The postoperative symptom burden in patients with lung cancer is severe and adversely impairs their quality of life. Symptom management is the cornerstone of medical care. Patient-reported outcome (PRO)-based symptom management is being increasingly recognized as the best "patient-centered care" model in clinical practice. However, the precise implementation of this model in patients undergoing lung cancer surgery is hindered by the lack of a lung cancer surgery-specific scale, implementation standards, clinical application parameters and high-quality researches. The use of a precise and simple PRO scale and an electronic PRO platform may greatly improve the feasibility of implementing this model. Currently, the application of PRO-based symptom management in lung cancer surgery is still being explored and needs to be improved in clinical research and practice.
ObjectiveTo investigate the preoperative symptom burden and quality of life of patients undergoing lung cancer surgery.MethodsThis study was a cross-sectional study. We used the MD Anderson Symptom Inventory-lung cancer module (MDASI-LC) and the single-item quality of life scale (UNISCALE) to collect the preoperative patient-reported outcomes of 265 patients with lung cancer from November 2017 to July 2019 in Sichuan Cancer Hospital.ResultsOf 265 patients, 90.9% had preoperative symptoms. The five most common symptoms were coughing (66.8%), dry mouth (53.6%), memory problems (52.8%), disturbed sleep (52.1%) and fatigue (44.2%). The five most common moderate to severe symptoms were disturbed sleep (23.0%), distress (18.5%), memory problems (16.6%), coughing (16.2%) and dry mouth (16.2%). Patients with early-stage lung cancer had less pain, fatigue, shortness of breath, lack of appetite, numbness and coughing, and their symptoms had less impact on work (including housework), relations with other people, walking and enjoyment of life as well as better quality of life before surgery (P<0.05). Patients with adenocarcinoma had milder coughing and a better quality of life before surgery (P<0.05). Symptom score was positively correlated with symptom interference with life score (r=0.66, P<0.01) and negatively correlated with quality of life score (r=-0.41, P<0.01).ConclusionMost patients undergoing lung cancer surgery have a mild symptom burden before surgery. The most common and severe symptoms are coughing, dry mouth, lung cancer and disturbed sleep. Patients with early-stage lung cancer have a milder symptom burden and a better quality of life.
The COSMIN-RoB checklist includes three sections with a total of 10 boxes, which is used to evaluate risk of bias of studies on content validity, internal structure, and other measurement properties. COSMIN classifies reliability, measurement error, criteria validity, hypothesis testing for construct validity, and responsiveness as other measurement properties, which primarily focus on the quality of the (sub)scale as a whole, rather than on the item level. Among the five measurement properties, reliability, measurement error and criteria validity are the most widely used in the studies. Therefore, this paper aims to interpret COSMIN-RoB checklist with examples to guide researchers to evaluate the risk of bias of the studies on reliability, measurement error and criteria validity of PROMs.
Measurement properties studies of patient-reported outcome measures (PROMs) aims to validate the measurement properties of PROMs. In the process of designing and statistical analysis of these measurement properties studies, bias will occur if there are any defects, which will affect the quality of PROMs. Therefore, the COSMIN (consensus-based standards for the selection of health measurement instruments) team has developed the COSMIN risk of bias (COSMIN-RoB) checklist to evaluate risk of bias of studies on measurement properties of PROMs. The checklist can be used to develop systematic reviews of PROMs measurement properties, and for PROMs developers, it can also be used to guide the research design in the measurement tool development process for reducing bias. At present, similar assessment tools are lacking in China. Therefore, this article aims to introduce the primary contents of COSMIN-RoB checklist and to interpret how to evaluate risk of bias of the internal structure studies of PROMs with examples.
ObjectiveTo compare the differences in patient satisfaction and health-related quality of life after total mastectomy and breast-conserving surgery for breast cancer. MethodsBreast cancer patients who underwent surgical treatment in the First Hospital of Shanxi Medical University and The People’s Hospital of Shanxi Province from March to June 2021 were selected as the research objects by convenient sampling method. Self-designed questionnaires were used to evaluate the general situation of the patients. Patients’ satisfaction and quality of life were investigated by using the postoperative scale of the BREAST-Q module of total mastectomy (to investigate patients after total mastectomy) and the postoperative scale of the breast-conserving plastic surgery module (to investigate patients after breast-conserving surgery), and the patient-reported outcomes of total mastectomy and breast-conserving surgery were compared, including breast satisfaction, psychosocial health, chest and upper limb physical health, sexual health, medical team satisfaction, and information satisfaction. ResultsIn this study, there were 100 patients in the total mastectomy group and 50 patients in the breast conserving group. There were no significant differences between the two groups in marital status, monthly family income, education, body mass index, whether combined with other physical diseases, chemotherapy, targeted therapy, axillary lymph node dissection, tumor stage, and molecular typing (P>0.05). The rates of radiotherapy and endocrine therapy in the breast conserving group were higher than those in total mastectomy group ( χ2=48.701, P<0.001; χ2=15.891, P<0.001). The scores of quality of life and patient satisfaction scores of the breast conserving group including breast satisfaction, satisfactions of breast doctors, nurses and other doctors, social and mental health, sexual health score were higher than those of the total mastectomy group (P<0.001), but there was no significant difference in the physical health of chest and upper limbs score between the two groups (P>0.05). In addition, the satisfaction score of radiotherapy information in the breast conserving group was 69.40±20.44 and that of medical information given by breast surgeons was 87.04±19.46. ConclusionScores of breast satisfaction, psychosocial health, sexual health, and health-related quality of life in breast-conserving patients are higher than those in total mastectomy patients.
Esophageal carcinoma is a malignant tumor with high morbidity and mortality worldwide, and surgery is the main treatment currently. With the development of patient-centered care, the effect of surgery should not be limited to the improvement of the incidence of postoperative complications, mortality and other indicators. It is also important to provide experience related to disease and surgery from the perspective of patients. Therefore, more and more attention is paid to patient-reported outcomes by scholars. This paper will provide an overview of the international widely used, reliable and effective scales and researches about patient-reported outcomes in esophageal carcinoma.
Objective To analyze the changes of perioperative symptoms of lung cancer patients by using patient-reported outcomes at different time points. MethodsA total of 109 patients who underwent thoracoscopic lung cancer resection in the department of thoracic surgery of our hospital from March to April 2021 were selected, including 55 (50.46%) males and 54 (49.54%) females. The mean age was 55.19±12.12 years. The postoperative symptom scale for lung cancer patients was used to investigate the changes of symptoms before surgery, 1 day after surgery, the day of discharge, and 30 days after surgery. Results The mean hospital stay was 6.89±2.25 days. None of the patients reported any clinical symptoms related to lung cancer before surgery. The most prominent symptoms 1 day after surgery were pain (3.33±0.96 points), nausea (2.81±1.18 points), dizziness (2.00±0.85 points), fatigue (1.89±0.79 points) and shortness of breath (1.79±1.37 points). The patients with dizziness, nausea, fatigue and other symptoms gradually decreased, and the symptoms were relieved significantly (P<0.05). However, the symptoms of conscious pain, cough and shortness of breath lasted for a long time. At 30 days after surgery, 70.64%, 64.22% and 33.03% of patients felt pain, cough and shortness of breath, respectively, and the degree of cough was aggravated (P<0.001). Conclusion Pain, cough, dizziness, shortness of breath and fatigue are the core postoperative symptoms of lung cancer patients. Most postoperative adverse symptoms can be effectively controlled in a short period of time, but pain, cough and shortness of breath still present persistent characteristics, which deserve further study.
ObjectiveTo categorize and describe stroke-patients based on factors related to patient reported outcomes. MethodsA questionnaire survey was conducted among stroke-patients in nine hospitals and communities in Shanxi Province. The general information questionnaire and stroke-patient reported outcome manual (Stroke-PROM) were completed. Latent profile analysis was used to analyze the scores of Stroke-PROM, and the explicit variables of the model were the final scores of each dimension. ANOVA and correlation analysis were used to measure the correlation between the factors and subtypes. ResultsFour unique stroke-patient profiles emerged, including a low physiological and low social group (9%), a high physiological and middle social group (40%), a middle physiological and middle social group (26%), and a middle physiological and high social group (25%). There were significant differences in scores of four areas among patients with different subtypes (P<0.05). Moreover, there was a correlation between age, payment, exercise and subtypes (P<0.05). ConclusionThere are obvious grouping characteristics for stroke patients. It is necessary to focus on stroke patients who are advanced in age, have a self-funded status and lack exercise, and provide targeted nursing measures to improve their quality of life.
Telephone follow-up is one of the important ways to follow up patients. High-quality follow-up can benefit both doctors and patients. However, clinical research-related follow-up is often faced with problems such as time-consuming, laborious and poor patient compliance. The authors belong to a team that has been committed to the study of patient-reported outcomes for a long time. The team has carried out long-term follow-up of symptoms, daily function and postoperative complications of more than 1 000 patients after lung cancer surgery, and accumulated certain experience. In this paper, the experience of telephone follow-up was summarized and discussed with relevant literatures from the aspects of clarifying the purpose of clinical research follow-up, understanding the needs of patients in follow-up, and using follow-up skills.