Symptom assessment following surgery for lung cancer: a Canadian population-based retrospective cohort study
Hirpara DH, Coburn N, Darling G, Kidane B, Rousseau M, Gupta V, Doherty M, Zuk V, Delibasic V, Chan W, Hallet J. Ann Surg. 2021 Feb 10 [Epub ahead of print]. DOI: https://doi.org/10.1097/SLA.0000000000004802
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.