Decision making for surgical resection of lung cancer is based on disease characteristics as well as patient-reported health factors. However, data regarding influence of functional status and health-related quality of life (HRQOL) on consideration for lung surgery are currently lacking. We identified lung cancer patients with localized disease from the SEER-Medicare Health Outcomes Survey (MHOS) linked database. HRQOL survey data captured physical/mental health, activities of daily living (ADLs), and medical comorbidities. Patients who had 1) baseline HRQOL survey prior to cancer diagnosis and 2) follow-up survey at least one year after diagnosis were selected. Generalized estimating equation (GEE) model was used to compare patients who underwent surgery versus those who did not in regard to demographics and HRQOL measures. Overall, 108 patients were evaluated, of whom 75 (69%) underwent surgery. Surgical patients were younger (mean 73 versus 80 years, p<0.0001); otherwise, patient groups were demographically similar. Surgery was not performed based on surgeon recommendation (n=21, 64%), contraindication(s) (n=9, 27%), or patients’ decision (n=3, 9%). Surgery and non-surgery groups experienced similar declines in physical HRQOL, mental HRQOL, and Katz aggregate ADL scores; and an increase in the number of major comorbidities (see Table). However, non-surgical patients had significant declines in specific individual ADLs, namely mobility and personal care activities, compared to surgical counterparts. On GEE, adjusting for age, non-surgical patients were significantly more likely to have decreased physical HRQOL (OR 5.7, p=0.008), mental HRQOL (OR 2.1, p=0.049), or ADL scores (OR 2.7, p=0.02); and multiple comorbidities (OR 2.3, p=0.046) compared to surgical patients. Patient-reported outcomes reflect patients’ perception of their own health, potentially providing information critical to surgical decision making that is not similarly reflected in other assessment tools. Identification and mitigation of such factors may increase surgeons’ recommendation for lung resection for patients with localized malignancy.