 01/29/2023]
Abstract
CONTEXT Few empirical studies have combined the patient's perspective (patient-reported outcomes [PROs]) with clinical outcomes (risk for complications, length of hospital stay, return to planned treatment) to assess the effectiveness of treatment after thoracic surgery for early-stage non-small cell lung cancer (NSCLC). OBJECTIVES Quantitatively measure PROs to assess functional recovery postsurgery. METHODS Treatment-naïve patients (N = 72) with NSCLC who underwent either open thoracotomy or video-assisted thoracoscopic surgery (VATS) used the MD Anderson Symptom Inventory (MDASI) to report symptom interference with general activity, work, walking, mood, relations with others, and enjoyment of life for three months after surgery. Functional recovery was defined as interference scores returning to presurgery levels. The MDASI's sensitivity to change in functional recovery over time was evaluated via its ability to distinguish between surgical techniques. RESULTS Interference scores increased sharply by Day 3 after surgery (all P < 0.001), then returned to baseline levels via different trajectories. Patients who had unscheduled clinic visits during the study period reported higher scores on all six MDASI interference items (all P < 0.05). Compared with the open-thoracotomy group, the VATS group returned more quickly to baseline interference levels for walking (18 vs. 43 days), mood (8 vs. 19 days), relations with others (4 vs. 16 days), and enjoyment of life (15 vs. 41 days) (all P < 0.05). CONCLUSION Repeated measurement of MDASI interference characterized functional recovery after thoracic surgery for NSCLC and was sensitive to VATS' ability to enhance postoperative recovery. Further study of the clinical applicability of measuring recovery outcomes using PRO-based functional assessment is warranted.
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Affiliation(s)
- Qiuling Shi
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Xin Shelley Wang
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
| | - Ara A Vaporciyan
- Department of Thoracic & Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - David C Rice
- Department of Thoracic & Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Keyuri U Popat
- Department of Anesthesiology & Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Charles S Cleeland
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Results of Postdischarge Nursing Telephone Assessments: Persistent Symptoms Common Among Pulmonary Resection Patients. Ann Thorac Surg 2016; 102:276-81. [PMID: 27083250 DOI: 10.1016/j.athoracsur.2016.01.062] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 12/23/2015] [Accepted: 01/04/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND After hospital discharge, patients may have questions or complaints that surface or remain inadequately addressed. However, the dominant concerns and indications for further intervention among recently discharged patients after pulmonary resection have not been well described. The aims of this study were to characterize dominant concerns of pulmonary resection patients after discharge and to elucidate any relevant risk factors for their development. METHODS A single-institution, retrospective review was conducted of all patients who underwent pulmonary resection over a 12-month period and included records of standardized, nurse-initiated follow-up phone calls to discharged patients. Records of postdischarge telephone calls were reviewed, and data collected pertaining to complaints requiring counseling over the phone or escalation to higher care level. Demographic, operative, and hospital data were examined by multivariate analyses to assess predictors of need for counseling or escalation of care. RESULTS In all, 523 patients underwent pulmonary resection during the study, and 245 (46.8%) had nursing-documented telephone conversations at 4.6 days (±0.18) days after discharge. Among those reached, 81 (33.1%) had problems requiring counseling during the call; 31 (12.7%) reported concerns requiring escalation of care, handled by subsequent telephone call for 7 (22.6%), clinic appointment for 22 (71.0%), or emergency room referral for 2 (6.5%). Age, sex, race, and residential proximity to the hospital did not predict need for counseling nor escalation of care. CONCLUSIONS Patient complaints after pulmonary resection were frequent, with most problems resolved by telephone counseling. Despite highly prevalent concerns, predictors of need for counseling or care escalation were not identified, suggesting ongoing utility in the practice of telephoning all patients. Further, this study serves as a needs assessment, highlighting the importance of patient education and discharge planning.
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Rauma V, Salo J, Sintonen H, Räsänen J, Ilonen I. Patient features predicting long-term survival and health-related quality of life after radical surgery for non-small cell lung cancer. Thorac Cancer 2016; 7:333-9. [PMID: 27148419 PMCID: PMC4846622 DOI: 10.1111/1759-7714.12333] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 12/14/2015] [Indexed: 12/03/2022] Open
Abstract
Background This study presents a retrospective evaluation of patient, disease, and treatment features predicting long‐term survival and health‐related quality of life (HRQoL) among patients who underwent surgery for non‐small cell lung cancer (NSCLC). Methods Between January 2000 and June 2009, 586 patients underwent surgery at the Helsinki University Hospital. The 276 patients still alive in June 2011 received two validated quality of life questionnaires (QLQ): the generic 15D and the cancer‐specific EORTC QLQ‐C30 + QLQ‐LC13. We used binary and linear regression analysis modeling to identify patient, disease, and treatment characteristics that predicted survival and long‐term HRQoL. Results When taking into account patient, disease, and treatment characteristics, long‐term survival was quite predictable (69.5% correct), but not long‐term HRQoL (R2 between 0.041 and 0.119). Advanced age at the time of surgery, male gender, comorbidity (measured with the Charlson comorbidity index), clinical and pathological stages II‐IV, and postoperative infectious complications predicted a lower survival rate. Features associated with poorer long‐term HRQoL (measured with the 15D) were comorbidity, postoperative complications, and the use of the video‐assisted thoracoscopic surgery (VATS) technique. Conclusions Long‐term HRQoL is only moderately predictable, while prediction of long‐term survival is more reliable. Lower HRQoL is associated with comorbidities, complications, use of the VATS technique, and reduced pulmonary function, while adjuvant therapy is associated with higher HRQoL.
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Affiliation(s)
- Ville Rauma
- Department of General Thoracic and Esophageal Surgery Helsinki University Hospital Heart and Lung Center Helsinki Finland
| | - Jarmo Salo
- Department of General Thoracic and Esophageal Surgery Helsinki University Hospital Heart and Lung Center Helsinki Finland
| | - Harri Sintonen
- Department of Public Health Helsinki University Hospital, Heart and Lung Center Helsinki Finland
| | - Jari Räsänen
- Department of General Thoracic and Esophageal Surgery Helsinki University Hospital Heart and Lung Center Helsinki Finland
| | - Ilkka Ilonen
- Department of General Thoracic and Esophageal Surgery Helsinki University Hospital Heart and Lung Center Helsinki Finland
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Andersson SEM, Rauma VHS, Sihvo EI, Räsänen JV, Ilonen IK, Salo JA. Bronchial sleeve resection or pneumonectomy for non-small cell lung cancer: a propensity-matched analysis of long-term results, survival and quality of life. J Thorac Dis 2015; 7:1742-8. [PMID: 26623096 DOI: 10.3978/j.issn.2072-1439.2015.10.62] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND No randomized studies exist comparing pneumonectomy (PN) and sleeve lobectomy (SL). We evaluated surgical results and long-term quality of life in patients operated on for central non-small cell lung cancer (NSCLC) using either SL or PN. METHODS A total of 641 NSCLC patients underwent surgery 2000-2010. SL was performed in 40 (6.2%) and PN in 67 (10.5%). In 2011, all surviving patients were sent a 15D Quality of Life Questionnaire which 83% replied. Propensity-score-matching analysis was utilized to compare the groups. RESULTS Thirty-two bronchial (18 right/14 left), seven vasculobronchial (3 right/4 left), one right wedge SL, and 18 right and 22 left PN were performed. Preoperatively, the Charlson Comorbidity Index (CCI) score, forced expiratory volume in 1 s (FEV1) and diffusion capacity did not differ between groups. The perioperative complication rate and pattern were similar, but SL group had less major complications (P<0.027). One perioperative death (2.5%) occurred in SL group and four (6%) in PN. The 90-day mortality rate was 5% (n=2) for SL and 7.5% (n=5) for PN. In the follow-up total cancer recurrence did not differ (P=0.187). Quality of life measured by 15D showed no significant difference in separate dimensions or total score, except tendency to favor SL in moving or breathing. The 5-year survival did not differ between groups (P=0.458), but no deaths were observed in SL group after 5 years. CONCLUSIONS Due to less major operative complications and better long-term survival, we would advocate using SL when feasible, but in patients tolerating PN it should be considered if SL seems not to be oncologically sufficiently radical.
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Affiliation(s)
- Saana E M Andersson
- Department of General Thoracic and Esophageal Surgery, Helsinki University Hospital, Heart and Lung Center, Helsinki, Finland
| | - Ville H S Rauma
- Department of General Thoracic and Esophageal Surgery, Helsinki University Hospital, Heart and Lung Center, Helsinki, Finland
| | - Eero I Sihvo
- Department of General Thoracic and Esophageal Surgery, Helsinki University Hospital, Heart and Lung Center, Helsinki, Finland
| | - Jari V Räsänen
- Department of General Thoracic and Esophageal Surgery, Helsinki University Hospital, Heart and Lung Center, Helsinki, Finland
| | - Ilkka K Ilonen
- Department of General Thoracic and Esophageal Surgery, Helsinki University Hospital, Heart and Lung Center, Helsinki, Finland
| | - Jarmo A Salo
- Department of General Thoracic and Esophageal Surgery, Helsinki University Hospital, Heart and Lung Center, Helsinki, Finland
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Prognostic impact of clinical variables on surgically resected small-cell lung cancer: Results of a retrospective multicenter analysis (FIGHT002A and HOT1301A). Lung Cancer 2015; 90:548-53. [PMID: 26604032 DOI: 10.1016/j.lungcan.2015.10.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 09/29/2015] [Accepted: 10/05/2015] [Indexed: 01/29/2023]
Abstract
OBJECTIVES Several American and Japanese guidelines recommend surgery for patients with c-stage I small-cell lung cancer (SCLC), whereas the European Society of Medical Oncology (ESMO) guidelines recommend surgery for patients with not only c-stage I but also c-stage II (T2N1) SCLC. In addition, previous studies identified various factors other than clinical stage that are related to survival in these patients. Thus, further validation and examination of the association of clinical stage and other clinical variables with survival are required for establishing practical management of early-stage SCLC. PATIENTS AND METHODS We reviewed the clinical courses of 156 SCLC patients who had undergone surgery at 17 institutions between January 2003 and January 2013. RESULTS Clinical stages (tumor-node-metastasis [TNM] version 7) of the 156 patients were 98 cases in IA, 14 in IB, 16 in IIA, 7 in IIB, 18 in IIIA, and 3 in IIIB. Median overall survival (OS) was 33.3 months (95% confidence interval: 20.9-45.8). Multivariate analysis revealed that OS was longer in patients either at c-stage II and under, with a maximum tumor diameter of <20mm, with preoperative diagnosis, without a history or presence of other types of cancer, or who underwent prophylactic cranial irradiation (PCI). CONCLUSION These results indicate that a history or presence of other types of cancer might be a major decisive factor for surgery. Patients with c-stages I and II (c-T2N1) can be considered for surgery, and PCI may be useful in patients undergoing surgery in a practical setting, partly supporting the ESMO guidelines.(1).
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Oksholm T, Rustoen T, Cooper B, Paul SM, Solberg S, Henriksen K, Kongerud JS, Miaskowski C. Trajectories of Symptom Occurrence and Severity From Before Through Five Months After Lung Cancer Surgery. J Pain Symptom Manage 2015; 49:995-1015. [PMID: 25593100 DOI: 10.1016/j.jpainsymman.2014.11.297] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 11/08/2014] [Accepted: 11/13/2014] [Indexed: 01/22/2023]
Abstract
CONTEXT Limited information is available about lung cancer patients' symptoms in the pre- and postoperative periods. OBJECTIVES 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. CONCLUSION 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.
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Affiliation(s)
- Trine Oksholm
- Division of Emergencies and Critical Care, Ullevål, Oslo University Hospital, Oslo, Norway; Department of Respiratory Medicine, Oslo University Hospital, Oslo, Norway.
| | - Tone Rustoen
- Division of Emergencies and Critical Care, Ullevål, Oslo University Hospital, Oslo, Norway; Department of Nursing Science, University of Oslo, Oslo, Norway
| | - Bruce Cooper
- School of Nursing, University of California, San Francisco, California, USA
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, California, USA
| | - Steinar Solberg
- Department for Thoracic and Cardiovascular Surgery, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Kari Henriksen
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
| | - Johny Steinar Kongerud
- Department of Respiratory Medicine, Oslo University Hospital, Oslo, Norway; Institute of Health and Society and Faculty of Medicine, University of Oslo, Oslo, Norway
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Rauma V, Sintonen H, Räsänen JV, Salo JA, Ilonen IK. Long-Term Lung Cancer Survivors Have Permanently Decreased Quality of Life After Surgery. Clin Lung Cancer 2015; 16:40-5. [DOI: 10.1016/j.cllc.2014.08.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 08/10/2014] [Accepted: 08/26/2014] [Indexed: 11/28/2022]
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Loimu V, Mäkitie AA, Bäck LJ, Sintonen H, Räsänen P, Roine R, Saarilahti K. Health-related quality of life of head and neck cancer patients with successful oncological treatment. Eur Arch Otorhinolaryngol 2014; 272:2415-23. [DOI: 10.1007/s00405-014-3169-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 06/17/2014] [Indexed: 11/29/2022]
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A systematic review and meta-analysis to assess patient-reported outcomes after lung cancer surgery. ScientificWorldJournal 2013; 2013:789625. [PMID: 24302870 PMCID: PMC3835912 DOI: 10.1155/2013/789625] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 09/11/2013] [Indexed: 12/04/2022] Open
Abstract
The main objective of this review was to systematically review, assess, and report on the studies that have assessed health related quality of life (HRQOL) after VATS and thoracotomy for resection of lung cancer. We performed a systematic review of six databases. The Downs and Black tool was used to assess the risk of bias. Five studies were included. In general, patients undergoing VATS have a better HRQOL when compared to thoracotomy; however, there was a high risk of bias in the included studies. The consistent use of a lung cancer specific questionnaire for measuring HRQOL after surgery is encouraged.
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Welter S, Schwan A, Cheufou D, Darwiche K, Christoph D, Eberhardt W, Weinreich G, Stamatis G. Midterm changes in quality of life: a prospective evaluation after open pulmonary metastasectomy. Ann Thorac Surg 2013; 95:1006-11. [PMID: 23374444 DOI: 10.1016/j.athoracsur.2012.11.059] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Revised: 11/26/2012] [Accepted: 11/27/2012] [Indexed: 12/17/2022]
Abstract
BACKGROUND Pulmonary metastasectomy has gained the status of a standard treatment for oligometastases of various primaries. Given that the consequences for quality of life (QoL) remain unclear, we initiated this study to characterize the therapy-induced effects of pulmonary metastasectomy on QoL. METHODS From 2008 to 2010, patients scheduled for metastasectomy were prospectively evaluated using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30) and the lung cancer module (LC13) questionnaire and again 3 months later. We analyzed QoL changes over time and looked for sex-specific and age-specific (<70 versus >70 years) differences. RESULTS A total of 126 cases were analyzed. The median age of the 73 male and 53 female patients was 59.2 years (range, 24.2 to 83.9). There was no significant change between preoperative and postoperative QoL values for emotional, cognitive, and social functioning. Significant deterioration of QoL items was found for physical functioning (-11.0; p < 0.001), role functioning (-16.4; p < 0.001), fatigue (11.1; p < 0.001), pain (15.0; p < 0.001), and dyspnea (16.9; p < 0.001). There were no differences between sexes concerning preoperative and postoperative scores. Younger patients (<70 years) had more preoperative symptoms (1.9; p = 0.03) and a worse function (2.2; p = 0.04). A tendency was found for decreased global QoL (-6.0; p = 0.08) in the older age group (>70 years) after metastasectomy. CONCLUSIONS Pulmonary metastasectomy can be offered every patient with a chance of cure or prolongation of life because the anticipated midterm changes in QoL are of moderate clinical importance, and the change in global health-related QoL is trivial.
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Affiliation(s)
- Stefan Welter
- Division of Thoracic Surgery, Ruhrlandklinik, West German Lung Center, University Hospital, University of Duisburg-Essen, Essen, Germany.
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Patient-reported quality of life after stereotactic ablative radiotherapy for early-stage lung cancer. J Thorac Oncol 2012; 7:1148-54. [PMID: 22610256 DOI: 10.1097/jto.0b013e318252cfef] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Deterioration in health-related quality of life (HRQOL) is frequently observed after surgery for stage I non-small-cell lung cancer. As stereotactic ablative radiotherapy (SABR) can result in local control percentages exceeding 90%, we studied baseline and post-treatment HRQOL in SABR patients. METHODS HRQOL data were collected prospectively using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire in 382 consecutive patients treated with SABR. Patients were referred from 68 Dutch centers, with 86% judged unfit for surgery, and 14% declining surgery. An SABR dose of 60 Gy was delivered in three-, five-, or eight treatment fractions, depending on tumor diameter and location. HRQOL data were available for 382 patients at baseline (pre-SABR), and for 282, 212, 144, 56, and 43 patients at 3, 6, 12, 18, and 24 months post-SABR, respectively. RESULTS Median survival was 40 months, with a 2-year survival of 66%. Local, regional, and distant failure percentages at 2 years were 6%, 13%, and 22%, respectively. Mean baseline global HRQOL and physical functioning scores were 62.9 ± 1.1 and 61.7 ± 1.1, respectively. Baseline symptom scores were highest for dyspnea (47.1 ± 1.7) and fatigue (37.4 ± 1.3). Except for a nonsignificant decrease in 2 to 3 points per year in physical functioning, no statistically or clinically significant worsening of any of the HRQOL functioning or symptom scores at any follow-up time point was observed. CONCLUSIONS Patients referred for SABR have substantially worse baseline HRQOL scores than those reported in the surgical literature. Clinically relevant deteriorations in HRQOL subscale scores were not observed after SABR.
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Fitzsimmons D, Wheelwright S, Johnson CD. Quality of life in pulmonary surgery: choosing, using, and developing assessment tools. Thorac Surg Clin 2012; 22:457-70. [PMID: 23084610 DOI: 10.1016/j.thorsurg.2012.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
There is mounting recognition that, to aid surgical decision making, treatment efficacy needs to be measured in a variety of ways, with health-related quality of life now widely regarded as an important outcome in pulmonary surgical populations. The aim of this review is to provide a comprehensive overview of the key issues to consider if an investigator wishes to incorporate health-related quality of life assessment into trials and studies of pulmonary surgery, drawing on recent studies of lung cancer surgery as an example.
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Affiliation(s)
- D Fitzsimmons
- Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Singleton Park, Swansea, United Kingdom
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Möller A, Sartipy U. Long-term health-related quality of life following surgery for lung cancer. Eur J Cardiothorac Surg 2011; 41:362-7. [PMID: 21733714 DOI: 10.1016/j.ejcts.2011.05.055] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The aim of the study was to examine the long-term health-related quality of life following surgery for lung cancer. METHODS We performed a prospective population-based cohort study to explore health-related quality of life after lung surgery. We used a validated quality-of-life instrument (Short Form-36 (SF-36)) to gather information on health-related quality of life at baseline, 6 months, and 2 years after surgery. The main outcome measures were the SF-36 physical component summary (PCS) and mental component summary (MCS) scores. RESULTS Between 2006 and 2008, 249 patients were included. The response rate at 6 months was 85% and, at 2 years of follow-up, was 95%. The study population consisted of 166 patients who completed all three SF-36 questionnaires. The PCS score decreased from baseline to 6 months (47.4 vs 41.1; p < 0.001) and remained unchanged at the 2-year follow-up (41.1 vs 41.4). The MCS score increased from baseline to 6 months (40.5 vs 44.6; p = 0.001), with a further improvement at 2 years (44.6 vs 46.9; p = 0.005). At 2-year follow-up, both the PCS score and the MCS score of the study population were lower than that of an age- and gender-matched reference population (41.4 vs 44.0; p = 0.013 and 46.9 vs 50.6; p = 0.01). CONCLUSIONS We found that patients undergoing surgery for lung cancer had an early decrease in the physical aspect of health-related quality of life at 6 months after surgery, which was still present at 2 years of follow-up. A moderate clinically relevant improvement was noted in the mental aspect at 6 months and further improvement was reported at 2 years of follow-up.
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Ilonen IK, Räsänen JV, Knuuttila A, Salo JA, Sihvo EI. Anatomic thoracoscopic lung resection for non-small cell lung cancer in stage I is associated with less morbidity and shorter hospitalization than thoracotomy. Acta Oncol 2011; 50:1126-32. [PMID: 21314296 DOI: 10.3109/0284186x.2011.555780] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Patients undergoing surgery for non-small cell lung cancer (NSCLC) are often elderly with co-morbid conditions and decreased performance status. Thus, the morbidity of lung resection via thoracotomy may be unacceptable for some patients. This is the reason why video-assisted thoracoscopic surgery (VATS) instead of open thoracotomy has gained more use and acceptance, especially in patients with stage I disease. The aim of this study was to evaluate the difference between VATS and open thoracotomy in treatment outcomes of stage I NSCLC patients. METHODS A total of 328 stage I NSCLC patients underwent lobectomy, bilobectomy or segmentectomy between January 2000 and February 2010. VATS was implemented in 116 patients, of which 16 were converted to thoracotomy. Muscle-sparing anterolateral thoracotomy was performed in 212. Propensity-matched groups were analyzed based on preoperative variables and stage. RESULTS VATS was associated with lower postoperative morbidity in both overall (p = 0.020) and propensity-matched analysis (p = 0.026) and shorter hospitalization (both p < 0.001). Patients selected for VATS were older (p = 0.001) with a significantly higher Charlson comorbidity index (p = 0.007) and poorer diffusion capacity (p < 0.001). The conversion rate was 14%. Between the two groups, no significant difference was observable in two-year overall and progression-free survival. CONCLUSIONS Despite the VATS lobectomy and segmentectomy patients' being older, with more comorbid condition and poorer pulmonary function, the incidence of major complications was lower and hospitalization shorter than for open thoracotomy patients. For stage I NSCLC, VATS should be considered the primary surgical approach.
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Affiliation(s)
- Ilkka K Ilonen
- Division of General Thoracic and Esophageal Surgery, Department of Cardiothoracic Surgery, Helsinki University Central Hospital, Finland
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