Poor preoperative patient-reported quality of life is associated with complications following pulmonary lobectomy for lung cancer

Objectives: To assess whether quality of life (QoL) was associated with cardiopulmonary complications following pulmonary lobectomy for lung cancer. Methods: Retrospective analysis of 200 consecutive patients submitted to pulmonary lobectomy for lung cancer (September 2014-October 2015). QoL was assessed by the self-administration of the EORTC-QLQC30 questionnaire within 2 weeks before operation. The individual QoL scales were tested for a possible association with cardiopulmonary complications along with other objective baseline and surgical parameters by univariable and multivariable analyses. Results 43 patients (21.5%) developed postoperative cardiopulmonary complications, 4 of them died within 30 days (2%). Univariable analysis showed that compared to non-complicated patients, those with complications reported a lower Global Health status (GHS) (59.1(SD 27.2) vs. 69.6(SD 20.6),p=0.02), were older (71.2(SD8.4) vs. 67.7(SD9.4),p=0.03), had lower values of forced expiratory volume in one second (FEV1) (83.9(SD27.2) vs. 91.4(SD20.9),p=0.06) and carbon monoxide lung diffusion capacity (DLCO) (67.9(SD20.9) vs. 74.2(SD17.6),p=0.02), and higher performance score (0.76(SD0.63) vs. 0.53(SD0.64),p=0.02). Stepwise logistic regression analysis showed that factors independently associated with cardiopulmonary complications were age (OR 1.04, 95%CI 1.0-1.09,p=0.02) and patient-reported GHS (OR 0.98, 95%CI 0.96-0.99,p=0.006), whereas other objective parameters (i.e. FEV1, DLCO) were not. The best cutoff value for GHS to discriminate patients with complications after surgery was 50 (c-index 0.65, 95%CI 0.58-0.72). Conclusions A poor global health status perceived by the patient was associated with postoperative cardiopulmonary morbidity. Patient perceptions and values should be included in the risk stratification process to tailor cancer treatment.