Quality Measures for NSCLC Significantly Improve Survival

Including certain quality measures as a part of care for patients with non-small cell lung cancer (NSCLC) who undergo surgery can significantly improve survival, according to results presented at the American Association for Thoracic Surgery Annual Meeting (May 14-18, 2016; Baltimore, MD).

Current guidelines by the National Comprehensive Cancer Network and American College of Chest Physicians recommend that operable patients with clinical stage IIIA NSCLC receive induction chemotherapy followed by resection if there is no sign of disease progression. While four quality measures have been identified that associate with better overall survival, it is still unclear to what extent physicians are using these measures as a part their care for patients.

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For the study, researchers used data obtained from the National Cancer Data Base to identify 10,304 patients with clinical stage 3A NSCLC who had undergone surgical resection between 2006 and 2010. They looked at how frequently four interventions—neoadjuvant multi-agent chemotherapy, lobar (or greater) resection, sampling of at least 10 lymph nodes, and R0 resection (tumor has been removed to the extent that the margins are free of cancerous cells)—were used in patients and whether they led to improved rates of survival.

Pamela Samson, MD, MPHS, Washington University (St Louis, MO), presented the results of the study. Overall, the most frequently missed measure was that of neoadjuvant multiagent chemotherapy, which was used in only ~30% of patients. Sampling of at least 10 lymph nodes was the next least used (40% of patients), followed by the receipt of lobectomy or greater resection (84% of patients) and negative surgical margins (87%). Only 12.8% of patients received all for interventions, said Dr Samson.

Median overall survival was 12.7 months for patients who did not receive any of the interventions, 25 months for those who received one interventions, 31.4 months for two interventions, 36.6 months for three interventions, and 43.5 months for patients who received all four interventions.

In addition, patients who were privately insured, had higher education, and received their care at an academic or high-volume surgical center were more likely to receive all four quality measures. Those who received fewer interventions tended to be older, non-Caucasian, and with multiple comorbidities.

"This analysis demonstrated that the majority of clinical Stage IIIA NSCLC patients are not receiving multiagent induction chemotherapy prior to resection. This is surprising, given the fact that the majority of patients in this study (80%) presented with clinical N2 disease," concluded Dr Samson.

She added that the improved survival of patients who received all four interventions, "underscores the need for evaluation of the clinical Stage IIIA NSCLC patient by a multi-disciplinary group."