In a groundbreaking multicenter cohort study published in BMC Cancer, researchers have unveiled compelling evidence that sex plays a significant role in shaping postoperative recovery trajectories among lung cancer patients. The study delves into patient-reported outcomes, specifically focusing on symptom burden after lung cancer surgery, and reveals distinct differences between men and women that could transform postoperative care paradigms.
Lung cancer remains a formidable health challenge worldwide, with surgical intervention often serving as a cornerstone of curative treatment. Despite advancements in surgical techniques and perioperative management, postoperative symptom management continues to be a critical determinant of recovery quality and patient satisfaction. The pioneering research addresses a gap in current knowledge by systematically exploring how biological sex influences symptom experience and recovery patterns in the acute postoperative phase.
The investigation drew on data from the CN-PRO-Lung 1 multicenter cohort, enrolling 372 adult patients who underwent lung cancer surgery. By utilizing the MD Anderson Symptom Inventory tailored for lung cancer, the study captured daily self-reported symptom severity and its functional impact from preoperative baseline through hospital discharge, typically spanning around a week. This high-resolution data collection allowed for nuanced analyses of symptom trajectories over time.
Key findings indicate that women report markedly higher symptom severity than men across multiple domains, including pain, fatigue, shortness of breath, appetite loss, dry mouth, and constipation during the immediate postoperative hospitalization period. These sex-related disparities spotlight the need to reconsider traditional postoperative care frameworks, which have often overlooked the differential experiences of male and female patients.
Notably, pain scores exhibited a downward trend over days in both sexes, reflecting general healing progress. However, factors associated with heightened pain were sex-specific. For men, higher American Society of Anesthesiologists (ASA) classification—a measure of preoperative physical status—advanced pathologic tumor-node-metastasis (pTNM) stage, and the presence of multiple chest drains correlated with increased postoperative pain. Conversely, in women, systematic lymph node dissection during surgery emerged as a significant contributor to pain amplification.
The elucidation of these diverging risk profiles carries profound clinical implications. It suggests that tailoring pain management strategies to sex-specific risk factors could optimize analgesic delivery and enhance recovery experiences. For instance, men with advanced disease stages or higher perioperative risk may benefit from proactive, multimodal pain interventions, while women undergoing extensive lymph node dissection might require specialized postoperative surveillance and supportive therapies.
The molecular and physiological basis underpinning these observed differences remains an active area of inquiry. Biological sex influences immune responses, hormonal milieus, and pain perception, all of which could modulate postoperative symptomatology. Furthermore, psychosocial and behavioral factors potentially contribute to sex-specific symptom reporting, indicating a complex interplay of biopsychosocial determinants.
Importantly, the study’s methodology harnessed linear mixed models to account for repeated measures over time and individual variability, enhancing the robustness of the findings. This statistical approach facilitated the identification of nuanced symptom patterns and their associations with clinical variables, offering a dynamic portrait of postoperative recovery that transcends traditional endpoint assessments.
These insights challenge oncologists, surgeons, and perioperative care teams to reexamine standardized care pathways through a sex-informed lens. Incorporating sex as a fundamental variable in postoperative risk stratification, symptom monitoring, and therapeutic decision-making could ultimately elevate patient-centered care standards in thoracic oncology.
Beyond clinical application, the research underscores the imperative of integrating patient-reported outcomes in surgical oncology trials and registries. Such data enrich understanding of treatment impacts from the patient perspective, illuminating dimensions of recovery that objective clinical metrics may underappreciate.
Looking ahead, future investigations would benefit from exploring the mechanistic underpinnings of sex-related symptom differences, potentially leveraging genomic, proteomic, and neurophysiological tools. Insights gained could pave the way for personalized interventions that mitigate symptom burden while enhancing quality of life during the critical postoperative window.
Moreover, extending follow-up beyond hospital discharge may reveal whether these sex disparities persist, diminish, or evolve during longer-term recovery phases. Such longitudinal perspectives are essential for developing comprehensive survivorship care plans that address enduring symptomatology and functional outcomes.
The study’s relevance is magnified by the increasing global incidence of lung cancer and the rising prominence of minimally invasive surgical approaches aimed at reducing postoperative morbidity. Understanding how sex interacts with these evolving treatment modalities could guide refinement of enhanced recovery protocols and patient education efforts.
In sum, this pioneering multicenter cohort study crystallizes the significance of sex-specific differences in symptom burden following lung cancer surgery. It calls for a paradigm shift toward nuanced, individualized postoperative management—one that acknowledges and addresses the unique needs of men and women to optimize recovery trajectories and improve overall patient well-being.
As the oncology community continues to strive toward precision medicine, integrating sex as a pivotal factor in perioperative care emerges as an indispensable component. Stakeholders at all levels, from clinicians to policymakers, must heed these findings to foster equitable and effective care delivery in the face of lung cancer’s relentless global burden.
Subject of Research: Sex-related differences in postoperative patient-reported outcomes among lung cancer patients
Article Title: Sex-related differences in postoperative patient-reported outcomes among lung cancer patients: a multicenter cohort study
Article References:
Liao, J., Hu, X., Wei, X. et al. Sex-related differences in postoperative patient-reported outcomes among lung cancer patients: a multicenter cohort study. BMC Cancer 25, 800 (2025). https://doi.org/10.1186/s12885-025-14191-z
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