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BackgroundThe effects of video-assisted thoracoscopic surgery (VATS) and traditional thoracotomy with respect to patient-reported outcomes (PROs) have only been assessed for early-stage lung cancer. This study was a longitudinal PRO assessment to compare the effects of these surgeries for locally advanced (stage II and III) lung cancer from the patients’ perspective.MethodsWe investigated lung cancer patients from a previous prospective, multicentre study. Longitudinal data of clinical characteristics and PROs were collected. PROs were obtained preoperatively, daily in the hospital postoperatively, and weekly up to 4 weeks after discharge or the beginning of postoperative adjuvant therapy. Symptoms and impact on daily functioning and quality of life (QOL) were assessed by using the MD Anderson Symptom Inventory for lung cancer and a single-item QOL scale. Trajectories of PROs over the investigation period were compared.ResultsOverall, 117 primary lung cancer patients (stage II or III), including 63 and 54 patients who underwent VATS and traditional thoracotomy, respectively, were included. During postoperative hospitalization, VATS patients reported milder disturbed sleep (p = 0.048), drowsiness (p = 0.008), and interference with activity (p = 0.001), as well as better work ability (p < 0.0001), walking ability (p < 0.0001), and life enjoyment (p = 0.004). Post-discharge, VATS patients had less distress (p = 0.039), milder pain (p = 0.006), better work ability (p = 0.001), and better QOL (p = 0.047).ConclusionsLocally advanced lung cancer patients who underwent VATS had lower postoperative symptom burden, less daily function interference, and better QOL than those who underwent thoracotomy.

Purpose Patients who undergo surgery for lung cancer experience a variety of symptoms, such as pain and coughing, which interfere with their postoperative daily functions. However, there may be differences between the perception of symptoms among healthcare providers and patients. This study aimed to investigate patients’ experiences after lung cancer surgery and analyze whether the perception of postoperative symptoms among the healthcare providers differed from that reported by patients. Methods Semi-structured qualitative interviews involving 39 patients who underwent lung cancer surgery at the Sichuan Cancer Hospital were conducted between November 2018 and October 2019. In addition, 22 healthcare providers from the Department of Thoracic Surgery at the hospital answered open-ended questions about their perception of symptoms related to lung cancer surgery. The types and frequencies of symptoms reported by the patients and healthcare providers were compared. Results The most frequent patient-reported symptoms were pain (967 times, 39 patients, 100%), coughing (904 times, 37 patients, 94.87%), shortness of breath (491 times, 35 patients, 89.74%), Disturbed sleep (412 times, 34 patients, 87.18%), and interference while walking (347 times, 36 patients, 92.31%). Of the patient-reported symptoms, the first four were perceived by the healthcare providers, while they interpreted interference while walking as fatigue. Conclusion Although the healthcare providers and patients had a certain consensus on the main symptoms, there were differences in perception. Healthcare providers need to pay more attention to postoperative interference while walking.

High-frequency patient-reported outcome (PRO) assessments are used to measure patients' symptoms after surgery for surgical research; however, the quality of those longitudinal PRO data has seldom been discussed. The aim of this study was to determine data quality-influencing factors and to profile error trajectories of data longitudinally collected via paper-and-pencil (P&P) or web-based assessment (electronic PRO [ePRO]) after thoracic surgery. We extracted longitudinal PRO data with 678 patients scheduled for lung surgery from an observational study (n=512) and a randomized clinical trial (n=166) on the evaluation of different perioperative care strategies. PROs were assessed by the MD Anderson Symptom Inventory Lung Cancer Module and single-item Quality of Life Scale before surgery and then daily after surgery until discharge or up to 14 days of hospitalization. Patient compliance and data error were identified and compared between P&P and ePRO. Generalized estimating equations model and 2-piecewise model were used to describe trajectories of error incidence over time and to identify the risk factors. Among 678 patients, 629 with at least 2 PRO assessments, 440 completed 3347 P&P assessments and 189 completed 1291 ePRO assessments. In total, 49.4% of patients had at least one error, including (1) missing items (64.69%, 1070/1654), (2) modifications without signatures (27.99%, 463/1654), (3) selection of multiple options (3.02%, 50/1654), (4) missing patient signatures (2.54%, 42/1654), (5) missing researcher signatures (1.45%, 24/1654), and (6) missing completion dates (0.30%, 5/1654). Patients who completed ePRO had fewer errors than those who completed P&P assessments (ePRO: 30.2% [57/189] vs. P&P: 57.7% [254/440]; P<.001). Compared with ePRO patients, those using P&P were older, less educated, and sicker. Common risk factors of having errors were a lower education level (P&P: odds ratio [OR] 1.39, 95% CI 1.20-1.62; P<.001; ePRO: OR 1.82, 95% CI 1.22-2.72; P=.003), treated in a provincial hospital (P&P: OR 3.34, 95% CI 2.10-5.33; P<.001; ePRO: OR 4.73, 95% CI 2.18-10.25; P<.001), and with severe disease (P&P: OR 1.63, 95% CI 1.33-1.99; P<.001; ePRO: OR 2.70, 95% CI 1.53-4.75; P<.001). Errors peaked on postoperative day (POD) 1 for P&P, and on POD 2 for ePRO. It is possible to improve data quality of longitudinally collected PRO through ePRO, compared with P&P. However, ePRO-related sampling bias needs to be considered when designing clinical research using longitudinal PROs as major outcomes.

Electronic patient-reported outcomes (ePROs)-based cancer symptom management presents an opportunity to improve patient outcomes by optimizing symptom detection and prompting clinician interventions in tertiary hospitals. However, real-world evidence is limited, especially in primary health care (PHC) settings, which are accompanied by more complex and unknown influencing factors. We conducted a qualitative study to identify facilitators and barriers associated with the implementation of ePRO-based symptom management in China's PHC settings under the implementation science (IS) framework. We further developed strategies and recommendations for real-world practices and health policies. This qualitative study was conducted from October to December 2023 in 9 purposively selected PHC institutions (5 urban and 4 rural) across 5 administrative districts of Yangzhou, Jiangsu Province, China. Community-dwelling patients with cancer, PHC providers, and medical supervisors participated in semistructured interviews and focus group discussions. We used 2 subframeworks under the IS framework-the Consolidated Framework for Implementation Research and Expert Recommendations for Implementing Change-to conduct data analysis and generate strategies. A total of 72 individuals were invited to participate in this study, including 35 community-dwelling patients with cancer (median 66, IQR 60-71.5 years; n=21, 60% men) and 23 PHC personnel (median 45, IQR 27-51 years; n=12, 52.17% men) who participated in semistructured interviews, and 14 medical supervisors (median 47.5, IQR 36.5-54 years; n=10, 71.43% men) who participated in focus group discussions. This study identified 29 barriers and 21 facilitators, and then developed 13 strategies. Crucial challenges include PHC providers' low self-efficacy and unclear role identification, coupled with community-dwelling patients' mistrust of primary care, cancer stigma, and fatalistic beliefs, which further reduce motivation; poor integration of ePRO with existing workflows and the absence of performance incentive mechanisms; a lack of nationwide standardized implementation guidelines and quality evaluation criteria; and outdated medical equipment and a limited range of medications. Common challenges included weak collaborative relationships and insufficient funding. Grounded in the IS framework, our study identifies 3 critical priorities for implementing ePRO-based cancer symptom management in PHC settings, including addressing individual-level motivational deficiencies among community-dwelling patients with cancer and PHC providers by resolving misconceptions, bridging knowledge gaps, and establishing supportive incentives; developing supportive medical partnerships and advancing tiered management systems to empower PHC settings; and creating standardized operational guidelines with clear workflows and implementing real-world data-driven regulatory feedback mechanisms to ensure quality control.

Purpose Oesophageal squamous cell carcinoma (ESCC) patients have severe symptom burden after oesophagectomy; however, longitudinal studies of symptom recovery after surgery are scarce. This study used longitudinal patient-reported outcome (PRO)-based symptoms to identify severe symptoms and profile symptom recovery from surgery in patients undergoing oesophagectomy. Methods Oesophageal cancer patients ( N  = 327) underwent oesophagectomy were consecutively included between April 2019 and March 2020. Data were extracted from the Sichuan Cancer Hospital’s Esophageal Cancer Case Management Registration Database. Symptom assessment time points were pre-surgery and 1, 3, 5, 7, 14, 21, 30, and 90 days post-surgery using the Chinese version of the MD Anderson Symptom Inventory. And each symptom was rated on an 11-point scale, with 0 being ‘not present’ and 10 being ‘as bad as you can imagine’. The symptom recovery trajectories were profiled using mixed effect models and Kaplan–Meier analysis. Results The most-severe symptoms on day 1 after oesophagectomy were pain, fatigue, dry mouth, disturbed sleep, and distress. The severity of symptoms peaked on day 1 after surgery. The top two symptoms were fatigue (mean: 5.44 [SD 1.88]) and pain (mean: 5.23 [SD 1.29]). Fatigue was more severe 90 days after surgery than at baseline (mean: 1.77 [SD 1.47] vs 0.65 [SD 1.05]; P  < .0001). Disturbed sleep and distress persisted from pre-surgery to 90 days post-surgery; average sleep recovery time was up to 20 days, and 50.58% of patients had sleep disturbances 90 days post-surgery. Conclusions Early post-operative pain management after oesophagectomy should be considered. Characteristics and intervention strategies of post-operative fatigue, distress, and disturbed sleep in oesophageal cancer patients warrant further studies.

AimsThe methodological quality of development, validation, and modification of those models have not been evaluated via a thoroughly literature review. This study aims to describe the overall status and evaluate the methodological quality of risk prediction models for stroke incidence in the general population.MethodsWe searched the database of EMBASE and MEDLINE by the combination of subject words and key words to collect the research on stroke risk prediction model in the general population. The retrieval time was from the establishment of the database to September 2019. It should be mentioned that risk of bias for each model was assessed, and data on population characteristics and model performance was also extracted.ResultsThe search screened 11,386 peer-reviewed publications and 57 citation searching, of which 48 were included in the review, describing the development of 51 prediction models, 47 external validation models, and 12 modification models. Among 51 development models, the predicted outcome concentrated on fatal or non-fatal stroke (n = 37, 73%). Thirty-nine development models (76%) were without internal validation. C-statistic or AUC was adopted for discrimination in 80% models, and Hosmer-Lemeshow test (n = 25, 49%) was also performed for calibration. Twenty-six development models (53%) were externally validated, among which only 2 (8%) were validated by independent researchers. Risk prediction performance was improved when models were modified by adding novel risk factors, such as the internal carotid artery plaque and intima-media thickness.ConclusionModels for predicting stroke occurrence need further external validation, recalibration, or modification in different populations, to help interpret those models in the practice of stroke prevention.

Background Studies on sex-related differences in post-lung cancer surgery symptoms are limited. Understanding these differences may provide insights into patient recovery. Therefore, we investigated sex-related differences in these symptoms and their underlying associated factors. Methods We included patients aged ≥ 18 years undergoing surgery for lung cancer from a multicenter cohort study (CN-PRO-Lung 1) that focused on postoperative lung cancer symptoms trajectories. On a daily assessment schedule, we evaluated patients’ symptoms and their impact on functioning from the day before surgery until discharge using the MD Anderson Symptom Inventory–Lung Cancer module. We evaluated sex-related differences in symptom scores over time and identified influencing factors using linear mixed models. Results Of 372 eligible patients (196 men and 176 women;) symptoms were milder in men than in women for pain (estimate = 0.427, P  = 0.021), fatigue (estimate = 1.071, P  < 0.001), shortness of breath (estimate = 0.431, P  = 0.021), lack of appetite (estimate = 0.728, P  < 0.001), dry mouth (estimate = 0.438, P  = 0.015), and constipation (estimate = 0.887, P  < 0.001) during postoperative hospitalization (median: 7 days). Pain scores decreased over time in both sexes (estimate = -0.440 in men, P  < 0.001; -0.510 in women, P  < 0.001), while different factors were associated with increased pain in each group. In men, higher American Society of Anesthesiologists (ASA) classification (estimate = 0.430, P  = 0.035), advanced pTNM stage (estimate = 0.550, P  = 0.007), and having more than one chest drain (estimate = 0.690, P  = 0.001) were associated with greater pain. In women, systematic lymph node dissection was associated with increased pain (estimate = 0.700, P  = 0.033). Conclusions Women reported a higher symptom burden than men in the early postoperative period after lung cancer surgery. Key factors associated with worse postoperative pain include higher ASA classification, advanced pTNM stage, and more than one chest tube in men and systematic lymph node dissection in women. Trial registration number NCT03341377

Background Although middle-aged and elderly users are the main group targeted by health maintenance-oriented WeChat official accounts (HM-WOAs), few studies have explored the relationship of these accounts and their users. Exploring the factors that influence the continuous adoption of WOAs is helpful to strengthen the health education of middle-aged and elderly individuals. Objective We developed a new theoretical model and explored the factors that influence middle-aged and elderly individuals' continuous usage intention for HM-WOA. Performance expectancy mediated the effects of the model in explaining continuous usage intention and introduced health literacy into the model. Methods We established a hybrid theoretical model on the basis of the unified theory of acceptance and use of technology 2 model (UTAUT2), the health belief model (BHM), protection motivation theory (PMT), and health literacy. We collected valid responses from 396 middle-aged and elderly users aged ≥ 45 years in China. To verify our hypotheses, we analyzed the data using structural equation modeling. Results Performance expectancy (β = 0.383, P  < 0.001), hedonic motivation (β = 0.502, P  < 0.001), social influence (β = 0.134, P  = 0.049), and threat appraisal (β = 0.136, P  < 0.001) positively influenced middle-aged and elderly users' continuous usage intention. Perceived health threat (β =  − 0.065, P  = 0.053) did not have a significant effect on continuous usage intention. Both threat appraisal (β = 0.579, P  < 0.001) and health literacy (β = 0.579, P  < 0.001) positively affected performance expectancy. Threat appraisal indirectly affected continuous usage intention through performance expectancy mediation. Conclusions Our new theoretical model is useful for understanding middle-aged and elderly users' continuous usage intention for HM-WOA. Performance expectancy plays a mediation role between threat appraisal and continuous usage intention, and health literacy positively affects performance expectancy.