Evaluation of adherence to the Commission on Cancer lung cancer quality measures

David Duston Odell, Joseph M Feinglass, Kathryn Engelhardt, Steven Papastefan, Shari L. Meyerson, Ankit Bharat, Malcolm M. DeCamp, Karl Y Bilimoria

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objective: In this study we present historic data on adherence to and survival outcomes associated with recently introduced quality measures for the management of non–small-cell lung cancer. Methods: The National Cancer Data Base was queried to identify all patients with non–small-cell lung cancer from 1998 to 2011. Adherence to guidelines was assessed for each of 3 Commission on Cancer-defined quality measures: (1) sampling 10 regional lymph nodes at surgery; (2a) surgery within 120 days of neoadjuvant chemotherapy or, (2b) 180 days of adjuvant chemotherapy; and (3) nonsurgical primary therapy in cN2 disease. The likelihood of measure adherence and the association of measure adherence with all-cause mortality were analyzed controlling for patient, hospital, and time period characteristics. Results: Regional lymph node sampling was inadequate in 72.7% of cases. Only 28.7% began adjuvant chemotherapy within 180 days of surgery. However, 96.5% of patients who received neoadjuvant chemotherapy proceeded to surgery within 120 days and surgery was first-line treatment for cN2 disease in only 3.7% of patients. Uninsured or Medicaid status was an independent risk factor for a prolonged delay between neoadjuvant chemotherapy and surgery (odds ratio, 1.36; 95% confidence interval, 1.08-1.72) and surgery and adjuvant treatment (odds ratio, 1.92; 95% confidence interval, 1.69-2.19). Overall survival was significantly better in patients whose care conformed to quality standards for nodal sampling (measure 1), and timing of chemotherapy. Conclusions: Adherence rates for nodal sampling at the time of surgery and receipt of adjuvant chemotherapy were low. These findings highlight opportunities for improvement efforts, but more measures are needed to more broadly assess the quality of lung cancer care.

Original languageEnglish (US)
Pages (from-to)1219-1235
Number of pages17
JournalJournal of Thoracic and Cardiovascular Surgery
Volume157
Issue number3
DOIs
StatePublished - Mar 1 2019

Fingerprint

Lung Neoplasms
Adjuvant Chemotherapy
Drug Therapy
Ambulatory Surgical Procedures
Non-Small Cell Lung Carcinoma
Lymph Nodes
Odds Ratio
Confidence Intervals
Guideline Adherence
Survival
Medicaid
Neoplasms
Patient Care
Therapeutics
Databases
Mortality

Keywords

  • guideline adherence
  • lung cancer
  • quality

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

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title = "Evaluation of adherence to the Commission on Cancer lung cancer quality measures",
abstract = "Objective: In this study we present historic data on adherence to and survival outcomes associated with recently introduced quality measures for the management of non–small-cell lung cancer. Methods: The National Cancer Data Base was queried to identify all patients with non–small-cell lung cancer from 1998 to 2011. Adherence to guidelines was assessed for each of 3 Commission on Cancer-defined quality measures: (1) sampling 10 regional lymph nodes at surgery; (2a) surgery within 120 days of neoadjuvant chemotherapy or, (2b) 180 days of adjuvant chemotherapy; and (3) nonsurgical primary therapy in cN2 disease. The likelihood of measure adherence and the association of measure adherence with all-cause mortality were analyzed controlling for patient, hospital, and time period characteristics. Results: Regional lymph node sampling was inadequate in 72.7{\%} of cases. Only 28.7{\%} began adjuvant chemotherapy within 180 days of surgery. However, 96.5{\%} of patients who received neoadjuvant chemotherapy proceeded to surgery within 120 days and surgery was first-line treatment for cN2 disease in only 3.7{\%} of patients. Uninsured or Medicaid status was an independent risk factor for a prolonged delay between neoadjuvant chemotherapy and surgery (odds ratio, 1.36; 95{\%} confidence interval, 1.08-1.72) and surgery and adjuvant treatment (odds ratio, 1.92; 95{\%} confidence interval, 1.69-2.19). Overall survival was significantly better in patients whose care conformed to quality standards for nodal sampling (measure 1), and timing of chemotherapy. Conclusions: Adherence rates for nodal sampling at the time of surgery and receipt of adjuvant chemotherapy were low. These findings highlight opportunities for improvement efforts, but more measures are needed to more broadly assess the quality of lung cancer care.",
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Evaluation of adherence to the Commission on Cancer lung cancer quality measures. / Odell, David Duston; Feinglass, Joseph M; Engelhardt, Kathryn; Papastefan, Steven; Meyerson, Shari L.; Bharat, Ankit; DeCamp, Malcolm M.; Bilimoria, Karl Y.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 157, No. 3, 01.03.2019, p. 1219-1235.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Evaluation of adherence to the Commission on Cancer lung cancer quality measures

AU - Odell, David Duston

AU - Feinglass, Joseph M

AU - Engelhardt, Kathryn

AU - Papastefan, Steven

AU - Meyerson, Shari L.

AU - Bharat, Ankit

AU - DeCamp, Malcolm M.

AU - Bilimoria, Karl Y

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N2 - Objective: In this study we present historic data on adherence to and survival outcomes associated with recently introduced quality measures for the management of non–small-cell lung cancer. Methods: The National Cancer Data Base was queried to identify all patients with non–small-cell lung cancer from 1998 to 2011. Adherence to guidelines was assessed for each of 3 Commission on Cancer-defined quality measures: (1) sampling 10 regional lymph nodes at surgery; (2a) surgery within 120 days of neoadjuvant chemotherapy or, (2b) 180 days of adjuvant chemotherapy; and (3) nonsurgical primary therapy in cN2 disease. The likelihood of measure adherence and the association of measure adherence with all-cause mortality were analyzed controlling for patient, hospital, and time period characteristics. Results: Regional lymph node sampling was inadequate in 72.7% of cases. Only 28.7% began adjuvant chemotherapy within 180 days of surgery. However, 96.5% of patients who received neoadjuvant chemotherapy proceeded to surgery within 120 days and surgery was first-line treatment for cN2 disease in only 3.7% of patients. Uninsured or Medicaid status was an independent risk factor for a prolonged delay between neoadjuvant chemotherapy and surgery (odds ratio, 1.36; 95% confidence interval, 1.08-1.72) and surgery and adjuvant treatment (odds ratio, 1.92; 95% confidence interval, 1.69-2.19). Overall survival was significantly better in patients whose care conformed to quality standards for nodal sampling (measure 1), and timing of chemotherapy. Conclusions: Adherence rates for nodal sampling at the time of surgery and receipt of adjuvant chemotherapy were low. These findings highlight opportunities for improvement efforts, but more measures are needed to more broadly assess the quality of lung cancer care.

AB - Objective: In this study we present historic data on adherence to and survival outcomes associated with recently introduced quality measures for the management of non–small-cell lung cancer. Methods: The National Cancer Data Base was queried to identify all patients with non–small-cell lung cancer from 1998 to 2011. Adherence to guidelines was assessed for each of 3 Commission on Cancer-defined quality measures: (1) sampling 10 regional lymph nodes at surgery; (2a) surgery within 120 days of neoadjuvant chemotherapy or, (2b) 180 days of adjuvant chemotherapy; and (3) nonsurgical primary therapy in cN2 disease. The likelihood of measure adherence and the association of measure adherence with all-cause mortality were analyzed controlling for patient, hospital, and time period characteristics. Results: Regional lymph node sampling was inadequate in 72.7% of cases. Only 28.7% began adjuvant chemotherapy within 180 days of surgery. However, 96.5% of patients who received neoadjuvant chemotherapy proceeded to surgery within 120 days and surgery was first-line treatment for cN2 disease in only 3.7% of patients. Uninsured or Medicaid status was an independent risk factor for a prolonged delay between neoadjuvant chemotherapy and surgery (odds ratio, 1.36; 95% confidence interval, 1.08-1.72) and surgery and adjuvant treatment (odds ratio, 1.92; 95% confidence interval, 1.69-2.19). Overall survival was significantly better in patients whose care conformed to quality standards for nodal sampling (measure 1), and timing of chemotherapy. Conclusions: Adherence rates for nodal sampling at the time of surgery and receipt of adjuvant chemotherapy were low. These findings highlight opportunities for improvement efforts, but more measures are needed to more broadly assess the quality of lung cancer care.

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