Elsevier

Lung Cancer

Volume 81, Issue 1, July 2013, Pages 11-26
Lung Cancer

Review
Health-related quality of life after surgical treatment in patients with non-small cell lung cancer: A systematic review

https://doi.org/10.1016/j.lungcan.2013.03.013Get rights and content

Abstract

Introduction

Surgical resection currently is the best available treatment to enhance long-term survival after non-small cell lung cancer (NSCLC). With the anticipated growth in the number of NSCLC survivors diagnosed through computed tomography screening, health-related quality of life (HR-QOL) as an endpoint of treatment will become increasingly important. This article is a systematic review of the literature regarding HR-QOL in patients after surgical treatment.

Methods

Three computerized databases (PubMed, Medline, and CINHAL) were used to identify relevant articles. Inclusion criteria were: empirical studies English language, assessment of HR-QOL after surgical treatment for stage I, II, or III NSCLC, and publication prior to January 2012. Data were abstracted and content analyses were used to synthesize the findings.

Results

Nineteen out of 337 studies were reviewed. The majority of participants (67%) had stable or improved mental HR-QOL at 6-months after surgery. Compared with the general population, however, NSCLC survivors have poorer mental HR-QOL. Compared to pre-surgical status, participants had worse physical function at 6-months after surgery and had decreased physical function up to 2-years after surgery. Pain, fatigue, dyspnea and coughing were the most prevalent symptoms. Increased levels of dyspnea and fatigue persisted for at least 2-years after surgery. Continued smoking, presence of comorbidities, extensive surgical resection, and use of adjuvant therapy were associated with lower HR-QOL.

Conclusions

New interventions focused on smoking cessation, improving symptom control and physical function are needed to enhance HR-QOL after lung cancer surgery.

Introduction

There are an estimated 374,000 lung cancer survivors in the United States [1]. Given that lung cancer screening is associated with increased survival, with increased screening, an increase in the number of lung cancer cases is expected to occur [2]. As the length of survival grows, attention toward maintaining an adequate health-related quality of life (HR-QOL) will assume greater importance [3], [4], [5].

Surgery is the best treatment to enhance survival among patients with early stage non-small cell lung cancer (NSCLC) [6], defined as stages I–II. In some instances, persons with locally advanced NSCLC, defined as stage IIIA, may be surgical candidates but this approach often adversely affects HR-QOL [7]. The purpose of this study was to synthesize evidence regarding HR-QOL in patients after surgical treatment for stage I, II, or III NSCLC. The following research questions are addressed in this review: (1) What changes in HR-QOL occur after surgical treatment for stage I, II, or III NSCLC? and (2) What patient sociodemographic and clinical characteristics are associated with changes in post-operative HR-QOL scores?

Section snippets

Literature search

Three electronic databases were searched: MEDLINE, PubMed, and CINAHL, using keywords “health related quality of life”, “quality of life”, “lung cancer”, “measurement”, “assessment”, “pulmonary resection”, and “surgery”. Additional keywords were added as well, such as “lobectomy”, “pneumonectomy”, “thoracotomy” and “instruments”. The inclusion criteria for studies were: empirical studies, English language, and that the studies examined HR-QOL after surgical treatment for stage I, II, or III

Results

Results of the studies are organized by HR-QOL domains and by instrument. In this review, three domains of HR-QOL are reported: mental, physical, and symptoms. Eleven (58%) studies used the SF-36 [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18] and eight (42%) studies used the EORTC QLQ-C30 with its lung cancer module the EORTC QLQ-LC13 [19], [20], [21], [22], [23], [24], [25], [26] to measure HR-QOL. The SF-36 scale was used alone in most studies, however, 3 of 11 studies (27%)

Discussion

This review focused on examining the impact of lung cancer surgery on HR-QOL, which is an important clinical outcome. The data from the included studies generated reference tables for HR-QOL values across time-periods and among various patient-related and treatment characteristics. These data can be used to compare HR-QOL scores and the expected course for recovery across time and among various treatments.

The findings regarding mental HR-QOL revealed that the majority of patients had improved

Conclusion

A small but substantial number of patients continue to have poor mental HR-QOL following surgery highlighting the importance of screening for psychosocial distress. It appears that the majority of patients have decreased physical functioning after surgery, which can last up to two-years. Patients at-risk for experiencing lower HR-QOL include those who continue to smoke, have multiple comorbidities, and received extensive surgical resection, and/or adjuvant therapies. Thus, these groups may

Conflict of interest statement

None declared.

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