Patient-Reported Symptom Interference as a Measure of Postsurgery Functional Recovery in Lung Cancer

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• 作者：Qiuling Shi ; PhD^a ; Xin Shelley Wang ; MD ; MPH^a ; ^{xswang@mdanderson.org} ; Ara A. Vaporciyan ; MD ; FACS^b ; David C. Rice ; MD^b ; Keyuri U. Popat ; MD^c ; Charles S. Cleeland ; PhD^a
• 关键词：Postoperative care ; thoracoscopy ; VATS ; thoracotomy ; quality of care ; symptom management ; outcomes
• 刊名：Journal of Pain and Symptom Management
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：52
• 期：6
• 页码：822-831
• 全文大小：186 K
• 卷排序：52

文摘

Few empirical studies have combined the patient's perspective (patient-reported outcomes [PROs]) with clinical outcomes (risk for complications, length of hospital stay, return to planned treatment) to assess the effectiveness of treatment after thoracic surgery for early-stage non–small cell lung cancer (NSCLC).ObjectivesQuantitatively measure PROs to assess functional recovery postsurgery.MethodsTreatment-naïve patients (N = 72) with NSCLC who underwent either open thoracotomy or video-assisted thoracoscopic surgery (VATS) used the MD Anderson Symptom Inventory (MDASI) to report symptom interference with general activity, work, walking, mood, relations with others, and enjoyment of life for three months after surgery. Functional recovery was defined as interference scores returning to presurgery levels. The MDASI's sensitivity to change in functional recovery over time was evaluated via its ability to distinguish between surgical techniques.ResultsInterference scores increased sharply by Day 3 after surgery (all P < 0.001), then returned to baseline levels via different trajectories. Patients who had unscheduled clinic visits during the study period reported higher scores on all six MDASI interference items (all P < 0.05). Compared with the open-thoracotomy group, the VATS group returned more quickly to baseline interference levels for walking (18 vs. 43 days), mood (8 vs. 19 days), relations with others (4 vs. 16 days), and enjoyment of life (15 vs. 41 days) (all P < 0.05).ConclusionRepeated measurement of MDASI interference characterized functional recovery after thoracic surgery for NSCLC and was sensitive to VATS' ability to enhance postoperative recovery. Further study of the clinical applicability of measuring recovery outcomes using PRO-based functional assessment is warranted.