Baseline QOL measures not associated with outcomes in high-risk operable lung cancer patients

Key clinical point: Baseline quality-of-life measures were not predictive of outcomes after lung cancer surgery in high-risk operable patients.

Major finding: A significantly greater improvement in the physical component of quality of life at 3 months and in dyspnea at 1 year was seen from using VATS, compared with thoracotomy.

Data source: Researchers reviewed self-assessment QOL data from 212 eligible high-risk operable patients from the ACSOG Z4032 trial who had sublobar resections with or without brachytherapy using VATS or thoracotomy.

Disclosures: The study was supported by the National Cancer Institute. Dr. Fernando reported receiving consulting fees from Galil and CSA Medical.

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‘How are you doing?’

This research is a noteworthy contribution because there source of prospectively acquired QOL data for such a high-risk group facing lung surgery, Dr. Michael T. Jaklitsch said in his invited editorial commentary (J. Thorac. Cardiovasc. Surg. 2015 Dec. 2 [doi:10.1016/j.jtcvs.2014.11.068]).

Dr. Michael T. Jaklitsch

Although there was no evidence of predictive ability of QOL data for this population, “the predictive value of self-assessment may be more powerful in a broader population, however, than in a selected high-risk population such as the Alliance Z4032 trial,” he said. “The amount of pulmonary impairment required to enter this trial was likely the prime determinant of morbidity.” Thus QOL tools may be predictive with certain populations, but not in others. Overall, however, one benefit of self-assessment tools is that they allow patients to be seen more as people than as disease cases by the surgeons.

“Self-assessment tools allow our patients to tell us more completely about themselves and frequently become a springboard to discuss fears of the near future after surgery and what that might look like,” he added. “They allow us to ask our patients more completely, ‘How are you doing?’ ”

Dr. Jaklitsch is a thoracic surgeon at Brigham and Woman’s Hospital, Harvard Medical School, Boston.




Poor baseline quality-of-life scores were not predictive of worse overall or recurrence-free survival, or of higher risk for adverse events following sublobar resection in high-risk surgical patients with lung cancer.

In addition, quality of life (QOL) and dyspnea scores did not deteriorate significantly overall, based upon the results of a prospective, multicenter study. Low dyspnea scores at baseline, however, did predict subsequent poor overall survival, according to Dr. Hiran C. Fernando of the Boston Medical Center and his colleagues.

Dr. Hiran C. Fernando
Dr. Hiran C. Fernando

The researchers assessed QOL using the 36-item Short-Form Health Survey (SF36) and the dyspnea score from the University of California, San Diego, Shortness of Breath Questionnaire (SOBQ). Both were measured at baseline, 3, 12, and 24 months. The SF36 scores were further broken down into the physical component summary (PCS) and the mental component summary (MCS), according to their report published online and in the March issue of the Journal of Thoracic and Cardiovascular Surgery (2014 Nov. 13 [doi:10.1016/j.jtcvs.2014.11.003]) .

A total of 212 eligible patients in the American College of Surgeons Oncology Group Z4032 trial were randomized to sublobar resection (108 patients) or sublobar resection with brachytherapy (104). The mean age was about 70.5 years, and 56% were women. There were no significant differences in baseline QOL scores between arms. Baseline PCS and MCS scores were at least 1 standard deviation below those of the U.S. general population in 65% and 46.5% of the patients, respectively.

Overall, there were no significant differences in grade 3+ adverse events, overall survival, or recurrence-free survival seen in patients with baseline scores greater than or equal to median QOL scores or less than median scores. There was, however, significantly worse overall survival for patients with baseline SOBQ scores less than or equal to median. In addition, a 10-point drop in SOBQ score at 12 months also predicted poor overall survival, according to Dr. Fernando and his associates.

In terms of results for operative procedures and tumor types, there was a significantly higher percentage of patients with a decline of 10 points or more in SOBQ scores with segmentectomy, compared with wedge resection (40.5% vs. 21.9%) at 12 months, with thoracotomy vs. video-assisted thoracic surgery (VATS) (38.8% vs. 20.4%, P = .03) at 12 months, and for T1b vs. T1a tumors (46.9% vs. 23.5%) at 24 months. In addition, there was a significantly greater than or equal to 10-point improvement in PCS scores at 3 months with VATS vs. thoracotomy (16.5% vs. 3.6%).

The researchers pointed out that, although QOL measurements can be useful to help decide the optimal surgery procedure, it has even more relevance when considering surgical versus nonsurgical therapies, such as using stereotactic body radiation therapy, for high-risk patients with early-stage lung cancer.

“Some advantages relating to minimizing postoperative dyspnea, as measured by the SOBQ, were gained by using VATS (rather than thoracotomy) or wedge resection (rather than segmentectomy). In addition, VATS, as opposed to thoracotomy, patients had improved PCS scores at 3 months, lending support to the preferential use of VATS when SR is performed,” the researchers concluded.

The study was supported by the National Cancer Institute. Dr. Fernando reported receiving consulting fees from Galil and CSA Medical.

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