Analysis of Outcomes for Early Stage Lung Cancer Surgery Could Yield Better Treatment Tactics

August 2014

The Agency for Healthcare Research and Quality (AHRQ) has notified Emory cardiothoracic surgeon-scientist Dr. Felix Fernandez that it will fund his RO1 application "National Longitudinal Outcomes Following Surgical Therapy for Lung Cancer." Dr. Fernandez is the PI of the grant on behalf of the Society of Thoracic Surgeons (STS). The study aims to identify which patients are at risk for reduced long-term survival following lung cancer surgery and determine the most advantageous surgical strategies for these patients.

"It is well known that lung cancer is the leading cause of cancer mortality in the U.S.," says Dr. Fernandez. "However, the opportunity to lessen that trend is becoming more obtainable because detection of early stage lung cancer is becoming more common. This was demonstrated by recent efforts like the National Lung Screening Trial, which showed that screening heavy smokers with CT scans could reduce lung cancer mortality by 20%. Early detection will allow us to cure more lung cancers with surgery, though we need to understand which procedures will yield the best possibility of non-morbid cures for unique patient types and groups."

The source data for Dr. Fernandez's investigation will be provided by the linkage of the STS General Thoracic Surgery Database (GTSD) with administrative data collected by the Centers for Medicare and Medicaid Services (CMS). The STS-GTSD captures unique patient-level demographic, medical history, treatment, and complication details that are unavailable in other cancer databases, making it perfectly suited for large comparative effectiveness studies of lung cancer surgical strategies, though it is unable to give longitudinal survival data beyond 30 days. This limitation will be resolved by the CMS connection.

"By leveraging two complimentary national datasets to produce a unique cross-linked data infrastructure of individual patient clinical characteristics and longitudinal outcomes that cannot otherwise be replicated, we will identify predictors of long-term outcomes following lung cancer resection, including the optimal strategies with respect to surgical approach and extent of resection," says Dr. Fernandez.

Dr. Fernandez hypothesizes that long-term survival following lung cancer surgery will vary according to individual patient clinical and treatment variables, that such minimally invasive approaches as video assisted thoracic surgery (VATS) and sublobar resections are not inferior in terms of long-term survival compared to more invasive approaches like thoracotomy and lobectomy, and that VATS and sublobar resections are associated with more favorable economic outcomes than the standard methods. These hypotheses will be tested by creating a risk prediction model for long-term survival following lung cancer resection and comparing survival, resource use, and cost according to surgical approach and extent of pulmonary resection.

By establishing those patients at risk for poor long-term survival following lung cancer surgery as well as the most favorable surgical strategies for treating those patients and associated costs, the study results could allow physicians and patients to focus on individual patient characteristics and make better informed treatment decisions, drive quality improvement and value in lung cancer care both nationally and internationally, and guide the development of future prospective trials.

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