Longitudinal changes in pulmonary function and patient-reported outcomes after lung cancer surgery

Area of Science:

• Thoracic Surgery
• Pulmonary Medicine
• Oncology

Background:

• Non-small cell lung cancer (NSCLC) treatment relies heavily on surgery.
• Post-operative pulmonary function decline is a significant concern requiring careful management.
• Longitudinal evaluation of lung function and patient-reported outcomes (PROs) is essential after lung cancer surgery.

Purpose of the Study:

• To assess longitudinal changes in pulmonary function after lung cancer surgery.
• To evaluate changes in patient-reported outcomes (PROs), including dyspnea and quality of life, post-surgery.
• To correlate surgical extent with pulmonary function and PROs recovery.

Main Methods:

• Prospective cohort study including 620 lung cancer patients.
• Measurement of forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) at 2 weeks, 6 months, and 1 year post-surgery.
• Assessment of modified Medical Research Council (mMRC) dyspnea scale and COPD Assessment Test (CAT) scores over time using mixed-effects models.

Main Results:

• Pulmonary function (FVC, FEV1) significantly decreased 2 weeks post-surgery, with partial recovery but not to baseline levels.
• Patient-reported outcomes (PROs) including mMRC and CAT scores initially worsened, with CAT scores returning to baseline by 1 year, while mMRC dyspnea remained elevated.
• Extent of surgery correlated with pulmonary function decline; bilobectomy/pneumonectomy resulted in greater FVC/FEV1 reduction compared to lobectomy or wedge resection/segmentectomy.

Conclusions:

• Lung cancer surgery leads to immediate post-operative declines in pulmonary function and PROs, with subsequent improvement.
• Dyspnea and lack of energy may persist one year after surgery, indicating a need for ongoing supportive care.
• Understanding the timeline of pulmonary function and symptom changes guides post-operative patient management strategies.