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Treatment Patterns and Postoperative Activities of Daily Living in Patients with Non-small Cell Lung Cancer: A Retrospective Study Using Nationwide Health Services Utilization Data in Japan

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The number of older patients with cancer has been increasing. This study aimed to determine the proportion of postoperative decline in activities of daily living (ADL), hospital mortality rate, home healthcare services use, and adjuvant chemotherapy treatment patterns of patients with early-stage non-small cell lung cancer (NSCLC) across age groups.

Methods

We analyzed health service utilization data of patients aged ≥ 40 years diagnosed with clinical stage I or II NSCLC in 2015 who underwent thoracoscopy or thoracotomy. The Barthel index was used to determine the proportions of patients aged 40–64, 65–74, ≥ 75 years who experienced a decline in the ADL of ≥ 10 points at postoperative discharge compared to the ADL at admission.

Results

Overall, 19,780 patients were analyzed. The proportion of patients with ADL decline slightly increased with increasing age: 1.1%, 1.6%, and 3.5% after thoracoscopic surgery, and 1.4%, 2.8%, and 4.8% after thoracotomy among those aged 40–64, 65–74, and ≥ 75 years, respectively. The hospital mortality rate and proportion of home healthcare services use was fewer than 10 cases, or < 2%. The unexpected readmission rate was slightly higher among those aged ≥ 75 years (3.7% for thoracoscopic surgery, 4.7% for thoracotomy) than among those aged 40–64 years (1.8% for thoracoscopic surgery, 2.5% for thoracotomy).

Conclusion

The difference in the proportion of patients with ADL decline between those aged 40–64 and ≥ 75 years was approximately 3%. This study provides practical information for clinicians involved in the care of older patients who undergo thoracic surgery.

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Data availability

We received permission for the use of the data necessary to conduct this study. The data are not publicly available.

References

  1. Committee for Scientific Affairs, The Japanese Association for Thoracic Surgery, Minatoya K, et al. Thoracic and cardiovascular surgery in Japan during 2019: annual report by the Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg. 2023;71(10):595–628. https://doi.org/10.1007/s11748-023-01945-4.

    Article  Google Scholar 

  2. Billmeier SE, Ayanian JZ, He Y, Jaklitsch MT, Rogers SO. Predictors of nursing home admission, severe functional impairment, or death one year after surgery for non-small cell lung cancer. Ann Surg. 2013;257:555–63.

    Article  PubMed  Google Scholar 

  3. Cykert S, Kissling G, Hansen CJ. Patient preferences regarding possible outcomes of lung resection: what outcomes should preoperative evaluations target? Chest. 2000;117:1551–9.

    Article  CAS  PubMed  Google Scholar 

  4. Koczywas M, Williams AC, Cristea M, et al. Longitudinal changes in function, symptom burden, and quality of life in patients with early-stage lung cancer. Ann Surg Oncol. 2013;20:1788–97.

    Article  PubMed  Google Scholar 

  5. Couderc AL, Tomasini P, Greillier L, et al. Functional status in older patients with lung cancer: an observational cohort study. Support Care Cancer. 2022;30:3817–27.

    Article  PubMed  Google Scholar 

  6. Kurtz ME, Kurtz JC, Stommel M, Given CW, Given B. Loss of physical functioning among geriatric cancer patients: relationships to cancer site, treatment, comorbidity and age. Eur J Cancer. 1997;33:2352–8.

    Article  CAS  PubMed  Google Scholar 

  7. Cabinet Office Government of Japan. 2022. The status of aging and implementation of measures for aging society in FY2022. Available at: https://www8.cao.go.jp/kourei/whitepaper/index-w.html. Accessed 21 Feb 2023.

  8. Brown NM, Lui CW, Robinson PC, Boyle FM. Supportive care needs and preferences of lung cancer patients: a semi-structured qualitative interview study. Support Care Cancer. 2015;23:1533–9.

    Article  PubMed  Google Scholar 

  9. Nightingale G, Battisti NML, Loh KP, et al. Perspectives on functional status in older adults with cancer: an interprofessional report from the International Society of Geriatric Oncology (SIOG) nursing and allied health interest group and young SIOG. J Geriatr Oncol. 2021;12:658–65.

    Article  CAS  PubMed  Google Scholar 

  10. Scotté F, Bossi P, Carola E, et al. Addressing the quality of life needs of older patients with cancer: a SIOG consensus paper and practical guide. Ann Oncol. 2018;29:1718–26.

    Article  PubMed  Google Scholar 

  11. Iwamoto M, Nakamura F, Higashi T. Monitoring and evaluating the quality of cancer care in Japan using administrative claims data. Cancer Sci. 2016;107:68–75.

    Article  CAS  PubMed  Google Scholar 

  12. The Japan lung cancer society. The clinical guidelines for lung cancer 2022. Available at: https://www.haigan.gr.jp/guideline/2022/index.html. Accessed 12 Jun 2023.

  13. Granger CV, Albrecht GL, Hamilton BB. Outcome of comprehensive medical rehabilitation: measurement by PULSES profile and the Barthel index. Arch Phys Med Rehabil. 1979;60:145–54.

    CAS  PubMed  Google Scholar 

  14. Montroni I, Rostoft S, Spinelli A, et al. GOSAFE—Geriatric oncology surgical assessment and functional recovery after surgery: early analysis on 977 patients. J Geriatr Oncol. 2020;11:244–55.

    Article  PubMed  Google Scholar 

  15. Hsieh YW, Wang CH, Wu SC, et al. Establishing the minimal clinically important difference of the Barthel Index in stroke patients. Neurorehabil Neural Repair. 2007;21:233–8.

    Article  PubMed  Google Scholar 

  16. Okuyama A, Boku N, Higashi T. Real-world emetic risk of chemotherapy and the corresponding antiemetic therapy in Japan: a study based on a nationwide database. Cancer Rep. 2022;5:e1482.

    Article  CAS  Google Scholar 

  17. Ministry of Health. Labout and welfare in Japan. Changes in life expectancy. 2019. Available at: https://www.mhlw.go.jp/stf/wp/hakusyo/kousei/19/backdata/01-01-02-01.html. Accessed 14 Jun 2023

  18. Ilonen IK, Räsänen JV, Knuuttila A, et al. Quality of life following lobectomy or bilobectomy for non-small cell lung cancer, a two-year prospective follow-up study. Lung Cancer. 2010;70:347–51.

    Article  PubMed  Google Scholar 

  19. Okuyama A, Higashi T. Patterns of cancer treatment in different age groups in Japan: an analysis of hospital-based cancer registry data, 2012–2015. Jpn J Clin Oncol. 2018;48:417–25.

    Article  PubMed  Google Scholar 

  20. Dotan E, Walter LC, Browner IS, et al. NCCN Guidelines® Insights: Older Adult Oncology, Version 1.2021. J Natl Compr Canc Netw. 2021; 19:1006-1019.

  21. Hamada C, Tanaka F, Ohta M, et al. Meta-analysis of postoperative adjuvant chemotherapy with tegafur-uracil in non-small-cell lung cancer. J Clin Oncol. 2005;23:4999–5006.

    Article  CAS  PubMed  Google Scholar 

  22. Pignon JP, Tribodet H, Scagliotti GV, et al. Lung adjuvant cisplatin evaluation: a pooled analysis by the LACE Collaborative Group. J Clin Oncol. 2008;26:3552–9.

    Article  PubMed  Google Scholar 

  23. Blasi M, Eichhorn ME, Christopoulos P, et al. Major clinical benefit from adjuvant chemotherapy for stage II-III non-small cell lung cancer patients aged 75 years or older: a propensity score-matched analysis. BMC Pulm Med. 2022;22:255.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Siefert ML. Fatigue, pain, and functional status during outpatient chemotherapy. Oncol Nurs Forum. 2010;37:E114–23.

    Article  PubMed  Google Scholar 

  25. Cheng KK, Lee DT. Effects of pain, fatigue, insomnia, and mood disturbance on functional status and quality of life of elderly patients with cancer. Crit Rev Oncol Hematol. 2011;78:127–37.

    Article  PubMed  Google Scholar 

  26. Cheng KK, Lim EY, Kanesvaran R. Quality of life of elderly patients with solid tumours undergoing adjuvant cancer therapy: a systematic review. BMJ Open. 2018;8:e018101.

    Article  PubMed  PubMed Central  Google Scholar 

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Funding

This work was supported by the Grants-In-Aid for Scientific Research (KAKENHI20EA1011) and JSPS KAKENHI (22K10700).

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Authors and Affiliations

  1. Graduate School of Nursing, St. Luke’s International University, Tokyo, Japan

    Ayako Okuyama PhD

  2. National Cancer Center Institute for Cancer Control, Tokyo, Japan

    Ayako Okuyama PhD & Takahiro Higashi PhD

  3. Department of Medical Oncology, Kyorin University Faculty of Medicine, 6-20-2 Shinkawa, Mitakashi, Tokyo, Japan

    Tomonori Mizutani PhD

  4. Department of Thoracic and Thyroid Surgery, Kyorin University Faculty of Medicine, 6-20-2 Shinkawa, Mitakashi, Tokyo, 181-8611, Japan

    Keisei Tachibana PhD

  5. Department of Public Health, The University of Tokyo, Tokyo, Japan

    Takahiro Higashi PhD

  6. Psycho-Oncology Division, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Chiba, Japan

    Asao Ogawa PhD

Authors
  1. Ayako Okuyama PhD
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  2. Tomonori Mizutani PhD
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  3. Keisei Tachibana PhD
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  4. Takahiro Higashi PhD
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  5. Asao Ogawa PhD
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Corresponding author

Correspondence to Ayako Okuyama PhD.

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Disclosure

Ayako Okuyama, Tomonori Mizutani, Keisei Tachibana, Takahiro Higashi, and Asao Ogawa have no conflicts of interest to declare in relation to this work.

Ethical approval

Ethical approval for data analysis was obtained from the Institutional Review Board of the National Cancer Center in Japan (2019-064). As per the national ethics guidelines for medical research on human subjects, given the retrospective nature of the database analysis, the requirement for patient consent was waived, and the project outlines were made publicly available, providing patients an opportunity to opt out.

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Okuyama, A., Mizutani, T., Tachibana, K. et al. Treatment Patterns and Postoperative Activities of Daily Living in Patients with Non-small Cell Lung Cancer: A Retrospective Study Using Nationwide Health Services Utilization Data in Japan. Ann Surg Oncol 31, 3409–3416 (2024). https://doi.org/10.1245/s10434-023-14798-1

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  • DOI: https://doi.org/10.1245/s10434-023-14798-1

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