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Quality of Life: VATS vs. Thoracotomy

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Numerous studies show that the higher a lung cancer patient's Quality of Life, the longer his/her Survival Rate (See http://www.lungevity.org/l_community/viewtopic.php?t=37598).

A recent study shows further that the postoperative Quality of Life is higher for NSCLC patients who undergo a lobectomy by VATS than by thoractomy:

Abstract: Prospective comparison of postoperative quality of life (QOL) in patients undergoing lobectomy by video-assisted thoracic surgery (VATS) versus thoracotomy for non-small cell lung cancer (NSCLC). Sub-category: Local-Regional Therapy Category: Lung Cancer--Local-Regional and Adjuvant Therapy. Meeting: 2008 ASCO Annual Meeting. Abstract No: 7543. Citation: J Clin Oncol 26: 2008 (May 20 suppl; abstr 7543). Author(s): B. J. Park, N. M. Ishill, R. M. Flores, C. T. Gawiak, R. Shen, N. Rizk, M. S. Bains, R. J. Downey, J. Ostroff, J. Burkhalter, V. W. Rusch

Background: VATS lobectomy in early stage NSCLC is thought to have benefits over thoracotomy with regard to postoperative recovery and QOL, but prospective comparative data is lacking.

Methods: A prospective, non-randomized trial was performed comparing postoperative QOL in patients undergoing lobectomy for pathologic stage I NSCLC either by VATS or thoracotomy. Validated patient-reported measures were administered pre- and postoperatively. Comparison of categorical variables was done by Fisher's exact test, continuous data by Wilcoxon's test, and QOL differences using ANOVA models adjusting for stage and baseline scores.

Results: There were 129 eligible patients (62 thoracotomy, 67 VATS). There were no differences between groups with respect to gender distribution, age, preoperative lung function, or tumor size. There was a greater proportion of pathologic stage IB disease (53% versus 19%, p<0>90 compared to thoracotomy (68% versus 38%, p=0.02). In addition, VATS patients had improved outcomes with respect to dyspnea, fatigue and pain relative to baseline (Table). There were no differences in activities of daily living or global QOL as measured by MOS SF-36.

Conclusions: VATS for lobectomy in early stage NSCLC resulted in shorter length of stay and significant improvements in immediate postoperative performance status, dyspnea, fatigue and pain compared with thoracotomy.

Quality of Life Outcomes

Characteristic Thoracotomy Baseline/Thoracotomy Postoperative/VATS Baseline/VATS Postoperative/p-value

Baseline Dyspnea Index 4.8 ± 1.8/7.6 ± 2.1/4.7 ± 1.7/6.3 ± 1.9/0.002

Brief Fatigue Inventory 19.9 ± 21.9/38.3 ± 21.5/11.4 ± 15.7/24.8 ± 20.3/<0.0001

Brief Pain Inventory (BPI)-Severity 0.93 ± 1.4/2.8 ± 2.1/0.59 ± 1.3/1.6 ± 1.8/0.001

BPI-Interference 0.80 ± 1.6/2.8 ± 2.2/0.51 ± 1.0/1.2 ± 1.3/0.0002

Instrumental Activities of Daily Living 13.6 ± 0.8/12.1 ± 1.9/13.6 ± 1.2/12.4 ± 1.7/0.60

P-values computed using ANOVA models adjusted for stage and baseline scores.

Source: http://www.asco.org/ASCO/Abstracts+%26+Virtual+Meeting/Abstracts?&vmview=abst_detail_view&confID=55&abstractID=35809

Submitted by Carole

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