Objective To analyse the consistency of perioperative self-reported pain scores of lung cancer patients with clinical records to provide a basis for optimal pain management. MethodsThe patients with lung cancer who underwent surgical treatment in the Department of Thoracic Surgery, Sichuan Cancer Hospital from November 2017 to January 2020 were selected. They were divided into two groups based on the source of pain data. The self-report group used a questionnaire in which patients self-reported their pain scores, and the pain scores for the clinical record group were extracted from the electronic medical record system. Kappa test was used to compare the concordance of pain scores between the two groups preoperatively, on postoperative 1-6 days and on the day of discharge. McNemar's paired χ2 test was used to compare the differences in pain intensity levels between the two groups. Binary logistic multi-factor regression was used to analyse the factors influencing the concordance of severe pain (7-10 points) between the two groups. Results Totally 354 patients were collected, including 191 males and 163 females, with an average age of 55.64±10.34 years. The median postoperative hospital stay was 6 days. The consistency of pain scores between the two groups was poor (Kappa=–0.035 to 0.262, P<0.05), and the distribution of pain levels at each time point was inconsistent and statistically significant (P<0.001). The percentage of inconsistent severe pain assessment ranged from 0.28% to 35.56%, with the highest percentage of inconsistent severe pain assessment on postoperative day 1 (35.56%). Single-port thoracoscopic surgical access was an influencing factor for inconsistent assessment of severe pain on postoperative day 3 (OR=2.571, P=0.005). Conclusion Self-reported perioperative pain scores of lung cancer patients are poorly aligned with clinical records. Clinical measures are needed to improve the accuracy of patient pain data reporting by choosing the correct assessment method, increasing education, and developing effective quality control measures.
ObjectiveTo determine the symptom burden and functional status of patients with early-stage lung cancer at 4 weeks after discharge, and to investigate the influencing factors. MethodsAn analysis was conducted on the clinical data of patients with early-stage lung cancer in a multicenter prospective cohort study conducted in six hospitals in China from November 2017 to January 2020. The MD Anderson Symptom Assessment Scale-Lung Cancer Module (MDASI-LC) was used to evaluate symptoms and functions. Binary logistic regression analysis was used to analyze the influencing factors of moderate to severe functional impairment (≥2 points) and moderate to severe symptoms affecting recovery (≥4 points). ResultsA total of 158 patients were included, including 59 males and 99 females, with an average age of (55.5±9.9) years. At 4 weeks of discharge, the three most severe moderate to severe symptoms were cough (30.4%), shortness of breath (25.3%), and disturbed sleep (22.2%). The proportions of patients with moderate to severe physical and psychological impairment were 53.2% and 38.6%, respectively. Multivariate analysis results showed that shortness of breath was an independent risk factor for moderate to severe postoperative physical impairment [OR=10.12, 95%CI (1.51, 67.60), P=0.017]; cough [OR=5.66, 95%CI (1.52-21.15), P=0.007], pain [OR=12.35, 95%CI (1.21, 126.39), P=0.034], and female sex [OR=4.01, 95%CI (1.10, 14.67), P=0.036] were independent risk factors for moderate to severe psychological impairment; forced expiratory volume in the first second <1.5 L [OR=0.10, 95%CI (0.02, 0.58), P=0.010] and female [OR=2.80, 95%CI (1.17, 6.66), P=0.020] were independent risk factors for moderate to severe shortness of breath; open surgery [OR=6.18, 95%CI (1.54, 24.80), P=0.010] and female [OR=7.33, 95%CI (1.84, 29.20), P=0.005] were independent risk factors for moderate to severe pain. ConclusionPatients with early-stage lung cancer still have a significant symptom burden and functional impairment 4 weeks after discharge. Preoperative attention should be given to patients with poor lung function and female patients. During the operation, open surgery should be avoided as much as possible. Effective management of shortness of breath, pain, and cough symptoms in the postoperative period can promote the functional recovery of patients with early-stage lung cancer.