Predictors of quality-of-life improvement following pulmonary resection due to lung cancer
Keywords:
Quality of life, Neoplasms, Medical oncology, Rehabilitation, QuestionnairesAbstract
CONTEXT AND OBJECTIVE: There is increasing involvement of health professionals in organizing protocols to determine the impact of lung surgery on functional state and activities of daily living, with the aim of improving quality of life (QoL). The objective of this study was to investigate predictors of QoL improvement among patients undergoing parenchyma resection due to lung cancer. DESIGN AND SETTING: Prospective study, at teaching hospital of Universidade Estadual de Campinas (Unicamp). METHODS: 36 patients with lung cancer diag nosis were assessed before surgery and on the 30th, 90th and 180th days after surgery. The Short-Form Health Survey (SF-36) was used as the dependent variable. The independent variables were the Hospital Anxiety and Depression (HAD) scale, a six-minute walking test (6-MWT), a visual analogue scale for pain, forced vital capacity (FVC), type of surgery and use of radiotherapy and chemotherapy. Generalized estimation equations (GEE) were utilized. RESULTS: The median age for these 20 men and 16 women was 55.5 ± 13.4 years. Both FVC and 6-MWT were predictors of improvement in the physical dimensions of QoL (p = 0.011 and 0.0003, respectively), as was smaller extent of surgical resection (p = 0.04). The social component of QoL had improved by the third postoperative month (p = 0.0005). CONCLUSION: The predictors that affected QoL positively were better FVC and 6-MWT results and less extensive lung resection. Three months after the surgery, an improvement in social life was already seen.
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References
Brasil. Ministério da Saúde. Instituto Nacional do Câncer — INCA. Estimativas da incidência e mortalidade por câncer no Brasil. Rio de Janeiro: INCA; 2003. Available from: http://www. inca.gov.br/estimativas/2003/versaofinal.pdf. Accessed in 2006 (Nov 21).
Parkin DM. Global cancer statistics in the year 2000. Lancet Oncol. 2001,2(9):533-43.
Romao PS, Mark DH. Patient and hospital characteristics related to in-hospital mortality after lung cancer resection. Chest. 1992;101(5):1332-7.
Smith RA, Glynn TJ. Early lung cancer detection: current and ongoing challenges. Cancer 2000, 89(11 Suppl):2327-8.
Welcker K, Marian P, Thetter O, Siebeck M. Cost and quality of life in thoracic surgery--a health economic analysis in a German center. Thorac Cardiovasc Surg. 2003;51(5):260-6.
Handy JR, Asaph JW, Skokan L, et al. What happens to patients undergoing lung cancer surgery? Outcomes and quality of life before and after surgery. Chest. 2002;122(1):21-30.
Haraldsen P, Andersson R. Quality of life, morbidity, and mor- tality after surgical intensive care: a follow-up study of patients treated for abdominal sepsis in the surgical intensive care unit. Eur J Surg Suppl. 2003;(588):23-7.
Klastersky J, Paesmans M. Response to chemotherapy, quality of life benefits and survival in advanced non-small cell lung cancer: review of literature results. Lung Cancer. 2001;34(Suppl 4):S95-101.
Ware JE, Snow KK, Kosinski M, Gandek B. SF-36 Health survey manual and interpretation guide. Boston: The Health Institute, New England Medical Center; 1993.
Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361-70.
ATS Committee on Proficiency Standards for Clinical Pul- monary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002;166(1):111-7.
Celli BR. Chronic respiratory failure after lung resection: the role of pulmonary rehabilitation. Thorac Surg Clin. 2004;14(3):417-28.
Doyle RL. Assessing and modifying the risk of postoperative pulmonary complications. Chest. 1999;115(5 Suppl):77S-81S.
Adamsen L, Midtgaard J, Rorth M, et al. Feasibility, physical capacity, and health benefits of a multidimensional exercise program for cancer patients undergoing chemotherapy. Support Care Cancer. 2003;11(11):707-16.
Lung function testing: selection of reference values and inter- pretative strategies. American Thoracic Society. Am Rev Respir Dis. 1991;144(5):1202-18.
Botega NJ, Bio MR, Zomignani MA, Garcia Júnior C, Pereira WAB. Transtornos do humor em enfermaria de clínica médica e validação de escala de medida (HAD) de ansiedade e depressão. [Mood disorders among medical in-patients: a validation study of the hospital anxiety and depression scale (HAD)]. Rev Saúde Pública. 1995;29(5):355-63.
Sarna L, Evangelista L, Tashkin D, et al. Impact of respiratory symp- toms and pulmonary function on quality of life of long-term survivors of non-small cell lung cancer. Chest. 2004;125(2):439-45.
Spiro SG, Porter JC. Lung cancer--where are we today? Current advances in staging and nonsurgical treatment. Am J Respir Crit Care Med. 2002;166(9):1166-96.
Montazeri A, Milroy R, Hole D, McEwen J, Gillis CR. How quality of life data contribute to our understanding of cancer patients’ experiences? A study of patients with lung cancer. Qual Life Res. 2003;12(2):157-66.
Lheureux M, Raherison C, Vernejoux JM, et al. Quality of life in lung cancer: does disclosure of the diagnosis have an impact? Lung Cancer. 2004;43(2):175-82.
The SAS System for Windows (Statistical Analysis System). [Computer program]. Version 8.02. USA: SAS Institute Inc; 1999-2001.
Ciconelli RM. Tradução para o português e validação do ques- tionário genérico de avaliação de qualidade de vida Medical Outcomes Study 36 Itens Short-Form Health Survey (SF-36). [Thesis]. São Paulo: Universidade Federal de São Paulo — Escola Paulista de Medicina; 1997.
Pompeo E, De Dominicis E, Ambrogi V, Mineo D, Elia S, Mineo TC. Quality of life after tailored combined surgery for stage I non-small-cell lung cancer and severe emphysema. Ann Thorac Surg. 2003;76(6):1821-7.
Melendez JA, Carlon VA. Cardiopulmonary risk index does not predict complications after thoracic surgery. Chest. 1998;114(1):69-75.
Myrdal G, Valtysdottir S, Lambe M, Stahle E. Quality of life following lung cancer surgery. Thorax. 2003;58(3):194-7.
