William R. Burfeind1, Betty C. Tong1, Erin E. O'Branski1, Eric M. Toloza1, Thomas A. D'Amico1, Linda H. Harpole2, David H. Harpole1; 1Thoracic Surgery, Duke University, Durham, NC; 2Glaxo Smith Kline, Research Triangle Park, NC
Objective: Prospective analyses of quality-of-life (QOL) in elderly patients after lobectomy are limited, yet older patients may be offered suboptimal therapy based on the belief that lobectomy would not be tolerated. Decision-making regarding surgery in elderly patients with lung cancer would be improved with better understanding of survival and QOL after resection.Methods: Using a validated QOL instrument, 421 patients were prospectively assessed preoperatively and at 3, 6, and 12 months after lobectomy. Outcomes were analyzed with respect to age (Group 1: < 70 years and Group 2: = 70 years). The outcome domains of physical functioning (PF), role functioning (RF), emotional functioning (EF), cognitive functioning (CF), social functioning (SF), global health (QL), and pain in the chest (PC) were analyzed using a mixed model. The trend in QOL was ascertained with respect to age. The Kaplan-Meier method was utilized for analysis of overall survival.
Results: The mean age in Group 1 (N=255) was 60.1 years and in Group 2 (N=166) was 74.7 years. Baseline demographics and QOL were similar except that Group 2 had higher EF scores and lower PC scores. Postoperatively, both age groups experienced significant decreases in the QOL as measured by the domains PF, RF, SF, QL, and PC at 3 months. However, at 6 months and 12 months, all domains had returned to baseline except PF, which remained below baseline in Group 2. EF improved postoperatively for both groups. Overall survival at 5 years was not different between groups.
Conclusion: Using a validated QOL assessment tool with measurements at baseline and serially after resection in a large patient population, this analysis demonstrates that the decreases in QOL domains after lobectomy are similar and transient in both age groups. Given similar 5-year survival, this data supports the use of lobectomy in the elderly.
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