1
|
Chen CY, Ding H, Wang SS. Effectiveness of Roy Adaptation Model-Based Cognitive Stimulation Therapy in Elderly Patients with Non-Small Cell Lung Cancer Undergoing Curative Resection. TOHOKU J EXP MED 2024; 263:27-34. [PMID: 38220169 DOI: 10.1620/tjem.2023.j108] [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] [Indexed: 01/16/2024]
Abstract
This study aimed to investigate the effects of a Roy adaptation model (RAM)-based cognitive stimulation therapy (CST) intervention on elderly patients diagnosed with primary non-small cell lung cancer (NSCLC) undergoing curative resection. A total of 280 patients diagnosed with primary NSCLC were randomized into RAM-based CST group and control group. Outcomes were assessed at three intervals: pre-surgery, discharge, and one-month post-discharge. Cognitive function was evaluated using Mini-Cognitive test. Postoperative delirium prevalence was determined within 48 hours post-surgery using Nursing Delirium Screening Scale. The Hospital Anxiety and Depression Scale evaluated anxiety and depression symptoms, while Quality of Life (QoL) was assessed via Short Form-36 (SF36) Health Survey. The RAM-based CST group demonstrated significantly higher Mini-Cog test scores than the control group upon discharge and post-intervention. Patients with RAM-based CST exhibited a decrease in postoperative delirium compared to the control group. The RAM-based CST intervention yielded an improvement in anxiety and depression at discharge and 1-month post-discharge compared to preoperative levels. Additionally, the RAM-based CST group exhibited substantial enhancements in SF36 subcategory scores at 1-month post-discharge compared to pre-surgery. At post-intervention, the RAM-based CST group demonstrated significantly higher scores than the control group across various health-related domains, including role limitations due to emotional problems, mental health, general health perception, bodily pain, and role limitations due to physical problems. The RAM-based CST intervention in elderly NSCLC patients undergoing curative resection yielded significant enhancements in cognitive function, reduced delirium incidence, improved emotional well-being, and better QoL postoperatively.
Collapse
Affiliation(s)
| | | | - Shang-Shang Wang
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Bade BC, Blasberg JD, Mase VJ, Kumbasar U, Li AX, Park HS, Decker RH, Madoff DC, Brandt WS, Woodard GA, Detterbeck FC. A guide for managing patients with stage I NSCLC: deciding between lobectomy, segmentectomy, wedge, SBRT and ablation-part 3: systematic review of evidence regarding surgery in compromised patients or specific tumors. J Thorac Dis 2022; 14:2387-2411. [PMID: 35813753 PMCID: PMC9264070 DOI: 10.21037/jtd-21-1825] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 05/09/2022] [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 (SBRT), 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 older patients, patients with limited pulmonary reserve and favorable tumors is the focus of this paper. Evidence was abstracted from randomized trials and non-randomized comparisons (NRCs) with 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 older patients, perioperative mortality is minimally altered by resection extent and only slightly affected by increasing age; sublobar resection may slightly decrease morbidity. Long-term outcomes are worse after lesser resection; the difference is slightly attenuated with increasing age. Reported short-term outcomes are quite acceptable in (selected) patients with severely limited pulmonary reserve, not clearly altered by resection extent but substantially improved by a minimally invasive approach. Quality-of-life (QOL) and impact on pulmonary function hasn't been well studied, but there appears to be little difference by resection extent in older or compromised patients. Patient selection is paramount but not well defined. Ground-glass and screen-detected tumors exhibit favorable long-term outcomes regardless of resection extent; however solid tumors <1 cm are not a reliably favorable group. Conclusions A systematic, comprehensive summary of evidence regarding resection extent in compromised patients and favorable tumors with attention to aspects of applicability, uncertainty and effect modifiers provides a foundation for a framework for individualized decision-making.
Collapse
Affiliation(s)
- Brett C. Bade
- Department of Pulmonary Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Justin D. Blasberg
- 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
| | - Ulas Kumbasar
- Department of Thoracic Surgery, Hacettepe University School of Medicine, Ankara, Turkey
| | - Andrew X. Li
- Department of General Surgery, 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
| | - Whitney S. Brandt
- Department of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Gavitt A. Woodard
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Frank C. Detterbeck
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| |
Collapse
|
4
|
Quality of Life in Octogenarians After Lung Resection Compared to Younger Patients. Clin Lung Cancer 2021; 23:e118-e130. [PMID: 34340923 DOI: 10.1016/j.cllc.2021.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/19/2021] [Accepted: 05/28/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION To evaluate postoperative outcome and quality of life (QOL), comparing patients <80 years old to patients ≥ 80. PATIENTS AND METHODS EORTC questionnaires, QLQ-C30 and QLQ-LC13 was used to assess QOL, in patients after surgery. Results were evaluated according to 3 age groups: <70, 70 to 79, and ≥80. RESULTS 106 patients were enrolled with 33 (<70), 25 (70-79), and 48 (≥80) patients per group. The median age was 74 years. 79% of patients had minimally invasive procedures, including 91% of those ≥80. Fifteen patients underwent wedge resections. Complication rates (18%, 32%, and 29%, P = .4) and median length of stay (4, 6, and 5 days, P = .2) were similar in all age groups, with no hospital mortality. One hundred one patients completed the questionnaires. Global QOL was highest among octogenarians. Overall functional and role QOL was higher among octogenarians than 70- to 79-year-olds, with emotional QOL higher than those <70 (P < .05). Social QOL in octogenarians was marginally lower than younger patients. Lung-specific symptom scores were at least 1.5 times lower than those <80 (P = .052). Patients aged 70 to 79 had the worst symptomatic and emotional effect on QOL. Surgical access and preoperative performance status did not affect final QOL across all age groups (P = .9 and P = .065). Among anatomical lung resections, QOL was higher in octogenarians than those 70 to 79 in all domains, and similar or higher than those <70 in most domains. CONCLUSION Quality of life among octogenarians after surgery remains similar to younger patients even after anatomical lung resection. Surgery in octogenarians is safe, with minimal impact on postoperative QOL.
Collapse
|
5
|
Dauriat G, LePavec J, Pradere P, Savale L, Fabre D, Fadel E. Our current understanding of and approach to the management of lung cancer with pulmonary hypertension. Expert Rev Respir Med 2021; 15:373-384. [PMID: 33107356 DOI: 10.1080/17476348.2021.1842202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Lung cancer is a frequent pathology for which the best curative treatment is pulmonary resection. Pulmonary arterial hypertension is a rare disease but pulmonary hypertension associated with parenchymal disease or left heart disease is frequently observed in these patients. The diagnosis of pulmonary hypertension before lung resection makes the perioperative management of these patients more difficult and sometimes leads to rejecting patients for surgery. AREAS COVERED We performed a review of literature on PubMed on Pulmonary hypertension associated lung resection, preoperative assessment of lung resection and perioperative management of PH patients, including guidelines and clinical trials.In this review, we summarize the current state of knowledge regarding the pre and perioperative management of patients with suspected or confirmed PH who can benefit from surgical treatment of lung cancer. EXPERT OPINION Management of PH patients before lung resection should include a very careful workup including at least right heart catheterization with evaluation of the targeted PH treatment in an expert center and evaluation of other comorbidities. Perioperative management must be carried out in a specialized center.
Collapse
Affiliation(s)
- Gaelle Dauriat
- Department of Thoracic and Vascular Surgery, Marie Lannelongue Hospital GHPSJ, Institut d'Oncologie Thoracique and Paris Saclay University, France
| | - Jerome LePavec
- Department of Thoracic and Vascular Surgery, Marie Lannelongue Hospital GHPSJ, Institut d'Oncologie Thoracique and Paris Saclay University, France
| | - Pauline Pradere
- Department of Thoracic and Vascular Surgery, Marie Lannelongue Hospital GHPSJ, Institut d'Oncologie Thoracique and Paris Saclay University, France
| | - Laurent Savale
- AP-HP, Service de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Séveère, Hôpital Bicêtre, France
| | - Dominique Fabre
- Department of Thoracic and Vascular Surgery, Marie Lannelongue Hospital GHPSJ, Institut d'Oncologie Thoracique and Paris Saclay University, France
| | - Elie Fadel
- Department of Thoracic and Vascular Surgery, Marie Lannelongue Hospital GHPSJ, Institut d'Oncologie Thoracique and Paris Saclay University, France
| |
Collapse
|
6
|
Okami J. Treatment strategy and decision-making for elderly surgical candidates with early lung cancer. J Thorac Dis 2019; 11:S987-S997. [PMID: 31183181 DOI: 10.21037/jtd.2019.04.01] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Among elderly cancer patients of the same chronological age, there is a wide range of heterogeneity in their ability to tolerate surgery. When an elderly patient comes to a thoracic surgeon, the surgeon first considers how healthy the patient is. If the patient looks healthy or in fit condition, the surgeon offers lobectomy plus mediastinal lymph node dissection. On the other hand, if the patient looks frail, the surgeon may offer, instead of a standard treatment, lobectomy without lymph node dissection, sublobar resection, or radiotherapy or may not offer any kind of treatment. This review was conducted to obtain an overview of these options and compare the treatment outcomes reported in the literature for the purpose of making a good decision for elderly surgical candidates with early lung cancer.
Collapse
Affiliation(s)
- Jiro Okami
- Department of General Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan
| |
Collapse
|
7
|
Shinde A, Li R, Kim J, Salgia R, Hurria A, Amini A. Stereotactic body radiation therapy (SBRT) for early-stage lung cancer in the elderly. Semin Oncol 2018; 45:210-219. [PMID: 30286944 DOI: 10.1053/j.seminoncol.2018.06.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 05/08/2018] [Accepted: 06/26/2018] [Indexed: 01/05/2023]
Abstract
Early-stage non-small cell lung cancer (NSCLC) is on the rise due to the implementation of screening guidelines for patients at risk for developing lung cancer. It is anticipated that as the US population continues to age, there will be a higher percentage of medically inoperable early-stage lung cancer patients. For this reason, noninvasive ablative therapies are necessary. Stereotactic body radiation therapy (SBRT) is an effective modality in addressing early-stage NSCLC. SBRT consists of high-dose radiation delivered over 3-5 treatments. Several randomized trials comparing surgery to SBRT in early-stage operable patients have unfortunately closed early due to poor accrual. However, a recent pooled analysis from 2 randomized trials (StereoTActic Radiotherapy and Radiosurgery Or Surgery for operable Early-stage non-small cell Lung cancer) comparing surgery to SBRT did show comparable local control and overall survival rates between surgery and SBRT, offering a very effective, noninvasive modality for older adult patients with early-stage NSCLC. In this review, we summarize the role of SBRT in early-stage NSCLC, in particularly applied to the older adult population.
Collapse
Affiliation(s)
- Ashwin Shinde
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Richard Li
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Jae Kim
- Department of Thoracic Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Ravi Salgia
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Arti Hurria
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Arya Amini
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, USA.
| |
Collapse
|
8
|
Tremmas I, Petsatodis G, Potoupnis M, Laskou S, Giannakidis D, Mantalovas S, Koulouris C, Katsaounis A, Pavlidis E, Amaniti A, Huang H, Bai C, Shi D, Dardas A, Zarogoulidis P, Sardeli C, Konstantinou F, Katsikogiannis N, Zarogoulidis K, Karapantzos I, Karapantzou C, Shen X, Kesisoglou I, Sapalidis K. Monitoring changes in quality of life in patients with lung cancer under treatment with chemotherapy and co administration of zoledronic acid by using specialized questionnaires. J Cancer 2018; 9:1731-1736. [PMID: 29805698 PMCID: PMC5968760 DOI: 10.7150/jca.24785] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 03/08/2018] [Indexed: 12/22/2022] Open
Abstract
Background: Due to the severity of the primary disease in patients with lung cancer, quality of life (QoL) is often overlooked. Factors that form QoL should be taken in consideration when planning the appropriate treatment and determining therapy targets, because of the increasing frequency of bone metastasis leading to high levels of pain. Purpose of this study is to assess quality of life in patients with lung cancer, before and after treatment combined with zoledronic acid. Methods and materials: QoL was assessed in 80 patients (49 males-31 females), of which 45 developed bone metastasis. Prior and post treatment (with co administration of zoledronic acid) seven reliable scales: Pittsburgh Sleep Quality index (PSQI), Epworth Sleeping Scale (ess), Dyspnea Scale (ds), Fatigue Severity Scale (FSS), Brief Pain Inventory (BPI), Fact-G scale for sleep quality and EQ-5D for general health condition. Results: Statistically positive correlations were verified between PSQI-DS, PSQI-FSS, BPI-ESS, DS-FSS, DS-BPI and BPI-FSS (p<0,005) prior and post treatment. Patients sleep quality was improved, pain levels decreased and betterment in quality of life was marked (p<0,001). Although significant decrease in fatigue levels was observed (p<0,001) there has been an increase in dyspnea symptoms (p<0,001). Conclusions: Significant improvement was apparent when zoledronic acid was co administered in any treatment in patients with lung cancer. Sleep quality, fatigue and pain parameters also improved, with no positive impact on the symptoms of dyspnea.
Collapse
Affiliation(s)
| | - George Petsatodis
- 1st Orthopaedic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Greece
| | - Michael Potoupnis
- Department of Orthopaedic Surgery, "G. Papageorgiou" General Hospital, Aristotle University of Thessaloniki, Greece
| | - Stella Laskou
- 3rd Department of Surgery, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - Dimitrios Giannakidis
- 3rd Department of Surgery, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - Stylianos Mantalovas
- 3rd Department of Surgery, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - Charilaos Koulouris
- 3rd Department of Surgery, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - Athanasios Katsaounis
- 3rd Department of Surgery, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - Efstathios Pavlidis
- 3rd Department of Surgery, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - Aikaterini Amaniti
- Anesthesiology Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - Haidong Huang
- Department of Respiratory and Critical Care Medicine, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Chong Bai
- Department of Respiratory and Critical Care Medicine, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Dongchen Shi
- Department of Respiratory and Critical Care Medicine, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Athanasios Dardas
- Scientific co-operator of Immunology - Histocompatibility Laboratory of "G. Papageorgiou" General Hospital, Thessaloniki Greece
| | - Paul Zarogoulidis
- Pulmonary-Oncology Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece
| | - Chrisanthi Sardeli
- Department of Pharmacology & Clinical Pharmacology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Fotis Konstantinou
- Thoracic Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Nikolaos Katsikogiannis
- Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Konstantinos Zarogoulidis
- Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Greece
| | - Ilias Karapantzos
- Ear, Nose and Throat Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece
| | - Chrysanthi Karapantzou
- Ear, Nose and Throat Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece
| | - Xiaping Shen
- Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Isaak Kesisoglou
- 3rd Department of Surgery, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - Konstantinos Sapalidis
- 3rd Department of Surgery, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| |
Collapse
|
9
|
Pompili C, Velikova G, White J, Callister M, Robson J, Dixon S, Franks K, Brunelli A. Poor preoperative patient-reported quality of life is associated with complications following pulmonary lobectomy for lung cancer. Eur J Cardiothorac Surg 2017; 51:526-531. [PMID: 28082473 DOI: 10.1093/ejcts/ezw363] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 09/05/2016] [Indexed: 12/20/2022] Open
Abstract
Objectives To assess whether quality of life (QOL) was associated with cardiopulmonary complications following pulmonary lobectomy for lung cancer. Methods Retrospective analysis of 200 consecutive patients who had pulmonary lobectomy for lung cancer (September 2014-October 2015). QOL was assessed by the self-administration of the European Organisation for Research and Treatment of Cancer QLQ-C30 questionnaire within 2 weeks before the operation. The individual QOL scales were tested for a possible association with cardiopulmonary complications along with other objective baseline and surgical parameters by univariable and multivariable analyses. Results Forty-three patients (21.5%) developed postoperative cardiopulmonary complications; 4 of them died within 30 days (2%). Univariable analysis showed that, compared to patients without complications, those with complications reported a lower global health status (GHS) [59.1; standard deviation (SD) 27.2 vs 69.6; SD 20.6, P = 0.02], were older (71.2; SD 8.4 vs 67.7; SD 9.4, P = 0.03), had lower values of forced expiratory volume in one second (FEV1) (83.9; SD 27.2 vs 91.4; SD 20.9), P = 0.06) and carbon monoxide lung diffusion capacity (DLCO) (67.9; SD 20.9 vs 74.2; SD 17.6, P = 0.02) and higher performance score (0.76; SD 0.63 vs 0.53; SD 0.64, P = 0.02). Stepwise logistic regression analysis showed that factors independently associated with cardiopulmonary complications were age [odds ratio (OR) 1.04, 95% CI 1.0-1.09, P = 0.02] and patient-reported GHS [OR 0.98, 95% confidence interval (CI) 0.96-0.99, P = 0.006], whereas other objective parameters (i.e. FEV1, DLCO) were not. The best cut-off value for GHS to discriminate patients with complications after surgery was 50 (c-index 0.65, 95% CI 0.58-0.72). Conclusions A poor GHS perceived by the patient was associated with postoperative cardiopulmonary morbidity. Patient perceptions and values should be included in the risk stratification process to tailor cancer treatment.
Collapse
Affiliation(s)
- Cecilia Pompili
- Leeds Institute of Cancer and Pathology, Section of Patient Centered Outcomes Research, Leeds, UK
| | - Galina Velikova
- Leeds Institute of Cancer and Pathology, Section of Patient Centered Outcomes Research, Leeds, UK
| | - John White
- Department of Thoracic Surgery, St. James's University Hospital, Leeds, UK
| | - Matthew Callister
- Department of Respiratory Medicine, St. James's University Hospital, Leeds, UK
| | - Jonathan Robson
- Department of Respiratory Medicine, St. James's University Hospital, Leeds, UK
| | - Sandra Dixon
- Department of Thoracic Surgery, St. James's University Hospital, Leeds, UK
| | - Kevin Franks
- Department of Clinical Oncology, St. James's University Hospital, Leeds, UK
| | | |
Collapse
|
10
|
Tanaka T, Morishita S, Hashimoto M, Itani Y, Mabuchi S, Kodama N, Hasegawa S, Domen K. Physical function and health-related quality of life in patients undergoing surgical treatment for malignant pleural mesothelioma. Support Care Cancer 2017; 25:2569-2575. [DOI: 10.1007/s00520-017-3666-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 03/06/2017] [Indexed: 10/20/2022]
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Abstract
Lung cancer is the leading cause of cancer-associated mortality in the USA. The median age at diagnosis of lung cancer is 70 years, and thus, about one-half of patients with lung cancer fall into the elderly subgroup. There is dearth of high level of evidence regarding the management of lung cancer in the elderly in the three broad stages of the disease including early-stage, locally advanced, and metastatic disease. A major reason for the lack of evidence is the underrepresentation of elderly in prospective randomized clinical trials. Due to the typical decline in physical and physiologic function associated with aging, most elderly do not meet the stringent eligibility criteria set forth in age-unselected clinical trials. In addition to performance status, ideally, comorbidity, cognitive, and psychological function, polypharmacy, social support, and patient preferences should be taken into account before applying prevailing treatment paradigms often derived in younger, healthier patients to the care of the elderly patient with lung cancer. The purpose of this chapter was to review the existing evidence of management of early-stage, locally advanced disease, and metastatic lung cancer in the elderly.
Collapse
Affiliation(s)
- Archana Rao
- Department of Medicine, Upstate Medical University, 750 E Adams Street, Syracuse, NY, 13210, USA
| | - Namita Sharma
- Department of Medicine, Upstate Medical University, 750 E Adams Street, Syracuse, NY, 13210, USA
| | - Ajeet Gajra
- Department of Medicine, Upstate Medical University, 750 E Adams Street, Syracuse, NY, 13210, USA.
| |
Collapse
|
13
|
Van Schil PE, Balduyck B, De Waele M, Hendriks JM, Hertoghs M, Lauwers P. Surgical treatment of early-stage non-small-cell lung cancer. EJC Suppl 2015. [PMID: 26217120 PMCID: PMC4041566 DOI: 10.1016/j.ejcsup.2013.07.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Surgical resection remains the standard of care for functionally operable early-stage non-small-cell lung cancer (NSCLC) and resectable stage IIIA disease. The role of invasive staging and restaging techniques is currently being debated, but they provide the largest biopsy samples which allow for precise mediastinal staging. Different types of operative procedures are currently available to the thoracic surgeon, and some of these interventions can be performed by video-assisted thoracic surgery (VATS) with the same oncological results as those by open thoracotomy. The principal aim of surgical treatment for NSCLC is to obtain a complete resection which has been precisely defined by a working group of the International Association for the Study of Lung Cancer (IASLC). Intraoperative staging of lung cancer is of utmost importance to decide on the extent of resection according to the intraoperative tumour (T) and nodal (N) status. Systematic nodal dissection is generally advocated to evaluate the hilar and mediastinal lymph nodes which are subdivided into seven zones according to the most recent 7th tumour-node-metastasis (TNM) classification. Lymph-node involvement not only determines prognosis but also the administration of adjuvant therapy. In 2011, a new multidisciplinary adenocarcinoma classification was published introducing the concepts of adenocarcinoma in situ and minimally invasive adenocarcinoma. This classification has profound surgical implications. The role of limited or sublobar resection, comprising anatomical segmentectomy and wide wedge resection, is reconsidered for early-stage lesions which are more frequently encountered with the recently introduced large screening programmes. Numerous retrospective non-randomised studies suggest that sublobar resection may be an acceptable surgical treatment for early lung cancers, also when performed by VATS. More tailored, personalised therapy has recently been introduced. Quality-of-life parameters and surgical quality indicators become increasingly important to determine the short-term and long-term impact of a surgical procedure. International databases currently collect extensive surgical data, allowing more precise calculation of mortality and morbidity according to predefined risk factors. Centralisation of care has been shown to improve results. Evidence-based guidelines should be further developed to provide optimal staging and therapeutic algorithms.
Collapse
Affiliation(s)
- Paul E Van Schil
- Antwerp University Hospital, Department of Thoracic and Vascular Surgery, Edegem, Antwerp, Belgium
| | - Bram Balduyck
- Antwerp University Hospital, Department of Thoracic and Vascular Surgery, Edegem, Antwerp, Belgium
| | - Michèle De Waele
- Antwerp University Hospital, Department of Thoracic and Vascular Surgery, Edegem, Antwerp, Belgium
| | - Jeroen M Hendriks
- Antwerp University Hospital, Department of Thoracic and Vascular Surgery, Edegem, Antwerp, Belgium
| | - Marjan Hertoghs
- Antwerp University Hospital, Department of Thoracic and Vascular Surgery, Edegem, Antwerp, Belgium
| | - Patrick Lauwers
- Antwerp University Hospital, Department of Thoracic and Vascular Surgery, Edegem, Antwerp, Belgium
| |
Collapse
|
14
|
Pompili C. Quality of life after lung resection for lung cancer. J Thorac Dis 2015; 7:S138-44. [PMID: 25984359 DOI: 10.3978/j.issn.2072-1439.2015.04.40] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 03/05/2015] [Indexed: 11/14/2022]
Abstract
Radical and palliative treatments for non-small cell lung cancer (NSCLC) have been reported to have a significant impact on the patient quality of life (QoL). The increasing improvements in lung cancer diagnosis and cures in recent years have changed the perspectives of quantity and quality of the life after cancer in these patients. However, despite a growing interest about patient reported outcome measures (PROMs) in surgical oncology, we are quite distant from a routine collection of QoL data after pulmonary resection for NSCLC. The presence of this gap is due to several reasons: the lack of validated surgical-specific questionnaires, the inappropriate consideration of traditional objective parameters as surrogates of QoL outcomes and the difficulties in dealing with missing items in this type of research. However, a recent the European Society of Thoracic Surgeons (ESTS) survey exploring the use of QoL data in our field has revealed that almost half of the units responding to the questionnaire collect QoL informations from their patients. Increased consensus and collaboration between surgeons are needed to include routinely PROMs in randomized controlled trials. The objective of this paper is to review the best available evidence published in the literature and regarding QoL after lung resection for cancer, aiming at identifying topics deserving further investigations.
Collapse
Affiliation(s)
- Cecilia Pompili
- Division of Thoracic Surgery, St. James' University Hospital, Leeds, UK
| |
Collapse
|
15
|
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]
|
16
|
Validity of the EuroQol-5 dimensions as a measure of recovery after pulmonary resection. J Surg Res 2014; 194:281-8. [PMID: 25499985 DOI: 10.1016/j.jss.2014.11.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 10/29/2014] [Accepted: 11/12/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND Surgical innovations advocated to improve patient recovery are often costly. Economic evaluation requires preference-based measures that reflect the construct of patient recovery. We investigated the responsiveness and construct validity of the EuroQol-5 dimensions (EQ-5D) as a measure of postoperative recovery after planned pulmonary resection for suspected malignant tumors. METHODS Patients undergoing pulmonary resection completed the EQ-5D questionnaire and visual analog scales (VAS) for pain and fatigue at baseline (preoperatively) and at 1 and 3 mo postoperatively. Responsiveness and construct validity (discriminant and convergent) were investigated by testing a priori hypotheses. RESULTS Fifty-five patients were analyzed (45% male, 62 ± 12 y, 29% video-assisted). There was no significant difference between median EQ-5D scores obtained at baseline (0.83 [interquartile range {IQR 0.80-1}]) compared to scores at 1 mo (0.83 [0.80-1], P = 0.86) and 3 mo after surgery (1 [0.83-1]; P = 0.09). At 1 mo after surgery, EQ-5D scores were significantly lower in patients undergoing thoracotomy versus video-assisted surgery (0.82 [IQR 0.77-0.89] versus 1 [0.83-1], P = 0.003), but there were no significant differences between patients ≥ 70-y old versus younger (0.95 [IQR 0.82-1] versus 0.83 [0.77-1], P = 0.09) or between patients with versus without complications (0.82 [IQR 0.79-0.95] versus 0.83 [0.80-1], P = 0.10). There was a low but significant correlation between EQ-5D and VAS scores of pain and fatigue (Rho -0.30 to -0.47, P ≤ 0.01). CONCLUSIONS Despite evidence of convergent validity, the EQ-5D was not sensitive to the hypothesized trajectory of postoperative recovery and showed limited discriminant validity. This study suggests that the EQ-5D may not be appropriate to value recovery after lung resection.
Collapse
|
17
|
Korc-Grodzicki B, Downey RJ, Shahrokni A, Kingham TP, Patel SG, Audisio RA. Surgical considerations in older adults with cancer. J Clin Oncol 2014; 32:2647-53. [PMID: 25071124 DOI: 10.1200/jco.2014.55.0962] [Citation(s) in RCA: 129] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE The aging of the population is a real concern for surgical oncologists, who are increasingly being asked to treat patients who would not have been considered for surgery in the past. In many cases, decisions are made with relatively little evidence, most of which was derived from trials in which older age was a limiting factor for recruitment. METHODS This review focuses on risk assessment and perioperative management. It describes the relationship between age and outcomes for colon, lung, hepatobiliary, and head and neck cancer, which are predominantly diseases of the elderly and are a major cause of morbidity and mortality. RESULTS Effective surgery requires safe performance as well as reasonable postoperative life expectancy and maintenance of quality of life. Treatment decisions for potentially vulnerable elderly patients should take into account data obtained from the evaluation of geriatric syndromes, such as frailty, functional and cognitive limitations, malnutrition, comorbidities, and polypharmacy, as well as social support. Postoperative care should include prevention and treatment of complications seen more frequently in the elderly, including postoperative delirium, functional decline, and the need for institutionalization. CONCLUSION Surgery remains the best modality for treatment of solid tumors, and chronologic age alone should not be a determinant for treatment decisions. With adequate perioperative risk stratification, functional assessment, and oncologic prognostication, elderly patients with cancer can do as well in terms of morbidity and mortality as their younger counterparts. If surgery is determined to be the appropriate treatment modality, patients should not be denied this option because of their age.
Collapse
Affiliation(s)
- Beatriz Korc-Grodzicki
- Beatriz Korc-Grodzicki, Robert J. Downey, Armin Shahrokni, T. Peter Kingham, and Snehal G. Patel, Memorial Sloan-Kettering Cancer Center, New York, NY; Riccardo A. Audisio, St Helens Teaching Hospital, University of Liverpool, St Helens, United Kingdom.
| | - Robert J Downey
- Beatriz Korc-Grodzicki, Robert J. Downey, Armin Shahrokni, T. Peter Kingham, and Snehal G. Patel, Memorial Sloan-Kettering Cancer Center, New York, NY; Riccardo A. Audisio, St Helens Teaching Hospital, University of Liverpool, St Helens, United Kingdom
| | - Armin Shahrokni
- Beatriz Korc-Grodzicki, Robert J. Downey, Armin Shahrokni, T. Peter Kingham, and Snehal G. Patel, Memorial Sloan-Kettering Cancer Center, New York, NY; Riccardo A. Audisio, St Helens Teaching Hospital, University of Liverpool, St Helens, United Kingdom
| | - T Peter Kingham
- Beatriz Korc-Grodzicki, Robert J. Downey, Armin Shahrokni, T. Peter Kingham, and Snehal G. Patel, Memorial Sloan-Kettering Cancer Center, New York, NY; Riccardo A. Audisio, St Helens Teaching Hospital, University of Liverpool, St Helens, United Kingdom
| | - Snehal G Patel
- Beatriz Korc-Grodzicki, Robert J. Downey, Armin Shahrokni, T. Peter Kingham, and Snehal G. Patel, Memorial Sloan-Kettering Cancer Center, New York, NY; Riccardo A. Audisio, St Helens Teaching Hospital, University of Liverpool, St Helens, United Kingdom
| | - Riccardo A Audisio
- Beatriz Korc-Grodzicki, Robert J. Downey, Armin Shahrokni, T. Peter Kingham, and Snehal G. Patel, Memorial Sloan-Kettering Cancer Center, New York, NY; Riccardo A. Audisio, St Helens Teaching Hospital, University of Liverpool, St Helens, United Kingdom
| |
Collapse
|
18
|
Lithoxopoulou H, Zarogoulidis K, Bostantzopoulou S, Eleftheriadou E, Zarogoulidis P, Huang H, Porpodis K, Kioumis I, Tsiouda T, Yarmus L, Kontakiotis T. Monitoring changes in quality of life in patients with lung cancer by using specialised questionnaires: implications for clinical practice. Support Care Cancer 2014; 22:2177-83. [DOI: 10.1007/s00520-014-2205-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 03/09/2014] [Indexed: 11/25/2022]
|
19
|
Peng Z, Li H, Zhang C, Qian X, Feng Z, Zhu S. A retrospective study of chronic post-surgical pain following thoracic surgery: prevalence, risk factors, incidence of neuropathic component, and impact on qualify of life. PLoS One 2014; 9:e90014. [PMID: 24587187 PMCID: PMC3938555 DOI: 10.1371/journal.pone.0090014] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 01/30/2014] [Indexed: 11/22/2022] Open
Abstract
Background Thoracic surgeries including thoracotomy and VATS are some of the highest risk procedures that often lead to CPSP, with or without a neuropathic component. This retrospective study aims to determine retrospectively the prevalence of CPSP following thoracic surgery, its predicting risk factors, the incidence of neuropathic component, and its impact on quality of life. Methods Patients who underwent thoracic surgeries including thoracotomy and VATS between 01/2010 and 12/2011 at the First Affiliated Hospital, School of Medicine, Zhejiang University were first contacted and screened for CPSP following thoracic surgery via phone interview. Patients who developed CPSP were then mailed with a battery of questionnaires, including a questionnaire referenced to Maguire's research, a validated Chinese version of the ID pain questionnaire, and a SF-36 Health Survey. Logistic regression analyses were subsequently performed to identify risk factors for CPSP following thoracic surgery and its neuropathic component. Results The point prevalence of CPSP following thoracic surgery was 24.9% (320/1284 patients), and the point prevalence of neuropathic component of CPSP was 32.5% (86/265 patients). CPSP following thoracic surgery did not improve significantly with time. Multiple predictive factors were identified for CPSP following thoracic surgery, including age<60 years old, female gender, prolonged duration of post-operative chest tube drainage (≥4 days), options of post-operative pain management, and pre-existing hypertension. Furthermore, patients who experienced CPSP following thoracic surgery were found to have significantly decreased physical function and worse quality of life, especially those with neuropathic component. Conclusions Our study demonstrated that nearly 1 out of 4 patients underwent thoracic surgery might develop CPSP, and one third of them accompanied with a neuropathic component. Early prevention as well as aggressive treatment is important for patients with CPSP following thoracic surgery to achieve a high quality of life.
Collapse
Affiliation(s)
- Zhiyou Peng
- Department of Anesthesiology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Huiling Li
- Department of Anesthesiology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Chong Zhang
- Department of Thoracic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Xiang Qian
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, United States of America
| | - Zhiying Feng
- Department of Anesthesiology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
- * E-mail:
| | - Shengmei Zhu
- Department of Anesthesiology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| |
Collapse
|
20
|
Lung surgery in the elderly today. Lung Cancer 2013; 80:115-9. [DOI: 10.1016/j.lungcan.2013.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 11/08/2012] [Accepted: 01/04/2013] [Indexed: 12/20/2022]
|
21
|
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.
Collapse
Affiliation(s)
- Stefan Welter
- Division of Thoracic Surgery, Ruhrlandklinik, West German Lung Center, University Hospital, University of Duisburg-Essen, Essen, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
22
|
McCloskey P, Balduyck B, Van Schil PE, Faivre-Finn C, O'Brien M. Radical treatment of non-small cell lung cancer during the last 5 years. Eur J Cancer 2013; 49:1555-64. [PMID: 23352436 DOI: 10.1016/j.ejca.2012.12.023] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 12/21/2012] [Indexed: 12/25/2022]
Abstract
The management of non-small cell lung cancer (NSCLC) has continued to improve over the last 5 years due to advances in surgery, radiological staging, combined modality therapies and advances in radiation technology. We have an updated staging classification (7th Edition American Joint Committee on Cancer staging) and now in 2011, a new histology classification introducing the concepts of adenocarcinoma in situ and minimally invasive adenocarcinoma. This classification has profound surgical implications as the role of limited resection is reconsidered for early stage lesions. Surgery is curative in early stage disease. The role of surgery in locally advanced NSCLC remains controversial. The principal aim is a complete resection as this will determine long-term prognosis. Intraoperative staging of lung cancer is extremely important to determine the extent of resection according to the tumour and nodal status. Systematic nodal dissection is generally advocated to obtain accurate intraoperative staging and to help decide on adjuvant therapy. Radiotherapy currently plays a major role in the management of lung cancer as most patients are not surgical candidates due to disease stage, fitness and co-morbidities. In the last 5 years we have seen continuing optimisation of chemo-radiotherapy combinations and technological advances including the development of image guided radiotherapy (IGRT), stereotactic ablative body radiotherapy (SABR) and intensity modulated radiotherapy (IMRT). Quality of life evaluation is becoming increasingly important and should be considered when deciding on a specific treatment, especially in a multimodality setting.
Collapse
Affiliation(s)
- Paula McCloskey
- Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | | | | | | | | |
Collapse
|
23
|
Brunelli A, Pompili C, Koller M. Changes in Quality of Life After Pulmonary Resection. Thorac Surg Clin 2012; 22:471-85. [DOI: 10.1016/j.thorsurg.2012.07.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
24
|
Ganai S, Ferguson MK. Quality of Life in the High-Risk Candidate for Lung Resection. Thorac Surg Clin 2012; 22:497-508. [DOI: 10.1016/j.thorsurg.2012.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
|
25
|
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.
Collapse
Affiliation(s)
- D Fitzsimmons
- Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Singleton Park, Swansea, United Kingdom
| | | | | |
Collapse
|
26
|
Pallis AG, Scarci M. Are we treating enough elderly patients with early stage non-small cell lung cancer? Lung Cancer 2011; 74:149-54. [PMID: 21696842 DOI: 10.1016/j.lungcan.2011.05.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Revised: 05/24/2011] [Accepted: 05/25/2011] [Indexed: 10/18/2022]
Abstract
Despite the fact that non-small-cell lung cancer (NSCLC) is very common in the older population, these patients are frequently underrepresented in clinical trials evaluating new anti-cancer agents, and thus it is difficult to reach evidence-based recommendations for this special population. The purpose of the present paper is to present the currently available evidence regarding treatment of early-stages of NSCLC in older patients. Although, age is still considered as a negative factor influencing treatment decisions and curative cancer-directed surgery is often omitted in the older population several studies support that surgical resection is feasible in the older patient and that age per se is not a contraindication for various surgical procedures. Pneumonectomy is associated with a higher mortality in the older population and this issue should be taken into account when deciding whether a patient is suitable for pneumonectomy. Older patients should be considered for adjuvant chemotherapy after surgical resection although little information is available regarding the real benefit and tolerability of these regimens for patients over 75 years of age. Given the lack of demonstrated benefit for the use of adjuvant RT it is also not recommended in older population.
Collapse
Affiliation(s)
- A G Pallis
- Department of Medical Oncology, University General Hospital of Heraklion, Voutes-Stavrakion Embranchement, 71305 Heraklion, Greece.
| | | |
Collapse
|
27
|
Pompili C, Brunelli A, Xiumé F, Refai M, Salati M, Sabbatini A. Predictors of postoperative decline in quality of life after major lung resections. Eur J Cardiothorac Surg 2011; 39:732-7. [DOI: 10.1016/j.ejcts.2010.08.046] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Revised: 08/26/2010] [Accepted: 08/30/2010] [Indexed: 10/19/2022] Open
|
28
|
Miaskowski C. Outcome measures to evaluate the effectiveness of pain management in older adults with cancer. Oncol Nurs Forum 2010; 37 Suppl:27-32. [PMID: 20797940 DOI: 10.1188/10.onf.s1.27-32] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To identify the most appropriate outcome measures to determine the effectiveness of pain management plans in older adults with cancer. DATA SOURCES PubMed literature searches, medical and nursing textbooks, and clinical experience. DATA SYNTHESIS Unrelieved chronic pain can have a significant impact on older adults' activity levels and their ability to function. Hence, effective pain management in older adults requires a comprehensive approach, including assessment of functional outcomes. Because the goals of pain management are broad, healthcare professionals should use an array of functional outcome measures along with pain intensity ratings to better assess the effectiveness of analgesic medications. CONCLUSIONS Particularly in older adults, evaluation of functional outcomes provides a better indication of the effectiveness of pain management strategies than pain intensity ratings. Appropriate outcome measures for older adults in the outpatient setting include pain relief, physical functioning, emotional functioning, patients' ratings of global improvement and satisfaction with treatment, and symptoms and adverse effects associated with analgesic medications. IMPLICATIONS FOR NURSING Healthcare providers should manage pain in older adults with cancer in an interdisciplinary environment with pharmacologic and nonpharmacologic interventions. The primary goals are decreasing pain and improving function and quality of life.
Collapse
Affiliation(s)
- Christine Miaskowski
- Department of Physiological Nursing, University of California, San Francisco, USA.
| |
Collapse
|
29
|
Clinical registries: a quantum of knowledge. Eur J Cardiothorac Surg 2010; 39:987-8. [PMID: 20971651 DOI: 10.1016/j.ejcts.2010.09.024] [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: 09/16/2010] [Revised: 09/16/2010] [Accepted: 09/17/2010] [Indexed: 11/22/2022] Open
|
30
|
|
31
|
Chambers A, Routledge T, Pilling J, Scarci M. In elderly patients with lung cancer is resection justified in terms of morbidity, mortality and residual quality of life? Interact Cardiovasc Thorac Surg 2010; 10:1015-21. [DOI: 10.1510/icvts.2010.233189] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
|
32
|
Changes in Quality of Life After Lung Surgery in Old and Young Patients: Are They Similar? World J Surg 2010; 34:684-91. [DOI: 10.1007/s00268-010-0430-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
33
|
|