There are two potential benefits to the management of any medical condition: quality and length of life. Whilst clinical trials may aim to explore improvements in both, there may be situations where gains in one might be offset by no change or even reduction in the other.
In thoracic malignancies (specifically lung cancer and mesothelioma), firstly surgery may be offered with the intent of palliation, whereby the aim is to reduce the bulk of the tumour, to prevent the reaccumulation of pleural fluid and reduce the restrictive defect seen on spirometry. Secondly, surgery may attempt to gain a cure, where the goal of surgery is complete macroscopic resection. Although often “assumed”, the benefits in terms of length of life can only be proven in randomised controlled trials. However, whilst quality of life may be investigated as an outcome in randomised controlled trials, useful data may also be gained from prospective “before – after” cohort studies. Here, quality of life is assessed before an intervention and then at planned timepoints afterwards to determine treatment effects.
This presentation will consider the roles of surgical interventions in thoracic malignancies with specific reference to well designed studies investigating quality of life. The level of evidence that should be assigned to such studies and the pitfalls in their interpretation will be considered.