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American Journal of Critical Care. 2008;17: 455-467
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CE Article

Symptom Severity 1 to 4 Months After Thoracotomy for Lung Cancer

By Linda Sarna, RN, DNSc, Mary E. Cooley, PhD, CRNP, CS, Jean K. Brown, RN, PhD, Cynthia Chernecky, RN, PhD, David Elashoff, PhD and Jenny Kotlerman, MS. Linda Sarna is a professor in the School of Nursing at the University of California, Los Angeles. Mary E. Cooley is a nurse scientist at the Phyllis F. Cantor Center, Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, Massachusetts. Jean K. Brown is a dean and professor at the University at Buffalo, State University of New York, Buffalo. Cynthia Chernecky is a professor at the School of Nursing, Medical College of Georgia in Augusta. David Elashoff is an associate professor in the School of Public Health and in the Department of Medicine of the David Geffen School of Medicine at the University of California, Los Angeles. Jenny Kotlerman is a principal statistician in the Department of Medicine of the David Geffen School of Medicine at the University of California, Los Angeles.

Corresponding author: Linda Sarna, RN, DNSc, FAAN, School of Nursing, University of California, Los Angeles, 700 Tiverton Ave, Los Angeles, CA 90095-6918 (e-mail: lsarna{at}sonnet.ucla.edu).

Background Information about the severity of symptoms during recovery from surgery for lung cancer can be useful in planning and anticipating needs for recovery.

Objectives To describe symptom severity during the first 4 months after thoracotomy for non–small cell lung cancer and factors associated with overall symptom severity at 1 and 4 months.

Methods Ninety-four patients were assessed at 1, 2, and 4 months after thoracotomy by using the Lung Cancer Symptom Scale, Brief Pain Inventory, Schwartz Fatigue Scale, Dyspnea Index, and Center for Epidemiology Studies–Depression Scale (CES-D). Clinically meaningful changes, decrease in the proportion of patients with severe symptoms, and relationships among symptoms were determined. Mixed effects models for repeated measures were used to evaluate changes in severity. Multiple regression models were used to examine correlates of overall symptoms.

Results Mean symptom severity significantly decreased over time for most symptoms. Only disrupted appetite, pain, and dyspnea had clinically meaningful improvement at 4 months. Severe symptoms included fatigue (57%), dyspnea (49%), cough (29%), and pain (20%). Prevalence of depressed mood decreased at 4 months. Most patients (77%) had comorbid conditions. Number of comorbid conditions and CES-D explained 54% of the variance in symptom severity at 1 month; comorbid conditions, male sex, neoadjuvant treatment, and CES-D score explained 50% of the variance at 4 months.

Conclusions Severe symptoms continued 4 months after surgery for some patients, indicating the need for support during recovery, especially for patients with multiple comorbid conditions and depressed mood.

Notice to CE enrollees:
A closed-book, multiple-choice examination following this article tests your understanding of the following objectives:
  1. Describe the characteristics associated with symptom severity at 1 and 4 months after surgery.
  2. Identify the 3 symptoms that met the threshold for clinically meaningful changes 1 month to 4 months after surgery.
  3. Recognize that depressed mood is associated with severity of 3 significant physical symptoms.
To read this article and take the CE test online, visit www.ajcconline.org and click "CE Articles in This Issue." No CE test fee for AACN members.






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