Measuring Patient Quality of Life Before Cancer Surgery May Yield Better Outcomes

Juliane Bingener, MD

A study conducted by researchers at the Mayo Clinic has found that family conflicts and other nonmedical problems may raise their risk of complications following cancer surgery.

The study, published in the Journal of Gastrointestinal Surgery, enrolled 431 colon cancer surgery patients and found that before surgery, 13 % had a quality of life deficit, defined as an overall quality of life score of less than 50 on a 100-point scale.

Nearly three times as many patients who entered surgery with a quality of life deficit experienced serious postsurgery complications versus those with a normal or good quality of life score, the results showed. Patients with a postoperative complication spent 3.5 days longer in the hospital on average than those who didn’t.

“We know that quality of life is a very complex thing, but we can now measure it and work with it almost like blood pressure,” lead author Juliane Bingener, MD, a gastroenterologic surgeon at the Mayo Clinic in Rochester, Minnesota, said in a statement. “We can say, ‘This is good, this is in the normal range, but this one here, that is not good, and maybe we should do something.’”

Quality of life as measured in the study is about more than happiness and how well people feel physically, Bingener explained. It also includes the financial, spiritual, emotional, mental, and social aspects of their lives and whether their needs are being met.

Stress can weaken patients’ immune response, putting them at higher risk of infection. Patients’ outlook on life can also influence how active they are in working to recover.

“You have a surgery, you’re lying there in pain, now you wonder, ‘Why should I even get up and walk around? Why do I have to do these deep-breathing exercises? I don’t feel like it.’ You might get pneumonia much faster than somebody who says, ‘Oh, I have to get up. There’s something worth living for, my quality of life is good, and I need to get back to that,’”Bingener said.

This study is part of ongoing work by Mayo to identify and address factors that can influence patients’ recovery from cancer surgery to help improve their outcomes.

Preventing complications by intervening with behavioral therapy or other assistance would likely cost much less than an ICU stay for an infection after major surgery, Bingener added.

“We’re understanding much better now that patients are not just a body with a disease: There’s a whole person with that, and everything plays together,” Bingener said. “Now that survival is possible, we want to achieve it in a way that preserves normal life for patients as much as possible. And we think that’s probably also the most economical way to go.”