Long-term quality of life in operated non-small cell lung cancer patients

Lung cancer is a nefarious disease causing more deaths than any other cancer worldwide. It is also among the most common cancers in Finland and the leading cause of cancer-related deaths, with 5-year survival rates of only 10-15%. However, more cases are being diagnosed at an earlier, possibly curable stage – radical surgery being the main curative treatment. As more patients survive the disease, long-term results, including quality of life, have attained more weight as treatment outcome measures. Thus, less invasive video-assisted thoracoscopic surgery (VATS) has largely replaced the more invasive thoracotomy as the standard treatment for operable local non-small cell lung cancer (NSCLC) patients. This study assessed the long-term health-related quality of life (HRQoL) among surgically treated NSCLC survivors, determining possible patient and treatment factors affecting the long-term HRQoL and survival among these patients, and comparing the effects of VATS and thoracotomy on the long-term HRQoL. For Studies I and II, we gathered patient and operational characteristics on 579 patients operated on for NSCLC in our clinic at Helsinki University Central Hospital between January 2000 and June 2009. The 276 survivors received two HRQoL questionnaires, the generic 15D and the cancer-specific EORTC QLQ-C30, in 2011. The HRQoL of our 230 respondents was compared with that of the age- and gender-standardized general population. Study II utilized the same data to determine factors predicting survival and long-term HRQoL among NSCLC survivors via regression analyses. Study III compared long-term HRQoL between 88 thoracotomy and 92 VATS patients undergoing lobectomy for local NSCLC in our clinic from January 2006 to January 2013. All of the studies were retrospective in nature. The NSCLC survivors reported significantly lower long-term HRQoL than the general population, with the most severe deterioration observed on the dimensions of mobility and breathing. Long-term survival proved to be moderately predictable by objective patient, disease, and treatment features, such as age, disease stage, and perioperative complications, but the regression models failed to notably predict long-term HRQoL. VATS patients reported significantly lower long-term HRQoL than thoracotomy patients, although the groups had comparable pre- and perioperative characteristics, and particularly no differences favouring the thoracotomy group were observed. The apparent long-term reduction in HRQoL should be considered in patient counselling, and more resources directed to the pre- and postoperative rehabilitation of the most severely affected functions. Long-term postoperative HRQoL seems poorly predictable, or at least the commonly measured clinical features fail to have a marked effect on HRQoL.