Predictors of Nursing Home Admission, Severe Functional Impairment, or Death One Year After Surgery for Non-Small Cell Lung Cancer
*Department of Surgery †Center for Surgery and Public Health ‡Division of General Medicine and Primary Care §Division of Thoracic Surgery, Brigham and Women's Hospital ‖Department of Health Care Policy, Harvard Medical School, Boston, MA. Annals of surgery
(Impact Factor: 8.33).
03/2013; 257(3):555-63. DOI: 10.1097/SLA.0b013e31828353af
: 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.
Available from: Julie Silver
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ABSTRACT: Cancer prehabilitation, a process on the continuum of care that occurs between the time of cancer diagnosis and the beginning of acute treatment, includes physical and psychological assessments that establish a baseline functional level, identifies impairments, and provides targeted interventions that improve a patient's health to reduce the incidence and the severity of current and future impairments. There is a growing body of scientific evidence that supports preparing newly diagnosed cancer patients for and optimizing their health before starting acute treatments. This is the first review of cancer prehabilitation, and the purpose was to describe early studies in the noncancer population and then the historical focus in cancer patients on aerobic conditioning and building strength and stamina through an appropriate exercise regimen. More recent research shows that opportunities exist to use other unimodal or multimodal prehabilitation interventions to decrease morbidity, improve physical and psychological health outcomes, increase the number of potential treatment options, decrease hospital readmissions, and reduce both direct and indirect healthcare costs attributed to cancer. Future research may demonstrate increased compliance with acute cancer treatment protocols and, therefore, improved survival outcomes. New studies suggest that a multimodal approach that incorporates both physical and psychological prehabilitation interventions may be more effective than a unimodal approach that addresses just one or the other. In an impairment-driven cancer rehabilitation model, identifying current and anticipating future impairments are the critical first steps in improving healthcare outcomes and decreasing costs. More research is urgently needed to evaluate the most effective prehabilitation interventions, and combinations thereof, for survivors of all types of cancer.
American journal of physical medicine & rehabilitation / Association of Academic Physiatrists 06/2013; 92(8). DOI:10.1097/PHM.0b013e31829b4afe · 2.20 Impact Factor
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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 · 5.12 Impact Factor
Available from: annonc.oxfordjournals.org
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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 · 7.04 Impact Factor
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