Effects Of Religious Faith On Outcomes After Robotic-assisted Pulmonary Lobectomy For Non-small Cell Lung Cancer
Allison O. Dumitriu Carcoana1, Jenna C. Marek1, Emily E. Weeden1, Carla C. Moodie2, Joseph R. Garrett2, Jenna R. Tew2, Jobelle J. Baldonado2, Jacques P. Fontaine2, Eric M. Toloza2.
1University of South Florida Health Morsani College of Medicine, Tampa, FL, USA, 2Moffitt Cancer Center, Tampa, FL, USA.
BACKGROUND: Numerous prospective cohort studies, systematic reviews, and meta-analyses have reported a robust relationship between religiosity and increased survival in patients with acute, chronic, or terminal illnesses. Religious faith has been associated with a decreased hazard ratio in cancer patients. Lung cancer is the number one cause of cancer mortality in the United States, with 80% of lung cancer patients having non-small cell lung cancer (NSCLC). The association between religion and outcomes in NSCLC patients pursuing surgical resection has not been evaluated. We examined the relationship between religious faith and robotic-assisted pulmonary lobectomy (RAPL) outcomes among NSCLC patients. METHODS: We retrospectively analyzed 697 patients who underwent RAPL from September 2010 to March 2022 by one surgeon. There were 637 religious patients and 60 non-religious patients. The patients’ demographics, tumor characteristics, past medical histories, perioperative complications, and outcomes were collected by individual chart review. Student’s t-test, Wilcoxon rank-sum, and Pearson chi-square tests were used for univariate analysis. Cox regression was used for survival analysis. RESULTS: There were no significant differences in demographics, tumor characteristics, Charlson comorbidity scores, or past medical history, including pulmonary fibrosis, chronic obstructive pulmonary disease, smoking history, cirrhosis, liver failure, end-stage renal disease, diabetes mellitus, myocardial infarction, atrial fibrillation, congestive heart failure, hypertension, and hyperlipidemia. Perioperatively, estimated blood loss (p<0.001), surgical skin-to-skin duration (p=0.013), and hospital length of stay (p=0.018) were greater among religious patients (Table I). There were no differences in discharge disposition (p=0.185), in-hospital mortality (p=0.254), or 30-day mortality (p=0.376; Table I). The proportion of patients who experienced postoperative complications in the follow-up period was higher among the religious patients (70.0%) compared to the non-religious patients (42.5%), although this difference did not reach statistical significance (p=0.094; Table I). Five-year all-cause mortality was similar between the groups (p=0.420).
CONCLUSIONS: The religious group experienced higher intraoperative estimated blood loss, longer skin-to-skin operative time, and higher rates of postoperative complications, but similar five-year all-cause mortality compared to the non-religious group. Further research is needed to determine whether surgical oncology patients or lung cancer patients experience survival benefits associated with religious faith. 
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