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

Roberto 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 Scopus citations

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

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

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    Benzo, R., Farrell, M. H., Chang, C. C. H., Martinez, F. J., Kaplan, R., Reilly, J., Criner, G., Wise, R., Make, B., Luketich, J., Fishman, A. P., & Sciurba, F. C. (2009). Integrating health status and survival data: The palliative effect of lung volume reduction surgery. American journal of respiratory and critical care medicine, 180(3), 239-246. https://doi.org/10.1164/rccm.200809-1383OC