• Dhruvin H Hirpara, Natalie G Coburn, Gail E Darling, Biniam Kidane, Mathieu Rousseau, Vaibhav Gupta, Mark Doherty, Victoria Zuk, Victoria Delibasic, Wing Chan, and Julie Hallet.
• Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
• Ann. Surg. 2023 Feb 1; 277 (2): e428e438e428-e438.

ObjectiveTo conduct a population-level analysis of temporal trends and risk factors for high symptom burden in patients receiving surgery for non-small cell lung cancer (NSCLC).BackgroundA population-level overview of symptoms after curative intent surgery is necessary to inform decision making and supportive care for patients with lung cancer.MethodsRetrospective cohort study of patients receiving surgery for stages I to III NSCLC between January 2007 and September 2018. Prospectively collection Edmonton Symptom Assessment System (ESAS) scores, linked to provincial administrative data, were used to describe the prevalence, trajectory, and predictors of moderate-to-severe symptoms in the year following surgery.ResultsA total of 5350 patients, with 28,490 unique ESAS assessments, were included in the analysis. Moderate-to-severe tiredness (68%), poor wellbeing (63%), and shortness of breath (60%) were the most common symptoms reported. The rise and fall in the proportion of patients experiencing moderate-to-severe symptoms after surgery coincided with the median time to first (58 days, interquartile range: 47-72) and last cycle of chemotherapy (140 days, interquartile range: 118-168), respectively. There was eventual stabilization, albeit above the preoperative baseline, within 6 to 7 months after surgery. Female sex (relative risk [RR] 1.09- 1.26), lower income (RR 1.08-1.23), stage III disease (RR 1.15-1.43), adjuvant therapy (RR 1.09-1.42), chemotherapy within 2 weeks of an ESAS assessment (RR 1.14-1.73), and pneumonectomy (RR 1.05-1.15) were associated with moderate-to-severe symptoms following surgery.ConclusionsKnowledge of population-level prevalence, trajectory, and predictors of moderate-to-severe symptoms after surgery for NSCLC can be used to facilitate shared decision making and improve symptom management throughout the course of illness.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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