When more quality measures are incorporated into patient care, survival rates for patients with stage IIIA non-small cell lung cancer (NSCLC) increase, but only 13% of eligible patients actually receive all 4 recommended quality measures, according to a presentation at the American Association for Thoracic Surgery Annual Meeting 2016.
“Compliance with national recommendations regarding induction therapy and approach to surgical resection are crucial to optimizing long-term survival outcomes in clinical stage IIIA NSCLC,” explained Pamela Samson, MD, MPHS, of Washington University in St. Louis, Missouri, and lead author of the study.
Current guidelines from the National Comprehensive Cancer Network (NCCN) and American College of Chest Physicians (ACCP) recommend that operable patients with clinical stage IIIA NSCLC should receive induction chemotherapy (with or without concurrent radiotherapy) followed by resection if there is no apparent progression of disease.
Samson reported a wide variability in compliance with quality measures. The study highlights the importance of implementing the recommended steps into actual practice. Its analysis of data from the National Cancer Data Base (NCDB) demonstrates that the survival rates of patients with stage IIIA NSCLC who underwent surgery increased more than 3-fold for those who received 4 quality measures as part of their care.
The recommended quality measures considered were neoadjuvant multiagent 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).
Study data showed that 19% (10 304) of 54 069 patients with clinical stage IIIA NSCLC underwent surgical resection between 2006 and 2010. Among these patients, the most frequently missed measure was neoadjuvant chemotherapy (included for only approximately 30% of patients), followed by lymph node sampling (only 40% of patients). A lobectomy or greater resection was performed in 84% of patients, with 87% achieving negative surgical margins. Despite the proven benefits of incorporating all the quality measures in patient’s treatment, the investigators found that only 12.8% of patients with clinical stage IIIA NSCLC had all 4 measures included of their care.
Patient survival was affected by the number of quality measures included in the patient’s care. Median overall survival was 12.7 months for patients whose care did not include any of the measures; survival increased to 25.0 months for those whose care included 1 measure, 31.4 months with 2 measures, 36.6 months with 3 measures, and 43.5 months with all 4 measures.
Samson stated that the findings underscore the need for evaluation of the clinical stage IIIA NSCLC patient by a multidisciplinary group.
1. American Association for Thoracic Surgery. Stage IIA non-small cell lung cancer survival rates improved when care includes 4 specific quality measures [news release]. EurekAlert! website. http://www.eurekalert.org/pub_releases/2016-05/aaft-sin051216.php. May 16, 2016. Accessed May 26, 2016.