肺癌手术患者的术后症状负担。
Postoperative Symptom Burden in Patients Undergoing Lung Cancer Surgery.
机构信息
Department of Surgery (A.M., J.E., B.M.W., G.N.M.), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
University Libraries (R.C.), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
出版信息
J Pain Symptom Manage. 2022 Sep;64(3):254-267. doi: 10.1016/j.jpainsymman.2022.05.016. Epub 2022 Jun 2.
CONTEXT
Previous studies on quality of life (QOL) after lung cancer surgery have identified a long duration of symptoms postoperatively. We first performed a systematic review of QOL in patients undergoing surgery for lung cancer. A subgroup analysis was conducted focusing on symptom burden and its relationship with QOL.
OBJECTIVE
To perform a qualitative review of articles addressing symptom burden in patients undergoing surgical resection for lung cancer.
METHODS
The parent systematic review utilized search terms for symptoms, functional status, and well-being as well as instruments commonly used to evaluate global QOL and symptom experiences after lung cancer surgery. The articles examining symptom burden (n = 54) were analyzed through thematic analysis of their findings and graded according to the Oxford Centre for Evidence-based Medicine rating scale.
RESULTS
The publication rate of studies assessing symptom burden in patients undergoing surgery for lung cancer have increased over time. The level of evidence quality was 2 or 3 for 14 articles (cohort study or case control) and level of 4 in the remaining 40 articles (case series). The most common QOL instruments used were the Short Form 36 and 12, the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire, and the Hospital Anxiety and Depression Score. Thematic analysis revealed several key findings: 1) lung cancer surgery patients have a high symptom burden both before and after surgery; 2) pain, dyspnea, cough, fatigue, depression, and anxiety are the most commonly studied symptoms; 3) the presence of symptoms prior to surgery is an important risk factor for higher acuity of symptoms and persistence after surgery; and 4) symptom burden is a predictor of postoperative QOL.
CONCLUSION
Lung cancer patients undergoing surgery carry a high symptom burden which impacts their QOL. Measurement approaches use myriad and heterogenous instruments. More research is needed to standardize symptom burden measurement and management, with the goal to improve patient experience and overall outcomes.
背景
先前关于肺癌手术后生活质量（QOL）的研究已经确定了术后症状持续时间长。我们首先对肺癌手术患者的 QOL 进行了系统评价。进行了亚组分析，重点关注症状负担及其与 QOL 的关系。
目的
对接受肺癌手术切除的患者的症状负担进行定性综述。
方法
该系统评价的母项使用了症状、功能状态和幸福感的检索词，以及常用于评估肺癌手术后整体 QOL 和症状体验的工具。对 54 篇分析症状负担的文章进行了主题分析，并根据牛津循证医学中心评价量表对其进行了分级。
结果
随着时间的推移，评估肺癌手术患者症状负担的研究的发表率有所增加。14 篇文章（队列研究或病例对照）的证据质量水平为 2 或 3，其余 40 篇文章（病例系列）的证据质量水平为 4。最常使用的 QOL 工具是简式 36 健康量表和 12 项健康调查简表、欧洲癌症研究与治疗组织生活质量问卷和医院焦虑抑郁量表。主题分析揭示了一些关键发现：1）肺癌手术患者在手术前后都有很高的症状负担；2）疼痛、呼吸困难、咳嗽、疲劳、抑郁和焦虑是最常研究的症状；3）手术前存在症状是术后症状加重和持续存在的重要危险因素；4）症状负担是术后 QOL 的预测因素。
结论
接受手术的肺癌患者背负着沉重的症状负担，这影响了他们的 QOL。测量方法使用了多种异质的工具。需要进一步研究以标准化症状负担的测量和管理，以改善患者的体验和整体结局。
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