Nicholas Faris1, Xinhua Yu2, Srishti Sareen1, Raymond S Signore3, Laura M McHugh3, Kristina Roark3, Edward T Robbins3, Raymond U Osarogiagbon4. 1. Thoracic Oncology Research Group, Baptist Cancer Center, Memphis, Tennessee. 2. School of Public Health, University of Memphis, Memphis, Tennessee. 3. Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee. 4. Thoracic Oncology Research Group, Baptist Cancer Center, Memphis, Tennessee; School of Public Health, University of Memphis, Memphis, Tennessee; Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee. Electronic address: rosarogi@bmhcc.org.
Abstract
BACKGROUND: We examined the presurgical evaluation of suspected lung cancer patients in a community-based health care system to establish current benchmarks of care that will lay the groundwork for an evidence-based quality improvement project. METHODS: We retrospectively reviewed clinical records of all recipients of lung resection at two institutions, and classified all lung cancer relevant procedures into five "nodal points": lesion detection, diagnostic biopsy, radiologic staging, invasive staging, and treatment. We analyzed the frequency of passage through each nodal point, the time intervals between nodal points, and the use of staging modalities. RESULTS: Of 614 eligible patients, 92% had lung cancer, 5% had a non-lung primary tumor, 3% had a benign lesion. Six percent received preoperative therapy; 39% of resections were minimally invasive. Ninety-eight percent of patients had a preoperative computed tomography (CT) scan, 27% had no preoperative diagnostic procedure, 22% had no preoperative positron emission tomography (PET)/CT scans, and 88% had no invasive preoperative staging test. Only 10% had trimodality staging with CT, PET/CT, and invasive staging. Twenty-one percent of patients who had an invasive staging test had mediastinal nodal metastasis at resection. The median duration (interquartile range) from initial lesion identification to resection was 84 days (43 to 189) days; from lesion identification to diagnostic biopsy, 28 days (7 to 96); and from diagnostic biopsy to surgery, 40 days (26 to 69). CONCLUSIONS: There is opportunity for improvement in the thoroughness, accuracy, and timeliness of preoperative evaluation of suspected lung cancer patients in this community cohort. Better coordination of care may significantly improve these benchmarks.
BACKGROUND: We examined the presurgical evaluation of suspected lung cancerpatients in a community-based health care system to establish current benchmarks of care that will lay the groundwork for an evidence-based quality improvement project. METHODS: We retrospectively reviewed clinical records of all recipients of lung resection at two institutions, and classified all lung cancer relevant procedures into five "nodal points": lesion detection, diagnostic biopsy, radiologic staging, invasive staging, and treatment. We analyzed the frequency of passage through each nodal point, the time intervals between nodal points, and the use of staging modalities. RESULTS: Of 614 eligible patients, 92% had lung cancer, 5% had a non-lung primary tumor, 3% had a benign lesion. Six percent received preoperative therapy; 39% of resections were minimally invasive. Ninety-eight percent of patients had a preoperative computed tomography (CT) scan, 27% had no preoperative diagnostic procedure, 22% had no preoperative positron emission tomography (PET)/CT scans, and 88% had no invasive preoperative staging test. Only 10% had trimodality staging with CT, PET/CT, and invasive staging. Twenty-one percent of patients who had an invasive staging test had mediastinal nodal metastasis at resection. The median duration (interquartile range) from initial lesion identification to resection was 84 days (43 to 189) days; from lesion identification to diagnostic biopsy, 28 days (7 to 96); and from diagnostic biopsy to surgery, 40 days (26 to 69). CONCLUSIONS: There is opportunity for improvement in the thoroughness, accuracy, and timeliness of preoperative evaluation of suspected lung cancerpatients in this community cohort. Better coordination of care may significantly improve these benchmarks.
Authors: Lucas W Thornblade; Douglas E Wood; Michael S Mulligan; Alexander S Farivar; Michal Hubka; Kimberly E Costas; Bahirathan Krishnadasan; Farhood Farjah Journal: J Thorac Cardiovasc Surg Date: 2018-02-09 Impact factor: 5.209
Authors: Turkey Refaee; Guangyao Wu; Abdallah Ibrahim; Iva Halilaj; Ralph T H Leijenaar; William Rogers; Hester A Gietema; Lizza E L Hendriks; Philippe Lambin; Henry C Woodruff Journal: Respiration Date: 2020-01-28 Impact factor: 3.580
Authors: Nicholas R Faris; Matthew P Smeltzer; Fujin Lu; Carrie L Fehnel; Nibedita Chakraborty; Cheryl L Houston-Harris; E Todd Robbins; Raymond S Signore; Laura M McHugh; Bradley A Wolf; Lynn Wiggins; Paul Levy; Vishal Sachdev; Raymond U Osarogiagbon Journal: Semin Thorac Cardiovasc Surg Date: 2016-10-14
Authors: Brandon T Mullins; Dominic T Moore; M Patricia Rivera; Lawrence B Marks; Jason Akulian; Kevin A Pearlstein; Kyle Wang; Allen C Burks; Ashley A Weiner Journal: J Thorac Dis Date: 2021-02 Impact factor: 2.895