Not following the rules in guideline care for lung cancer diagnosis and staging has negative impact.

Publication Title

The Annals of thoracic surgery

Authors

Candice L. Wilshire, Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, 1101 Madison Street, Suite 900, Seattle, WA, 98104, USA.Follow
Joshua R Rayburn, Division of Interventional Pulmonology and Thoracic Surgery, Swedish Cancer Institute, Seattle, WA.
Shu-Ching Chang, Medical Data Research Center, Providence St. Joseph Health, Portland, OR.Follow
Christopher R Gilbert, Swedish Cancer Institute Seattle, WashingtonFollow
Brian Louie, Division of Thoracic Surgery, Swedish Medical Center and Cancer Institute, Seattle, WashingtonFollow
Ralph W Aye, Division of Thoracic Surgery, Swedish Medical Center and Cancer Institute, Seattle, WashingtonFollow
Alexander S Farivar, Division of Thoracic Surgery, Swedish Medical Center and Cancer Institute, Seattle, WashingtonFollow
Adam J Bograd, Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, WA, USA.Follow
Eric Vallières, Division of Thoracic Surgery, Swedish Cancer InstituteFollow
Jed A Gorden, Swedish Cancer Institute Seattle, WashingtonFollow

Document Type

Article

Publication Date

5-31-2020

Abstract

BACKGROUND: Recent studies have identified poor adherence to recommended guidelines in diagnosing and staging patients with non-small cell lung cancer (NSCLC), which has been associated with numerous negative downstream effects. However, these reports are comprised predominantly of large administrative databases with inherent limitations. We aimed to describe guideline-inconsistent care and identify any associated factors within our healthcare system.

METHODS: A review of patients diagnosed with primary NSCLC between 1/1/2014 and 12/31/2014 within our community hospital network was performed. Univariate and multivariable logistic regression analyses were performed to identify factors associated with guideline-inconsistent care.

RESULTS: Guideline-inconsistent care was identified in 24% (98/406) of patients: 58% (46/81) in clinical stage III and 29% (52/179) in stage IV. Of the 46 clinical stage III patients with guideline-inconsistent care, 43% (20) had no invasive mediastinal lymph node sampling prior to treatment initiation. Patients with guideline-inconsistent care more frequently underwent additional invasive procedures and a delay in management. Regression analyses identified clinical stage III disease, stage IV with distant metastases and specialty ordering the diagnostic test to be associated with guideline-inconsistent care.

CONCLUSIONS: Guideline-inconsistent diagnosis and staging of patients with NSCLC, particularly those with stage III disease, is highly prevalent. This is associated with incomplete staging, a higher number of additional procedures and a delay in management. The identification of this vulnerable population may serve as a target for quality improvement interventions aimed to increase adherence to guidelines, while decreasing unnecessary procedures and time to treatment.

Area of Special Interest

Cancer

Specialty/Research Institute

Oncology

Specialty/Research Institute

Pulmonary Medicine

Specialty/Research Institute

Swedish Thoracic Surgery

DOI

10.1016/j.athoracsur.2020.04.049