Preoperative predictors of physical functioning in patients after gastrointestinal- or lung cancer surgery.

Abstract

Background: Undergoing gastrointestinal- or lung cancer surgery is a major life event, and recovery after surgery significantly impacts physical, psychological, and social functioning. However, the course of recovery varies between patients. Knowledge of preoperative predictors of functional recovery can be used to inform patients about the likely course of their recovery and can contribute to developing therapeutic and preventive interventions. Physical functioning after hospital discharge is not often used as an outcome in prediction models, although it is relevant for patients and rehabilitation professionals. Furthermore, modifiable preoperative nutritional and physical factors, often omitted in current prediction models, predict physical functioning after discharge. Aim: To identify preoperative predictors, including physical and nutritional factors, for change in physical functioning at four weeks after hospital discharge in patients who underwent gastrointestinal- or lung cancer surgery. Methods: A multicenter longitudinal observational study was conducted in patients undergoing gastrointestinal- or lung cancer surgery. The primary outcome was physical functioning at four weeks after hospital discharge using the Dutch-Flemish Patient Reported Outcome Measure Information System for Physical Functioning. Potential preoperative predictors included demographic factors (i.e., age), clinical factors (i.e., physical health status, tumor location, and operation technique), physical factors (i.e., physical activity and measures of physical performance), and nutritional factors (i.e., fat-free mass index and protein intake). Univariable and multivariable linear regression analyses were conducted. Results: Data from 88 patients were available for analysis. The average physical functioning decreased from 46.99 (SD = 6.7) before surgery to 40.84 (SD = 6.0) at four weeks after hospital discharge. Univariable regression analysis showed that physical activity and physical health were associated with changes in physical functioning at four weeks after hospital discharge (p<0.2). Multivariable linear regression analysis did not identify any significant predictors for change in physical functioning at four weeks after hospital discharge. Conclusion and key findings: No significant preoperative predictors for change in physical functioning were identified in patients who underwent gastrointestinal- or lung cancer surgery. Further research is necessary to gain more insight into predictors of physical functioning after cancer surgery.