Change in quality of life of stage IA non-small cell lung cancer after surgery or radiation therapy

Jiafang Zhang; Rowena Yip; Emanuela Taioli; Raja M Flores; Claudia I Henschke; David F Yankelevitz; Rebecca M Schwartz; IELCART Investigators*

doi:10.21037/jtd-23-1201

Change in quality of life of stage IA non-small cell lung cancer after surgery or radiation therapy

J Thorac Dis. 2024 Jan 30;16(1):147-160. doi: 10.21037/jtd-23-1201. Epub 2024 Jan 9.

Authors

Jiafang Zhang¹, Rowena Yip¹, Emanuela Taioli^{2

3

4

5}, Raja M Flores^{2

4

5}, Claudia I Henschke^{1

4

5

6}, David F Yankelevitz^{1

4

5}, Rebecca M Schwartz^{3

4

7}; IELCART Investigators*

Affiliations

¹ Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
² Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
³ Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
⁴ Tisch Center Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
⁵ Center for Thoracic Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
⁶ Phoenix Veterans Affairs Health Care System, Phoenix, AZ, USA.
⁷ Department of Occupational Medicine, Epidemiology and Prevention (OMEP), Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY, USA.

Abstract

Background: Few studies have examined the differential impact of stereotactic body radiotherapy (SBRT) and surgery for early-stage non-small cell lung cancer (NSCLC) on quality of life (QoL) during the first post-treatment year.

Methods: A prospective cohort of stage IA NSCLC patients undergoing surgery or SBRT at Mount Sinai Health System had QoL measured before treatment, and 2, 6, and 12 months post-treatment using: 12-item Short Form Health Survey version 2 (SF-12_v2) [physical component summary (PCS) and mental component summary (MCS)], Functional Assessment of Cancer Therapy-Lung Cancer Subscale (FACT-LCS), and the Patient Health Questionnaire-4 (PHQ-4) measuring depression and anxiety. Locally weighted scatterplot smoothing (LOWESS) was fitted to identify the best interval knot for the change in the QoL trends post-treatment, adjusted piecewise linear mixed effects model was developed to estimate differences in baseline, 2- and 12-month scores, and rates of change.

Results: In total, 503 (88.6%) patients received surgery and 65 (11.4%) SBRT. LOWESS plots suggested QoL changed at 2 months post-surgery. Worsening in PCS was observed for both surgery and SBRT within 2 months after treatment but was only significant for surgical patients (-2.11, P<0.001). Two months later, improvements were observed for surgical but not SBRT patients (0.63 vs. -0.30, P<0.001). Surgical patients had significantly better PCS (P<0.001) and FACT-LCS (P<0.001) scores 1-year post-treatment compared to baseline, but not SBRT patients. Both surgical and SBRT patients reported significantly less anxiety 1-year post-treatment compared to baseline (P<0.001 and P=0.03). Decrease in depression from baseline to 1-year post-treatment was only significant for surgical patients (P<0.001).

Conclusions: Post-treatment, surgical patients exhibited improvements in physical health and reductions in lung cancer symptoms following initial deterioration within the first two months; in contrast, SBRT patients showed persistent decline in these areas throughout the year. Nonetheless, improved mental health was noted across both patient categories post-treatment. Targeted interventions and continuous monitoring are recommended during the initial 2 months post-surgery and throughout the year post-SBRT to alleviate physical and mental distress in patients.

Keywords: Lung cancer; quality of life (QoL); stereotactic body radiotherapy (SBRT); surgery.