Ara Vaporciyan, Xin S. Wang, Santosh Bashkar, Arlene Correa, Qiuling Shi, Ibou Gning, Wayne Hofstetter, David Rice, Reza Mehran, Steven Swisher, Charles Cleeland.
UT M. D. Anderson Cancer Center, Houston, TX, USA.
OBJECTIVE: To evaluate the impact of video assisted thoracic surgery (VATS) on symptom burden compared to open thoracotomy for lung resection.
METHODS: We conducted a longitudinal study in 81 non-small cell lung cancer patients (59 open thoracotomy and 22 VATS) treated with lobectomy. The validated M.D. Anderson Symptom Inventory (MDASI) for symptom measurement was applied using a novel symptom assessment (SA) system. Computer generated phone calls for weekly tracking of post-operative symptoms was used to compare symptom burden after open or VATS resection 8 weeks postoperatively. Scores (0 to 10) for each question were entered using the phone’s keypad. Differences over time in symptom severity were examined using t-test and mixed effect modeling.
RESULTS: A similar pattern of postoperative symptom severity was shown for both groups, including a peak severity level in first week. The most severe symptoms were similar in both groups: pain, fatigue, sleeping disturbance and shortness of breath. There was an observed earlier reduction for pain severity in VATS group, with a faster returned to pre-op level ( VATS on week 3 vs open group on week 6). Fatigue severity followed a similar trend (VATS on week 3 vs open on week 7). The VATS total symptom score (MDASI 13 core symptom items) also returned to baseline faster (VATS group on week 5 vs open on week 7). Mixed effect modeling for longitudinal data revealed total interferences in VATS was significantly lower than open group over the 8 post-op weeks (P<.01). Lowess curves in Figure 1 presented average level of total interferences by groups.
CONCLUSIONS: Patients who received VATS demonstrated lower symptom interferences and more rapid return to pre-op symptom severity. Weekly symptom monitoring with a multiple SA tool allows a precise and comprehensive profile of post-op symptom burden. Our novel computer-generated phone call system can achieve this level of data acquisition. Frequent SA provides a effective method to monitor differences in treatment and should be applied to other novel treatment strategies. 
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