Sex differences in health-related quality of life following pulmonary resection: a systematic review

Abstract Objectives Pulmonary resection is a cornerstone of lung cancer treatment, but its impact on health-related quality of life (HRQoL) extends beyond oncological outcomes and may vary by sex and gender. Understanding these differences is essential to optimizing patient-centered care in non-small cell lung cancer particulary with the addition of new therapies in the early-stage space. This systematic review evaluates sex-related disparities in HRQoL following pulmonary resection for lung cancer. Methods A systematic review was conducted in accordance with PRISMA guidelines, using Cochrane, MEDLINE, EMBASE, and PubMed databases selecting publications from January 2014 to June 2024. Eligible studies reported HRQoL outcomes with sex-disaggregated data in patients undergoing pulmonary resection for lung cancer. The risk of bias was assessed using the Risk of Bias 1 (RoBINS-1) tool, and data were synthesized qualitatively. Results Among 9,861 studies screened, 66 full-text articles were reviewed, and 11 met inclusion criteria. HRQoL tools included: Short-Form 36 (SF-36; 20%), European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ-C30; 20%), Short-Form 12 (20%), and the Visual Analog Scale (VAS; 30%). The time points for data collection also varied: preoperative/baseline (60%), postoperative day 1 (40%), postoperative day 3 (40%), and postoperative month 6 (40%). The studies assessed diverse HRQoL domains. Around half (5/11) reported sex-based differences, while the others found none. Sex-based differences in selected HRQoL domains have been reported by a subset of studies: higher postoperative pain (3/6 studies), worse sleep quality/insomnia (2/2 studies), and more psychosocial, depressive and physical issues (3/6 studies) in female patients. Conclusions Available evidence, although limited and heterogeneous, suggests that women may experience greater adverse impacts on HRQoL following pulmonary resection, particularly in pain, mental health, and physical recovery. However, the current findings should be interpreted with caution due to variability in study design, instruments, and timepoints.