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Symptom Trajectories Informing Patient Care After Lung Cancer Surgery: A Longitudinal Patient-Reported Outcome Study

  • Global Health Services Research
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Application of patient-reported outcomes (PROs) in surgical oncology has been limited because of patient heterogeneity. We analyzed symptom trajectories and their associations with recovery outcomes after lung cancer surgery, aiming to profile the heterogeneity of patients’ experiences and to identify patients needing extensive care.

Methods

Symptoms were assessed with the MDASI-LC before surgery, daily after surgery in hospital and weekly within 1 month after discharge. Patients were clustered based on symptoms from post-operative day 1 (POD1) to POD5, using the latent-class-trajectory-model. Functional recovery was compared across the trajectories. Logistic regression was used to explore risk factors for trajectories of more severe symptoms.

Results

Based on the five most severe post-surgery symptoms (pain, fatigue, coughing, shortness of breath, and disturbed sleep), we identified three distinct symptom trajectories among 424 patients [mild, N = 225 (53.07%); severe-to-mild, N = 86 (20.28%); severe, N = 104 (24.53%)]. At discharge, more ‘severe’ patients (73.96%) did not achieve a functional recovery compared with those in mild (32.54%, P < 0.0001) or severe-to-mild (56.96%, P = 0.0274) groups. Factors of significant symptom increase on POD1 were younger-than-55 (OR = 1.94 [95% CI 1.30–2.93], P = 0.001), undergoing open or multi-port video-assisted thoracoscopic surgery (OR = 1.59 [95% CI 1.05–2.41], P = 0.03), and using two chest tubes (OR = 1.72 [95% CI 1.12–2.65], P = 0.01). For patients experiencing dramatic symptom increase on POD1, older age (OR = 2.51 [95% CI 1.40–4.59], P = 0.002) was associated with ‘severe’ trajectory.

Conclusions

This study demonstrated that PRO measures were capable of profiling heterogeneous symptom trajectories after lung cancer surgery. Those in-hospital trajectories were able to differentiate patients’ responses to treatments and signal the needs for extensive post-discharge care.

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Acknowledgement

We thank the patients and staff at the participating centers. We thank Yuxian Nie, Yaqin Wang, and Jia Liao for help with the data collection. We would also like to thank Editage (www.editage.com) for English language edits.

Funding

This work was supported by National Natural Science Foundation of China (No. 81872506).

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Authors and Affiliations

  1. State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, School of Public Health and Management, Chongqing Medical University, Yuzhong District, Chongqing, 400016, China

    Li Tang MD & Qiuling Shi MD

  2. School of Public Health, Chongqing Medical University, Chongqing, China

    Hongfan Yu BSC & Qiuling Shi MD

  3. Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, Chengdu, Sichuan, China

    Wei Dai MD, Xiaojun Yang MD, Xing Wei MD & Qiang Li MD

  4. Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Xin Shelley Wang MD & Charles S. Cleeland MD

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  1. Li Tang MD
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Contributions

Conceptualization: QS, QL, CC, XW; Data curation: QS, LT, HY, WD, XW, QL, XY; Formal analysis: QS, LT, HY, XW; Funding acquisition: QS; Investigation: QS, LT, HY, XW, XW; Methodology: QS, LT, HY, XW; Project administration: QS, QL; Resources: LT, WD, XW; Software: QS, LT, HY; Supervision: HY, WD, XW; Validation: QS, LT, HY; Visualization: HY, WD, XW; Writing – original draft: QS, LT; Writing – review & editing: QS, LT, HY, WD, XW, QL, XY, XW, CC.

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Correspondence to Qiuling Shi MD.

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Tang, L., Yu, H., Dai, W. et al. Symptom Trajectories Informing Patient Care After Lung Cancer Surgery: A Longitudinal Patient-Reported Outcome Study. Ann Surg Oncol 30, 2607–2617 (2023). https://doi.org/10.1245/s10434-022-13065-z

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