Database Linkage Finds Greater Survival Rates After Lung Cancer Surgery for Older Adults
In a study posted online by The Annals of Thoracic Surgery on May 5 and published in its June 2016 edition, the longitudinal linkage of lung cancer operations data from the Society of Thoracic Surgeons (STS) General Thoracic Surgery Database (GTSD) with data for patients 65 years of age or older from the Centers for Medicare and Medicaid Services (CMS) discovered that these patients are living longer after lung cancer surgery.
"With elderly people representing an increasing proportion of patients diagnosed with lung cancer, this improved survival is especially significant," says study leader Felix Fernandez, MD, associate professor of surgery of the Emory Division of Cardiothoracic Surgery. "Data linkage studies such as these tell us more about long-term survival after our interventions, which is important to patients. This information can be included in the shared decision-making process when discussing treatment options with lung cancer patients, whom we expect to be seeing more of as the population continues to grow older and more people survive into old age."
As a solution to the inability of the STS GTSD to capture long-term survival after lung cancer surgery beyond 30 days, Dr. Fernandez and his colleagues merged 37,009 GTSD records for patients 65 years of age and older who underwent lung cancer surgery between 2002 and 2012 with claims data from CMS for the same period. The records of 26,055 patients were successfully linked, providing access to vital information related to long-term patient outcomes, including hospital readmission rates, reinterventions (a second procedure), and long-term survival.
According to the National Cancer Institute, the five-year survival of all patients diagnosed with lung cancer in the United States is approximately 17%. Fewer than half of all patients who undergo surgery for lung cancer survive as long as 5 years.
In examining the STS-CMS linked data, the researchers found that the median survival following lung cancer surgery for pathologic Stage I was 6.7 years, almost two years longer than the benchmark five-year survival rate. In addition, the study showed that the five-year survival rate for selected older patients with advanced lung cancer who were treated with surgical therapy was 29.9% for Stage III and 26.7% for Stage IV.
"The ability to connect discrete data pools like this is yet another highly useful tool we can use to improve lung cancer treatment," says Dr. Fernandez. "The scope and substance of studies in such areas as comparative effectiveness among different surgical approaches for lung cancer could only benefit."
The STS National Database, established in 1989, represents the largest cardiothoracic surgery outcomes and quality improvement program in the world. The database has three components: the Adult Cardiac Surgery Database, the Congenital Heart Surgery Database, and the GTSD. The GTSD contains data on nearly 460,000 procedures, including lobectomy and esophagectomy, and has more than 900 surgeon participants.
"Longitudinal Follow-up of Lung Cancer Resection From the Society of Thoracic Surgeons General Thoracic Surgery Database in Patients 65 Years and Older." Felix G. Fernandez, Anthony P. Furnary, Andrzej S. Kosinski, Mark W. Onaitis, Sunghee Kim, Daniel Boffa, Patricia Cowper, Jeffrey P. Jacobs, Cameron D. Wright, Joe B. Putnam. The Annals of Thoracic Surgery, 2016.