Patients who undergo surgery for lung cancer often wait too long to receive treatment, and many do not receive critical diagnostic tests that are necessary to determine the best possible treatment, according to a study published in the August 2015 issue of The Annals of Thoracic Surgery.1
The 5-year relative survival rate of patients diagnosed with lung cancer remains below 20%, and has not changed significantly over the past 30 years.2 Most patients who survive more than 5 years have had surgery as part of their treatment, yet fewer than half of patients who undergo surgery for lung cancer survive 5 years.3
A group of researchers from Baptist Centers for Cancer Care, in Southaven, MS, and Memphis, TN, and the University of Memphis in Tennessee, led by Raymond Osarogiagbon, MBBS and Nicolas Faris, MDiv, retrospectively reviewed the clinical records of all recipients of lung resection surgery at two hospitals over 42 months.
They classified all lung cancer-related procedures into five points of care: lesion detection, diagnostic biopsy, radiologic staging, invasive staging, and treatment, and analyzed the duration between points and what steps were taken to determine the best possible treatment.
Of 614 eligible patients, 92% had lung cancer, 5% had a non-lung primary tumor, and 3% had a benign lesion. Only 6% received preoperative therapy.
Twenty-seven percent had no preoperative diagnostic procedure; 22% did not receive PET/CT imaging scans; and 88% did not receive an invasive staging test. Only 10% received the recommended combination of CT, PET/CT, and invasive staging.
The researchers also found that it took anywhere from 43 and 189 days from when lesions were initially detected to when patients underwent surgery.
The median wait from initial detection to diagnostic biopsy was 28 days, and from diagnostic biopsy to surgery, 40 days. In an interview with Cancer Therapy Advisor, Dr. Osarogiagbon said “delay in diagnosis and treatment is extremely unpleasant to patients and their home caregivers.”
His team concluded that their findings represented an opportunity to improve the thoroughness, accuracy, and speed of preoperative evaluation of potential lung care patients, and noted that these benchmarks may be significantly improved with better coordination of care.
“Early involvement of all the key specialists involved in lung cancer care, adopting a strategic approach to sequential decision-making, actively involving patients and home caregivers in these strategic plans, and ensuring these decisions about optimal evidence-based care are executed in practice significantly shortens time from initial lesion to diagnosis, staging, and treatment, and increases the appropriate use of tests and appropriate treatment selection,” said Dr. Osarogiagbon.
“The bottom line is that interdisciplinary decision-making, rigorous data-collection and analysis, and program benchmarking are all necessary to improve the quality of lung cancer care.”
Farhood Farjah, MD, MPH, of the University of Washington in Seattle, WA, provided an invited commentary in the same issue of The Annals.
He wrote that the authors’ findings “mirror those revealed through analyses of national cancer care registries—there are significant gaps in the quality of lung cancer care.” Dr. Farjah also emphasized the importance of the authors’ intention to use a disease-based, rather than treatment-based, approach to quality improvement.
Dr. Osarogiagbon said, “treatment-based approaches look at only one segment of the full spectrum of treatment options, and try to analyze how to improve that narrow sliver of options, without understanding how patients flow into that track and where they leak out of the pipeline to that track.”
His team is continuing their research in an ongoing “Lung Cancer Milestones Phase II” analysis, which they intend to present in a few years.