Symptom assessment following surgery for lung cancer: a Canadian population-based retrospective cohort study

Objective — To conduct a population-level analysis of temporal trends and risk factors for high symptom burden in patients receiving surgery for non-small-cell lung cancer (NSCLC).

Summary Background Data — A population-level overview of symptoms after curative intent surgery is necessary to inform decision making and supportive care for patients with lung cancer.

Methods — Retrospective cohort study of patients receiving surgery for stage I-III NSCLC between January 2007-September 2018. Prospectively collection Edmonton Symptom Assessment System (ESAS) scores, linked to provincial administrative data, were used to describe the prevalence, trajectory and predictors of moderate-to-severe symptoms in the year following surgery.

Results — A total of 5,350 patients, with 28,490 unique ESAS assessments, were included in the analysis. Moderate-to-severe tiredness (68%), poor wellbeing (63%) and shortness of breath (60%) were the most common symptoms reported. The rise and fall in the proportion of patients experiencing moderate-to-severe symptoms after surgery coincided with the median time to first (58 days, IQR: 47-72) and last cycle of chemotherapy (140 days, IQR: 118-168), respectively. There was eventual stabilization, albeit above the pre-operative baseline, within 6-7 months after surgery. Female sex (RR 1.09-1.26), lower income (RR 1.08-1.23), stage III disease (RR 1.15-1.43), adjuvant therapy (RR 1.09-1.42), chemotherapy within two weeks of an ESAS assessment (RR 1.14-1.73), and pneumonectomy (RR 1.05-1.15) were associated with moderate-to-severe symptoms following surgery.

Conclusions — Knowledge of population-level prevalence, trajectory and predictors of moderate-to-severe symptoms after surgery for NSCLC can be used to facilitate shared decision making and improve symptom management throughout the course of illness.