Predictors of Nursing Home Admission, Severe Functional Impairment, or Death One Year After Surgery for Non-Small Cell Lung Cancer
ABSTRACT : To assess factors associated with nursing home admission, severe functional impairment, or death 1 year after surgery for stage I-IIIa non-small cell lung cancer.
: Patients perceive long-term disability to be one of the most undesirable complications of lung cancer treatment.
: A multiregional cohort was surveyed 12 months after surgery. Logistic regression was used to determine adjusted predictors of long-term disability. Recursive partitioning was used to create a risk index based on preoperative factors.
: Of the 1007 patients, 146 (15%) were admitted to a nursing home or died by 1 year after surgery, with higher risk among patients 80 years or older, those with severe comorbidities, and those with stage II-IIIa disease (all Ps ≤ 0.01). Among 759 survivors who completed the follow-up survey, 51 (7%) were admitted to a nursing home or reported inability to get out of bed, dress or wash themselves, or perform usual activities. Patients with moderate comorbidities (P < 0.001) or lack of high school diploma (P = 0.03) were more likely to experience nursing home admission or severe functional impairment. The risk of nursing home admission, severe functional impairment, or death was low (16%) for patients younger than 75 years and for those 75 years or older with stage I disease, intermediate (33%) for patients 75 years or older with stage II-IIIa disease and no or mild comorbidities, and high (60%) for those 75 years or older with stage II-IIIa disease and moderate or severe comorbidities.
: Patients' risk of long-term disability should be incorporated in preoperative counseling.
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ABSTRACT: Surgical patients and their physicians currently have tools to provide individualized prognostication for morbidity and mortality. For improved shared decision making, formal prediction of patient-centered outcomes is necessary. We derived and validated a simple, interview-based method to predict discharge home after surgery. We used the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Patient User File for 2011. Derivation in general and vascular surgery patients undergoing inpatient surgery was completed using serial multiple logistic regression. Validation was performed within multiple surgical specialties. The derivation cohort included 88,068 patients, of whom 11,771 (13.4%) were not discharged home. The derived Home Calculator had excellent discrimination (c-statistic = 0.864) using 4 variables: age, American Society of Anesthesiologists' performance status, elective surgery, and preadmission residence. Validation cohorts had varying rates of home discharge as follows: general (63,826 of 71,591, 89.2%), vascular (12,319 of 16,102, 76.5%), gynecologic (16,603 of 17,005, 97.6%), urologic (13,662 of 14,435, 94.6%), orthopaedic (12,000 of 19,514, 61.5%), thoracic (4,467 of 5,092, 87.7%). The Home Calculator provided good to excellent discrimination in validation cohorts: general (c = 0.866), vascular (c = 0.800), gynecologic (c = 0.793), urologic (c = 0.814), orthopaedic (c = 0.876), and thoracic (c = 0.800). Comparable discrimination was demonstrated in sensitivity analyses in surgical patients admitted exclusively from home. We derived and validated a simple Home Calculator that reliably predicts discharge to home after surgery and may be useful when counseling patients about postoperative course. Patient-centered tools such as this may allow physicians to better prepare patients and families for surgery and the recovery process.Journal of the American College of Surgeons 02/2014; 218(2):226-36. DOI:10.1016/j.jamcollsurg.2013.11.002 · 4.45 Impact Factor
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ABSTRACT: Non-small-cell lung cancer (NSCLC) is a very common disease in the elderly population and its incidence in this particular population is expected to increase further, because of the ageing of the Western population. Despite this, limited data are available for the treatment of these patients and, therefore, the development of evidence-based treatment recommendations is challenging. In 2010, European Organization for Research and Treatment of Cancer (EORTC) took an initiative in collaboration with International Society of Geriatric Oncology (SIOG) and created an experts panel that provided an experts' opinion consensus paper for the management of elderly NSCLC patients. Since this publication, important new data are available and EORTC and SIOG recommended to update the 2010 recommendations. Besides recommendations for surgery, adjuvant chemotherapy and radiotherapy, treatment of locally advanced and metastatic disease, recommendations were expanded, to include data on patient preferences and geriatric assessment.Annals of Oncology 03/2014; 25(7). DOI:10.1093/annonc/mdu022 · 6.58 Impact Factor