Symptom Recovery after thoracic surgery: Measuring patient-reported outcomes with the MD Anderson Symptom Inventory.

 

Reference Fagundes, Christopher P. , Qiuling, Shi, Vaporciyan, Ara, Rice, David, Popat, Keyuri, Cleeland, Charles S.,Wang, Xin Shelley. JTCVS 2015, Volume150, Issue 3, 613-619

Supplement - Perioperative Management: Thoracic

Presented by: Dr Deborah Douglas, University College London

 

 

Expanded abstract:

 

Background

o   Measuring patient-reported outcomes (PROs) has become increasingly important for assessing quality of care and guiding patient management.

o   PROs however are yet to be integrated with traditional clinical outcomes to evaluate perioperative care.

o   This study aimed to use longitudinal PRO assessments to define the postoperative symptom recovery trajectory in patients undergoing thoracic surgery for lung cancer.

Methods

·         Newly diagnosed patients (N=60) with stage I or II non-small cell lung cancer who underwent either standard open thoracotomy or video-assisted thorascopic surgery lobectomy reported multiple symptoms from before surgery to 3 months after surgery, using the MD Anderson Symptom Inventory.

·         Kaplan – Meir analyses were conducted to determine when symptoms returned to pre-surgical levels and to mild-severity levels during recovery.

 

 Results

o   The most-severe postoperative symptoms were fatigue, pain, shortness of breath, disturbed sleep, and drowsiness.

o   The median time to return to mild symptom severity for these 5 symptoms was shorter than the time to return to baseline severity, with fatigue taking longer.

o   Recovery from pain occurred more quickly for patients who underwent lobectomy versus thoracotomy (8 vs 18 days, respectively; P =0.022).

o   Patients who had poor preoperative performance status or comorbidities reported higher postoperative pain (all P < 0.05).

 

Conclusions

o   Assessing symptoms from the patient’s perspective throughout the postoperative recovery period is an effective strategy for evaluating perioperative care.

o   This study demonstrates that the MD Anderson Symptom Inventory is a sensitive tool for detecting symptomatic recovery, with an expected relationship among surgery type, preoperative performance status, and comorbid conditions.

 

 

 

KEYWORDS

 

Patient reported outcome (PRO), Enhanced recovery, MDASI, Postoperative care, VATS

 

 

 

 

Strengths

·         First longitudinal study to use PROs to define postoperative recovery course.

·         Demonstrating of the use of the MDASI (PRO assessment tool) for evaluating symptom severity in this cohort of patients.

·         Demonstrating of the sensitivity of the MDASI to differentiate postoperative symptoms by type of procedure.

 

Weaknesses

·         Use of a homogenous group of patients who had early-stage lung cancer.

·         Study conducted prior to the establishment of an enhanced recovery pathway programme.

·         MDASI version that is specifically geared to perioperative care after thoracic surgery not yet validated.

 

Potential for impact:

·         Easy introduction of a straightforward tool to gain insight into the recovery period of thoracic patients.

·         Routine inclusion of user-friendly method as a novel PRO application in optimizing perioperative care.