Patient-reported outcomes after oncologic hepatic resection predict the risk of delayed readiness to return to intended oncologic therapy (RIOT)

Xin Shelley Wang; Qiuling Shi; Shu-En Shen; Elizabeth Letona; Mona Kamal; Charles S Cleeland; Thomas Aloia; Vijaya Gottumukkala

doi:10.1016/j.ejso.2024.108396

Patient-reported outcomes after oncologic hepatic resection predict the risk of delayed readiness to return to intended oncologic therapy (RIOT)

Eur J Surg Oncol. 2024 May 11;50(7):108396. doi: 10.1016/j.ejso.2024.108396. Online ahead of print.

Authors

Xin Shelley Wang¹, Qiuling Shi², Shu-En Shen³, Elizabeth Letona³, Mona Kamal³, Charles S Cleeland³, Thomas Aloia⁴, Vijaya Gottumukkala⁵

Affiliations

¹ Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. Electronic address: xswang@mdanderson.org.
² School of Public Health, Chongqing Medical University, Chongqing, China.
³ Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
⁴ Ascension Health, USA.
⁵ Department of Anesthesia and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.

PMID: 38754314
DOI: 10.1016/j.ejso.2024.108396

Abstract

Background: Optimal surgical recovery is critical to readiness to return to intended oncologic therapy (RIOT). The current study defined the value of patient-reported outcomes (PROs) in predicting the risk for delayed RIOT after oncologic hepatic resection.

Methods: In a prospective longitudinal study, perioperative symptoms were assessed using a valid PRO assessment tool, the MD Anderson Symptom Inventory module for hepatectomy perioperative care (MDASI-PeriOp-Hep), for 4 weeks after surgery. The timed up and go test (TUGT) was administered before surgery, by discharge day, and at the first postoperative follow-up visit. Multivariate logistic regression analysis assessed the predictive value of PROs for delayed RIOT.

Results: We enrolled 210 patients and analyzed 148 patients who received adjuvant chemotherapy and contributed more than 3 PRO assessments postoperatively. About 36 percent of the patients had delayed RIOT (>5 weeks, range 1-14 weeks). MDASI scores for drowsiness, fatigue, dry mouth, and interference with general activity, walking, and work on day 7 after discharge and MDASI scores for incisional tightness, fatigue, dry mouth, shortness of breath, and interference with work on day 14 after discharge were associated with delayed RIOT (all P < 0.05). Walking and general activity items on the MDASI-Interference subscale on day 7 after discharge were highly correlated with prolonged TUGT scores at discharge (P < 0.01).

Conclusion: We defined clinically meaningful PROs on MDASI-PeriOp-Hep after hepatic resection that predicted increased risk of delayed RIOT. These findings highlight the importance PROs for monitoring symptoms and functioning 1-2 weeks after discharge to be implementing into perioperative care.

Keywords: Functional recovery; Liver surgery; MDASI; Patient-reported outcome; Perioperative care; Return to intended oncologic therapy; Symptom burden.

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