Dyspnea and cough trajectories in older adults (aged 60–80 years) after lung cancer surgery: a 6-month longitudinal study

BACKGROUND: To characterize postoperative trajectories of dyspnea and cough and identify clinical factors associated with delayed recovery in older adults undergoing lung cancer surgery. METHODS: This single-center prospective longitudinal study enrolled older adults aged 60-80 years with non-small cell lung cancer (NSCLC) undergoing video-assisted thoracic surgery (VATS). Dyspnea and cough were assessed using the modified Medical Research Council dyspnea scale (mMRC-DS) and the Leicester Cough Questionnaire Mandarin Chinese version (LCQ-MC) preoperatively and at multiple time points up to 6 months after discharge. RESULTS: Among 292 patients (median age 68; 40.4% men), dyspnea recovered rapidly, with 95.2% reporting no clinically significant symptoms (mMRC-DS grade 0-1) by 6 months. In contrast, cough recovery was significantly more protracted. The LCQ-MC total score decreased from 20.29 preoperatively to 15.69 at discharge and, among patients who remained under follow-up, partially recovered to 17.39 at 6 months, remaining below preoperative levels (all P < 0.001). The median time to the composite recovery endpoint was 75 days. After multivariable adjustment, extent of resection remained associated with postoperative recovery. Patients undergoing VATS lobectomy demonstrated significantly slower recovery than those undergoing VATS sublobectomy (adjusted HR = 0.47, 95% CI 0.34-0.66; p < 0.001). CONCLUSION: Cough demonstrated a more prolonged postoperative recovery trajectory than dyspnea in older adults following lung cancer surgery. Recovery to preoperative symptom levels required a substantial postoperative period, and extent of resection remained associated with delayed recovery after multivariable adjustment. These findings highlight the importance of longitudinal postoperative symptom assessment in older adults undergoing lung cancer surgery. TRIAL REGISTRATION: This study was prospectively registered in the Chinese Clinical Trial Registry (ChiCTR2200064378) on October 5, 2022. The first patient was enrolled after registration.