Impact on Health-Related Quality of Life of Video-Assisted Thoracoscopic Surgery for Lung Cancer

Abstract

Background. Video-assisted thoracoscopic surgery (VATS) approaches are increasingly used in lung cancer surgery, but little is known about their impact on patients' health-related quality of life (HRQL). This prospective study measured recovery and HRQL in the year after VATS for non-small cell lung cancer (NSCLC) and explored the feasibility of HRQL data collection in patients undergoing VATS or open lung resection. Patients and Methods. Consecutive patients referred for surgical assessment (VATS or open surgery) for proven/suspected NSCLC completed HRQL and fatigue assessments before and 1, 3, 6 and 12 months post-surgery. Mean HRQL scores were calculated for patients who underwent VATS (segmental, wedge or lobectomy resection). Paired t-tests compared mean HRQL between baseline and expected worst (1 month), early (3 months) and longer-term (12 months) recovery time points. Results. A total of 92 patients received VATS, and 18 open surgery. Questionnaire response rates were high (presurgery 96-100%; follow-up 67-85%). Pre-surgery, VATS patients reported mostly high (good) functional health scores [(European Organisation for Research and Treatment of Cancer) EORTC function scores [ 80] and low (mild) symptom scores (EORTC symptom scores \ 20). One-month post-surgery, patients reported clinically and statistically significant deterioration in overall health and physical, role and social function (19-36 points), and increased fatigue, pain, dyspnoea, appetite loss and constipation [EORTC 12-26; multidimensional fatigue inventory (MFI-20) 3-5]. HRQL had not fully recovered 12 months post-surgery, with reduced physical, role and social function (10-14) and persistent fatigue and dyspnoea (EORTC 12-22; MFI-20 2.7-3.2). Conclusions. Lung resection has a considerable detrimental impact on patients' HRQL that is not fully resolved 12 months post-surgery, despite a VATS approach.

Effect of Exercise Training on Quality of Life after Colorectal and Lung Cancer Surgery: A Meta-Analysis

“…In the early stages of these tumors, surgical resection is the primary treatment modality, and the intervention associated with better long-term prognosis [ 2 , 3 ]. However, as a result of surgical resection, there is a significant deterioration in patients’ health-related quality of life (HRQoL) [ 4 , 5 , 6 , 7 , 8 , 9 ].…”

“…A study conducted after lobectomy found that 100% of the patients reported being concerned about the limitations in their physical function and 96% about the levels of fatigue and pain [ 10 ]. Although, in general, HRQoL progressively returns to preoperative levels between 3 to 6 months after LC surgery, it has been shown that domains like physical function, fatigue and dyspnea persist significantly worse than at the preoperative phase for at least 1 to 2 years after surgery [ 4 , 7 , 9 , 11 , 12 , 13 ], even in patients selected for LC resection by video-assisted thoracoscopic surgery (VATS) approaches [ 4 ].…”

Physical function and health-related quality of life after surgery for nontuberculous mycobacterium pulmonary disease: a prospective cohort study

“…The continuation of chemotherapy may contribute to a lack of improvement in HRQOL after lung resection. In patients who undergo lung resection for cancer, HRQOL does not recover to the preoperative level by 1 year postoperatively [24], [25], and lower HRQOL is associated with continued postoperative chemotherapy [24]. Thus, continued chemotherapy might also decrease HRQOL in patients who undergo surgery for NTM-PD.…”

Feasibility study of a randomised controlled trial of pre and postoperative nutritional supplementation in major lung surgery

“…Through nutritional supplementation one might be able to optimise recovery after surgery and preventing complications. 23…”