Original article
General thoracic
Quality of Life Before and After Major Lung Resection for Lung Cancer: A Prospective Follow-Up Analysis

https://doi.org/10.1016/j.athoracsur.2007.04.019Get rights and content

Background

The objective of this study was to assess the preoperative and postoperative quality of life of candidates for major lung resection with lung cancer.

Methods

In all, 156 consecutive patients (144 lobectomies, 12 pneumonectomies) were prospectively assessed by means of the Short Form-36 Health Survey, version 2, preoperatively and 1 month and 3 months after operation. Serial quality of life scales were compared by repeated measures analysis of variance.

Results

In our series, most quality of life values were reduced compared with the general population. Compared with preoperative values, the physical composite scale was significantly reduced at 1 month (51 versus 45.1, p < 0.0001), and completely recovered at 3 months (51 versus 52.4, p = 0.2), whereas the mental composite scale remained unchanged. All correlation coefficients between these values and forced expiratory volume in 1 second, carbon monoxide lung diffusion capacity, and height reached at stair-climbing test at each evaluation period were below 0.2. With the exception of pneumonectomy patients (who had a significantly lower physical composite scale [p = 0.04]), no significant differences in both physical and mental values were noted in other high-risk subgroups of patients (elderly, coronary artery disease, poor pulmonary function) compared with lower-risk counterparts.

Conclusions

Candidates for lung resection with lung cancer had a worse preoperative quality of life compared with the general population. Quality-of-life measures had poor correlation with forced expiratory volume in 1 second, carbon monoxide lung diffusion capacity, and exercise test performance. Therefore, these functional variables cannot substitute for specific evaluation instruments. Finally, patients traditionally considered at higher risk for lung resection had postoperative physical and emotional quality of life scores similar to those observed in younger and fitter patients.

Section snippets

Population

One hundred ninety-one consecutive patients underwent major lung resection for nonsmall-cell lung cancer at our unit from July 2004 through September 2006 and were prospectively enrolled in this study. The study was approved by the local Institutional Review Board of the hospital, and all patients gave their informed consent to participate in the study. Postoperative early mortality was 2.6% (5 cases). Of the 186 patients surviving the operation, a total of 156 patients had complete

Results

The characteristics of the patients enrolled in the study are shown in Table 1. Twenty-two patients were treated by neoadjuvant chemotherapy before operation. These patients had a similar preoperative MCS score (47.5 versus 46.8, p = 0.7), but significantly lower PCS score (46.3 versus 51.8, p = 0.003) compared with those not treated.

Figure 1 shows the box plot of the PCS and MCS scores at different evaluation periods. In particular, compared with preoperative values, the PCS was significantly

Comment

The patients’ perspective about the surgical risk of lung resection may differ from that of the surgeons. What patients fear most is not an increased risk of perioperative major morbidity or mortality, but to be left physically and mentally handicapped and not be able anymore to resume an acceptable daily lifestyle [1]. Therefore, reliable information about the anticipated residual QOL should always complement the traditional data concerning early outcome and long-term survival whenever

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