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Clinical Investigations: SURGERY |

What Happens to Patients Undergoing Lung Cancer Surgery?*: Outcomes and Quality of Life Before and After Surgery

John R. Handy, Jr, MD, FCCP; James W. Asaph, MD, FCCP; Laurie Skokan, PhD; Carolyn E. Reed, MD, FCCP; Sydney Koh, RN; Gladney Brooks, FNP; E. Charles Douville, MD; Andrew C. Tsen, MD; Gary Y. Ott, MD; Gerard A. Silvestri, MD, FCCP
Author and Funding Information

*From the Division of Cardiothoracic Surgery (Drs. Handy, Douville, Tsen, and Ott, and Ms. Koh), The Oregon Clinic, Portland, OR; the Earle A. Chiles Research Institute (Dr. Asaph), Providence Portland Medical Center, Portland, OR; the Center for Outcomes Research and Education (Dr. Skokan), Providence Health Systems, Portland, OR; the Divisions of Cardiothoracic Surgery, Pulmonary and Critical Care Medicine, and The Center for Health Care Research (Drs. Reed, Brooks, and Silvestri), Medical University of South Carolina, Charleston, SC.

Correspondence to: John R. Handy Jr., MD, FCCP, Division of Cardiothoracic Surgery, The Oregon Clinic, 507 NE 47th Ave, Portland, OR, 97213; e-mail: jhandy@orclinic.com



Chest. 2002;122(1):21-30. doi:10.1378/chest.122.1.21
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Objective: To compare baseline preoperative and 6-month postoperative functional health status and quality of life in patients undergoing lung cancer resection.

Methods: Lung cancer surgery patients from three hospitals were administered the Short-Form 36 Health Survey (SF-36) and the Ferrans and Powers’ quality-of-life index (QLI) before surgery and 6 months after surgery. Preoperative, intraoperative, hospital stay, and 6-month postoperative clinical data were collected. All p values ≤ 0.05 were considered significant.

Results: One hundred thirty-nine patients were studied; 131 patients were discharged and 8 patients (5.8%) died. One hundred three patients (78.6%) who survived underwent an evaluation at 6 months, 16 patients (12.2%) died during follow-up, 2 patients refused follow-up, 4 patients were unavailable for follow-up, and 6 patients are awaiting an evaluation at 6 months. Compared with matched healthy subjects, preoperative lung cancer patients had worse results on the SF-36 physical functioning, role–emotional, mental health, and energy subscales. At 6 months, SF-36 subscales for physical functioning, role–physical, bodily pain, and mental health were significantly worse than preoperative values. The visual analog pain scale was significantly worse at follow-up. The QLI with all subscales and SF-36 for role–emotional, energy, and general health subscales were unaffected by lung cancer resection. Whereas preoperative FEV1 and 6-min walk results did not predict postoperative functional health status or QLI, a low preoperative diffusion capacity of the lung for carbon monoxide (Dlco) predicted poor postoperative QLI. Preoperative chemoradiation, extent of resection, postoperative complications, or adjuvant therapy did not negatively affect the results of the 6-month QLI or SF-36.

Conclusions: Preoperative functional health status in patients who undergo lung cancer surgery is significantly impaired. A significant number of patients die during the 6 months after surgery. Pain and impairment of functional health status persists for 6 months after lung cancer resection. Dlco, not FEV1, predicts postoperative quality of life. Preoperative chemoradiation, extent of resection, postoperative complications, or adjuvant therapy do not adversely affect functional health status or quality of life 6 months after surgery. Future studies should focus on risk prediction, technical improvements, and postoperative intervention to improve the functional outcomes and quality of life after lung cancer surgery.

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