Long-term Quality of Life After

Pneumonectomy

American Association for Thoracic Surgery

92nd Annual Meeting, San Francisco, CA 2012

0

Ayesha S. Bryant, MSPH, MDRobert J Cerfolio, MD & Douglas J. Minnich, MD

University of Alabama at Birmingham

Birmingham, AL USA

QOL after PneumonectomyFinancial Disclosures

Robert Cerfolio MD

• Intuitive (lecture/procto), Precision (lecture, grant/research), Covidien (lecture), Pfizer (grant/research), grant/research), Covidien (lecture), Pfizer (grant/research), Neomend (grant/research)

Ayesha Bryant MSPH, MD - None

Douglas J. Minnich MD - SuperDimension

QOL after Pneumonectomy

Introduction

• QOL after surgery an increasing important

part of conversation between surgeons &

patientspatients

• Pneumonectomy associated with poor QOL

• Pneumonectomy is often referred to as a

“disease”

QOL after Pneumonectomy

Objectives

• To determine the Quality of Life (QOL)

using mental and physical component using mental and physical component

scores via the SF-12 QOL survey in

patients who underwent pneumonectomy

at least 1 year prior

QOL after Pneumonectomy

Methods• Cross sectional study

– SF-12 survey administered to patients

– Results compared to National Survey Functional Health Status: healthy patients, hypertension, diabetes, liver and kidney disease Health Status: healthy patients, hypertension, diabetes, liver and kidney disease

• Inclusion criteria:

– Pneumonectomy

– 1 year post-op or greater

• Exclusion criteria:

– < 19 years old

QOL after PneumonectomyDemographics

1/19971/1997 12/201012/2010152152 patients patients

7474 7878

22 7373

59 years59 years

QOL after PneumonectomyPatient Flow

152 pts pneumonectomy

150 patients 2 pts excluded (<19

150 patients

9 pts died 30 days or prior to discharge

2 patients died 90 days

29 patients died before 1 year post-op

111 pts alive

@ 1 year post-op

2 pts excluded (<19 yrs)

108 (98%) 1 year survivors responded

QOL after PneumonectomyPatient Characteristics

Quit smoking <1 month prior to surgery 21%

Pre-operative pulmonary function

--FEV 1% (median) 76 %

--DLCO% (median) 72 %

Echo - median LVEF%, (range) > 55% (35-70)

Neo-adjuvant therapy 29%

Coronary Artery Disease 18%

Diabetes 5%

ECOG -median, (range) 1 (0-2)

QOL after PneumonectomyPatient Characteristics

Indication for surgery

Malignancy

Benign (Infection)

87%

13%

Laterality Laterality

Right

Left

52%

48%

Type of pneumonectomy

Completion

Radical

Standard

27%

7%

67%

QOL after PneumonectomyMental Component QOL: N=108

QOL

Score

QOL after PneumonectomyPhysical Component QOL N=108

QOL QOL

Score

QOL after PneumonectomyUnivariate analysis: Mental Score

Sub-groups p-value

Male

Female ����

<0.001

Female ����

Malignancy ����

Benign (infection)

<0.001

Disease recurrence

No recurrence ����

<0.001

No significant differences in final path stage, co-morbidities, PFTs ,

neo-adjuvant therapy, smoking status pre-op

QOL after PneumonectomyUnivariate analysis: Physical Score

Sub-groups p-value

Elderly (age ≥ 58)

Younger (age < 58) ����

0.01

Younger (age < 58) ����

Pre-operative FEV1%

Higher (≥ 76) ����

Lower (<76%)<0.001

Malignancy ����

Benign (infection)

0.05

No significant differences in gender, neo-adjuvant therapy, smoking

status pre-op, co-morbidites , recurrence or final path stage

QOL after Pneumonectomy

Strengths Strengths

� One surgeon – similar pre-, intra- and post-

operative protocols

�� Validated SF-12 survey

� Compared to literature

� Long-term (1 year or more after surgery)

� Stratified by mental and physical scores

� Larger pneumonectomy cohort

� High response rate (98%)

QOL after Pneumonectomy

LimitationsLimitations

� Small sample size

� SF-12 may not be as valid

� Not administered pre- and post-

operatively

� Base line or temporal changes

� Possible sampling bias

� Only pts alive one year after surgery

QOL after Pneumonectomy

Conclusions

• Physical QOL score significantly lower than the

average population and those with other chronic

diseases: diabetes, hypertension, kidney disease diseases: diabetes, hypertension, kidney disease

• Mental QOL score is significantly higher than the

average population, probably b/c most patients

had cancer (reported to be more optimistic)

• Pneumonectomy is tolerated in carefully selected

pts, but can be considered a “disease” given

physical QOL scores and significant 1 year

mortality