Quality of Life After Lung Cancer Surgery

Having lung cancer surgery is a life-altering event, and there is no way to minimize the emotions a person can go through when undergoing a procedure like this. The aim of surgery, however, is to not only extend life but improve your overall quality of life. The benefits of treatment will almost invariably outweigh the risks.

Healthcare providers today are paying attention to more than just "life years" when monitoring how people respond to lung cancer surgery. They want to know how people feel, how readily they can return to normal life, and how they perceive their own quality of life.

Recovery is different for everyone. It depends not only on the type of surgery used but also on an individual's general health and psychological well-being before and after surgery.

Perception

Lung cancer is the most commonly diagnosed cancer worldwide and a disease characterized by often intense emotional and physical stresses. Even before surgery is factored in, there are many things that can impact a person's quality of life, both perceived and real, when diagnosed with lung cancer.

According to research published in 2017, 32% of people in good health at the time of their lung cancer diagnosis report "high" to "very high" quality of life following treatment, compared to 31% who report "very low" QoL.

This illustrates that the severity of illness does not necessarily translate to the same perceptions of quality of life in people with lung cancer. As this study demonstrates, it can often go either way.

Among the factors known to influence the perceived quality of life in people with lung cancer are:

• Being female: Women with lung cancer are twice as likely to report poor QoL than good QoL. Men are split 50/50.
• Older age: People over 59 are more likely to report poor quality of life, while those under 52 are more likely to report good QoL.
• Marital status: Being divorced or unmarried doubles your chances of a poor perceived quality of life.
• Employment status: People who are employed full-time are more likely to report good quality of life. Those who are employed part-time are less likely to do so, while those who are unemployed are more than five times more likely to report low quality of life than good.

Lung cancer surgery invariably influences these perceptions as well. In people who undergo surgery, the perception of quality of life drops dramatically, with 81% reporting poor QoL overall. By contrast, only 60% of those who do not undergo surgery report poor quality of life.

While this may suggest that lung cancer surgery reduces a person's quality of life physically—making them unhealthier or less able to take care of themselves—research suggests that perceptions of ill health can influence a person's quality of life just as profoundly. It some cases, it can undermine it completely even if a person's ability to function is restored.

Level of Functioning

While many people regard lung cancer surgery as a means to "cut out the cancer," one of the primary aims of the surgery is to restore or improve the quality of life. And, despite what some may think, people can live normal, active lives even when part or all of a lung is removed.

Lung cancer surgery is an option for some people based on the type, stage, and location of a tumor. It may be used for the purpose of curing early-stage non-small cell lung cancer (NSCLC) or carcinoid cancer, or to relieve symptoms of advanced lung cancer. For most people, the benefits of surgery, when indicated, outweigh the risks.

With that said, a "return to pre-operative levels of function" doesn't necessarily mean an improvement in one's quality of life. If the quality of life (both perceived and real) before surgery is poor, it will often continue to be poor after surgery.

In virtually all cases, people with poor levels of functioning and high levels of symptoms before lung cancer surgery will have a poorer quality of life after surgery. Those who are at greater risk include the elderly who are more likely to have diminished lung function and people who are current smokers at the time of their surgery.

Among the other contributing factors—arguably the most important ones—are the type of surgery used and the extent of lung tissue removed.

Type of Surgery

There are three main types of surgery used for people diagnosed with lung cancer, each with different indications and challenges:

• Wedge resection, also known as segmental resection, involves the removal of a wedge-shaped portion of a lung that contains the tumor and surrounding tissues.
• Lobectomy, the most common surgery used to treat lung cancer, involves the removal of a lobe of the lung (three of which are in the right lung and two of which are in the left lung). Compared to wedge resection, it offers a lesser risk of metastasis, albeit with greater loss of lung tissue mass.
• Pneumonectomy, involving the removal of an entire lung, is used when lobectomy is unable to ensure the complete removal (resection) of a tumor. Despite offering greater assurance of a complete resection, pneumonectomy carries a higher risk of post-operative complications and death.

Although these surgeries can dramatically increase survival times—with five-year survival rates of 45% for pneumonectomy—the quality of life can vary by the choice of surgery.

When compared to wedge resection or lobectomy, people who undergo pneumonectomy score consistently lower on physical function, vitality, energy, social function, cognitive function, and role function (the ability to retain their role as parent, spouse, employee, or community member).

Because of this, surgeons today will opt for less invasive surgeries whenever possible, considering not only a person's health outcomes but quality of life outcomes as well.

Minimally Invasive Surgeries

In place of traditional open surgery, thoracic surgeons are turning to a less-invasive technique known as video-assisted thoracoscopic surgery (VATS) whenever possible. During a VATS procedure, specialized surgical equipment and a tiny camera called thoracoscope are inserted through tiny incisions in the chest wall.

VATS is commonly used to perform both wedge resection and lobectomy. Studies have shown that people with lung cancer who undergo VATS consistently score higher in physical function, social function, role function, and vitality than those who undergo traditional open surgery.

Another less invasive procedure called stereotactic ablative radiotherapy (SBRT) is explored when people with early-stage NSCLC are either unable to undergo surgery or have an inoperable tumor. Within this context, SBRT can not only significantly increase survival times but may improve quality of life compared to even minimally invasive forms of lung cancer surgery.

However, with SBRT, the quality of life is conversely linked to the dose of radiation used, meaning that higher doses generally lead to poorer QoL scores.

Disease Remission

As much as lung cancer surgery can influence a person's quality of life, remission from the disease can often restore a person's quality of life to that of the general population. This is especially true for people with complete remission in which all signs of cancer have disappeared for five years or more.

A 2012 study published in the Annals of Surgery took an extensive look at the quality of life of people who had successfully undergone lung cancer surgery versus a matched set of individuals in the general population who didn't have cancer.

What this suggests is that it doesn't matter how complicated lung cancer surgery is, once a person is deemed cancer-free, the likelihood of living a normal quality of life is as good as someone who had undergone less extensive surgery.

How to Improve Your Quality of Life

Your quality of life is influenced by more than the type of surgery your healthcare provider chooses to perform. QoL is determined by multiple factors within your control, including a commitment to pulmonary rehabilitation, building a strong support network, and managing diet, stress, and fatigue.

Among some of the things you can do:

• Do not rush recovery. Once discharged from the hospital, you should aim to take at least two months off to recuperate. Those who have undergone pneumonectomy may require longer recovery time.
• Focus on progression. Quality of life can be positively influenced by setting and meeting goals. A good place to start is pulmonary rehabilitation. Try not to plateau in your recovery efforts but rather increase the intensity and duration of workouts gradually under the care and advice of your healthcare provider or physical therapist.
• Walk. Part of pulmonary rehabilitation may be no less than 30 minutes of dedicated walking per day. Walking not only improves lung function and builds lean muscle mass but can also enhance mood by stimulating the release of "feel good" hormones called endorphins.
• Stop smoking. The treatment of lung cancer is complicated by smoking, which can significantly reduce quality of life and increase recovery time. If you find it hard to quit, ask your healthcare provider for a prescription smoking cessation aid, many of which are provided free of charge under the Affordable Care Act. Also, ask about smoking support groups.
• Address nutrition. Weight loss is a common concern after lung cancer surgery, which not only undermines your energy levels but feelings of self-esteem and well-being. Work with a dietitian to ensure your caloric and nutritional needs are met. This may involve a daily intake of as much as 3,325 calories and 140 grams of protein per day.
• Reduce stress. Stress is a major factor in the reduction in quality of life in people with lung cancer. Find ways to manage stress on a daily basis to help reduce anxiety and depression. This may involve stress reduction modalities such as meditation, gentle yoga, guided imagery, biofeedback, and progressive muscle relaxation (PMR).
• Seek support. Lung cancer is difficult enough without having to go it alone. Start by building a network of friends and family members you can trust. Seek online support groups, or ask your oncologist about in-person support groups in your area.