Baseline demographic
All patients received surgical treatment and were pathologically diagnosed with lung cancer. Among them, 34 (87.18%) patients underwent VATS, three (7.7%) underwent thoracotomy surgery, and two (5.1%) underwent VATS converted to thoracotomy. There were eight (20.5%) and six patients who underwent segmentectomy and sleeve resection, respectively. After lung cancer surgery, 39 patients, including 24 (61.5%) females and 15 (38.5%) males, aged between 42 and 82 years underwent semi-structured interviews about their experience and related events in the hospital. A total of 22 medical staff (10 [45.5%] male surgeons and 12 [54.5%] female nurses) aged between 21 and 50 years with ≥ 1 year of experience in the Department of Thoracic Surgery filled out the survey forms based on their daily observations and perception of lung cancer surgery-related symptoms. Table 1 details the baseline demographic of interviewed patients and the investigated medical staff.
Table 1
Sample demographic characteristics
Characteristics
|
|
Patients (n = 39)
|
Age (years), median (IQR)
|
57.03 (42.29–82.26)
|
Sex
Male
Female
|
24 (61.5%)
15 (38.5%)
|
BMI (kg/m2), median (IQR)
|
22.60 (18.20–34.10)
|
Educational level
Middle school graduate or below
Above middle school graduate
Unknown
|
20 (51.3%)
16 (41.2%)
3 (7.7%)
|
Medical insurance type
Employee medical insurance
Resident medical insurance
Rural medical insurance
Unknown
|
20 (51.3%)
9 (23.1%)
7 (17.9%)
3 (7.7%)
|
Smoking status
Never smoker
Current smoker
Former smoker
|
21 (53.8%)
13 (33.3%)
5 (12.8%)
|
Drinking history
No
Yes
|
27 (69.2%)
12 (30.8%)
|
ASA classification
I
II
III
|
11 (28.9%)
25 (65.8%)
2 (5.3%)
|
Surgical history
No
Yes
|
37 (94.9%)
2 (5.1%)
|
Medical staff who filled out the questionnaires (n = 22)
|
Sex
Male
Female
|
10 (45.5%)
12 (54.5%)
|
Age
18 ~ 25
26 ~ 30
31 ~ 40
40 ~ 50
༞50
|
5 (22.7%)
10 (45.5%)
3 (13.6%)
4 (18.2%)
0 (0%)
|
Occupation
Surgeon
Nurse
|
10 (45.5%)
12 (54.5%)
|
Highest educational level
College
Master
Doctor
Missing
|
13(59.1%)
3(13.6%)
5(22.7%)
1(4.5%)
|
Years of work experience
1–5
5–8
8–10
10–15
Over 15
|
4(18.2%)
6(27.3%)
3(13.6%)
3(13.6%)
6(27.3%)
|
Professional titles
Senior
Deputy senior
Intermediate
Primary
None
|
2(9.1%)
1(4.5%)
11(50.0%)
7(31.8%)
1(4.5%)
|
BMI, body mass index |
ASA, American Society of Anesthesiologists |
Symptoms reported by the patient
Twenty-seven types of postoperative lung cancer-related symptoms were reported by patients in semi-structured interviews, of which 10 (10/27, 37.04%) were mentioned by more than half of the patients. The top five most frequently mentioned symptoms included 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 with walking (347 times, 36 patients, 92.31%).Table 2 and Fig. 1 present the symptoms experienced by interviewed patients.
Table 2
Symptom frequency and number of patients who reported a symptom
Symptoms
|
Frequency (times)
|
Mentioned patients (n)
|
Mentioned patients (%)
|
Pain
|
967
|
39
|
100.00
|
Coughing
|
904
|
37
|
94.87
|
Shortness of breath
|
491
|
35
|
89.74
|
Disturbed sleep
|
412
|
34
|
87.18
|
Walking
|
347
|
36
|
92.31
|
Lack of appetite
|
310
|
31
|
79.49
|
Constipation
|
306
|
29
|
74.36
|
Anxiety
|
199
|
24
|
61.54
|
Fatigue
|
177
|
30
|
76.92
|
Dry mouth
|
135
|
16
|
41.03
|
Fever
|
104
|
12
|
30.77
|
Drowsiness
|
86
|
20
|
51.28
|
Night sweating
|
75
|
12
|
30.77
|
Hoarseness
|
69
|
10
|
25.64
|
Dizziness
|
62
|
10
|
25.64
|
Distress
|
61
|
15
|
38.46
|
Abdominal distention
|
56
|
13
|
33.33
|
Swollen wound
|
39
|
2
|
5.13
|
Hemoptysis
|
38
|
6
|
15.38
|
Diarrhea
|
35
|
3
|
7.69
|
Dyspnea
|
23
|
7
|
17.95
|
Nausea
|
18
|
5
|
12.82
|
Itchy throat
|
17
|
9
|
23.08
|
Vomiting
|
12
|
3
|
7.69
|
Air leakage
|
10
|
3
|
7.69
|
Atrial fibrillation
|
10
|
2
|
5.13
|
Remembering things
|
7
|
4
|
10.26
|
Postoperative pain
Pain was a symptom mentioned by all interviewed patients and had the highest frequency among all the symptoms. As shown in indicative quotations in Table S1, according to the patients, the pain they experienced was related to surgical wounds. Pain was among the most influential symptom experienced by patients after operation. Although we performed more individualized pain management based on routine intervention, there were significant differences in the severity of pain reported by different patients.
Some patients did not feel much pain after the operation (e.g., patient nos. 22, 31, 39 in Table S1), whereas others (e.g., patient nos. 6, 16 in Table S1) reported that the pain was significantly severe that it was unbearable even with the administration of analgesic pumps and painkillers. Some patients reported that pain was significantly relieved after the removal of the thoracic drainage tube (e.g., patient no. 22 in Table S1), but others reported that there was no significant difference in the degree of pain before and after the removal of the chest drainage tube (e.g., patient no. 31 in Table S1). The severity of patients’ pain was also related to the time during the day. Some patients stated that the pain they experienced was more evident in the afternoon until nighttime (e.g., patient no. 22 in Table S1), and some patients reported that it was most evident during the fourth or fifth day after the operation (e.g., patient no. 39 in Table S1).
Coughing
Postoperative coughing was also one of the most common postoperative symptoms. Table S2 shows some indicative quotations about coughing. Some patients even considered coughing to be the most influential postoperative symptom during their stay in the hospital (e.g., patient no. 29 in Table S2). Some patients reported stimulating dry cough (e.g., patient nos. 1, 29 in Table S2), while others reported coughing with expectoration (e.g., patient no. 8 in Table S2).
A few patients believed that increased sputum after the operation may be related to long-term smoking (e.g., patient no. 8 in Table S2). The time period during which the patients experienced the most severe cough differed. Some patients reported that the severity of cough they experienced after the operation gradually reduced over time (e.g., patient no. 13 in Table S2), whereas other patients stated that they experienced severe cough for few days after the operation (e.g., patient no. 1, 19 in Table S2), accompanied by increased body temperature and lung infection (e.g., patient no. 19 in Table S2). Additionally, concerning the time during the day, some patients reported that their cough was particularly severe at night (e.g., patient no. 1 in Table S2), whereas others reported that they coughed mainly during the day and did not cough at all at night (e.g., patient no. 29 in Table S2). More than one patient mentioned the association between their cough and body posture. According to them, cough was significantly associated with a particular position. Some patients reported that coughing was more evident when they were lying down (e.g., patient no. 8 in Table S2), whereas others mentioned that coughing was more evident when they lay on their side (e.g., patient no. 29 in Table S2).
Shortness of breath
Many patients reported shortness of breath after surgery. Table S3 shows the quotations about disturbed sleep from some patients. Shortness of breath was the third most mentioned symptom after pain and coughing. According to the patients, shortness of breath began to appear in different situations. Some patients had shortness of breath while lying in bed after surgery (e.g., patient nos. 2, 18, 26 in Table S3), whereas others did not feel shortness of breath until they walked around (e.g., patient nos. 13, 34 in Table S3). Some patients reported that raising their upper body could help relieve shortness of breath (e.g., patient no. 2 in Table S3), whereas others stated that effective expectoration relieved shortness of breath (e.g., patient no. 18 in Table S3). Shortness of breath significantly affected patient’s performance after surgery, and some patients considered shortness of breath to be the most serious symptom during their postoperative recovery (e.g., patient no. 26 in Table S3). According to the patients, shortness of breath was particularly disruptive during sleeping (e.g., patient nos. 2, 18 in Table S3) and walking after surgery (e.g., patient no. 13 in Table S3, patient no. 36 in Table S5).
Disturbed sleep
According to our interviews with patients before discharge, most patients experienced disturbed sleep to varying degrees post-surgery. According to the patients, postoperative pain (e.g., patient no. 6 in Table S1, patient no. 3 in Table S4), coughing (e.g., patient no. 8 in Table S2, patient nos. 3, 20 in Table S4), shortness of breath (e.g., patient no. 18 in Table S3), worries about their own condition (e.g., patient no. 33 in Table S4), and other worries (e.g., patient no. 3 in Table S4) all disturbed sleep to varying degrees, among which pain, coughing, and shortness of breath were most commonly mentioned. Simultaneously, some patients (e.g., patient no. 20 in Table S4) suspected that anesthesia during surgery was a factor affecting poor sleep management after surgery. Moreover, it is worth mentioning that a small number of patients (e.g., patient no. 33 in Table S4) believed that the surgery treated their disease, removed their worries, and reduced their psychological burden, so they actually slept better after the surgery. Table S4 shows the quotations from some patients about disturbed sleep.
Interference with walking
During the interview, patients frequently mentioned the effects of thoracic drainage tubes on walking and mentioned that removal of the tubes increased their pace while walking and helped them cover longer distances (e.g., patient nos. 36, 37 in Table S5). Patients reported that chest drainage tubes often affected their convenience of moving around (e.g., patient no. 37 in Table S5). Additionally, pain was another factor that affected walking. Patients were reluctant to move or walk slowly because of pain (e.g., patient no. 27 in Table S5). Shortness of breath was also a factor leading to interference while walking; some patients stopped to rest because they felt shortness of breath during walking (e.g., patient no.34 in Table S3). Table S5 shows some of the quotations from patients concerning interferences while walking.
Symptoms mentioned by 22 interviewed medical staff
Table 3 shows the frequency of symptoms mentioned by 22 medical staff and the corresponding number of medical staff. During hospitalization, the top five commonly mentioned symptoms were pain (22 times), shortness of breath (17 times), coughing (18 times), chest tightness (11 times), and fatigue (8 times), similar with disturbed sleep (8 times). Within 3 months after discharge, the top five symptoms were shortness of breath (18 times), coughing (17 times), fatigue (17 times), pain (16 times), and disturbed sleep (14 times). In the survey of medical staff, interference with walking was not mentioned once during the hospital stay and was mentioned only twice within 3 months after discharge (Table 3, Fig. 2, Fig. 3).
Table 3
Symptom frequencies of the 22 medical staff who were investigated
Symptoms
|
Frequency (times)
|
Number of involved medical staff
|
Hospitalization
|
Within 3 months after discharge
|
Overall
|
Hospitalization
|
Within 3 months after discharge
|
Overall
|
Pain
|
22
|
16
|
38
|
22
|
16
|
22
|
Shortness of breath
|
17
|
18
|
35
|
17
|
17
|
19
|
Coughing
|
18
|
17
|
35
|
18
|
17
|
20
|
Fatigue
|
8
|
17
|
25
|
8
|
17
|
19
|
Disturbed sleep
|
8
|
14
|
22
|
8
|
14
|
14
|
Chest tightness
|
11
|
9
|
20
|
11
|
9
|
14
|
Anxiety
|
3
|
9
|
12
|
3
|
9
|
9
|
Lack of appetite
|
3
|
5
|
8
|
3
|
5
|
7
|
Constipation
|
4
|
1
|
5
|
4
|
1
|
4
|
Hemoptysis
|
4
|
0
|
4
|
4
|
0
|
4
|
Dyspnea
|
3
|
0
|
3
|
3
|
0
|
3
|
Abdominal distention
|
3
|
0
|
3
|
3
|
0
|
3
|
Walking
|
0
|
2
|
2
|
0
|
2
|
2
|
Dry mouth
|
2
|
0
|
2
|
2
|
0
|
2
|
Sore throat
|
1
|
0
|
1
|
1
|
0
|
1
|
Palpitations
|
1
|
1
|
2
|
1
|
1
|
2
|
Fever
|
1
|
0
|
1
|
1
|
0
|
1
|
Diarrhea
|
1
|
0
|
1
|
1
|
0
|
1
|