| Summary: | 博士 === 國防醫學院 === 醫學科學研究所 === 103 === Background: Few interventional studies on the postoperative health status of lung cancer patients have considered the efficacy of programs designed to improve critical health variables. While studies have documented gender differences among lung cancer patients, the effect of these differences on the health-related quality of life (HRQoL) of post-lobectomy lung-cancer patients and related factors remain uncertain.
Objectives: This study has two parts. The first one study examined the effects of an early postoperative walking exercise (EPWE) program on health status in post-lobectomy lung cancer patients. In addition, in the other study, we further examined gender-specific HRQoL and related factors in post-lobectomy lung-cancer patients.
Methods: There were two designs in this study, the first one was a two-group experimental, longitudinal approach with repeated 4 times examined participant data collected prior to surgery and again 1, 3, and 6 months after surgery between 2005 and 2008 and the next one was a cross-sectional study design from March to December 2012.
The two-group experimental, longitudinal approach, we assigned the first 33 enrolled participants to the intervention group and the second 33 to the control group. The intervention was a daily supervised walking exercise program consisting of 12 weeks of brisk walking exercise that began on the day following transfer to the regular ward along with weekly telephone calls up to 12 weeks after discharge. Health status was measured by a structured questionnaire (World Health Organization Quality of Life, brief version [WHOQOL-BREF]) and clinical tests (pulmonary function test and 6- minute walk test [6MWT]). We analyzed data using general estimating equations (GEEs).
The cross-sectional study design was a convenience sample of 231 post-lobectomy lung-cancer patients recruited from the thoracic surgery outpatient departments of two teaching hospitals in Taipei, Taiwan. Patients performed a spirometry test and completed instruments that included a Beck Depression Inventory-II, an Interpersonal Support Evaluation List, and the symptom and function scales of the Quality of Life Questionnaire. Data analysis used descriptive statistics, including mean and standard deviations, frequency, and percentage values. Independent-sample Student’s t-tests and multivariate analyses were used for comparative purposes, with p < 0.05 considered significant.
Results: One of the two studies found that an early postoperative walking exercise program pulmonary and physical functions were increasingly better than those of the control group over time, with no significant difference in quality of life between the two groups. For the intervention group, values for FVC% were significantly better at postoperative month 3, and FEV1% better at postoperative months 3 and 6, than those of the control group. Intervention group 6MWT scores were significantly better than those of the control group at postoperative months 1, 3, and 6.
The other study confirmed a significant gender effect on HRQoL and HRQoL-related factors such as marital status, religious affiliation, smoking status, histologic type, symptoms, pulmonary function, depression, and family support. Moreover, multivariate analysis found gender to be a significant determinant of the HRQoL aspects of physical functioning, emotional functioning, and cognitive functioning.
Conclusion: This study demonstrated the benefits of an EPWE intervention for pulmonary and physical function of post-lobectomy lung cancer patients. This study also found that gender impacts the HRQoL and related factors of postoperative lung-cancer patients. Therefore, gender should be considered in assessing and addressing the individual care needs of these patients in order to attain optimal treatment outcomes.
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