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Lan Z, Zeng C, Li Z, Xia X, Mo A, Li X, Ben X, Zhou H, Deng C, Chen R, Shi Q, Tang Y, Qiao G. Early patient-reported outcomes after robotic-assisted versus video-assisted thoracoscopic lobectomy. Thorac Cancer 2024; 15:1563-1571. [PMID: 38816940 PMCID: PMC11246782 DOI: 10.1111/1759-7714.15379] [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: 02/05/2024] [Revised: 05/07/2024] [Accepted: 05/11/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Robotic-assisted thoracoscopic surgery (RATS) can achieve traditional clinical outcomes comparable to those of video-assisted thoracoscopic surgery (VATS). However, patient-reported outcomes (PROs) during the early period after RATS and VATS remain unclear. This study aimed to utilize longitudinal electronic PRO (ePRO) assessments to evaluate symptom burden and functional status between these approaches from patients' perspective. METHODS This study comprised patients who underwent lobectomy via RATS or VATS for non-small cell lung cancer. We collected multiple-time-point PROs data from the prospective longitudinal study via an ePRO system. Symptom severity and function status were assessed using the perioperative symptom assessment for patients undergoing lung surgery and were analyzed between groups using linear mixed-effects models. RESULTS Of the 164 patients, 42 underwent RATS and 122 underwent VATS. After propensity score matching (PSM), 42 RATS and 84 VATS exhibited similar baseline characteristics. During the 7-day postoperative period, participants underwent RATS reported milder pain (p = 0.014), coughing (p < 0.001), drowsiness (p = 0.001), and distress (p = 0.045) compared with those underwent VATS. Moreover, participants in RATS group showed less functional interference with walking (p < 0.001) and general activity (p < 0.001). RATS exhibited a shorter postoperative hospitalization (p = 0.021) but higher hospital cost (p < 0.001). Meanwhile, short-term clinical outcomes of operative time, dissected lymph node stations, chest tube drainage, and postoperative complication rates were comparable. CONCLUSION PROs are important metrics for assessing patients' recovery after lobectomy. Compared with VATS, RATS may induce less symptom burden and better functional status for patients in the early postoperative period.
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Affiliation(s)
- Zihua Lan
- Department of Thoracic SurgeryGuangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical UniversityGuangzhouChina
- Shantou University Medical CollegeShantouChina
| | - Cheng Zeng
- Department of Thoracic SurgeryGuangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical UniversityGuangzhouChina
- Department of Pulmonary Nodules Surgerythe First People's Hospital of FoshanFoshanChina
| | - Zijie Li
- Department of Thoracic SurgeryGuangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical UniversityGuangzhouChina
- Shantou University Medical CollegeShantouChina
| | - Xin Xia
- Department of Thoracic SurgeryGuangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical UniversityGuangzhouChina
| | - Aotian Mo
- Department of Thoracic SurgeryGuangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical UniversityGuangzhouChina
| | - Xianglin Li
- Department of Thoracic SurgeryGuangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical UniversityGuangzhouChina
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical SciencesGuangzhouChina
| | - Xiaosong Ben
- Department of Thoracic SurgeryGuangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical UniversityGuangzhouChina
| | - Haiyu Zhou
- Department of Thoracic SurgeryGuangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical UniversityGuangzhouChina
| | - Cheng Deng
- Department of Thoracic SurgeryGuangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical UniversityGuangzhouChina
| | - Rixin Chen
- Department of Thoracic SurgeryGuangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical UniversityGuangzhouChina
- Research Center of Medical Sciences, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical UniversityGuangzhouChina
| | - Qiuling Shi
- College of Public Health, Chongqing Medical UniversityChongqingChina
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical UniversityChongqingChina
| | - Yong Tang
- Department of Thoracic SurgeryGuangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical UniversityGuangzhouChina
| | - Guibin Qiao
- Department of Thoracic SurgeryGuangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical UniversityGuangzhouChina
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2
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Bonanno A, Dixon M, Binongo J, Force SD, Sancheti MS, Pickens A, Kooby DA, Staley CA, Russell MC, Cardona K, Shah MM, Gillespie TW, Fernandez F, Khullar O. Recovery of Patient-reported Quality of Life After Esophagectomy. Ann Thorac Surg 2023; 115:854-861. [PMID: 36526007 DOI: 10.1016/j.athoracsur.2022.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 11/20/2022] [Accepted: 12/06/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Esophagectomy is an important, but potentially morbid, operation used to treat benign and malignant conditions that may significantly impact patient quality of life (QOL). Patient-reported outcomes (PROs) are measures of QOL that come directly from patient self-report. This study characterizes patterns of change and recovery in PROs in the first year after esophagectomy. METHODS Longitudinal QOL scores measuring physical function, pain, and dyspnea were obtained from esophagectomy patients during all clinic visits. PRO scores were obtained using the National Institutes of Health-sponsored Patient-Reported Outcomes Measurement Information System from April 2018 to February 2021. Mean PRO scores over 100 days after surgery were compared with baseline PRO scores using mixed-effects modeling with compound symmetry correlational structure. RESULTS One hundred three patients with PRO results were identified. Reasons for esophagectomy were malignancy (87.4%), achalasia (5.8%), stricture (5.8%), and dysplasia (1.0%). When comparing mean PRO scores at visits ≤ 50 days after surgery with preoperative PRO scores, physical function scores declined by 27.3% (P < .001), whereas dyspnea severity and pain interference scores had increased by 24.5% (P < .001) and 17.1% (P < .001), respectively. Although recovery occurred over the course of the 100 days after surgery, mean physical function scores and dyspnea scores were still 12.7% (P = .02) and 26.4% (P = .001) worse, respectively, than mean preoperative levels. CONCLUSIONS Despite declines in QOL scores immediately after esophagectomy, recovery back toward baseline was observed during the first 100 days. These findings are of considerable importance when counseling patients regarding esophagectomy, tracking recovery, and implementing quality improvement initiatives. Further long-term follow-up is needed to determine recovery beyond 100 days.
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Affiliation(s)
- Alicia Bonanno
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Meredith Dixon
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Jose Binongo
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Seth D Force
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Manu S Sancheti
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Allan Pickens
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - David A Kooby
- Division of Surgical Oncology, Emory University School of Medicine, Atlanta, Georgia
| | - Charles A Staley
- Division of Surgical Oncology, Emory University School of Medicine, Atlanta, Georgia
| | - Maria C Russell
- Division of Surgical Oncology, Emory University School of Medicine, Atlanta, Georgia
| | - Kenneth Cardona
- Division of Surgical Oncology, Emory University School of Medicine, Atlanta, Georgia
| | - Mihir M Shah
- Division of Surgical Oncology, Emory University School of Medicine, Atlanta, Georgia
| | - Theresa W Gillespie
- Division of Surgical Oncology, Emory University School of Medicine, Atlanta, Georgia
| | - Felix Fernandez
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Onkar Khullar
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
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3
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Khullar OV, Perez A, Dixon M, Binongo JN, Sancheti MS, Pickens A, Gillespie T, Force SD, Fernandez FG. Routine Implementation of Patient-Reported Outcomes Assessment Into Thoracic Surgery Practice. Ann Thorac Surg 2023; 115:526-532. [PMID: 35561801 DOI: 10.1016/j.athoracsur.2022.04.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 03/31/2022] [Accepted: 04/18/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patient-reported outcomes (PROs) assessment is a necessary component of surgical outcome assessment and patient care. This study examined the success of routine PROs assessment in an academic-based thoracic surgery practice. METHODS PROs, measuring pain intensity, physical function, and dyspnea, were routinely obtained using the National Institutes of Health-sponsored Patient-Reported Outcomes Measurement Information System (PROMIS) on all thoracic surgery patients beginning in April 2018 through January 2021. Questionnaires were administered electronically through a web-based platform at home or during the office visit. Completion rates and barriers were measured. RESULTS A total of 9725 thoracic surgery office visits occurred during this time frame. PROs data were obtained in 6899 visits from a total of 3551 patients. The mean number of questions answered per survey was 22.4 ± 2.2. Overall questionnaire completion rate was 65.7%. A significant decline in survey completion was noted in April 2020, after which adjustments were made to allow for questionnaire completion through a mobile health platform. Overall monthly questionnaire completion rates ranged from 20% (April 2020) to 90% (October 2018). Mean T scores were dyspnea, 41.6 ± 12.3; physical function, 42.7 ± 10.5; and pain intensity, 52.8 ± 10.3. CONCLUSIONS PROs can be assessed effectively in a thoracic surgery clinic setting, with minimal disruption of clinical activities. Future efforts should focus on facilitating PROs collection from disadvantaged patient populations and scaling implementation across programs.
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Affiliation(s)
- Onkar V Khullar
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
| | - Aubriana Perez
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Meredith Dixon
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Jose N Binongo
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Manu S Sancheti
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Allan Pickens
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Theresa Gillespie
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Seth D Force
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Felix G Fernandez
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
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4
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Gao X, Dai W, Zhang Q, Liu W, Liu Y, Yang L, Wei X, Shi Q, Pompili C, Pu Y, Xie S, Xiang R, Tian B, Hu B, Yang X, Wang X, Yang X, Xie T, Tang Y, Qiao G, Sun N, Gao S, Zhang G, Chen D, Cui Y, Chen X, He Y, Zhang R, Li Q, Zhuang X. Longitudinal patient-reported outcomes 1 year after thoracoscopic segmentectomy versus lobectomy for early-stage lung cancer: a multicentre, prospective cohort study protocol. BMJ Open 2023; 13:e067841. [PMID: 36657755 PMCID: PMC9853240 DOI: 10.1136/bmjopen-2022-067841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Segmentectomy and lobectomy are the main surgical procedures for early-stage lung cancer. However, few studies have analysed patient-reported outcomes after segmentectomy versus lobectomy. This study aims to compare patient-reported outcomes-such as symptoms, daily functioning and quality of life-between thoracoscopic segmentectomy and lobectomy for early-stage lung cancer during the 1 year after surgery. METHODS AND ANALYSIS Overall, 788 newly diagnosed patients with early-stage lung cancer (tumour size ≤2 cm), who are scheduled to undergo thoracoscopic segmentectomy or lobectomy, will be recruited in this multicentre, prospective cohort study. The patients will receive standardised care after surgery. The Perioperative Symptom Assessment for Lung Surgery-a validated lung cancer surgery-specific scale-will be used to assess the symptoms and functions at baseline, at discharge and monthly after discharge for 1 year. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 and Lung Cancer module 29 will be used to assess the patients' quality of life at the same time points. The primary outcome will be the shortness of breath scores during the first year after thoracoscopic segmentectomy and lobectomy and will be compared using mixed-effects models. The secondary outcomes will include other symptoms, indicators of daily functioning, quality of life scores and traditional clinical outcomes. These will be compared using mixed-effects models and the Student's t-test, non-parametric test or Χ2 test. Propensity score matching will be used to ensure an even distribution of known confounders between the groups. ETHICS AND DISSEMINATION The Ethics Committee for Medical Research and New Medical Technology of Sichuan Cancer Hospital approved this study (approval number: SCCHEC-02-2022-002). All participants will be instructed to provide informed consent. The manuscript is based on protocol version 3.0. The study results will be presented at medical conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER ChiCTR2200060753.
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Affiliation(s)
- Xin Gao
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Wei Dai
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Qi Zhang
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
- Graduate School, Chengdu Medical College, Chengdu, Sichuan, China
| | - Wenwu Liu
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Yangjun Liu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Lingjia Yang
- College of Medical and Dental Science, University of Birmingham, Birmingham, UK
| | - Xing Wei
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Qiuling Shi
- Center for Cancer Prevention Research, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Cecilia Pompili
- Thoracic Surgery Unit, University and Hospital Trust - Ospedale Borgo Trento, Verona, Italy
- Section of Patient Centered Outcomes Research, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Yang Pu
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Shaohua Xie
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Run Xiang
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Bo Tian
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Bin Hu
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Xiaozun Yang
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Xiang Wang
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Xiaojun Yang
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Tianpeng Xie
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Yong Tang
- Department of Thoracic Surgery, Guangdong Provincial People's Hospital, Guangzhou, Guangdong, China
| | - Guibin Qiao
- Department of Thoracic Surgery, Guangdong Provincial People's Hospital, Guangzhou, Guangdong, China
| | - Nan Sun
- Department of Thoracic Surgery, Liaoning Cancer Hospital & Institute, Shenyang, Liaoning, China
| | - Shan Gao
- Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Guangjian Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Dan Chen
- Department of Thoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, Chongqing, China
| | - Yue Cui
- Department of Thoracic Surgery, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Xiaobo Chen
- Department of Thoracic Surgery, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Yu He
- Department of Thoracic Surgery, Ya'an People's Hospital, Ya'an, Sichuan, China
| | - Rong Zhang
- Department of Thoracic Surgery, Ya'an People's Hospital, Ya'an, Sichuan, China
| | - Qiang Li
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Xiang Zhuang
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
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Allar BG, Eruchalu CN, Rahman S, Mou D, Ortega G, Reich A, Pusic A, Brook CD, Sisodia R, Bergmark RW. Lost in translation: A qualitative analysis of facilitators and barriers to collecting patient reported outcome measures for surgical patients with limited English proficiency. Am J Surg 2022; 224:514-521. [DOI: 10.1016/j.amjsurg.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/09/2022] [Accepted: 03/01/2022] [Indexed: 11/16/2022]
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Dai W, Wang Y, Liu Y, Wei X, Osman AMY, Pompili C, Koller M, Wang Q, Wang Y, Ge J, Xie T, Li Q. Translation and adaptation of the EORTC QLQ-LC 29 for use in Chinese patients with lung cancer. J Patient Rep Outcomes 2021; 5:122. [PMID: 34757501 PMCID: PMC8581083 DOI: 10.1186/s41687-021-00397-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 11/02/2021] [Indexed: 11/16/2022] Open
Abstract
Background The latest European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Lung Cancer 29 (QLQ-LC29) has been translated and validated in several languages but not yet in simplified Chinese. This study aimed to translate this questionnaire into simplified Chinese and adapt it for use in Chinese patients with lung cancer. Methods The translation and adaptation process followed the EORTC translation procedure, and consisted of eight steps, namely, translation preparation, forward translations, reconciled translation, back translations, a back translation report, proofreading, pilot testing, and finalisation. The pilot testing included 10 patients with lung cancer. Results We obtained the permission to perform the EORTC QLQ-LC29 translation work on November 17, 2020. Thereafter, it took 3 weeks to complete the forward translations, reconciled translation, and back translations. After several rounds of discussion with the EORTC Translation Unit, 19 items used the existing translations from the EORTC Item Library (a database of EORTC questionnaire items and their translations), and 10 items were translated from scratch. The 10 patients included in the pilot testing phase had a median age of 64 years (range 31–69 years); five were male, five had an educational level of high school or above, and six had undergone surgery. Eight items received comments from patients (six items by one patient alone and the other two items by three patients). No patients commented on the instructions or the format used for responses. After discussion with the EORTC Translation Unit, we modified the Chinese wording in item 50 to ensure that the meaning of “lifeless” was clear. No changes were made to the remaining items. Conclusions The simplified Chinese version of the EORTC QLQ-LC29 is now available on the EORTC website. This translation may contribute to the application of the EORTC QLQ-LC29 scale in both research and clinical practice in the Chinese population with lung cancer. Further evaluation of the psychometric properties of the translated EORTC QLQ-LC29 is warranted.
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Affiliation(s)
- Wei Dai
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yaqin Wang
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yangjun Liu
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Xing Wei
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Ahmed M Y Osman
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China.,Center for Social Science Survey and Data, Tianjin University, Tianjin, China
| | - Cecilia Pompili
- Section of Patient Centred Outcomes Research, Leeds Institute for Medical Research at St James's, University of Leeds, Leeds, UK.,Department of Thoracic Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Michael Koller
- Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - Qifeng Wang
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institution, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yi Wang
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institution, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jun Ge
- Department of Medical Oncology, Sichuan Cancer Hospital & Institution, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Tianpeng Xie
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
| | - Qiang Li
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
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7
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Dai W, Chang S, Pompili C, Qiu B, Wei X, Mu Y, Zhang R, Shen C, Shi Q, Li Q, Wu Z, Che G. Early Postoperative Patient-Reported Outcomes After Thoracoscopic Segmentectomy Versus Lobectomy for Small-Sized Peripheral Non-small-cell Lung Cancer. Ann Surg Oncol 2021; 29:547-556. [PMID: 34743281 DOI: 10.1245/s10434-021-10946-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 09/04/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Patient-reported outcomes are critical for obtaining valuable patient insight into different surgical treatment options with comparable clinical outcomes. This study aimed to compare early postoperative patient-reported symptoms and functioning between thoracoscopic segmentectomy and lobectomy for small-sized (≤ 2 cm) peripheral non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS This study included 110 patients who underwent thoracoscopic segmentectomy or lobectomy for peripheral NSCLC ≤ 2 cm in a multicenter prospective longitudinal study (CN-PRO-Lung 1). Symptom severity, functional status, and short-term clinical outcomes were compared between the groups. Symptom severity and functional status were measured using the MD Anderson Symptom Inventory-Lung Cancer at baseline, daily post-surgery, and weekly post-discharge for up to 4 weeks. Both the proportion of moderate-to-severe scores and mean scores on a 0-10 scale were compared between the groups. RESULTS Overall, 48 and 62 patients underwent thoracoscopic segmentectomy and lobectomy, respectively. No significant between-group differences were found in the severity of the top five symptoms (coughing, shortness of breath, pain, fatigue, and disturbed sleep) or in the impairment of all six function items (work, walking, general activity, enjoyment of life, mood, and relations with others) during both the 6-day postoperative hospitalization and the 4-week post-discharge (all p > 0.05). Short-term clinical outcomes of postoperative hospital stay, operative time, drainage time, postoperative in-hospital oral morphine equivalent dose, and complication rate were also comparable (all p > 0.05). CONCLUSIONS In patients with peripheral NSCLC ≤ 2 cm, thoracoscopic segmentectomy and lobectomy might produce comparable symptom burden and functional impairment during the early postoperative period.
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Affiliation(s)
- Wei Dai
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Shuai Chang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Cecilia Pompili
- Section of Patient Centred Outcomes Research, Leeds Institute for Medical Research at St James's, University of Leeds, Leeds, UK.,Department of Thoracic Surgery, Leeds Teaching Hospital Trust, Leeds, UK
| | - Bin Qiu
- Department of Thoracic Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xing Wei
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yunfei Mu
- Department of Thoracic Surgery, Chengdu Third People's Hospital, Chengdu, China
| | - Rui Zhang
- Department of Thoracic Surgery, Chengdu Seventh People's Hospital, Chengdu, China
| | - Cheng Shen
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Qiuling Shi
- Center for Cancer Prevention Research, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Qiang Li
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Zhong Wu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China.
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.
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8
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Ankeny D, Chitilian H, Bao X. Anesthetic Management for Pulmonary Resection: Current Concepts and Improving Safety of Anesthesia. Thorac Surg Clin 2021; 31:509-517. [PMID: 34696863 DOI: 10.1016/j.thorsurg.2021.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Increasingly complex procedures are routinely performed using minimally invasive approaches, allowing cancers to be resected with short hospital stays, minimal postsurgical discomfort, and improved odds of cancer-free survival. Along with these changes, the focus of anesthetic management for lung resection surgery has expanded from the provision of ideal surgical conditions and safe intraoperative patient care to include preoperative patient training and optimization and postoperative pain management techniques that can impact pulmonary outcomes as well as patient lengths of stay.
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Affiliation(s)
- Daniel Ankeny
- Department of Anesthesia, Critical Care and Pain Management, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Hovig Chitilian
- Department of Anesthesia, Critical Care and Pain Management, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
| | - Xiaodong Bao
- Department of Anesthesia, Critical Care and Pain Management, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
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9
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Dai W, Mu Y, Chang S, Wu Z, Che G. ASO Author Reflections: Using Patient-Reported Outcomes to Compare Thoracoscopic Segmentectomy and Lobectomy. Ann Surg Oncol 2021; 29:557-558. [PMID: 34671885 DOI: 10.1245/s10434-021-10948-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 09/21/2021] [Indexed: 02/05/2023]
Affiliation(s)
- Wei Dai
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yunfei Mu
- Department of Thoracic Surgery, Chengdu Third People's Hospital, Chengdu, China
| | - Shuai Chang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zhong Wu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.
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10
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Dai W, Dai Z, Wei X, Pompili C, Shi QL, Xie TP, He JT, Li Q. Early Patient-Reported Outcomes After Uniportal Versus Multiportal Thoracoscopic Lobectomy. Ann Thorac Surg 2021; 114:1229-1237. [PMID: 34599909 DOI: 10.1016/j.athoracsur.2021.08.058] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 08/24/2021] [Accepted: 08/30/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Uniportal video-assisted thoracoscopic surgery (U-VATS) can achieve comparable traditional clinical outcomes as those of multiportal video-assisted thoracoscopic surgery (M-VATS). This study aimed to compare patient-reported outcomes between U-VATS and M-VATS for lung cancer lobectomy in the early postoperative period. METHODS This comparative analysis used data from a longitudinal prospective study (CN-PRO-Lung 1). Symptom severity, functional status, and quality of life were compared between groups using generalized estimation equation models. Symptom severity and functional status were reported as proportion of patients with clinically meaningful severe scores on 0-10-point scales assessed using the MD Anderson Symptom Inventory-Lung Cancer module. RESULTS Of the 174 patients included, 102 (58.6%) underwent U-VATS lobectomy and 72 (41.4%) underwent M-VATS lobectomy. After adjusting for confounders, patients in the U-VATS group reported less severe pain (p = 0.02), fatigue (p = 0.001), constipation (p = 0.01), coughing (p = 0.003), shortness of breath (p < 0.001), and disturbed sleep (p = 0.007) during the 6-day postoperative hospitalization than those in the M-VATS group. Moreover, fewer patients reported severe impairment to walking (p = 0.033) or their capacity to enjoy life (p = 0.027) in the U-VATS group. Meanwhile, there were no significant between-group differences in the quality of life scores, operative time, chest tube duration, length of hospital stay, or early complication rate (≥ grade II) (all p ˃ 0.05). CONCLUSIONS U-VATS might produce fewer severe symptoms and better functional status than M-VATS for lung cancer lobectomy in the early postoperative period.
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Affiliation(s)
- Wei Dai
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Zhen Dai
- Chengdu Center for Disease Control & Prevention, Chengdu, Sichuan, China
| | - Xing Wei
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Cecilia Pompili
- Section of Patient Centred Outcomes Research, Leeds Institute for Medical Research at St James's, University of Leeds, Leeds, UK; Department of Thoracic Surgery, Leeds Teaching Hospital Trust, Leeds, UK
| | - Qiu-Ling Shi
- Center for Cancer Prevention Research, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Tian-Peng Xie
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Jin-Tao He
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Qiang Li
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China.
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11
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Charles EJ, Mehaffey JH, Hawkins RB, Burks SG, McMurry TL, Yarboro LT, Kern JA, Ailawadi G, Kron IL, Stukenborg GJ, Kozower BD. Meaningful Patient-centered Outcomes 1 Year Following Cardiac Surgery. Ann Surg 2021; 273:e247-e254. [PMID: 31397691 DOI: 10.1097/sla.0000000000003357] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To evaluate meaningful, patient-centered outcomes including alive-at-home status and patient-reported quality of life 1 year after cardiac surgery. BACKGROUND Long-term patient-reported quality of life after cardiac surgery is not well understood. Current operative risk models and quality metrics focus on short-term outcomes. METHODS In this combined retrospective/prospective study, cardiac surgery patients at an academic institution (2014-2015) were followed to obtain vital status, living location, and patient-reported outcomes (PROs) at 1 year using the NIH Patient-Reported Outcomes Measurement Information System (PROMIS). We assessed the impact of cardiac surgery, discharge location, and Society of Thoracic Surgeons perioperative predicted risk of morbidity or mortality on 1-year outcomes. RESULTS A total of 782 patients were enrolled; 84.1% (658/782) were alive-at-home at 1 year. One-year PROMIS scores were global physical health (GPH) = 48.8 ± 10.2, global mental health (GMH) = 51.2 ± 9.6, and physical functioning (PF) = 45.5 ± 10.2 (general population reference = 50 ± 10). All 3 PROMIS domains at 1 year were significantly higher compared with preoperative scores (GPH: 41.7 ± 8.5, GMH: 46.9 ± 7.9, PF: 39.6 ± 9.0; all P < 0.001). Eighty-two percent of patients discharged to a facility were alive-at-home at 1 year. These patients, however, had significantly lower 1-year scores (difference: GPH = -5.1, GMH = -5.1, PF = -7.9; all P < 0.001). Higher Society of Thoracic Surgeons perioperative predicted risk was associated with significantly lower PRO at 1 year (P < 0.001). CONCLUSIONS Cardiac surgery results in improved PROMIS scores at 1 year, whereas discharge to a facility and increasing perioperative risk correlate with worse long-term PRO. One-year alive-at-home status and 1-year PRO are meaningful, patient-centered metrics that help define long-term quality and the benefit of cardiac surgery.
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Affiliation(s)
- Eric J Charles
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA
| | - J Hunter Mehaffey
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA
| | - Robert B Hawkins
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA
| | - Sandra G Burks
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA
| | - Timothy L McMurry
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA
| | - Leora T Yarboro
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA
| | - John A Kern
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA
| | - Gorav Ailawadi
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA
| | - Irving L Kron
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA
| | - George J Stukenborg
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA
| | - Benjamin D Kozower
- Department of Surgery, Washington University School of Medicine, St. Louis, MO
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12
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Dowzicky PM, Shah AA, Barg FK, Eriksen WT, McHugh MD, Kelz RR. An Assessment of Patient, Caregiver, and Clinician Perspectives on the Post-discharge Phase of Care. Ann Surg 2021; 273:719-724. [PMID: 31356271 DOI: 10.1097/sla.0000000000003479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE We sought to elicit patients', caregivers', and health care providers' perceptions of home recovery to inform care personalization in the learning health system. SUMMARY BACKGROUND DATA Postsurgical care has shifted from the hospital into the home. Daily care responsibilities fall to patients and their caregivers, yet stakeholder concerns in these heterogeneous environments, especially as they relate to racial inequities, are poorly understood. METHODS Surgical oncology patients, caregivers, and clinicians participated in freelisting; an open-ended interviewing technique used to identify essential elements of a domain. Within 2 weeks after discharge, participants were queried on 5 domains: home independence, social support, pain control, immediate, and overall surgical impact. Salience indices, measures of the most important words of interest, were calculated using Anthropac by domain and group. RESULTS Forty patients [20 whites and 20 African-Americans (AAs)], 30 caregivers (17 whites and 13 AAs), and 20 providers (8 residents, 4 nurses, 4 nurse practitioners, and 4 attending surgeons) were interviewed. Patients and caregivers attended to the personal recovery experience, whereas providers described activities and individuals associated with recovery. All groups defined surgery as life-changing, with providers and caregivers discussing financial and mortality concerns. Patients shared similar thoughts about social support and self-care ability by race, whereas AA patients described heterogeneous pain management and more hopeful recovery perceptions. AA caregivers expressed more positive responses than white caregivers. CONCLUSIONS Patients live the day-to-day of recovery, whereas caregivers and clinicians also contemplate more expansive concerns. Incorporating relevant perceptions into traditional clinical outcomes and concepts could enhance the surgical experience for all stakeholders.
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Affiliation(s)
- Phillip M Dowzicky
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Arnav A Shah
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Frances K Barg
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Whitney T Eriksen
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | | | - Rachel R Kelz
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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13
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Charles EJ, Mehaffey JH, Hawkins RB, Green CJ, Craddock A, Tyerman ZM, Larson ND, Kron IL, Ailawadi G, Kozower BD. Effect of Cardiac Surgery on One-Year Patient-Reported Outcomes: A Prospective Cohort Study. Ann Thorac Surg 2020; 112:1410-1416. [PMID: 33309733 DOI: 10.1016/j.athoracsur.2020.09.061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 08/06/2020] [Accepted: 09/20/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Current cardiac surgery risk algorithms and quality measures focus on perioperative outcomes. However, delivering high-value, patient-centered cardiac care will require a better understanding of long-term patient-reported quality of life after surgery. Our objective was to prospectively assess the effect of cardiac surgery on long-term patient-reported outcomes. METHODS Patients undergoing cardiac surgery at an academic medical center (2016 to 2017) were eligible for enrollment. Patient-reported outcomes were measured using the National Institutes of Health Patient-Reported Outcomes Measurement Information System preoperatively and 1 year postoperatively across five domains: mental health, physical health, physical functioning, social satisfaction, and applied cognition. Baseline data and perioperative outcomes were obtained from The Society of Thoracic Surgeons Database. The effect of cardiac surgery on long-term patient-reported quality of life was assessed. RESULTS Ninety-eight patients were enrolled and underwent cardiac surgery, with 92.9% (91 of 98) successful follow-up. The most common operation was coronary artery bypass graft surgery at 63.3% (62 of 98), with 60.2% (59 of 98) undergoing an elective operation. One-year all-cause mortality was 5.1% (5 of 98). Rate of major morbidity was 11.2% (11 of 98). Cardiac surgery significantly improved patient-reported outcomes at 1 year across four domains: mental health (preoperative 47.3 ± 7.7 vs postoperative 51.1 ± 8.9, P < .001), physical health (41.2 ± 8.2 vs 46.3 ± 9.3, P < .001), physical functioning (39.8 ± 8.6 vs 44.8 ± 8.5, P < .001), and social satisfaction (46.8 ± 10.9 vs 50.7 ± 10.8, P = .023). Hospital discharge to a facility did not affect 1-year patient-reported outcomes. CONCLUSIONS Cardiac surgery improves long-term patient-reported quality of life. Mental, physical, and social well-being scores were significantly higher 1 year postoperatively. Data collection with the National Institutes of Health Patient-Reported Outcomes Measurement Information System provides meaningful, quantifiable results that may improve delivery of patient-centered care.
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Affiliation(s)
- Eric J Charles
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - J Hunter Mehaffey
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Robert B Hawkins
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - China J Green
- Surgical Therapeutic Advancement Center, University of Virginia, Charlottesville, Virginia
| | - Ashley Craddock
- Surgical Therapeutic Advancement Center, University of Virginia, Charlottesville, Virginia
| | - Zachary M Tyerman
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Nathaniel D Larson
- Surgical Therapeutic Advancement Center, University of Virginia, Charlottesville, Virginia
| | - Irving L Kron
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Gorav Ailawadi
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Benjamin D Kozower
- Department of Surgery, Washington University School of Medicine, St Louis, Missouri.
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14
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Valsangkar N, Wei JW, Binongo JN, Pickens A, Sancheti MS, Force SD, Gillespie TW, Fernandez FG, Khullar OV. Association Between Patient Physical Function and Length of Stay After Thoracoscopic Lung Cancer Surgery. Semin Thorac Cardiovasc Surg 2020; 33:559-566. [PMID: 33186736 DOI: 10.1053/j.semtcvs.2020.10.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 10/14/2020] [Indexed: 11/11/2022]
Abstract
Patient-reported outcomes (PRO) are an ideal method for measuring patient functional status. We sought to evaluate whether preoperative PRO were associated with resource utilization. We hypothesize that higher preoperative physical function PRO scores, measured via the NIH-sponsored Patient Reported Outcome Measurement Information System (PROMIS), are associated with shorter length of stay (LOS). Preoperative physical function scores were obtained using NIH PROMIS in a prospective observational study of patients undergoing minimally invasive surgery for lung cancer. Poisson regression models were constructed to estimate the association between the length of stay and PROMIS physical function T-score, adjusting for extent of resection, age, gender, and race. Due to the significant interaction between postoperative complications and physical function T-score, the relationship between physical function and LOS was described separately for each complication status. A total of 123 patients were included; 88 lobectomy, 35 sublobar resections. Mean age was 67 years, 35% were male, 65% were Caucasian. Among patients who had a postoperative complication, a lower preoperative physical function T-score was associated with progressively increasing LOS (P value = 0.006). In particular, LOS decreased by 18% for every 10-point increase in physical function T-score. Among patients without complications, T-score was not associated with LOS (P = 0.86). Preoperative physical function measured via PRO identifies patients who are at risk for longer LOS following thoracoscopic lung cancer surgery. In addition to its utility for preoperative counseling and planning, these data may be useful in identifying patients who may benefit from risk-reduction measures.
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Affiliation(s)
- Nakul Valsangkar
- Section of General Thoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Jane W Wei
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Jose N Binongo
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Allan Pickens
- Section of General Thoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Manu S Sancheti
- Section of General Thoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Seth D Force
- Section of General Thoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Theresa W Gillespie
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Felix G Fernandez
- Section of General Thoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Onkar V Khullar
- Section of General Thoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
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15
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Khullar OV, Wei JW, Wagh K, Binongo JN, Pickens A, Sancheti MS, Force SD, Gillespie TW, Fernandez FG. Preoperative Lung Function Is Associated With Patient-Reported Outcomes After Lung Cancer Surgery. Ann Thorac Surg 2020; 112:415-422. [PMID: 33130117 DOI: 10.1016/j.athoracsur.2020.09.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/21/2020] [Accepted: 09/16/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Patient quality of life (QOL) is a critical outcomes measure in lung cancer surgery. Patient-reported outcomes (PROs) provide valuable insight into the patient experience and allow measurement of preoperative and postoperative QOL. Our objective was to determine which clinical factors predict differences in QOL, as measured by patient-reported physical function and pain intensity among patients undergoing minimally invasive lung cancer surgery. METHODS PRO surveys assessing physical function and pain intensity were conducted using instruments from the National Institutes of Health Patient-Reported Outcomes Measurement Information System. PRO surveys were administered to patients undergoing minimally invasive lung cancer resections at preoperative, 1-month, and 6-month postoperative time points, in an academic institution. Linear mixed-effects regression models were constructed to assess the association between clinical variables on PRO scores over time. RESULTS A total of 123 patients underwent a thoracoscopic lung resection for cancer. Mean age of the cohort was 67 ± 9.6 years, 43% were male, and 80% were White. When comparing clinical variables with PRO scores after surgery, lower diffusing capacity of the lungs for carbon monoxide (Dlco) was associated with significantly worse physical function (P < .01) and greater pain intensity scores (P < .01) at 6 months, with no differences identified at 1 month. No other studied clinical factor was associated with significant differences in PRO scores. CONCLUSIONS Low preoperative Dlco was associated with significant decreases in PRO after minimally invasive lung cancer surgery. Dlco may be of utility in identifying patients who experience greater decline in QOL after surgery and for guiding surgical decision making.
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Affiliation(s)
- Onkar V Khullar
- Section of General Thoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
| | - Jane W Wei
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Kaustabh Wagh
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Jose N Binongo
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Allan Pickens
- Section of General Thoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Manu S Sancheti
- Section of General Thoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Seth D Force
- Section of General Thoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Theresa W Gillespie
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Felix G Fernandez
- Section of General Thoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
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16
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Kneuertz PJ, McAlearney AS, Moffatt-Bruce SD. Patient-reported outcomes in thoracic surgery-opportunities and current challenges. J Thorac Dis 2020; 12:6880-6882. [PMID: 33282390 PMCID: PMC7711410 DOI: 10.21037/jtd.2019.12.139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Peter J Kneuertz
- Thoracic Surgery Division, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST) in Health Services and Implementation Science Research, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Ann Scheck McAlearney
- Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST) in Health Services and Implementation Science Research, The Ohio State University College of Medicine, Columbus, OH, USA.,Department of Family Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Susan D Moffatt-Bruce
- Thoracic Surgery Division, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST) in Health Services and Implementation Science Research, The Ohio State University College of Medicine, Columbus, OH, USA
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17
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Moffatt-Bruce SD. Healthcare systems approach to patient reported outcomes-benefits and challenges in thoracic surgery. J Thorac Dis 2020; 12:6947-6951. [PMID: 33282399 PMCID: PMC7711401 DOI: 10.21037/jtd.2020.01.36] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Quality outcomes are the ultimate goal for our thoracic surgery patients. The collection of data to measure the outcomes have been in place for many years and yet are insufficient. The inclusion of patient reported outcomes (PROs) into data reporting, collection and analysis will help to truly understand what matters most to patients and allow us to provide value-based care every time. It is the responsibility of the healthcare system to provide the resources in order to leverage the patient voice and collect meaningful PROs that can influence the best outcomes possible.
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Affiliation(s)
- Susan D Moffatt-Bruce
- Division of Thoracic Surgery, Department of Surgery, The Ohio State University, Columbus, OH, USA
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18
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Ahmed M, Lau A, Hirpara DH, Kidane B. Choosing the right survey-patient reported outcomes in esophageal surgery. J Thorac Dis 2020; 12:6902-6912. [PMID: 33282393 PMCID: PMC7711431 DOI: 10.21037/jtd.2020.03.58] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Patient reported outcomes (PROs) fulfill a crucial and unique niche in patient management, providing health-care providers a glimpse into their patients’ health experience. This is of utmost importance in patients with benign and malignant disorders of esophagus requiring surgery, which carries significant morbidity, in part due to a high burden of symptoms affecting health-related quality of life (HRQOL). There are a variety of generic and disease-specific patient reported outcome measures (PROMs) available for use in esophageal surgery. This article provides a broad overview of commonly used HRQOL instruments in esophageal surgery, including their utility in comparative effectiveness research, prognostication and shared decision-making for patients undergoing surgery for benign and malignant disorders of the esophagus.
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Affiliation(s)
- Maira Ahmed
- College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Angus Lau
- College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Dhruvin H Hirpara
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Biniam Kidane
- College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.,Section of Thoracic Surgery, Health Sciences Centre, Winnipeg, Manitoba, Canada.,Research Institute in Oncology and Hematology, Cancer Care Manitoba, Manitoba, Canada
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19
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Abstract
Patient-centered care is a growing focus of research and modern surgical practice. To this end, there has been an ever-increasing utilization of patient reported outcomes (PRO) and health-related quality of life metrics (HR-QOL) in thoracic surgery research. Here we describe reasons and methods for integration of PRO measurement into routine thoracic surgical practice, commonly utilized PRO measurement instruments, and several examples of successful integration.
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Affiliation(s)
- Nakul Valsangkar
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Felix Fernandez
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Onkar Khullar
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA
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20
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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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21
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Dai W, Xie S, Zhang R, Wei X, Wu C, Zhang Y, Feng W, Liao X, Mu Y, Zhou H, Cheng X, Jiang Y, He J, Li Q, Yang X, Shi Q. Developing and validating utility parameters to establish patient-reported outcome-based perioperative symptom management in patients with lung cancer: a multicentre, prospective, observational cohort study protocol. BMJ Open 2019; 9:e030726. [PMID: 31662377 PMCID: PMC6830688 DOI: 10.1136/bmjopen-2019-030726] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Patient-reported outcome-based symptom monitoring and alerting have been attractive for patient care after a tumour-removal surgery. However, the implementation parameters of this patient-centred symptom management system in perioperative patients with lung cancer are still lacking. We aim to develop a perioperative symptom scale (PSS) for monitoring, to determine the optimal time points for symptom assessment and to define the alert thresholds for medical intervention. METHODS AND ANALYSIS This study will prospectively recruit 300 patients undergoing lung cancer surgery in six hospitals. The MD Anderson Symptom Inventory-Lung Cancer Module (MDASI-LC) is used to collect longitudinal symptom data preoperatively, daily postoperatively during in-hospital stay and weekly after discharge until 4 weeks or the start of postoperative oncological therapy. Symptoms that change significantly over time will be generated as the PSS. We will determine the optimal time points for follow-up using the generalised linear mixed-effects models. The MDASI-LC interference-measured functional status will be used as the anchor for the alert thresholds. ETHICS AND DISSEMINATION Ethics Committee of Sichuan Cancer Hospital approved this study on 16 October 2017 (No. SCCHEC-02-2017-042). The manuscript is based on the latest protocol of Version 3.0, 15 September 2019. The results of this study will be presented at medical conferences and published in peer-reviewed journals. TRIALS REGISTRATION NUMBER NCT03341377.
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Affiliation(s)
- Wei Dai
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Shaohua Xie
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Graduate School, Chengdu Medical College, Chengdu, China
| | - Rui Zhang
- Department of Thoracic Surgery, The Seventh People's Hospital of Chengdu, Chengdu, China
| | - Xing Wei
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Chuanmei Wu
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yuanqiang Zhang
- Department of Cardiothoracic Surgery, Zigong First People's Hospital, Zigong, China
| | - Wenhong Feng
- Department of Thoracic and Cardiovascular Surgery, Jiangyou People's Hospital, Jiangyou, China
| | - Xiaoqing Liao
- Department of Cardiothoracic Surgical Oncology, Dazhu County People's Hospital, Dazhu County, China
| | - Yunfei Mu
- Department of Thoracic Surgery, The Third People's Hospital of Chengdu, Chengdu, China
| | - Heling Zhou
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xuemei Cheng
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yanhua Jiang
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jintao He
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Qiang Li
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiaojun Yang
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Qiuling Shi
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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22
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Subramanian M, Kozower BD, Brown LM, Khullar OV, Fernandez FG. Patient-Reported Outcomes in Cardiothoracic Surgery. Ann Thorac Surg 2019; 107:294-301. [PMID: 30009806 DOI: 10.1016/j.athoracsur.2018.06.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 06/04/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Current studies in cardiothoracic clinical research frequently fail to use end points that are most meaningful to patients, including measures associated with quality of life. Patient-reported outcomes (PROs) represent an underused but important component of high-quality patient-centered care. Our objective was to highlight important principles of PRO measurement, describe current use in cardiothoracic operations, and discuss the potential for and challenges associated with integration of PROs into large clinical databases. METHODS We performed a literature review by using the PubMed/EMBASE databases. Clinical articles that focused on the use of PROs in cardiothoracic surgical outcomes measurement or clinical research were included in this review. RESULTS PROs measure the outcomes that matter most to patients and facilitate the delivery of patient-centered care. When effectively used, PRO measures have provided detailed and nuanced quality-of-life data for comparative effectiveness research. However, further steps are needed to better integrate PROs into routine clinical care. CONCLUSIONS Incorporation of PROs into routine clinical practice is essential for delivering high-quality patient-centered care. Future integration of PROs into prospectively collected registries and databases, including that The Society of Thoracic Surgeons National Database, has the potential to enrich comparative effectiveness research in cardiothoracic surgery.
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Affiliation(s)
- Melanie Subramanian
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Benjamin D Kozower
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Lisa M Brown
- Division of Cardiothoracic Surgery, University of California Davis Health, Davis, California
| | - Onkar V Khullar
- Section of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Felix G Fernandez
- Section of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
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23
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Dai W, Zhang Y, Feng W, Liao X, Mu Y, Zhang R, Wei X, Wu C, Xie S, Li Q, Shi Q. Using patient-reported outcomes to manage postoperative symptoms in patients with lung cancer: protocol for a multicentre, randomised controlled trial. BMJ Open 2019; 9:e030041. [PMID: 31455710 PMCID: PMC6720560 DOI: 10.1136/bmjopen-2019-030041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 07/18/2019] [Accepted: 08/01/2019] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Surgery is one of the primary treatments for lung cancer. The postoperative symptom burden experienced by patients with lung cancer is substantial, seriously delaying their recovery from surgery and impairing their quality of life. Patient-reported outcome (PRO)-based symptom management is increasingly regarded as an optimal model for patient-centred care. Currently, clinical trial-based evidence involving early-phase (immediately after surgery for up to 1 month) symptom management of lung cancer is lacking. We propose a randomised trial to evaluate the effect of a PRO-based symptom-monitoring programme with overthreshold alerts and responses for postoperative recovery in patients with lung cancer. METHODS AND ANALYSIS The study will recruit 160 patients with lung cancer from six hospitals. The patients will be randomly allocated to the intervention group or control group in a ratio of 1:1. Patients in the intervention group will receive PRO-based symptom management from the specialists when their reported target symptom (pain, coughing, fatigue, disturbed sleep and shortness of breath) scores reach the preset threshold (score ≥4). Patients in the control group will not generate alerts and will follow the standard procedures for symptom management. All patients will receive symptom assessments via the MD Anderson Symptom Inventory-lung cancer module on the day before surgery, daily after surgery and twice a week after discharge until 4 weeks or the start of postoperative oncological treatment. The primary outcome-mean symptom threshold events-will be compared between the intervention and control group via independent sample Student's t-test. ETHICS AND DISSEMINATION The study was approved by the Ethics Committee of Sichuan Cancer Hospital on 22 November 2018 (No. SCCHEC-02-2018-045). This manuscript is based on V.2.0, 9 May 2019 of the protocol. The study results will be disseminated in publications in peer-reviewed journals and presentations at academic conferences. TRIALS REGISTRATION NUMBER ChiCTR1900020846.
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Affiliation(s)
- Wei Dai
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yuanqiang Zhang
- Department of Cardiothoracic Surgery, Zigong First People's Hospital, Zigong, China
| | - Wenhong Feng
- Department of Thoracic and Cardiovascular Surgery, Jiangyou People's Hospital, Jiangyou, China
| | - Xiaoqing Liao
- Department of Cardiothoracic Surgical Oncology, Dazhu County People's Hospital, Dazhu County, China
| | - Yunfei Mu
- Department of Thoracic Surgery, The Third People's Hospital of Chengdu, Chengdu, China
| | - Rui Zhang
- Department of Thoracic Surgery, The Seventh People's Hospital of Chengdu, Chengdu, China
| | - Xing Wei
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Chuanmei Wu
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Shaohua Xie
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Graduate School, Chengdu Medical College, Chengdu, China
| | - Qiang Li
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Qiuling Shi
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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24
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A call for cease-fire: We can only move forward together. J Thorac Cardiovasc Surg 2019; 157:e393-e395. [DOI: 10.1016/j.jtcvs.2019.01.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 01/31/2019] [Indexed: 11/24/2022]
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25
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Medbery RL, Fernandez FG, Khullar OV. ERAS and patient reported outcomes in thoracic surgery: a review of current data. J Thorac Dis 2019; 11:S976-S986. [PMID: 31183180 DOI: 10.21037/jtd.2019.04.08] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Quality-focused, cost-effective, patient-centered care is at the forefront of current healthcare reform. Recent data show that enhanced recovery after surgery (ERAS) results in improved surgical outcomes and decreased hospital costs. As a result, ERAS has been widely accepted among multiple surgical subspecialties as a modality for increasing the value of healthcare delivered to our patients. While this objective data is convincing for practitioners and administrators alike, how ERAS directly impacts the patient experience is unclear. Patient reported outcomes (PRO) are starting to drive patterns of healthcare delivery and influence surgical decision-making. In order to improve surgical outcomes and deliver patient-centered care, it is imperative that clinicians start reviewing objective metrics contained within morbidity and mortality data alongside subjective data regarding patients' experience. This article reviews the current data surrounding both ERAS and PROs within thoracic surgery and investigates how the two concepts are ultimately related.
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Affiliation(s)
- Rachel L Medbery
- Section of General Thoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Felix G Fernandez
- Section of General Thoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Onkar V Khullar
- Section of General Thoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
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26
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Shen C, Li J, Li P, Che G. [Evaluation Index of Enhanced Recovery After Surgery: Status and Progress of Patient Report Outcomes in Thoracic Surgery]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2019; 22:161-166. [PMID: 30909996 PMCID: PMC6441120 DOI: 10.3779/j.issn.1009-3419.2019.03.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
加速康复外科临床应用的良好效果体现在降低围手术期并发症的发生率并缩短住院时间,但对围术期的患者症状管理及术后患者生活质量的关注不够高。从患者报告的资料角度评估临床疗效越来越受到重视。结合目前国内外关于病人报告结局的研究成果,本文系统论述了病人报告结局的概念内涵、研究意义及在胸外科的临床应用现状,提出借鉴国外病人报告的临床结局研究模式,开展有中国特色的结合学科特点的相关研究,并对已有的文献报告进行总结及分析。
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Affiliation(s)
- Cheng Shen
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jue Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Pengfei Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
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27
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Hirpara DH, Gupta V, Brown L, Kidane B. Patient-reported outcomes in lung and esophageal cancer. J Thorac Dis 2019; 11:S509-S514. [PMID: 31032069 DOI: 10.21037/jtd.2019.01.02] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Carcinomas of the lung and esophagus are associated with significant disease and treatment related morbidity. Measuring patients' self-perceived notion of their health-related quality of life (HRQOL), throughout the course of illness, is central to the delivery of comprehensive, patient-centered care. This article reviews commonly used HRQOL instruments in thoracic surgery and discusses the integral role of patient-reported outcomes (PROs) in comparative effectiveness research and prognostication in the realm of lung and esophageal cancer. We also highlight challenges and future directions for widespread implementation of PROs into clinical and research practice.
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Affiliation(s)
- Dhruvin H Hirpara
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Vaibhav Gupta
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Lisa Brown
- Department of Surgery, University of California, Davis, Sacramento, California, USA.,Thoracic Surgery Outcomes Research Network (ThORN)
| | - Biniam Kidane
- Thoracic Surgery Outcomes Research Network (ThORN).,Section of Thoracic Surgery, Health Sciences Center, Winnipeg, Manitoba, Canada
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28
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Medbery RL, Fernandez FG, Khullar OV. Patient-Reported Outcomes: Time to Integrate Into Outcomes Reporting? Semin Thorac Cardiovasc Surg 2019; 31:856-860. [DOI: 10.1053/j.semtcvs.2019.05.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 05/28/2019] [Indexed: 12/11/2022]
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29
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Lee MK, Yost KJ, Pierson KE, Blackmon SH. Patient-reported outcome domains for the esophageal CONDUIT report card: a prospective trial to establish domains. Health Qual Life Outcomes 2018; 16:197. [PMID: 30305083 PMCID: PMC6180437 DOI: 10.1186/s12955-018-1023-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 09/21/2018] [Indexed: 02/06/2023] Open
Abstract
Background Health-related quality of life (QoL) deteriorates immediately after esophagectomy. Patients may benefit from periodic assessments to detect increased morbidity on the basis of subjective self-reports. Using input from patients and health care providers, we developed a brief prototype for the esophageal conduit questionnaire (Mayo Clinic Esophageal Conduit Outcomes Noting Dysphagia/Dumping, and Unknown outcomes with Intermittent symptoms over Time after esophageal reconstruction [CONDUIT] Report Card) and previously used it in comparative research. The present study aimed to expand its content and establish health-related QoL and symptom domains of a patient-reported postesophagectomy conduit evaluation tool. Methods We expanded tool content by selecting items measuring patient-reported symptoms from existing questionnaires or written de novo. A multidisciplinary group of clinician content-matter experts approved the draft tool, together with a designated patient advocate. The expanded tool was administered to patients postesophagectomy from March 1 to November 30, 2016. We established domains of conduit performance for score reporting through data analysis with exploratory factor analyses. We assessed psychometric properties such as dimensionality, internal consistency, and inter-item correlations in each domain and compared content coverage with other existing measures intended for this patient population. For data that were missing less than 50% of patient responses, the missing values were imputed. Results Five multi-item domains were established from data of 76 patients surveyed after esophagectomy; single items were used to assess stricture and conduit emptying. For every multi-item domain, dominance of 1 factor was present. Internal consistency reliability estimates for the domains were 0.87, 0.78, 0.75, 0.80, and 0.83 and average inter-item correlations were 0.40, 0.50, 0.40, 0.33, and 0.73 for dysphagia, reflux, dumping-gastrointestinal symptoms, dumping-hypoglycemia, and pain, respectively. Some items observed to have lower inter-item correlation were reworded or flagged for removal at future validation. For reflux and dumping-related hypoglycemia, additional items were written after these analyses. Conclusions The CONDUIT Report Card is a novel questionnaire for assessing QoL and symptoms of patients after esophageal reconstruction. It covers major symptoms of these patients and has good content validity and psychometric properties. The tool can be used to help direct patient care, guide intervention, and compare efficacy of different treatment options. Trial registration ClinicalTrials.gov identifier No. 02530983 on 8/18/2015.
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Affiliation(s)
- Minji K Lee
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Kathleen J Yost
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Karlyn E Pierson
- Department of Surgery, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Shanda H Blackmon
- Department of Surgery, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
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30
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Semenkovich TR, Meyers BF. Understanding the impact of neoadjuvant chemoradiation on health-related quality of life in esophageal cancer. VIDEO-ASSISTED THORACIC SURGERY 2018; 3. [PMID: 30221248 DOI: 10.21037/vats.2018.06.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Tara R Semenkovich
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Bryan F Meyers
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University in St. Louis, St. Louis, MO, USA
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