Better adherence to surgical quality metrics may improve outcomes in early-stage NSCLC
Click Here to Manage Email Alerts
Adherence to intraoperative quality metrics may increase OS and recurrence-free survival after curative-intent resection of early-stage non-small cell lung cancer, according to results of a study published in JAMA Surgery.
Nevertheless, researchers found poor adherence to several guideline-established quality measures in both Veteran Affairs and civilian hospitals.
“Our study emphasizes the importance of delivering evidence-based, high-quality surgical care in the treatment of lung cancer,” Brendan T. Heiden, MD, MPHS, surgical resident and research fellow at Washington University School of Medicine in St. Louis, told Healio. “Efforts to standardize and optimize surgical quality parameters may disproportionately impact long-term survival rates among patients with early-stage lung cancer receiving curative-intent surgery.”
Background and methodology
Lung cancer remains the leading cause of cancer-related death throughout the United States, and surgical resection is the preferred treatment option for fit patients with early-stage disease.
In addition, most lung cancer treatment guidelines recommend several modifiable, process-based surgical quality metrics that, with adherence to such guidelines, have improved outcomes for patients with NSCLC who received definitive surgical treatment.
Heiden and colleagues defined five surgical quality metrics based on guidelines from National Comprehensive Cancer Network and other groups: timely surgery, minimally invasive approach, lobectomy or segmentectomy, adequate lymph node sampling and negative surgical margin.
The researchers analyzed adherence to the metrics among 9,628 veterans (mean age, 67.6 years; 96.4% men; 58.4% smokers at time of surgery) with clinical stage I NSCLC who received definitive surgical treatment from October 2006 through September 2016. They created an integer-based Veterans Affairs Lung Cancer Operative (VALCAN-O) score, ranging from zero (no metrics met) to 13 (all metrics met), to reflect the correlation of surgical quality metrics and OS. They also analyzed the association of the quality score with RFS.
Results
After median follow-up of 6.2 years (range, 2.5-11.4), researchers determined that 6,633 patients (68.9%) received timely surgery, 3,986 (41.4%) underwent a minimally invasive approach, 6,843 (71.1%) underwent lobectomy, 532 (5.5%) underwent segmentectomy, 3,278 (34%) received adequate lymph node sampling and 9,312 (96.7%) had a negative surgical margin.
Median OS differed significantly among the score categories (0 to 5 points, 2.6 years; 6 to 8 points, 4.3 years; 9 to 11 points, 6.3 years; 12 to 13 points, 7 years; P < .001).
In addition, risk-adjusted RFS improved in a stepwise manner among the score categories (6-8 vs. 0-5 points, multivariable-adjusted HR [aHR] = 0.62; 95% CI, 0.48-0.79; 12-13 vs. 0-5 points, aHR = 0.39; 95% CI, 0.31-0.49).
Researchers validated the findings in a cohort of 107,674 nonveterans with early-stage NSCLC.
“Our study demonstrates that what happens in the operating room can dramatically impact long-term outcomes after lung cancer surgery,” Heiden told Healio. “Further efforts are needed to ensure that guideline-concordant treatment metrics are achieved as frequently as possible in surgical practice settings across the U.S. We were encouraged to see dramatic improvements in these metrics over the last several years. The thoracic oncology community should be applauded for these gains and continue their efforts to deliver high-quality care.”
Next steps
Heiden said he hopes the study results assist oncologists across the United States in providing quicker treatment to patients while adhering to the surgical quality metrics studied.
“Our group is interested in assessing interventions that can improve adherence to surgical quality metrics across the U.S.,” Heiden told Healio. “For example, leveraging new technologies within electronic health systems may allow patients to receive lung cancer treatment more quickly, with fewer delays.”
For more information:
Brendan T. Heiden, MD, MPHS, can be reached at Washington University School of Medicine in St. Louis, 660 S. Euclid Ave., Campus Box 8234, St. Louis, MO 63110; email: bheiden@wustl.edu.
Collapse
Heiden BT, et al. JAMA Surg. 2023;doi:10.1001/jamasurg.2002.6826.
Click Here to Manage Email Alerts