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Weighing projections of physical decline in lung cancer surgery decisions
Samuel Cykert1, Paul R Walker, Lloyd J Edwards
1Division of General Internal Medicine and Clinical Epidemiology (SC), North Carolina Area Health Education Centers Program, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Thoracic Oncology Program (PRW), Leo Jenkins Cancer Center, Brody School of Medicine at East Carolina University, Greenville, North Carolina; Department of Biostatistics (LJE), Gillings School of Global Public Health, The University of North Carolina-Chapel Hill, Chapel Hill, North Carolina; Division of Pulmonary and Critical Care Medicine (FRM), The University of South Carolina School of Medicine; and Department of Health Policy and Management (PD-A), Gillings School of Global Public Health, The University of North Carolina-Chapel Hill, Chapel Hill, North Carolina.
Background:
Patients with early-stage lung cancer often have comorbid illnesses and fear debility and death when contemplating surgery. However, data that compare physical function of patients who receive surgery with similar patients who do not are sparse. The authors report 1-year outcome results for surgical and nonsurgical patients in a prospective lung cancer cohort to address this gap.
Methods:
The authors enrolled 386 patients with early-stage lung cancer. A 106-item survey was completed at the time of enrollment including the Short-Form 12 (SF-12) Health Survey to assess functional status. Patients were followed for a year. Chart abstractions were obtained to determine comorbid illnesses and surgical status. Death was ascertained through vital records. The SF-12 was repeated 1 year after the enrollment. Regression models were constructed to identify predictors of 1-year mortality and decline in physical function.
Results:
Fifty-nine patients (15.3%) died before 1-year follow-up. Mortality in the surgical group was 10.8% compared with 22.8% in the nonsurgical group (P < 0.001). In regression analysis controlling for age and comorbidities, surgical treatment was associated with a reduction in 1-year mortality (odds ratio: 0.5 and 95% confidence interval: 0.3-1.0) but did not worsen physical function relative to the untreated group (average decrease in physical component score of SF-12 = 1.9 for surgery group and 2.5 for no surgery group, P = 0.66).
Conclusions:
Functional decline between surgically treated and untreated patients did not differ. This result casts doubt on its value as a treatment determinant. Cancer mortality seems to be a more essential issue in treatment decisions.
