TY - JOUR
T1 - Symptom Trajectories Informing Patient Care After Lung Cancer Surgery
T2 - A Longitudinal Patient-Reported Outcome Study
AU - Tang, Li
AU - Yu, Hongfan
AU - Dai, Wei
AU - Yang, Xiaojun
AU - Wei, Xing
AU - Wang, Xin Shelley
AU - Cleeland, Charles S.
AU - Li, Qiang
AU - Shi, Qiuling
N1 - Publisher Copyright:
© 2023, Society of Surgical Oncology.
PY - 2023/5
Y1 - 2023/5
N2 - 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.
AB - 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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U2 - 10.1245/s10434-022-13065-z
DO - 10.1245/s10434-022-13065-z
M3 - Article
C2 - 36658248
AN - SCOPUS:85146541272
SN - 1068-9265
VL - 30
SP - 2607
EP - 2617
JO - Annals of surgical oncology
JF - Annals of surgical oncology
IS - 5
ER -