Deterioration in Health-Related Quality of Life Diminishes Benefit of Lung Cancer Resection in Older Adults

Abstract

IntroductionOutcomes of oncologic resection are related to tumor biology and patient-reported health factors. However, data regarding changes in functional status and health-related quality of life (HRQOL) before and after lung surgery for older adults are lacking. Patients and MethodsWe identified lung cancer patients from the Surveillance, Epidemiology, and End Results (SEER)-Medicare Health Outcomes Survey (MHOS) linked database. HRQOL surveys captured physical/mental health, activity of daily living (ADLs), and medical comorbidities. Patients who underwent surgery with baseline prediagnosis HRQOL survey and postdiagnosis follow-up survey were selected. Patient, disease, and HRQOL measures were analyzed by Cox proportional hazards regression for overall and disease-specific survival. ResultsOverall, 138 patients were evaluated. Disease extent was localized for 75 (54%) and regional for 58 (42%). The cohort experienced an increase in the number of major comorbidities and declines in physical HRQOL, mental HRQOL, and ADLs. Median overall survival was 74 months. Decreased overall survival was independently associated with male sex (hazard ratio [HR] = 1.7, P = .03), more advanced disease (regional vs. localized: HR = 1.8, P = .01; distant vs. localized: HR = 2.1, P = .22), and decline in ADLs (HR = 1.8, P = .02). Decreased disease-specific survival was independently associated with male sex (HR = 2.2, P = .03), more advanced disease (regional vs. localized: HR = 2.9, P = .002; distant vs. localized: HR = 3.1, P = .22), and decline in mental HRQOL (odds ratio = 2.1, P = .02). ConclusionThe potential survival benefit of lung resection for malignancy is diminished by declines in physical and mental health. Among older surgical patients at risk for functional and HRQOL deterioration, identification and mitigation of such deterioration may optimize oncologic outcomes.