Impact of Surgery on Functional and Patient-reported Outcomes in Patients With Early-stage Non-small Cell Lung Cancer

Abstract

Rationale In patients with early-stage non-small cell lung cancer (NSCLC), the treatment of choice is surgical resection, with or without (neo)adjuvant chemotherapy. As a result of the disease and its treatment, patients have an increased risk for poor functional performances, decreased quality of life and high symptom burden. Current knowledge is mainly based on cross-sectional evaluations after treatment; longitudinal changes have been poorly characterized. Therefore, we aimed to investigate functional and patient-reported outcomes in patients with early-stage NSCLC before treatment and 12 weeks after treatment. Methods Patients with early-stage NSCLC (stage I-IIIB) were assessed before surgery and 12 weeks after treatment initiation. Functional outcome measures were a six-minute walk distance (6MWD), 1-minute sit-to-stand test (1-MSTST), quadriceps muscle strength (QMS; microFET), and handgrip strength (HGS; Jamar). Patient-reported outcome measures were the European Organization for the Research and Treatment of Cancer Questionnaire and lung cancer module (EORTC QLQ-C30-LC13), multidimensional fatigue inventory (MFI-20), and San Diego shortness of breath questionnaire (SOBQ). Analyses were performed using JMP PRO 14.2.0. Paired t-tests and Wilcoxon Signed rank tests were used to compare differences between both timepoints. Results Fifteen patients were included (10 males; age 65±9yrs; 5 with COPD). Patients had NSCLC stage IA (n=10), IB (n=1), IIB (n=2) or IIIA (n=2) and were treated via VATS only (n=11) or VATS and adjuvant chemotherapy (n=4). Results are presented in Figure 1. Twelve weeks after treatment, a significant worsening was found for 1-MSTST (27reps vs. 23reps, p=0.008), HGS (36kg vs. 31kg, p=0.036), and SOBQ score (11 vs. 21, p=0.010). No significant differences were found for the other outcomes. Conclusion In early-stage NSCLC, the treatment mainly affected the performance on the 1-MSTST, peripheral muscle strength, and shortness of breath. In contrast to previous findings, we did not observe a significant decrease in 6MWD, quality of life, and fatigue levels.