Yu Hongfan, Lei Cheng, Wei Xing, Wang Yaqin, Xu Wei, Tang Li, Dai Wei, Liao Jia, Pu Yang, Gong Ruoyan, Su Xueyao, Yu Qingsong, Zhang Jiayuan, Zhang Lijun, Huang Yanyan, Zhuang Xiang, Bai Jin, Wang Zhibiao, Li Qiang, Shi Qiuling
State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China.
School of Public Health, Chongqing Medical University, Chongqing, China.
Int J Surg. 2024 Oct 1;110(10):6591-6600. doi: 10.1097/JS9.0000000000001855.
Electronic symptom monitoring via patient-reported outcomes in surgical oncology is limited owing to lengthy instruments and non-specific items in common patient-reported outcome instruments. To establish electronic symptom monitoring through a clinically relevant and fit-for-purpose core set of patient-reported outcome in patients undergoing lung cancer surgery.
One qualitative (Cohort 1) and two prospective studies (Cohorts 2 and 3) were conducted between 2018 and 2022. Patients undergoing lung cancer surgery were recruited. Items of symptoms and daily functioning were generated through extensive interviews in Cohort 1 and incorporated into a smartphone-based platform to establish the electronic Perioperative Symptom Assessment for Lung surgery (ePSA-Lung). This instrument was finalized and validated in Cohort 2. Patients in Cohort 3 were longitudinally monitored for the first-year post-surgery using the validated ePSA-Lung.
In total, 1037 patients scheduled for lung cancer surgery were recruited. The 11-item draft PSA-Lung was generated based on qualitative interview with 39 patients and input from a Delphi study involving 42 experts. A 9-item ePSA-Lung was finalized by assessing 223 patients in the validation cohort; the results supported the instrument's understandability, reliability, sensitivity, and surgical specificity. In Cohort 3 ( n =775), compliance ranged from 63.21 to 84.76% during the 1-year follow-up after discharge. Coughing, shortness of breath, and disturbed sleep were the most severe symptoms after discharge. Longitudinally, patients who underwent single-port video-assisted thoracic surgery had a lower symptom burden than those who underwent multi-port video-assisted thoracic surgery or thoracotomy (all symptoms, P <0.001).
The ePSA-Lung is valid, concise, and clinically applicable as it supports electronic symptom monitoring in surgical oncology care. The need for long-term extensive care was identified for patients after discharge, even in early-stage cancer with potential curative treatment.
由于常见患者报告结局工具中的条目冗长且不具特异性，手术肿瘤学中通过患者报告结局进行电子症状监测受到限制。目的是通过一套临床相关且适用的肺癌手术患者报告结局核心集来建立电子症状监测。
在2018年至2022年期间进行了一项定性研究（队列1）和两项前瞻性研究（队列2和队列3）。招募了接受肺癌手术的患者。队列1通过广泛访谈生成症状和日常功能条目，并纳入基于智能手机的平台，以建立肺癌手术围手术期症状电子评估工具（ePSA-Lung）。该工具在队列2中最终确定并验证。队列3的患者在术后第一年使用经过验证的ePSA-Lung进行纵向监测。
共招募了1037例计划接受肺癌手术的患者。基于对39例患者的定性访谈以及42位专家参与的德尔菲研究的意见，生成了包含11个条目的PSA-Lung草案。通过对验证队列中的223例患者进行评估，最终确定了包含9个条目的ePSA-Lung；结果支持该工具的可理解性、可靠性、敏感性和手术特异性。在队列3（n = 775）中，出院后1年随访期间的依从率在63.21%至84.76%之间。咳嗽、呼吸急促和睡眠障碍是出院后最严重的症状。纵向来看，接受单孔电视辅助胸腔镜手术的患者症状负担低于接受多孔电视辅助胸腔镜手术或开胸手术的患者（所有症状，P <0.001）。
ePSA-Lung有效、简洁且临床适用，因为它支持手术肿瘤学护理中的电子症状监测。即使是接受了潜在治愈性治疗的早期癌症患者，出院后也需要长期的广泛护理。
