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J Thorac Cardiovasc Surg 2008;136:603-604
© 2008 The American Association for Thoracic Surgery

Invited Commentary

Discussion

Dr Francis C. Nichols (Rochester, Minnesota). Dr Burfeind and colleagues have pointed out that surgical morbidity, mortality, and long-term survival have been our traditional reported outcome parameters. However, with multimodality diagnostic and treatment options now becoming routine in patients with certain diseases, particularly lung cancer, an ever-increasing amount of time has to be spent by patients in investigating, treating, and hopefully regaining their personal health. This has resulted in a growing appreciation about health-related QOL for these patients. Specifically regarding our patients with lung cancer, who are indeed oftentimes middle-age, as you said, or older, it would seem that knowledge of QOL would provide useful information, in fact, essential information for the patients, their families, primary care providers, and other specialists, namely, our referrers. In broad terms, QOL is a concept that is easy to intuitively grasp but difficult to reliably measure. It's a dynamic concept varying over time. The authors are to be commended on the prospective nature of this study dating back to 1999, which involved a large cohort of patients, 422, which to my knowledge represents the largest number of patients thus reported on. As a clinician, I worry about missing data. Although many of us in the room aren't statisticians, I and perhaps others get nervous when 20% to 38% of the data are missing. I would have thought that with a dedicated clinical research assistant administering the questionnaire and use of a computer that missing data elements could have been less or caught earlier. If the missing data were due to patients not keeping their scheduled clinic appointments, is there any process now in place for avoiding that in the future? Could you please comment on this 20% to 38% missing data and the validity of imputing data?

Dr Burfeind. As you know, missing data . . . [Full Text of this Article]