Temporal trends in the management of potentially resectable lung cancer.

Temporal trends in the management of potentially resectable lung cancer. Research Abstract Details 

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Temporal trends in the management of potentially resectable lung cancer. Abstract Text:

BACKGROUND: Standardized, evidence-based guidelines recommend lung resection for patients with stage I or II nonsmall-cell lung cancer (NSCLC), and select patients with stage IIIA disease. We hypothesized that the proportion of patients operated on would increase over time coincident with increasing adherence to practice guidelines and improved patient/provider education over time. METHODS: This investigation was a cohort study of tumor-registry data linked to Medicare claims. RESULTS: Between 1992 and 2002, 24,030 patients--mean age 75 +/- 6 years, 55% men--were diagnosed with NSCLC. In each stage, the proportion of patients undergoing resection was lower in 2002 compared with 1992: stage I (68% versus 80%, p < 0.001), II (59% versus 74%, p < 0.001), and IIIA (23% versus 35%, p < 0.001). The mean age and comorbidity index of the cohort was higher in 2002 compared with 1992 (76 versus 74 years, p < 0.001; and 0.47 and 0.82, p < 0.001, respectively). The unadjusted odds of resection decreased by 6% per year (odds ratio 0.94, 99% confidence interval: 0.93 to 0.95), and adjustment for age, comorbidity index, race, and stage resulted in a slightly smaller (4% per year) but significantly decreasing trend in operative management over time (odds ratio 0.96, 99% confidence interval: 0.95 to 0.97). CONCLUSIONS: Unexpectedly, the use of resection for lung cancer has decreased dramatically over time, and this decline is not fully accounted for by an older cohort with more comorbid conditions. Future investigations should determine whether increasing unmeasured contraindications to resection, barriers to accessing specialty care, an inadequate supply of thoracic surgeons, or bias against operative therapy are responsible.

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Temporal trends in the management of potentially resectable lung cancer. Journal Published:

PUBLICATION TYPE: Research Support, N.I.H., Extr

Journal: The Annals of thoracic surgery

VOLUME: 85

Page Numbers: 1850-5; discussion 1856

Journal Abbreviation: Ann. Thorac. Surg.

ISSN: 1552-6259

DAY: 23

MONTH: Jun

YEAR: 2008

Temporal trends in the management of potentially resectable lung cancer. Information

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LANGUAGE: eng

NlmUniqueID: 15030100

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Grant and Affiliation Information for Temporal trends in the management of potentially resectable lung cancer.

AFFILIATION: Surgical Outcomes Research Center, University of Washington, Seattle, Washington, USA.

Country: Netherlands

AGENCY: United States NCI

GRANT: T32 CA09168-30

ACRONYM: CA

MEDLINETA: Ann Thorac Surg

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