Schwartz Rebecca M, Yip Rowena, You Nan, Gillezeau Christina, Song Kimberly, Yankelevitz David F, Taioli Emanuela, Henschke Claudia I, Flores Raja M
Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai.
Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai.
MDM Policy Pract. 2022 Mar 21;7(1):23814683221085570. doi: 10.1177/23814683221085570. eCollection 2022 Jan-Jun.
Patients with early-stage non-small-cell lung cancer (NSCLC) have high survival rates, but patients often say they did not anticipate the effect of the surgery on their postsurgical quality of life (QoL). This study adds to the literature regarding patient and surgeon interactions and highlights the areas where the current approach is not providing good communication.
Since its start in 2016, the Initiative for Early Lung Cancer Research on Treatment (IELCART), a prospective cohort study, has enrolled 543 patients who underwent surgery for stage I NSCLC within the Mount Sinai Health System. Presurgical patient and surgeon surveys were available for 314 patients, postsurgical surveys for 420, and both pre- and postsurgical surveys for 285.
Of patients with presurgical surveys, 31.2% said that their surgeon recommended multiple types of treatment. Of patients with postsurgical surveys, 85.0% felt very well prepared and 11.4% moderately well prepared for their postsurgical recovery. The median Functional Assessment of Cancer Therapy-Lung Cancer score and social support score of the patients who felt very well prepared was significantly higher than those moderately or not well prepared (24.0 v. 22.0, < 0.001) and (5.0 [interquartile range: 4.7-5.0] v. 5.0 [IQR: 4.2-5.0], = 0.015).
This study provides insight into the areas where surgeons are communicating well with their patients as well as the areas where patients still feel uninformed. Most surgeons feel that they prepare their patients well or very well for surgical recovery, whereas some patients still feel that their surgeons did not prepare them well for postsurgical recovery. Surgeons may want to spend additional time emphasizing postsurgical recovery and QoL with their patients or provide their patients with additional avenues to get their questions and concerns addressed.
Pretreatment discussions could help surgeons understand patient priorities and patients understand the anticipated outcomes for their surgeries.There is an association between feeling prepared for surgery and higher quality of life and social support scores after adjustment for confounders.Despite these pretreatment discussions, patients still feel that they are not well prepared about what to expect during their postsurgical recovery.
早期非小细胞肺癌（NSCLC）患者生存率较高，但患者常表示未预料到手术对其术后生活质量（QoL）的影响。本研究补充了有关患者与外科医生互动的文献，并突出了当前方法在沟通方面存在不足的领域。
自2016年启动以来，肺癌早期治疗研究倡议（IELCART）这一前瞻性队列研究已纳入543例在西奈山医疗系统内接受I期NSCLC手术的患者。314例患者有术前患者和外科医生调查问卷，420例有术后调查问卷，285例同时有术前和术后调查问卷。
在有术前调查问卷的患者中，31.2%表示其外科医生推荐了多种治疗方式。在有术后调查问卷的患者中，85.0%感觉对术后恢复准备得非常充分，11.4%感觉准备得较为充分。感觉准备得非常充分的患者的癌症治疗功能评估-肺癌评分中位数和社会支持评分显著高于感觉准备得一般或不充分的患者（24.0对22.0，P<0.001）以及（5.0[四分位间距：4.7-5.0]对5.0[四分位间距：4.2-5.0]，P=0.015）。
本研究深入了解了外科医生与患者沟通良好的领域以及患者仍感觉信息不足的领域。大多数外科医生认为他们让患者为手术恢复做好了充分或非常充分的准备，而一些患者仍觉得外科医生没有让他们为术后恢复做好充分准备。外科医生可能需要额外花时间向患者强调术后恢复和生活质量，或者为患者提供更多解决其问题和担忧的途径。
术前讨论有助于外科医生了解患者的优先事项，患者了解手术的预期结果。在调整混杂因素后，对手术准备充分与更高的生活质量和社会支持评分之间存在关联。尽管有这些术前讨论，但患者仍觉得他们对术后恢复期间的预期没有做好充分准备。
