ObjectiveTo determine the symptom burden and functional status of patients with early-stage lung cancer at 4 weeks after discharge, and to investigate the influencing factors. MethodsAn analysis was conducted on the clinical data of patients with early-stage lung cancer in a multicenter prospective cohort study conducted in six hospitals in China from November 2017 to January 2020. The MD Anderson Symptom Assessment Scale-Lung Cancer Module (MDASI-LC) was used to evaluate symptoms and functions. Binary logistic regression analysis was used to analyze the influencing factors of moderate to severe functional impairment (≥2 points) and moderate to severe symptoms affecting recovery (≥4 points). ResultsA total of 158 patients were included, including 59 males and 99 females, with an average age of (55.5±9.9) years. At 4 weeks of discharge, the three most severe moderate to severe symptoms were cough (30.4%), shortness of breath (25.3%), and disturbed sleep (22.2%). The proportions of patients with moderate to severe physical and psychological impairment were 53.2% and 38.6%, respectively. Multivariate analysis results showed that shortness of breath was an independent risk factor for moderate to severe postoperative physical impairment [OR=10.12, 95%CI (1.51, 67.60), P=0.017]; cough [OR=5.66, 95%CI (1.52-21.15), P=0.007], pain [OR=12.35, 95%CI (1.21, 126.39), P=0.034], and female sex [OR=4.01, 95%CI (1.10, 14.67), P=0.036] were independent risk factors for moderate to severe psychological impairment; forced expiratory volume in the first second <1.5 L [OR=0.10, 95%CI (0.02, 0.58), P=0.010] and female [OR=2.80, 95%CI (1.17, 6.66), P=0.020] were independent risk factors for moderate to severe shortness of breath; open surgery [OR=6.18, 95%CI (1.54, 24.80), P=0.010] and female [OR=7.33, 95%CI (1.84, 29.20), P=0.005] were independent risk factors for moderate to severe pain. ConclusionPatients with early-stage lung cancer still have a significant symptom burden and functional impairment 4 weeks after discharge. Preoperative attention should be given to patients with poor lung function and female patients. During the operation, open surgery should be avoided as much as possible. Effective management of shortness of breath, pain, and cough symptoms in the postoperative period can promote the functional recovery of patients with early-stage lung cancer.
ObjectiveTo explore the necessity of routine chest X-ray (CXR) examination after lung surgery based on patient symptom burden. MethodsA retrospective study was conducted on the patients who underwent thoracoscopic lung resection at the Department of Thoracic Surgery of Guangdong Provincial People's Hospital from March 2020 to April 2023. Routine CXR findings obtained within 24 h post-operation, after chest tube removal, and at 1-month post-discharge, as well as subsequent clinical interventions triggered by these examinations, were collected and analyzed. The Perioperative Symptom Assessment Lung (PSA-Lung) inventory was used to quantify symptom burden including pain, dyspnea, and sleep disturbance. Results A total of 2 101 patients were collected, including 986 males and 1 115 females, with a median age of 56 years. The rate of clinical interventions triggered by routine CXR examinations was very low, being 1.0%, 0.5%, and 1.3% within 24 h post-operation, within 12 h after extubation, and at 1-month post-discharge, respectively. One month after discharge, patients in the intervention group exhibited significantly higher scores for dyspnea (3 points vs. 2 points, P=0.015), pain (2 points vs. 1 point, P=0.039), and sleep disturbance (3 points vs. 2 points, P=0.036) compared with the non-intervention group. Conclusion Very few routine postoperative CXR examinations change patients’ management, and patients who need extra-intervention tended to have more severe symptom burden after surgery.
