Integrating health status and survival data: The palliative effect of lung volume reduction surgery

Roberto P Benzo, Max H. Farrell, Chung Chou H Chang, Fernando J. Martinez, Robert Kaplan, John Reilly, Gerard Criner, Robert Wise, Barry Make, James Luketich, Alfred P. Fishman, Frank C. Sciurba

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Rationale: In studies that address health-related quality of life (QoL) and survival, subjects who die are usually censored from QoL assessments. This practice tends to inflate the apparent benefits of interventions with a high risk of mortality. Assessing a composite QoL-death outcome is a potential solution to this problem. Objectives: To determine the effect of lung volume reduction surgery (LVRS) on a composite endpoint consisting of the occurrence of death or a clinically meaningful decline in QoL defined as an increase of at least eight points in the St. George's Respiratory Questionnaire total score from the National Emphysema Treatment Trial. Methods: In patients with chronic obstructive pulmonary disease and emphysema randomized to receive medical treatment (n = 610) or LVRS (n = 608), we analyzed the survival to the composite endpoint, the hazard functions and constructed prediction models of the slope of QoL decline. Measurements and Main Results: The time to the composite endpoint was longer in the LVRS group (2 years) than the medical treatment group (1 year) (P < 0.0001). It was even longer in the subsets of patients undergoing LVRS without a high risk for perioperative death and with upper-lobe-predominant emphysema. The hazard for the composite event significantly favored the LVRS group, although it was most significant in patients with predominantly upper-lobe emphysema. The beneficial impact of LVRS on QoL decline was most significant during the 2 years after LVRS. Conclusions: LVRS has a significant effect on the composite QoL-survival endpoint tested, indicating its meaningful palliative role, particularly in patients with upper-lobe-predominant emphysema.

Original languageEnglish (US)
Pages (from-to)239-246
Number of pages8
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume180
Issue number3
DOIs
StatePublished - Aug 1 2009

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Pneumonectomy
Health Status
Quality of Life
Survival
Emphysema
Pulmonary Emphysema
Chronic Obstructive Pulmonary Disease
Therapeutics
Mortality

Keywords

  • Chronic obstructive pulmonary disease
  • Emphysema
  • Outcome assessment
  • Palliative care
  • Quality of life
  • Survival

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Integrating health status and survival data : The palliative effect of lung volume reduction surgery. / Benzo, Roberto P; Farrell, Max H.; Chang, Chung Chou H; Martinez, Fernando J.; Kaplan, Robert; Reilly, John; Criner, Gerard; Wise, Robert; Make, Barry; Luketich, James; Fishman, Alfred P.; Sciurba, Frank C.

In: American Journal of Respiratory and Critical Care Medicine, Vol. 180, No. 3, 01.08.2009, p. 239-246.

Research output: Contribution to journalArticle

Benzo, RP, Farrell, MH, Chang, CCH, Martinez, FJ, Kaplan, R, Reilly, J, Criner, G, Wise, R, Make, B, Luketich, J, Fishman, AP & Sciurba, FC 2009, 'Integrating health status and survival data: The palliative effect of lung volume reduction surgery', American Journal of Respiratory and Critical Care Medicine, vol. 180, no. 3, pp. 239-246. https://doi.org/10.1164/rccm.200809-1383OC
Benzo, Roberto P ; Farrell, Max H. ; Chang, Chung Chou H ; Martinez, Fernando J. ; Kaplan, Robert ; Reilly, John ; Criner, Gerard ; Wise, Robert ; Make, Barry ; Luketich, James ; Fishman, Alfred P. ; Sciurba, Frank C. / Integrating health status and survival data : The palliative effect of lung volume reduction surgery. In: American Journal of Respiratory and Critical Care Medicine. 2009 ; Vol. 180, No. 3. pp. 239-246.
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AU - Kaplan, Robert

AU - Reilly, John

AU - Criner, Gerard

AU - Wise, Robert

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