Construction of a multi-dimensional evaluation system for physical function and functional rehabilitation of elderly patients with lung cancer during perioperative period based on modified Delphi method_West China Medical Journal

Authors：

CHU Xiaotian ¹ , WANG Qiaoling ¹ , SHI Weihong ¹ , ZHANG Lu ¹ ,  CHEN Lixia ¹ ,  LIU Lunxu ²

1. Department of Rehabilitation Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, P. R. China;
2. Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

CHEN Lixia, Email: clx727@126.com; LIU Lunxu, Email: lunxu_liu@aliyun.com

Keywords：

Elderly; lung cancer; multi-dimensional evaluation; modified Delphi method

DOI：

10.7507/1002-0179.202510207

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To construct a multi-dimensional evaluation system for physical function and functional rehabilitation of elderly patients with lung cancer during perioperative period based on the modified Delphi method.Methods From December 2024 to April 2025, based on literature search and group research, a multi-dimensional evaluation indicator system for perioperative physical function and functional rehabilitation of elderly patients with lung cancer was initially constructed, and 13 experts in the field of elderly lung cancer treatment and perioperative rehabilitation were selected. Based on the modified Delphi method, two rounds of consultation and in-depth communication were conducted with experts to objectively evaluate the importance of indicators at all levels and finally appropriate indicators were selected. Results Through two rounds of expert consultation, a multi-dimensional comprehensive evaluation system was established, including 6 primary indicators (general situation and disease characteristics; physical fitness; pulmonary function; respiratory muscle function; balance function; activities of daily living, quality of life and emotional and psychological conditions) and 24 secondary indicators. The response rate of the two rounds of consultation questionnaires reached 100%, the coefficient of expert authority was 0.93±0.05, and the Kendall’s coefficient of concordance of the primary and secondary indicators were 0.391 and 0.187, respectively (P<0.05).Conclusions The multi-dimensional perioperative evaluation system of elderly patients with lung cancer constructed based on the modified Delphi method has good rationality and scientificity, which is helpful to comprehensively and multi-dimensionally evaluate the perioperative risk and functional status of elderly patients with lung cancer, and provide guidance and reference for clinical practice.

Citation： CHU Xiaotian, WANG Qiaoling, SHI Weihong, ZHANG Lu, CHEN Lixia, LIU Lunxu. Construction of a multi-dimensional evaluation system for physical function and functional rehabilitation of elderly patients with lung cancer during perioperative period based on modified Delphi method. West China Medical Journal, 2025, 40(12): 1949-1955. doi: 10.7507/1002-0179.202510207 Copy

1.	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2.	Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
3.	吳瀟然, 張慧, 冀昌, 等. 1990-2021 年中國及全球肺癌流行病學變化趨勢及發病率死亡率預測: 基于年齡-時期-隊列模型的分析. 現代預防醫學, 2025, 52(10): 1735-1741.
4.	Pei G, Zhou S, Han Y, et al. Risk factors for postoperative complications after lung resection for non-small cell lung cancer in elderly patients at a single institution in China. J Thorac Dis, 2014, 6(9): 1230-1238.
5.	Pagni S, McKelvey A, Riordan C, et al. Pulmonary resection for malignancy in the elderly: is age still a risk factor?. Eur J Cardiothorac Surg, 1998, 14(1): 40-45.
6.	Fan J, Wang XJ, Jiang GN, et al. Survival and outcomes of surgical treatment of the elderly NSCLC in China: a retrospective matched cohort study. Eur J Surg Oncol, 2007, 33(5): 639-643.
7.	Gonzalez M, Brunelli A, Szanto Z, et al. Report from the European Society of Thoracic Surgeons database 2019: current surgical practice and perioperative outcomes of pulmonary metastasectomy. Eur J Cardiothorac Surg, 2021, 59(5): 996-1003.
8.	Yang X, Zhang Q, Ye C, et al. Factors influencing symptom severity at discharge after lobectomy and sublobar resection through video-assisted thoracoscopic surgery. Interdiscip Cardiovasc Thorac Surg, 2025, 40(8): ivaf170.
9.	Baimas-George M, Watson M, Elhage S, et al. Prehabilitation in frail surgical patients: a systematic review. World J Surg, 2020, 44(11): 3668-3678.
10.	Bertani A, Ferrari P, Terzo D, et al. A comprehensive protocol for physiokinesis therapy and enhanced recovery after surgery in patients undergoing video-assisted thoracoscopic surgery lobectomy. J Thorac Dis, 2018, 10(Suppl 4): S499-S511.
11.	Batchelor TJP, Rasburn NJ, Abdelnour-Berchtold E, et al. Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERAS^?) Society and the European Society of Thoracic Surgeons (ESTS). Eur J Cardiothorac Surg, 2019, 55(1): 91-115.
12.	Wang L, Yu M, Ma Y, et al. Effect of pulmonary rehabilitation on postoperative clinical status in patients with lung cancer and chronic obstructive pulmonary disease: a systematic review and meta-analysis. Evid Based Complement Alternat Med, 2022, 2022: 4133237.
13.	Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, 2016, 66(2): 115-132.
14.	Cho SJ, Stout-Delgado HW. Aging and lung disease. Annu Rev Physiol, 2020, 82: 433-459.
15.	Paul S, Altorki NK, Sheng S, et al. Thoracoscopic lobectomy is associated with lower morbidity than open lobectomy: a propensity-matched analysis from the STS database. J Thorac Cardiovasc Surg, 2010, 139(2): 366-378.
16.	Falcoz PE, Puyraveau M, Thomas PA, et al. Video-assisted thoracoscopic surgery versus open lobectomy for primary non-small-cell lung cancer: a propensity-matched analysis of outcome from the European Society of Thoracic Surgeon database. Eur J Cardiothorac Surg, 2016, 49(2): 602-609.
17.	Whitson BA, Groth SS, Duval SJ, et al. Surgery for early-stage non-small cell lung cancer: a systematic review of the video-assisted thoracoscopic surgery versus thoracotomy approaches to lobectomy. Ann Thorac Surg, 2008, 86(6): 2008-2018.
18.	Niskakangas A, Mustonen O, Puro I, et al. Results of video-assisted thoracoscopic surgery versus thoracotomy for lung cancer in a mixed practice medium-volume hospital: a propensity-matched study. Interdiscip Cardiovasc Thorac Surg, 2023, 37(6): ivad189.
19.	Berry MF, Hanna J, Tong BC, et al. Risk factors for morbidity after lobectomy for lung cancer in elderly patients. Ann Thorac Surg, 2009, 88(4): 1093-1099.
20.	Berry MF, Onaitis MW, Tong BC, et al. A model for morbidity after lung resection in octogenarians. Eur J Cardiothorac Surg, 2011, 39(6): 989-994.
21.	Friedel G, Fritz P, Goletz S, et al. Postoperative survival of lung cancer patients: are there predictors beyond TNM?. Anticancer Res, 2013, 33(4): 1609-1619.
22.	Licker M, Schnyder JM, Frey JG, et al. Impact of aerobic exercise capacity and procedure-related factors in lung cancer surgery. Eur Respir J, 2011, 37(5): 1189-1198.
23.	Brunelli A, Pompili C, Salati M, et al. Preoperative maximum oxygen consumption is associated with prognosis after pulmonary resection in stage I non-small cell lung cancer. Ann Thorac Surg, 2014, 98(1): 238-242.
24.	Jones LW, Watson D, Herndon JE 2nd, et al. Peak oxygen consumption and long-term all-cause mortality in nonsmall cell lung cancer. Cancer, 2010, 116(20): 4825-4832.
25.	Williams T, Gulack BC, Kim S, et al. Operative risk for major lung resection increases at extremes of body mass index. Ann Thorac Surg, 2017, 103(1): 296-302.
26.	Boudreaux AM, Simmons JW. Prehabilitation and optimization of modifiable patient risk factors: the importance of effective preoperative evaluation to improve surgical outcomes. AORN J, 2019, 109(4): 500-507.
27.	Mantziari S, Hübner M, Demartines N, et al. Impact of preoperative risk factors on morbidity after esophagectomy: is there room for improvement?. World J Surg, 2014, 38(11): 2882-2890.
28.	S?rensen LT. Wound healing and infection in surgery: the pathophysiological impact of smoking, smoking cessation, and nicotine replacement therapy: a systematic review. Ann Surg, 2012, 255(6): 1069-1079.
29.	Yoshida N, Baba Y, Hiyoshi Y, et al. Duration of smoking cessation and postoperative morbidity after esophagectomy for esophageal cancer: how long should patients stop smoking before surgery?. World J Surg, 2016, 40(1): 142-147.
30.	Brunelli A, Kim AW, Berger KI, et al. Physiologic evaluation of the patient with lung cancer being considered for resectional surgery: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 2013, 143(Suppl 5): e 166S-e190S.
31.	AlGhatrif M, Morrell CH, Fleg JL, et al. Longitudinal decline in peak Vo2 with aging in a healthy population is associated with a reduction in peripheral oxygen utilization but not in cardiac output. Am J Physiol Heart Circ Physiol, 2024, 327(2): H509-H517.
32.	Fleg JL, Morrell CH, Bos AG, et al. Accelerated longitudinal decline of aerobic capacity in healthy older adults. Circulation, 2005, 112(5): 674-682.
33.	中華醫學會心血管病學分會, 中國康復醫學會心肺預防與康復專業委員會, 中華心血管病雜志編輯委員會. 六分鐘步行試驗臨床規范應用中國專家共識. 中華心血管病雜志, 2022, 50(5): 432-442.
34.	郭科迪, 武巖, 湯夕慧, 等. 術前衰弱對老年肺癌患者術后并發癥的影響. 實用醫學雜志, 2023, 39(15): 1956-1960.
35.	劉彩云, 霍曉鵬, 劉曉萱, 等. 基于老年綜合評估的預康復在術前衰弱老年肺癌病人中的應用. 實用老年醫學, 2024, 38(11): 1153-1157.
36.	Okazaki T, Suzukamo Y, Miyatake M, et al. Respiratory muscle weakness as a risk factor for pneumonia in older people. Gerontology, 2021, 67(5): 581-590.
37.	Bellinetti LM, Thomson JC. Respiratory muscle evaluation in elective thoracotomies and laparotomies of the upper abdomen. J Bras Pneumol, 2006, 32(2): 99-105.
38.	Kendall F, Silva G, Almeida J, et al. Influence of respiratory muscle training on patients’ recovery after lung resection. Int J Sports Med, 2020, 41(7): 484-491.
39.	Zhao JY, Presley C, Madariaga ML, et al. Prehabilitation for older adults undergoing lung cancer surgery: a literature review and needs assessment. Clin Lung Cancer, 2024, 25(7): 595-600.
40.	Wang J, Deng N, Qi F, et al. The effectiveness of postoperative rehabilitation interventions that include breathing exercises to prevent pulmonary atelectasis in lung cancer resection patients: a systematic review and meta-analysis. BMC Pulm Med, 2023, 23(1): 276.
41.	Brocki BC, Andreasen JJ, Langer D, et al. Postoperative inspiratory muscle training in addition to breathing exercises and early mobilization improves oxygenation in high-risk patients after lung cancer surgery: a randomized controlled trial. Eur J Cardiothorac Surg, 2016, 49(5): 1483-1491.
42.	龔靖杰, 張海波, 楊毅, 等. 晚期非小細胞肺癌患者生活質量影響因素研究. 中國癌癥防治雜志, 2023, 15(3): 322-327.
43.	Zheng W, Tang L, Chen J, et al. Current status and influencing factors of spiritual care needs of patients with lung cancer in chemotherapy: a longitudinal observational study. Support Care Cancer, 2025, 33(9): 757.
44.	Zeng Y, Hu CH, Li YZ, et al. Association between pretreatment emotional distress and immune checkpoint inhibitor response in non-small-cell lung cancer. Nat Med, 2024, 30(6): 1680-1688.
45.	Hsu CC, Sandford BA. The Delphi technique: making sense of consensus. Pract Assess Res Eval, 2007, 12(10): 1-8.
46.	范曼如, 申泉, 王丹琦, 等. 臨床實踐指南制訂方法——形成推薦意見的共識方法學. 中國循證心血管醫學雜志, 2019, 11(6): 647-653.

1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2. Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
3. 吳瀟然, 張慧, 冀昌, 等. 1990-2021 年中國及全球肺癌流行病學變化趨勢及發病率死亡率預測: 基于年齡-時期-隊列模型的分析. 現代預防醫學, 2025, 52(10): 1735-1741.
4. Pei G, Zhou S, Han Y, et al. Risk factors for postoperative complications after lung resection for non-small cell lung cancer in elderly patients at a single institution in China. J Thorac Dis, 2014, 6(9): 1230-1238.
5. Pagni S, McKelvey A, Riordan C, et al. Pulmonary resection for malignancy in the elderly: is age still a risk factor?. Eur J Cardiothorac Surg, 1998, 14(1): 40-45.
6. Fan J, Wang XJ, Jiang GN, et al. Survival and outcomes of surgical treatment of the elderly NSCLC in China: a retrospective matched cohort study. Eur J Surg Oncol, 2007, 33(5): 639-643.
7. Gonzalez M, Brunelli A, Szanto Z, et al. Report from the European Society of Thoracic Surgeons database 2019: current surgical practice and perioperative outcomes of pulmonary metastasectomy. Eur J Cardiothorac Surg, 2021, 59(5): 996-1003.
8. Yang X, Zhang Q, Ye C, et al. Factors influencing symptom severity at discharge after lobectomy and sublobar resection through video-assisted thoracoscopic surgery. Interdiscip Cardiovasc Thorac Surg, 2025, 40(8): ivaf170.
9. Baimas-George M, Watson M, Elhage S, et al. Prehabilitation in frail surgical patients: a systematic review. World J Surg, 2020, 44(11): 3668-3678.
10. Bertani A, Ferrari P, Terzo D, et al. A comprehensive protocol for physiokinesis therapy and enhanced recovery after surgery in patients undergoing video-assisted thoracoscopic surgery lobectomy. J Thorac Dis, 2018, 10(Suppl 4): S499-S511.
11. Batchelor TJP, Rasburn NJ, Abdelnour-Berchtold E, et al. Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERAS^?) Society and the European Society of Thoracic Surgeons (ESTS). Eur J Cardiothorac Surg, 2019, 55(1): 91-115.
12. Wang L, Yu M, Ma Y, et al. Effect of pulmonary rehabilitation on postoperative clinical status in patients with lung cancer and chronic obstructive pulmonary disease: a systematic review and meta-analysis. Evid Based Complement Alternat Med, 2022, 2022: 4133237.
13. Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, 2016, 66(2): 115-132.
14. Cho SJ, Stout-Delgado HW. Aging and lung disease. Annu Rev Physiol, 2020, 82: 433-459.
15. Paul S, Altorki NK, Sheng S, et al. Thoracoscopic lobectomy is associated with lower morbidity than open lobectomy: a propensity-matched analysis from the STS database. J Thorac Cardiovasc Surg, 2010, 139(2): 366-378.
16. Falcoz PE, Puyraveau M, Thomas PA, et al. Video-assisted thoracoscopic surgery versus open lobectomy for primary non-small-cell lung cancer: a propensity-matched analysis of outcome from the European Society of Thoracic Surgeon database. Eur J Cardiothorac Surg, 2016, 49(2): 602-609.
17. Whitson BA, Groth SS, Duval SJ, et al. Surgery for early-stage non-small cell lung cancer: a systematic review of the video-assisted thoracoscopic surgery versus thoracotomy approaches to lobectomy. Ann Thorac Surg, 2008, 86(6): 2008-2018.
18. Niskakangas A, Mustonen O, Puro I, et al. Results of video-assisted thoracoscopic surgery versus thoracotomy for lung cancer in a mixed practice medium-volume hospital: a propensity-matched study. Interdiscip Cardiovasc Thorac Surg, 2023, 37(6): ivad189.
19. Berry MF, Hanna J, Tong BC, et al. Risk factors for morbidity after lobectomy for lung cancer in elderly patients. Ann Thorac Surg, 2009, 88(4): 1093-1099.
20. Berry MF, Onaitis MW, Tong BC, et al. A model for morbidity after lung resection in octogenarians. Eur J Cardiothorac Surg, 2011, 39(6): 989-994.
21. Friedel G, Fritz P, Goletz S, et al. Postoperative survival of lung cancer patients: are there predictors beyond TNM?. Anticancer Res, 2013, 33(4): 1609-1619.
22. Licker M, Schnyder JM, Frey JG, et al. Impact of aerobic exercise capacity and procedure-related factors in lung cancer surgery. Eur Respir J, 2011, 37(5): 1189-1198.
23. Brunelli A, Pompili C, Salati M, et al. Preoperative maximum oxygen consumption is associated with prognosis after pulmonary resection in stage I non-small cell lung cancer. Ann Thorac Surg, 2014, 98(1): 238-242.
24. Jones LW, Watson D, Herndon JE 2nd, et al. Peak oxygen consumption and long-term all-cause mortality in nonsmall cell lung cancer. Cancer, 2010, 116(20): 4825-4832.
25. Williams T, Gulack BC, Kim S, et al. Operative risk for major lung resection increases at extremes of body mass index. Ann Thorac Surg, 2017, 103(1): 296-302.
26. Boudreaux AM, Simmons JW. Prehabilitation and optimization of modifiable patient risk factors: the importance of effective preoperative evaluation to improve surgical outcomes. AORN J, 2019, 109(4): 500-507.
27. Mantziari S, Hübner M, Demartines N, et al. Impact of preoperative risk factors on morbidity after esophagectomy: is there room for improvement?. World J Surg, 2014, 38(11): 2882-2890.
28. S?rensen LT. Wound healing and infection in surgery: the pathophysiological impact of smoking, smoking cessation, and nicotine replacement therapy: a systematic review. Ann Surg, 2012, 255(6): 1069-1079.
29. Yoshida N, Baba Y, Hiyoshi Y, et al. Duration of smoking cessation and postoperative morbidity after esophagectomy for esophageal cancer: how long should patients stop smoking before surgery?. World J Surg, 2016, 40(1): 142-147.
30. Brunelli A, Kim AW, Berger KI, et al. Physiologic evaluation of the patient with lung cancer being considered for resectional surgery: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 2013, 143(Suppl 5): e 166S-e190S.
31. AlGhatrif M, Morrell CH, Fleg JL, et al. Longitudinal decline in peak Vo2 with aging in a healthy population is associated with a reduction in peripheral oxygen utilization but not in cardiac output. Am J Physiol Heart Circ Physiol, 2024, 327(2): H509-H517.
32. Fleg JL, Morrell CH, Bos AG, et al. Accelerated longitudinal decline of aerobic capacity in healthy older adults. Circulation, 2005, 112(5): 674-682.
33. 中華醫學會心血管病學分會, 中國康復醫學會心肺預防與康復專業委員會, 中華心血管病雜志編輯委員會. 六分鐘步行試驗臨床規范應用中國專家共識. 中華心血管病雜志, 2022, 50(5): 432-442.
34. 郭科迪, 武巖, 湯夕慧, 等. 術前衰弱對老年肺癌患者術后并發癥的影響. 實用醫學雜志, 2023, 39(15): 1956-1960.
35. 劉彩云, 霍曉鵬, 劉曉萱, 等. 基于老年綜合評估的預康復在術前衰弱老年肺癌病人中的應用. 實用老年醫學, 2024, 38(11): 1153-1157.
36. Okazaki T, Suzukamo Y, Miyatake M, et al. Respiratory muscle weakness as a risk factor for pneumonia in older people. Gerontology, 2021, 67(5): 581-590.
37. Bellinetti LM, Thomson JC. Respiratory muscle evaluation in elective thoracotomies and laparotomies of the upper abdomen. J Bras Pneumol, 2006, 32(2): 99-105.
38. Kendall F, Silva G, Almeida J, et al. Influence of respiratory muscle training on patients’ recovery after lung resection. Int J Sports Med, 2020, 41(7): 484-491.
39. Zhao JY, Presley C, Madariaga ML, et al. Prehabilitation for older adults undergoing lung cancer surgery: a literature review and needs assessment. Clin Lung Cancer, 2024, 25(7): 595-600.
40. Wang J, Deng N, Qi F, et al. The effectiveness of postoperative rehabilitation interventions that include breathing exercises to prevent pulmonary atelectasis in lung cancer resection patients: a systematic review and meta-analysis. BMC Pulm Med, 2023, 23(1): 276.
41. Brocki BC, Andreasen JJ, Langer D, et al. Postoperative inspiratory muscle training in addition to breathing exercises and early mobilization improves oxygenation in high-risk patients after lung cancer surgery: a randomized controlled trial. Eur J Cardiothorac Surg, 2016, 49(5): 1483-1491.
42. 龔靖杰, 張海波, 楊毅, 等. 晚期非小細胞肺癌患者生活質量影響因素研究. 中國癌癥防治雜志, 2023, 15(3): 322-327.
43. Zheng W, Tang L, Chen J, et al. Current status and influencing factors of spiritual care needs of patients with lung cancer in chemotherapy: a longitudinal observational study. Support Care Cancer, 2025, 33(9): 757.
44. Zeng Y, Hu CH, Li YZ, et al. Association between pretreatment emotional distress and immune checkpoint inhibitor response in non-small-cell lung cancer. Nat Med, 2024, 30(6): 1680-1688.
45. Hsu CC, Sandford BA. The Delphi technique: making sense of consensus. Pract Assess Res Eval, 2007, 12(10): 1-8.
46. 范曼如, 申泉, 王丹琦, 等. 臨床實踐指南制訂方法——形成推薦意見的共識方法學. 中國循證心血管醫學雜志, 2019, 11(6): 647-653.

West China Medical Journal

Construction of a multi-dimensional evaluation system for physical function and functional rehabilitation of elderly patients with lung cancer during perioperative period based on modified Delphi method

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content