Deterioration in Health-Related Quality of Life Diminishes Benefit of Lung Cancer Resection in Older Adults

ABSTRACT Introduction Outcomes of oncologic resection are related to tumor biology and patient-reported health factors. However, data regarding changes in functional status and health-related quality of life (HRQOL) before and after lung surgery for older adults are lacking. Methods We identified lung cancer patients from the SEER-Medicare Health Outcomes Survey (MHOS) linked database. HRQOL surveys captured physical/mental health, activities of daily living (ADLs), and medical comorbidities. Patients who underwent surgery with baseline pre-diagnosis HRQOL survey and post-diagnosis follow-up survey were selected. Patient, disease, and HRQOL measures were analyzed using Cox proportional hazards regression for overall survival (OS) and disease-specific survival (DSS). Results Overall, 138 patients were evaluated. Disease extent was localized for 75 (54%), and regional for 58 (42%). The cohort experienced an increase in the number of major comorbidities and declines in physical HRQOL, mental HRQOL, and ADLs. Median OS was 74 months. Decreased OS was independently associated with male sex (HR 1.7, p=0.03), more advanced disease (regional vs. localized: HR 1.8, p=0.01; distant vs. localized: HR 2.1, p=0.22), and decline in ADLs (HR 1.8, p=0.02). Decreased DSS was independently associated with male sex (HR 2.2, p=0.03), more advanced disease (regional vs. localized: HR 2.9, p=0.002; distant vs. localized: HR 3.1, p=0.22), and decline in mental HRQOL (OR 2.1, p=0.02). Conclusions The potential survival benefit of lung resection for malignancy is diminished by declines in physical and mental health. Among older surgical patients at risk for functional and HRQOL deterioration, identification and mitigation of such deterioration may optimize oncologic outcomes.