Originally published as JCO Early Release 10.1200/JCO.2006.07.7230 on December 17 2007

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Quality of Life and Survival in the 2 Years After Surgery for Non–Small-Cell Lung Cancer

Patricia M. Kenny, Madeleine T. King, Rosalie C. Viney, Michael J. Boyer, Christine A. Pollicino, Jocelyn M. McLean, Michael J. Fulham, Brian C. McCaughan

From the Centre for Health Economics Research and Evaluation (CHERE), University of Technology; Medical Oncology Unit, Sydney Cancer Centre; MBF Health Insurance (formerly CHERE); Department of PET and Nuclear Medicine, and Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, Australia

Corresponding author: Patricia Kenny, MPH, Centre for Health Economics Research and Evaluation, University of Technology, Sydney, PO Box 123, Broadway, Sydney, New South Wales 2007, Australia; e-mail: patsy.kenny{at}chere.uts.edu.au

Purpose: Although surgery for early-stage non–small-cell lung cancer (NSCLC) is known to have a substantial impact on health-related quality of life (HRQOL), there are few published studies about HRQOL in the longer term. This article examines HRQOL and survival in the 2 years after surgery.

Patients and Methods: Patients with clinical stage I or II NSCLC (n = 173) completed HRQOL questionnaires before surgery, at discharge, 1 month after surgery, and then every 4 months for 2 years. HRQOL was measured with a generic cancer questionnaire (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire [EORTC-QLQ] C30) and a lung cancer–specific questionnaire (EORTC QLQ-LC13). Data were analyzed to examine the impact of surgery and any subsequent therapy, and to describe the trajectories of those who remained disease free at 2 years and those with recurrent cancer diagnosed during follow-up.

Results: Disease recurred within 2 years for 36% of patients and 2-year survival was 65%. Surgery substantially reduced HRQOL across all dimensions except emotional functioning. HRQOL improved in the 2 years after surgery for patients without disease recurrence, although approximately half continued to experience symptoms and functional limitations. For those with recurrence within 2 years, there was some early postoperative recovery in HRQOL, with subsequent deterioration across most dimensions.

Conclusion: Surgery had a substantial impact on HRQOL, and although many disease-free survivors experienced recovery, some lived with long-term HRQOL impairment. HRQOL generally worsened with disease recurrence. The study results are important for informed decision making and ongoing supportive care for patients with operable NSCLC.

Supported by a National Health and Medical Research Council Project Grant No. 991255.

Presented in part at the Australian Health Outcomes Conference, September 15-16, 2004, Canberra, Australia, and the annual conference of the International Society for Quality of Life Research, October 16-19, 2004, Hong Kong, China.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.