Section of Patient Centred Outcomes Research, Leeds Institute for Medical Research at St James's, University of Leeds, Leeds, UK.
Department of Thoracic Surgery, James Cook University Hospital, Middlesbrough, UK.
Interact Cardiovasc Thorac Surg. 2021 May 27;32(6):911-920. doi: 10.1093/icvts/ivab030.
Technology has the potential to assist healthcare professionals in improving patient-doctor communication during the surgical journey. Our aims were to assess the acceptability of a quality of life (QoL) application (App) in a cohort of cancer patients undergoing lung resections and to depict the early perioperative trajectory of QoL.
This multicentre (Italy, UK, Spain, Canada and Switzerland) prospective longitudinal study with repeated measures used 12 lung surgery-related validated questions from the European Organisation for Research and Treatment of Cancer Item Bank. Patients filled out the questionnaire preoperatively and 1, 7, 14, 21 and 28 days after surgery using an App preinstalled in a tablet. A one-way repeated measures analysis of variance was run to determine if there were differences in QoL over time.
A total of 103 patients consented to participate in the study (83 who had lobectomies, 17 who had segmentectomies and 3 who had pneumonectomies). Eighty-three operations were performed by video-assisted thoracoscopic surgery (VATS). Compliance rates were 88%, 90%, 88%, 82%, 71% and 56% at each time point, respectively. The results showed that the operation elicited statistically significant worsening in the following symptoms: shortness of breath (SOB) rest (P = 0.018), SOB walk (P < 0.001), SOB stairs (P = 0.015), worry (P = 0.003), wound sensitivity (P < 0.001), use of arm and shoulder (P < 0.001), pain in the chest (P < 0.001), decrease in physical capability (P < 0.001) and scar interference on daily activity (P < 0.001) during the first postoperative month. SOB worsened immediately after the operation and remained low at the different time points. Worry improved following surgery. Surgical access and forced expiratory volume in 1 s (FEV1) are the factors that most strongly affected the evolution of the symptoms in the perioperative period.
We observed good early compliance of patients operated on for lung cancer with the European Society of Thoracic Surgeons QoL App. We determined the evolution of surgery-related QoL in the immediate postoperative period. Monitoring these symptoms remotely may reduce hospital appointments and help to establish early patient-support programmes.
技术有潜力帮助医疗保健专业人员改善手术过程中的医患沟通。我们的目的是评估生活质量（QoL）应用程序（App）在接受肺切除术的癌症患者中的接受程度，并描述 QoL 的早期围手术期轨迹。
这项多中心（意大利、英国、西班牙、加拿大和瑞士）前瞻性纵向研究采用重复测量方法，使用欧洲癌症研究与治疗组织（EORTC）项目库中的 12 个与肺手术相关的经过验证的问题。患者在术前和术后第 1、7、14、21 和 28 天使用预先安装在平板电脑上的 App 填写问卷。使用单向重复测量方差分析来确定 QoL 是否随时间而变化。
共有 103 名患者同意参与研究（83 名接受肺叶切除术，17 名接受肺段切除术，3 名接受全肺切除术）。83 例手术采用电视辅助胸腔镜手术（VATS）进行。在每个时间点的依从率分别为 88%、90%、88%、82%、71%和 56%。结果表明，手术引起了以下症状的统计学显著恶化：呼吸困难（SOB）休息时（P=0.018）、SOB 行走时（P<0.001）、SOB 上楼梯时（P=0.015）、担忧（P=0.003）、伤口敏感度（P<0.001）、手臂和肩部使用（P<0.001）、胸痛（P<0.001）、体力活动能力下降（P<0.001）和疤痕对日常活动的干扰（P<0.001）在术后第一个月内。SOB 在手术后立即恶化，并在不同时间点保持较低水平。手术后，担忧得到改善。手术入路和 1 秒用力呼气量（FEV1）是影响围手术期症状演变的最重要因素。
我们观察到接受肺癌手术的患者对欧洲胸外科医师学会 QoL App 的早期依从性良好。我们确定了术后即刻与手术相关的 QoL 的演变。远程监测这些症状可能会减少医院就诊次数，并有助于建立早期患者支持计划。
