Symptom Cluster Trajectories of Cough, Shortness of Breath, and Disturbed Sleep in Patients Undergoing Lung Cancer Surgery: A Longitudinal Study.

Abstract

The symptom cluster of cough, shortness of breath, and disturbed sleep is common in patients undergoing lung cancer surgery, but its longitudinal patterns remain unclear. This study aimed to identify distinct cluster trajectories and associated factors. Data were drawn from a cohort study on perioperative patient-reported outcomes of lung cancer patients. Symptoms were measured with the Perioperative Symptom Assessment for Lung Surgery (PSA-Lung) at eight time points: preoperation, postoperative day 1, at discharge, and 1, 3, 6, 9, and 12 months postdischarge. A parallel-process latent growth curve model identified trajectory classes, and multivariate logistic regression explored associated factors. Among 1377 patients, three trajectory classes were identified: persistently low (N = 814, 60.8%), persistently declining (N = 410, 30.7%), and persistently moderate (N = 114, 8.5%). Male sex (OR = 0.59, 95% CI 0.41-0.87, P = 0.01), no readmission (OR = 0.42, 95% CI 0.20-0.89, P = 0.02), were associated with the "persistently low" trajectory. Lower education level of middle school and below (OR = 2.05, 95% CI 1.07-3.92, P = 0.03), annual family income <100,000 CNY (OR = 2.00, 95% CI 1.01-3.97, P = 0.048), lymph node sampling (OR = 0.41, 95% CI 0.17-0.99, P = 0.047), and high hospitalization costs (OR = 1.37, 95% CI 1.14-1.65, P = 0.001) were associated with the "persistently moderate" trajectory. There is significant heterogeneity in the trajectories of the cough, shortness of breath, and disturbed sleep symptom cluster. Early identification of high-risk groups may facilitate targeted interventions to improve outcomes.