It is my great honor to present our study today. The title of our study is Prospective Observational Study of Activity of Daily Living in Elderly Patients After Lung Cancer Surgery. This is a multi-institutional study by Lung Cancer Surgical Study Group of J-COG, Japan Clinical Oncology Group. I will explain the unique primary endpoint of this study, which is the proportion of non-deteriorating of ADL at six months after lung cancer surgery. Post-operative activities of daily living's ADL are of critical importance to elderly lung cancer patients undergoing surgical resection and their families. However, currently available data are only on short-term surgical morbidity, mortality, and overall survival. Very few studies evaluate its post-operative ADL or quality of life. This illustration shows the study concept. In previous studies, the success or failure of the surgical treatment was determined by patient survival. Cancer deaths and surgery-related deaths are a failure. Otherwise the treatment was deemed a success. This study aimed to assess the patient's ADL after surgery. If a patient survived the operation and the cancer, he or she would not be happy with poor ADL. The boundaries that take ADL into account can be defined as worsening of ADL over the one standard deviation level. The main purpose of this study is to elucidate how many elderly patients with lung cancer who underwent surgical treatment suffer from ADL-significant deterioration and to investigate whether it is predictable. Key LGBT criteria are shown. The patient ages over 75 years old having tumor suspected on lung cancer on thoracic CT, clinical stage 0 to 3 are enrolled in this study. The elderly patient were enrolled after obtaining written informed consent. Baseline geriatric function assessment such as Tokyo Metropolitan Institute of Gerontology Index of Competence, Instrumental Activities of Daily Living, TMIG-IADL, G8, Social Situation, Charleston Comorbidity Index, and EQ5D were conducted before surgery. TMIG-IADL and EQ5D were collected at 6, 12, and 24 months after the operation. TMIG-IADL questionnaires are collected through the attending physicians, whereas EQ5D questionnaires are mailed by patients themselves directly to the research office. The details of TMIG-IADL are shown in this slide. It is a multi-component scale composed of a 13-item questionnaire that includes three activity capacities, instrumental self-maintenance, effectance, and social rule. This scale is frequently used in Japan. It is characterized by its self-administered design, its known distribution and standard deviation in a representative sample, and its acknowledged validity. Primary endpoint is the proportion of non-deteriorating of TMIG-IADL at 6 months after surgery. Distribution of TMIG-IADL was defined as decline of three points, which correspond to one standard error in the Japanese population or more. 986 patients were enrolled during May 2019 and May 2020 from 47 institutions. According to the final pathological result, 876 patients had non-small cell lung cancer and underwent complete resection. We followed up these 876 patients. Patient characteristics are shown here. There were 56% male. Lobectomy was the most common, observed in 73%. Combined resection, such as pulmonary artery porosity, bronchoporosity, and costal resection were performed in 13 patients. This slide shows the result of the primary endpoint. The rate of non-deteriorating of TMIG-IADL at 6 months post-operation. Deteriorating of three points or more was observed in 96 patients. TMIG-IADL questionnaire was not retrieved from 19 patients due to patient death, from 9 patients due to inability to go to the hospital due to complications, and from 7 patients for other reasons. Questionnaires were successfully retrieved from 98.1% of the living patients. A deterioration of two points or less was observed in 745 of 876 patients with a non-deteriorating rate of 85.1%. Univariate analysis was performed to identify factors associated with non-deterioration of TMIG-IADL at 6 months. The results are shown in three slides. First, it is related to the patient background. We observed more significant IADL deterioration in men, those aged 80 years old or older, poor performance status, and those who had smoked for more than 20 years. This slide shows the association with comorbidities. Those with emphysema, interstitial pneumonia, and four or more regular medication were more likely to have significantly decreased IADL at 6 months. We also observed more significant IADL deterioration in case with less G8 score and positive CCI. The third slide shows the association with surgery. There is no clear association with the extent of lung resection. A significant deterioration was observed in patient who underwent combined resection. Multivariable analysis was performed using all the factors shown in the last three slides. The three factors that were associated with non-deteriorating rates of IADL in the multivariate analysis are shown on this slide. Poor preoperative performance status, low G8 point, segmentectomy compared with wedge resection, and surgery lasting less than three hours are significant factors. In conclusion, it was feasible to evaluate postoperative IADL for elderly patients after lung cancer surgery with data retrieved in more than 95% of the patients. At six months after surgical resection of the lung cancer, IADL deteriorated in about 15% of elderly patients. Patients with male gender, age over 80 years old, poor performance status, smoking habit, emphysema, interstitial pneumonia, daily use medicine, more than four kinds, low G8 points, positive CCI, and those receiving combined resection were more likely to suffer deterioration of postoperative IADL at six months. This information would be helpful for patient counseling, treatment decision making, and preoperative care for elderly patients with lung cancer. More research on IADL after cancer therapy should be warranted to optimize care of elderly patients with cancer, including other tumor type and treatment modalities. Thank you for your attention.

activity of daily living

elderly patients

lung cancer surgery

ADL deterioration

geriatric function assessments