Change in quality of life of stage IA lung cancer patients after sublobar resection and lobectomy

Fevrier, E.; Yip, Rowena; Becker, Betsy Jane; Taioli, Emanuela; Yankelevitz, David F.; Flores, Raja M.; Henschke, Claudia I.; Investigators, Ielcart

doi:10.21037/jtd-20-402

Cited by 13 publications

(18 citation statements)

References 30 publications

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“… 10 , 11 , 12 Furthermore, a recent study from the I-ELCART group revealed that older patients with NSCLC who had underwent wedge had better quality of life scores postoperatively compared with lobectomy. 19 Therefore, patients who might have a compromised health should be counseled on the trade-offs associated with the different surgical options available for NSCLC. These concepts may potentially be extended to other forms of local therapy with lower potential for local control than lobectomy.…”

Section: Discussionmentioning

confidence: 99%

“… 13 , 14 , 15 Finally, a limited literature suggests that for patients with significant lung disease, quality of life after sublobar is superior to that following lobectomy. 16 , 17 , 18 , 19 , 20 As a result, many patients with early-stage NSCLC must strike a balance between procedures that may maximize how long they will live, with procedures that maximize how well they recover.…”

Section: Introductionmentioning

confidence: 99%

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The Survival Advantage of Lobectomy over Wedge Resection Lessens as Health-Related Life Expectancy Decreases

Salazar

Canavan

Walters

et al. 2021

JTO Clinical and Research Reports

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Introduction Patients with early-stage NSCLC typically must choose between a surgery with superior local control (lobectomy) or one that preserves lung parenchyma (wedge). Recognizing that many patients with cancer have competing mortality risks unrelated to cancer, we investigated whether an established model of predicting life expectancy could be used to identify patients with stage I NSCLC for whom survival after wedge is not different from lobectomy. Methods A retrospective cohort study using the National Cancer Institute’s Surveillance Epidemiology and End Results—Medicare was performed to evaluate survival among treatment-naive patients, diagnosed 2005–2015, who underwent lobectomy or wedge for stage I (≤2 cm tumors) NSCLC. Comorbidity-related life expectancy (CR-LE) was estimated using a standard life-table approach based on comorbid conditions, sex, and age. Cox models and perioperative complications were stratified by 5-year CR-LE. Results A total of 4560 patients (median age 74, interquartile range 70–78) were identified. CR-LE was greater than or equal to 5 years for 4016 patients (wedge = 23%). CR-LE was less than 5 years for 544 patients (wedge = 41%). Among patients with CR-LE greater than or equal to 5, wedge resection was associated with higher risk of mortality than lobectomy (hazard ratio: 1.68, 95% confidence interval: 1.52–1.86, p < 0.001). For those with CR-LE less than 5, there was no significant difference in mortality risk between lobectomy and wedge (hazard ratio: 1.19, 95% confidence interval: 0.96–1.47; p = 0.11). CR-LE less than five patients who underwent a lobectomy had higher 90-day mortality compared with wedge (9% versus 4%, p = 0.04). Conclusion The survival advantage of lobectomy over wedge for stage I NSCLC seems to dissipate among patients with shorter life expectancy owing to age and comorbidities. Wedge resection may be a reasonable option for patients at high risk of dying from non–cancer-related causes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Survival Advantage of Lobectomy over Wedge Resection Lessens as Health-Related Life Expectancy Decreases

Salazar

Canavan

Walters

et al. 2021

JTO Clinical and Research Reports

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“…In Table 6 (102)(103)(104)(105)(106)(107)(108)(109)(110)(111)(112)(113)(114)(115)(116)(117) and Table 7 (11,24,(118)(119)(120)(121)(122)(123)(124)(125)(126)(127)(128)(129)(130) postoperative QOL results are depicted reflecting no change, or small, moderate or large changes vs. baseline by generally accepted thresholds for clinically meaningful differences (128,(131)(132)(133)(134)(135)(136). Table 6 is mostly yellow (i.e., no change); these studies used the SF-36 tool (why this tool appears less sensitive is unclear; little change remains when using lower proposed thresholds for clinically meaningful differences).…”

Section: Long-term Qolmentioning

confidence: 99%

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

Detterbeck¹,

Mase²,

Li³

et al. 2022

J Thorac Dis

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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.

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“… 10 Patients who underwent sublobar resections have reported fewer health-related QoL symptoms 12 mo after surgery compared with patients who underwent lobectomy. 11 , 12 …”

mentioning

confidence: 99%

“…10 Patients who underwent sublobar resections have reported fewer health-related QoL symptoms 12 mo after surgery compared with patients who underwent lobectomy. 11,12 There has been little research into NSCLC patient preferences regarding surgical treatment. Despite guidance encouraging discussions of treatment options for early-stage NSCLC, patients often feel that they get incomplete lists of treatment options from their clinicians.…”

mentioning

confidence: 99%

Early-Stage Lung Cancer Patients’ Perceptions of Presurgical Discussions

Yip

You

Gillezeau

et al. 2022

MDM Policy & Practice

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Background Patients with early-stage non–small-cell lung cancer (NSCLC) have high survival rates, but patients often say they did not anticipate the effect of the surgery on their postsurgical quality of life (QoL). This study adds to the literature regarding patient and surgeon interactions and highlights the areas where the current approach is not providing good communication. Design Since its start in 2016, the Initiative for Early Lung Cancer Research on Treatment (IELCART), a prospective cohort study, has enrolled 543 patients who underwent surgery for stage I NSCLC within the Mount Sinai Health System. Presurgical patient and surgeon surveys were available for 314 patients, postsurgical surveys for 420, and both pre- and postsurgical surveys for 285. Results Of patients with presurgical surveys, 31.2% said that their surgeon recommended multiple types of treatment. Of patients with postsurgical surveys, 85.0% felt very well prepared and 11.4% moderately well prepared for their postsurgical recovery. The median Functional Assessment of Cancer Therapy–Lung Cancer score and social support score of the patients who felt very well prepared was significantly higher than those moderately or not well prepared (24.0 v. 22.0, P < 0.001) and (5.0 [interquartile range: 4.7–5.0] v. 5.0 [IQR: 4.2–5.0], p = 0.015). Conclusions This study provides insight into the areas where surgeons are communicating well with their patients as well as the areas where patients still feel uninformed. Most surgeons feel that they prepare their patients well or very well for surgical recovery, whereas some patients still feel that their surgeons did not prepare them well for postsurgical recovery. Surgeons may want to spend additional time emphasizing postsurgical recovery and QoL with their patients or provide their patients with additional avenues to get their questions and concerns addressed. Highlights Pretreatment discussions could help surgeons understand patient priorities and patients understand the anticipated outcomes for their surgeries. There is an association between feeling prepared for surgery and higher quality of life and social support scores after adjustment for confounders. Despite these pretreatment discussions, patients still feel that they are not well prepared about what to expect during their postsurgical recovery.

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Change in quality of life of stage IA lung cancer patients after sublobar resection and lobectomy

Cited by 13 publications

References 30 publications

The Survival Advantage of Lobectomy over Wedge Resection Lessens as Health-Related Life Expectancy Decreases

The Survival Advantage of Lobectomy over Wedge Resection Lessens as Health-Related Life Expectancy Decreases

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

Early-Stage Lung Cancer Patients’ Perceptions of Presurgical Discussions

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