Cohort study investigating evolution and factors associated with dyspnoea after anatomic lung resection

Cecilia Pompili; Javeria Tariq; Sanjush Dalmia; Amelie Harle; Alexandra Gilbert; Laura Valuckiene; Alessandro Brunelli

doi:10.21037/jtd-23-835

Cohort study investigating evolution and factors associated with dyspnoea after anatomic lung resection

J Thorac Dis. 2024 Jan 30;16(1):113-122. doi: 10.21037/jtd-23-835. Epub 2024 Jan 15.

Authors

Cecilia Pompili^{1

2}, Javeria Tariq³, Sanjush Dalmia⁴, Amelie Harle⁵, Alexandra Gilbert⁶, Laura Valuckiene³, Alessandro Brunelli³

Affiliations

¹ Section of Patient Centred Outcomes Research, Leeds Institute for Medical Research, St James's University Hospital, University of Leeds, Leeds, UK.
² Thoracic Surgery Unit, University Hospital, Verona, Italy.
³ Division of Thoracic Surgery, St James's University Hospital, Leeds, UK.
⁴ School of Medicine, University of Leeds, Leeds, UK.
⁵ Department of Oncology, Poole Hospital, Dorset, UK.
⁶ Leeds Institute of Medical Research, St James's University Hospital, Leeds, UK.

Abstract

Background: Dyspnoea is common following surgical resection for non-small cell lung cancer (NSCLC). The effects range from reduced quality of life to impact on adjuvant therapy outcomes. Currently, dyspnoea beyond the immediate postoperative phase and risk factors are not well characterised. We hope to assess the evolution of patient-reported dyspnoea after anatomic lung resection and associated factors.

Methods: Single-centre cohort study with analysis on data collected longitudinally of 131 patients undergoing anatomic lung resections for NSCLC between September 2014 and December 2018. The European Organization for Research and Treatment Lung Cancer-specific Quality of Life Questionnaire Dyspnoea Scale was used to measure dyspnoea before and after surgery. Multivariable regression analysis was used to identify factors associated with clinically meaningful perioperative changes in dyspnoea at 6-12 months.

Results: Mean Dyspnoea Scale scores preoperatively and 6-12 months after resection were 12.6 (standard deviation 17.4) and 17.9 (standard deviation 20.5), respectively. Of all patients 31% experienced a clinically meaningful increase in dyspnoea, defined as >10 points between Dyspnoea Scale scores preoperatively and at 6-12 months. Comparatively, 71% of patients without preoperative symptoms of dyspnoea developed a clinically meaningful increase of dyspnoea postoperatively. After adjusting the analysis for baseline factors and preoperative Dyspnoea Scale score, female sex remained the only patient factor associated with increased postoperative dyspnoea at 6-12 months after surgery (P=0.046). A total of 34% of patients reported increased dyspnoea after lobectomies and 9% after segmentectomies (P=0.014). Segmentectomy (as opposed to larger resections) was the only surgical factor associated with lower risk of increased dyspnoea (P=0.057).

Conclusions: A clinically meaningful increase in dyspnoea is frequent after lung resection. Postoperative evolution of dyspnoea is non-predictable using objective baseline factors highlighting the importance of patient reported symptoms and involvement in clinical consultation.

Keywords: Non-small cell lung cancer (NSCLC); lung resection; post-operative; quality of life (QOL); shortness of breath.