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:



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.


·         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.



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).



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.






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






·         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.



·         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.