Longitudinal changes in pulmonary function and patient reported outcomes after lung cancer surgery

Abstract

The aim of this study was to evaluate longitudinal changes in pulmonary function and its integrated patient-reported outcomes (PROs) after lung cancer surgery. The data were obtained from a prospective cohort study, Coordinate Approach to Cancer Patients’ Health for Lung Cancer. Changes in FVC and FEV1at 2 weeks, 6 months, and 1 year after surgery and the corresponding mMRC dyspnea scale and CAT score were evaluated. Mixed effect models were used to investigate the changes in pulmonary function and PROs. Among 620 patients, 477 (76.9%) underwent lobectomy, while 120 (19.4%) and 23 (3.7%) were treated with limited resection and bilobectomy/pneumonectomy, respectively. Both FVC and FEV1 markedly decreased 2 weeks after surgery and improved thereafter but did not recover to baseline values. The corresponding mMRC dyspnea scale and CAT score also showed worsening immediately after surgery. The dyspnea scale was still higher, while the CAT score returned to baseline 1 year after surgery, although the breathlessness and lack of energy persisted. Patients treated with bilobectomy/pneumonectomy showed -2.3%, -6.8%, and -6.0% more decrease in FEV1 (% predicted) compared to the patients who underwent lobectomy at each time point. Moreover, worsening quality of life including dyspnea was also robust in patients treated with pneumonectomy/bilobectomy. After lung cancer surgery, pulmonary function and PROs was remarkable decreased at immediate post-operative period and improved thereafter except for dyspnea and lack of energy. The proper information on timeline of change in lung function and symptoms following lung cancer surgery could guide patient care approach following lung cancer surgery.