Quality of life in older adults (aged 60–80 years) after lung cancer surgery: a longitudinal observational study

Accurate health-related quality of life (HRQOL) data after video-assisted thoracic surgery (VATS) are lacking for older patients with non-small cell lung cancer (NSCLC). We aimed to characterize the trajectories of symptom burden and functional interference and identify predictors of delayed recovery. In this longitudinal study, older adults (aged 60–80 years) with NSCLC undergoing VATS were enrolled. The MD Anderson Symptom Inventory for Lung Cancer (MDASI-LC) was used to assess symptom burden and functional interference at preoperative, discharge, and 7 days, 1, 2, 3, and 6 months after discharge. Complete prospective data were available for 250 of 254 consecutive patients (98.4% completion rate). The cohort had a median age of 68 years (IQR: 64–71) and comprised 40.9% men. The four most prevalent symptom items were fatigue, pain, shortness of breath, and coughing, while the four most prevalent interference items were general activity, work (including housework), walking, and enjoyment of life. By 6 months after discharge, 68.8% of patients overall returned to preoperative levels (symptoms: 66.9–83.5%; interference: 62.6–66.5%). Multivariable analysis identified the extent of VATS resection (wedge → segmentectomy → lobectomy)as an independent predictor of delayed recovery (ORs per increment:1.868–2.109, 95% CIs:1.260–3.157). The majority of older adults’ symptom burden and functional interference returned to preoperative levels 6 months after discharge. The extent of VATS resection was independently associated with delayed recovery. These findings advocate for the preoperative integration of recovery patterns into surgical strategy selection, particularly when weighing oncological radicality against geriatric patients’ physiological reserves.