The quality of lung cancer treatment varies widely across the United States – Washington University School of Medicine in St. Louis

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Researchers identify measures to improve treatment quality and health outcomes

Tim Parker

Lung cancer treatment is rapidly evolving with new technologies and research-proven procedures. However, a study from Washington University School of Medicine in St. Louis found that the quality of lung cancer care in the United States varies widely, with significantly worse outcomes among patients whose surgery does not meet established treatment guidelines.

To help close the gap in quality of care, researchers examined five measures of surgical quality based on guidelines established by the National Comprehensive Cancer Network and other cancer groups, and found that adherence to these quality measures was associated with improved overall survival rates.

The study was published Jan. 18 in the journal JAMA Surgery.

“It is critical to have a solid understanding of what constitutes high-grade lung cancersaid the study’s senior author, Varun Puri, MD, a University of Washington thoracic surgeon and professor of surgery who treats patients at the Siteman Cancer Center, based at Barnes-Jewish Hospital and the University of Washington. “Improving adherence to surgical quality procedures is critical to improving long-term outcomes among patients with early-stage lung cancer who seek treatment aimed at curing their cancer.”

Lung cancer is the leading cause of cancer deaths in the United States and is the second most common type of cancer, with non-small cell lung cancer accounting for 84% of all lung cancer cases, according to the American Cancer Society.

The five recommended quality measures identified by the researchers include timely surgery, soon after diagnosis; determining the appropriate amount of lung tissue to be surgically removed; taking samples from multiple lymph nodes to ensure that the cancer has been properly staged and has not spread to the lymph nodes; the use of minimally invasive surgery to reduce postoperative pain and speed up the recovery process; And making sure that no cancer is left inside the body, also known as a positive margin.

“Ideally, these quality measures should be met as frequently as possible in any lung cancer surgery,” Bury said. However, as our data shows, adherence to these measures can be highly variable across the United States.

For the study, the researchers analyzed medical records that were not identified in a database maintained by the US Veterans Health Administration, the nation’s largest integrated healthcare delivery system. The researchers examined information on 9,628 patients with early-stage non-small cell lung cancer who underwent surgery from October 1, 2006 through September 31, 2016. The researchers developed a surgical quality score that reflects the association between the five measures and the overall measures. Survival.

The mean age of the VA patients was 67.8 years. The patients were predominantly male and white. However, statistical modeling is controlled for different ages, races, and genders.

The researchers also looked at adherence to quality measures and overall survival rates among 107,674 nonveteran patients who were listed as patients in the National Cancer Database from 2010 to 2016.

The researchers found poor adherence to several quality standards, both within VA and civilian hospitals. For example, about a third of patients in both groups received appropriate lymph node sampling, and only about 40% received minimally invasive surgery.

“Many patient- and tumor-specific factors can influence the apparent quality of surgical care for lung cancer,” said the study’s first author, Brendan Hayden, MD, a resident and research fellow at the University of Washington. “However, it is important to try to standardize and improve adherence to quality procedures whenever possible. Treatments for early-stage lung cancer are rapidly evolving with the introduction of exciting new therapies. However, at the core of these developments is the underlying principle of high-quality, evidence-based surgery.” she explains In our study, adherence to surgical quality measures could have a disproportionate effect on patients with lung cancer.Surgical treatment aimed at curing cancer.

Heiden BT and Eaton Jr. DB, Chang S, Yan Y, Baumann AA, Schoen MW, Tohmasi S, Rossetti NE, Patel MR, Kreisel D, Nava RG, Meyers BF, Kozower BD, Puri V. Overall survival among US veterans with cancer Non-small cell lung in its early stages. JAMA surgery. Published January 18, 2023. DOI: 10.1001/jamasurg.2022.6826.

This research was funded by National Institutes of Health (NIH) grant 5T32HL007776-25; and Veterans Administration grant 1I01HX002475-01A2.


About the University of Washington School of Medicine

WashU Medicine is a global leader in academic medicine, including biomedical research, patient care, and educational programs with 2,700 faculty members. The National Institutes of Health’s (NIH) research funding portfolio is the fourth-largest among U.S. medical schools, and has grown 54% in the past five years. Combined with institutional investment, WashU Medicine commits more than $1 billion annually for basic research, clinical innovation, and training. Its faculty practice is consistently in the top five in the nation, with more than 1,790 physicians working on the faculty at more than 60 locations who are also the medical staff at Barnes-Jews and St. Louis Children’s Hospitals at BJC HealthCare. WashU Medicine has a strong history of MD/PhD training, recently committed $100 million to scholarships and curriculum renewals for medical students, and is home to first-class training programs in every medical subspecialty as well as physical therapy, occupational therapy, audiology, and communication sciences.

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