In surgical publications, Quality Of Life (QOL) is rarely reported. Yet it can be an important metric that can be of use to physicians and patients when making treatment decisions.
Prior studies of average-risk patients undergoing lobectomy suggested that low baseline QOL scores predict worse survival in patients undergoing non-small cell lung cancer surgery. The results of a multi-center, longitudinal study of high-risk lung cancer patients who underwent sublobar resection counters this idea, finding that poor baseline global QOL scores did not predict for worse overall survival or recurrence-free survival or greater risk of adverse events. Bryan F. Meyers, MD, is presenting the results of this research on behalf of the Alliance for Clinical Trials in Oncology at the 94th AATS Annual Meeting in Toronto, ON, Canada on April 29, 2014.
"The longitudinal quality of life information now available from this study can be factored into clinical decision-making for high-risk lung cancer patients facing surgery," comments lead investigator Hiran C. Fernando, MD, Chief of the Division of Thoracic Surgery, Boston Medical Center. The results of this study suggest that having poor global quality of life initially should not exclude patients as surgical candidates based on unfounded expectations of poor survival.
In these lung cancer patients, who were generally 70 years of age or older and had poor initial lung function, baseline PCS and MCS scores (that were lower than the U.S. normal values) did not predict poor survival. What did impact overall survival was having breathing problems as measured by low UCSD scores at baseline or experiencing a significant decline in breathing function at 12 months.
The study also found that global QOL and dyspnea did not deteriorate significantly after sublobar resection. Those who experienced a significant decline in PCS, MCS, or UCSD at 3 months showed no difference in recurrence-free survival compared to those who showed no such changes.
There were some indications that the surgical technique affected QOL, with better results associated with video-assisted thoracic surgery rather than thoracotomy, and wedge resection rather than segmentectomy.