TY - JOUR
T1 - Determinants of practice patterns and quality gaps in lung cancer staging and diagnosis
AU - Ost, David E.
AU - Niu, Jiangong
AU - Elting, Linda S.
AU - Buchholz, Thomas A.
AU - Giordano, Sharon H.
N1 - Funding Information:
Author contributions: Dr Ost was principal investigator and was responsible for study oversight. Dr Ost: contributed to data analysis and writing, editing, and review of the manuscript. Dr Niu: contributed to data analysis and writing, editing, and review of the manuscript. Dr Elting: contributed to data analysis and writing, editing, and review of the manuscript. Dr Buchholz: contributed to writing, editing, and review of the manuscript. Dr Giordano: contributed to data analysis and writing, editing, and review of the manuscript. Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article. Role of sponsors: The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the official views of the Texas Department of State Health Services, the Cancer Prevention Research Institute of Texas, or the Centers for Disease Control and Prevention. Other contributions: This study used the linked SEER-Medicare database. We thank the Applied Research Program, National Cancer Institute; the Office of Research, Development and Information, Centers for Medicare and Medicaid Services; Information Management Services (IMS), Inc; and the SEER Program tumor registries for their efforts in the creation of the SEER-Medicare database. All work was performed at The University of Texas MD Anderson Cancer Center, Houston, Texas. Additional information: The e-Appendix and e-Tables can be found in the “Supplemental Materials” area of the online article.
PY - 2014/5
Y1 - 2014/5
N2 - Background: Guidelines recommend mediastinal lymph node sampling as the fi rst invasive diagnostic procedure in patients with suspected lung cancer with mediastinal lymphadenopathy without distant metastases. Methods: Patients were a retrospective cohort of 15,316 patients with lung cancer with regional spread without metastatic disease in the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) or Texas Cancer Registry Medicare-linked databases. Patients were categorized based on the sequencing of invasive diagnostic tests performed: (1) evaluation consistent with guidelines, mediastinal sampling done fi rst; (2) evaluation inconsistent with guidelines, non-small cell lung cancer (NSCLC) present, mediastinal sampling performed but not as part of the fi rst invasive test; (3) evaluation inconsistent with guidelines, NSCLC present, mediastinal sampling never done; and (4) evaluation inconsistent with guidelines, small cell lung cancer. The primary outcome was whether guideline-consistent care was delivered. Secondary outcomes included whether patients with NSCLC ever had mediastinal sampling and use of transbronchial needle aspiration (TBNA) among pulmonologists. Results: Only 21% of patients had a diagnostic evaluation consistent with guidelines. Only 56% of patients with NSCLC had mediastinal sampling prior to treatment. There was signifi cant regional variability in guideline-consistent care (range, 12%-29%). Guideline-consistent care was associated with lower patient age, metropolitan areas, and if the physician ordering or performing the test was male, trained in the United States, had seen more patients with lung cancer, and was a pulmonologist or thoracic surgeon who had graduated more recently. More recent pulmonary graduates were also more likely to perform TBNA ( P < .001). Conclusions: Guideline-consistent care varied regionally and was associated with physician-level factors, suggesting that a lack of effective physician training may be contributing to the quality gaps observed.
AB - Background: Guidelines recommend mediastinal lymph node sampling as the fi rst invasive diagnostic procedure in patients with suspected lung cancer with mediastinal lymphadenopathy without distant metastases. Methods: Patients were a retrospective cohort of 15,316 patients with lung cancer with regional spread without metastatic disease in the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) or Texas Cancer Registry Medicare-linked databases. Patients were categorized based on the sequencing of invasive diagnostic tests performed: (1) evaluation consistent with guidelines, mediastinal sampling done fi rst; (2) evaluation inconsistent with guidelines, non-small cell lung cancer (NSCLC) present, mediastinal sampling performed but not as part of the fi rst invasive test; (3) evaluation inconsistent with guidelines, NSCLC present, mediastinal sampling never done; and (4) evaluation inconsistent with guidelines, small cell lung cancer. The primary outcome was whether guideline-consistent care was delivered. Secondary outcomes included whether patients with NSCLC ever had mediastinal sampling and use of transbronchial needle aspiration (TBNA) among pulmonologists. Results: Only 21% of patients had a diagnostic evaluation consistent with guidelines. Only 56% of patients with NSCLC had mediastinal sampling prior to treatment. There was signifi cant regional variability in guideline-consistent care (range, 12%-29%). Guideline-consistent care was associated with lower patient age, metropolitan areas, and if the physician ordering or performing the test was male, trained in the United States, had seen more patients with lung cancer, and was a pulmonologist or thoracic surgeon who had graduated more recently. More recent pulmonary graduates were also more likely to perform TBNA ( P < .001). Conclusions: Guideline-consistent care varied regionally and was associated with physician-level factors, suggesting that a lack of effective physician training may be contributing to the quality gaps observed.
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U2 - 10.1378/chest.13-1628
DO - 10.1378/chest.13-1628
M3 - Article
C2 - 24202651
AN - SCOPUS:84899828470
SN - 0012-3692
VL - 145
SP - 1097
EP - 1113
JO - Chest
JF - Chest
IS - 5
ER -