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