Association between health-related quality of life and perioperative exercise capacity in older postoperative patients with non-small cell lung cancer.

Background: Lung cancer represents a significant global health concern and constitutes the primary cause of cancer-related mortality. Complete surgical resection with curative intent remains the most efficacious treatment modality for improving the survival rate of patients with localized lung cancer. Average life expectancy has increased in many countries, and the number of older patients undergoing surgery has increased. We aimed to evaluate the change in health-related quality of life (HRQOL) during perioperative lung resection and the association between HRQOL and perioperative physical function (PF) in older patients with lung cancer.

Methods: This prospective observational study was conducted in a single tertiary university hospital. Patients aged ≥70 years who underwent lung resection between 1 April 2013 and 31 December 2020 were included. HRQOL was assessed utilizing the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) preoperatively and at 1, 3, and 6 months postoperatively. PF was evaluated using the handgrip, quadriceps force, and 6-minute walking distance (6MWD) tests preoperatively and 1 week after surgery. We analyzed a model for total HRQOL and each domain of HRQOL scores at different time points using a mixed-effects model for repeated measures. A multiple regression analysis was performed to estimate the associations between changes in total HRQOL scores following surgery and clinically relevant factors.

Results: In total, 260 patients (172 with stage IA disease, 162 men; median age, 75 years) were included in the analysis. The median preoperative total HRQOL score was 90.1 points, while the scores at postoperative 1, 3, and 6 months were 81.5, 87.5, and 87.4 points, respectively. The total HRQOL score at baseline and the decline in postoperative 6MWD were significant predictors of the total HRQOL score at each time point.

Conclusions: HRQOL recovered to preoperative levels 3 months after surgery; the 6MWD decrease before and after surgery was associated with HRQOL recovery than other clinically relevant factors. These results suggest the importance of active early mobilization in preventing functional decline during hospitalization and continuing exercise training after discharge.