Advancing surgical and pathologic techniques may improve overall survival rates in high-risk patients with lung cancer, according to new findings presented by Akinbobola et al at the 2024 ASCO Quality Care Symposium (Abstract 278).
Background
“Over the past 15 years, a quality improvement initiative in the heart of the Mississippi Delta has made stepped progress to change the status quo for lung cancer outcomes in this high-risk population. Their consistent efforts led the 120-day mortality rate after surgery to be cut in half and improvements in both 3- and 5-year overall survival,” emphasized Fumiko Chino, MD, a radiation oncologist at The University of Texas MD Anderson Cancer Center, Houston.
Study Methods and Results
In the new study, researchers implemented two interventions over four periods with the goal of improving the quality of surgery and the examination of lymph nodes across 14 hospitals—which covered almost 100% of lung cancer surgeries in a defined population within the Mississippi Delta region.
Among the interventions were a lymph node specimen collection kit and a novel gross dissection protocol. The collection kit was designed to remind surgeons to retrieve the hilar and specific mediastinal lymph nodes—which play a critical role in staging lung cancer and guiding postsurgical treatment—during surgery as well as standardize communication and the transport of the retrieved lymph nodes to pathology teams. The gross dissection protocol sought to help pathology teams yield and examine more intrapulmonary lymph nodes from the lung specimen.
During period 1 (2004–2008), baseline data was collected without implementing the interventions. During period 2 (2009–2013), the researchers introduced continuous quality feedback and monitoring as well as began implementing the lymph node specimen collection kit. During period 3 (2014–2018), the lymph node collection kit was implemented at any hospital in the region that had performed five or more lung cancer surgeries per year. During period 4 (2019–2023), the gross dissection protocol was implemented.
During the four study periods, there were 7,240 lung cancer surgeries performed at the participating hospitals. With each period, the number of complete resections—using a stringent definition—increased from 0% in period 1 to 9%, 21%, and 32% in periods 2, 3 and 4, respectively. The quality of the surgeries was also measured with the American College of Surgeons Operative Standard 5.8. The number of surgeries that met this standard also increased throughout each period, from 4% for period 1 to 24% in period 2, 50% in period 3, and 67% in period 4.
The number of patients who died within 120 days following surgery also decreased, from 10% in period 1 to 4% in period 4. From periods 1 to 4, the 3-year overall survival rates were 60%, 64%, 70%, and 79%, respectively; and the 5-year overall survival rates were 48%, 52%, 58%, and 70%, respectively. The researchers found that the interventions also lowered the risk of mortality for patients over time. For instance, compared with the baseline period, mortality was reduced 9% by the end of period 2 and 51% by the end of period 4. The advanced surgical quality and pathologic practices helped physicians improve care among patients with lung cancer, including streamlined care during and following surgery.
Conclusions
“These findings are important because they show that surgical outcomes of [patients with] lung cancer can be drastically improved over time. While we believe the improvements seen in this study are likely multifactorial, among the strongest reasons is linkage to improvements in the quality of care. We highlight the impact of disseminating our specific quality improvement initiatives on improving patient outcomes and set new expectations for population-level quality and outcomes of the surgical care of [patients with] lung cancer,” underscored lead study author Olawale Akinbobola, MPH, a research scientist and analyst of Thoracic Oncology Research at the Baptist Cancer Center.
The researchers plan to analyze the biological factors involved in the improved survival outcomes and how to determine which patients may benefit from additional treatment prior to and following surgery.
Disclosure: The research in this study was funded by the National Institutes of Health. For full disclosures of the study authors, visit meetings.asco.org.
