The researchers found that the median OS began at 12.7 months for patients who did not receive any of the measures, 25.0 months for those who received 1 measure, 31.4 months for those who received 2 measures, 36.6 months for those who received 3 measures, and 43.5 months for those who received all 4 measures.

Between 2006 and 2010, 19% (10,323) of 54,069 patients with stage IIIA NSCLC underwent surgical resection. Among these patients, the most frequently missed measure was receipt of neoadjuvant multiagent chemotherapy (approximately 30%), followed by a minimum of 10 lymph node samples, which was taken for only 40% of patients.


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The study showed that 84% received a lobectomy or greater resection and 87% had negative surgical margins. Despite the proven benefits of receiving all 4 quality measures as part of patient care, the investigators found that only 13% of individuals with stage IIIA NSCLC received all 4 interventions.

“Stage IIIA NSCLC requires a multidisciplinary approach among medical oncologists, surgeons, and radiation oncologists. In our analysis of the patients receiving surgical therapy, over 80% had clinical N2 disease. To ensure the maximum benefit from surgery, collaboration among specialists is key to ensure timely and appropriate delivery of multiagent neoadjuvant chemotherapy. It was the quality measure that was the least frequently met,” Dr Samson told Cancer Therapy Advisor.

The study showed that private insurance or Medicare status, higher education, and treatment at an academic cancer or high-volume surgical center were linked with a patient’s receiving all 4 quality measures. Those who received fewer interventions tended to be older, non-Caucasian, and with multiple comorbidities. The researchers hope these findings will encourage individual institutions to evaluate their practice patterns, as there may be variations both within and among cancer centers.

Mark Allen, MD, professor of surgery at the Mayo Clinic in Rochester, Minnesota, said that the large sample of patients with a diverse background is the study’s main strength. He added that the study shows that clinicians may not be doing as well as they think they are when it comes to managing this patient population.

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He urged caution, however: “the biggest limitations are those of the database used. It did not include specifics about how clinical mediastinal staging was performed, and it did not include pulmonary function data,” Dr Allen told Cancer Therapy Advisor. “We need to do a better job of getting the word out about what the guidelines are and that we need to follow them to improve the survival of patients. We get only one chance to do it right, and we should be able to do much better than we are doing now. It is sad that only 13% received all 4 quality measures. We should be able to get well above 75% without too much effort.”

Reference

  1. Samson P, Crabtree T, Morgensztern D, Robinson C, Broderick S, Patterson GA, et al. Surgical quality measures in stage IIIA non-small cell lung cancer are associated with improved survival. Paper presented at: 96th Annual Meeting of the American Association for Thoracic Surgery; May 2016; Baltimore, MD.