FOR PROFIT HEALTHCARE
Quality of treatment for lung cancer varies widely across US
Researchers identify measures to improve treatment quality, health outcomes
Peer-Reviewed PublicationIMAGE: A NEW STUDY BY RESEARCHERS AT WASHINGTON UNIVERSITY SCHOOL OF MEDICINE IN ST. LOUIS FOUND THAT THE QUALITY OF CARE FOR LUNG CANCER IN THE U.S. VARIES WIDELY. THE FINDINGS SHOW THAT HIGH-QUALITY CARE IS ASSOCIATED WITH IMPROVED OVERALL SURVIVAL RATES AMONG PATIENTS WITH LUNG CANCER. PICTURED IS THE STUDY’S SENIOR AUTHOR, VARUN PURI, MD, A THORACIC SURGEON AND PROFESSOR OF SURGERY AT THE SCHOOL OF MEDICINE, DURING A SURGERY. view more
CREDIT: TIM PARKER/WASHINGTON UNIVERSITY
Treatment for lung cancer is rapidly evolving, with new technologies and research-proven procedures. However, a study from Washington University School of Medicine in St. Louis found the quality of care for lung cancer in the U.S. varies widely, with significantly worse outcomes among patients whose surgeries fall short of established treatment guidelines.
To help close the gap in the quality of care, the researchers examined five surgical quality metrics based on guidelines established by the National Comprehensive Cancer Network and other cancer groups, and found that adherence to these quality metrics was associated with improved overall survival rates.
The study is published Jan. 18 in JAMA Surgery.
“It is crucial to have a solid understanding of what constitutes a high-quality lung cancer surgery,” said the study’s senior author, Varun Puri, MD, a Washington University thoracic surgeon and professor of surgery who treats patients at Siteman Cancer Center, based at Barnes-Jewish Hospital and Washington University. “Improving adherence to surgical quality measures is critical to optimize long-term outcomes among patients with early-stage lung cancer seeking treatment intended to cure their cancer.”
Lung cancer is the leading cause of cancer deaths in the United States and is the second most common type of cancer, with non-small cell lung cancer accounting for 84% of all lung cancer cases, according to the American Cancer Society.
The five recommended quality metrics identified by researchers include performing surgery in a timely manner, shortly after diagnosis; determining the appropriate amount of lung tissue to be surgically removed; sampling multiple lymph nodes to confirm the cancer is staged correctly and has not spread to the lymph nodes; using minimally invasive surgery to reduce postsurgical pain and accelerate the recovery process; and ensuring that no cancer is left within the body, also known as a positive margin.
“Ideally, these quality metrics should be met as frequently as possible in any lung cancer surgery,” Puri said. “However, as our data show, adherence to these metrics can be highly variable across the U.S.”
For the study, the researchers analyzed de-identified medical records in a database maintained by the U.S. Veterans Health Administration, the nation’s largest integrated health-care delivery system. The researchers examined information involving 9,628 patients with early-stage non-small cell lung cancer who underwent surgery from Oct. 1, 2006, through Sept. 31, 2016. The researchers developed a surgical quality score reflecting the association between the five metrics and overall survival.
The average age of the VA patients was 67.8 years. The patients were predominantly male and white; however, statistical modeling controlled for different ages, genders and races.
Researchers also studied adherence to quality metrics and overall survival rates among 107,674 nonveteran patients who were listed in the National Cancer Database as patients from 2010 to 2016.
The researchers found poor adherence to several quality measures, both within VA and civilian hospitals. For example, only about one-third of patients in both cohorts received adequate lymph node sampling, and only about 40% received minimally invasive surgery.
“Many patient- and tumor-specific factors can influence the apparent quality of surgical care for lung cancer,” said the study’s first author, Brendan Heiden, MD, a surgical resident and research fellow at Washington University. “Nevertheless, it is important to try to standardize and optimize adherence to quality measures whenever possible. Early-stage lung cancer treatments are rapidly evolving with the introduction of exciting new therapies. Central to these advances, however, is the foundational principle of performing high-quality, evidence-based surgery. As our study demonstrates, adherence to surgical quality metrics can have a disproportionate impact on patients with lung cancer receiving surgical treatment aimed at curing the cancer.”
JOURNAL
JAMA Surgery
METHOD OF RESEARCH
Data/statistical analysis
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Quality of treatment for lung cancer varies widely across US
ARTICLE PUBLICATION DATE
18-Jan-2023
Delayed appendicitis diagnosis more common among non-Hispanic Black adults
Delayed diagnosis less common in poorer-quality hospitals with more non-Hispanic Black adult populations
Peer-Reviewed Publication· Delays linked to longer hospital stays, increased return to hospital within 30 days after appendectomy
· Appendicitis is the most common surgical diagnosis
· First study to show racial-ethnic disparities in delayed appendicitis diagnosis
· Racially integrating hospitals would provide better clinical care, more sustainable health care system
CHICAGO --- Non-Hispanic Black adults more frequently experience delays in receiving an appendicitis diagnosis in hospital emergency departments, putting them at a higher likelihood of perforated appendicitis and subsequent post-surgical infections, reports a new Northwestern Medicine study.
However, the delay in diagnosis was less common for patients cared for in hospitals serving greater than 50% Black-Hispanic populations compared to hospitals serving less than 25% Black-Hispanic populations.
The study also found nearly half the cohort with delayed diagnosis was ultimately diagnosed and treated with surgery for their appendicitis at a different hospital from the first one that failed to diagnose the appendicitis.
This is the first study to show racial-ethnic disparities in the delay of diagnosis of appendicitis in adults. It also is the first to find that hospitals serving more minority patient populations are less likely to delay diagnosis of appendicitis than hospitals serving fewer minority patient populations.
The retrospective observational study was based on data from 80,312 patients, aged 18 to 64, who underwent appendectomy from 2016 to 2017 in Florida, Maryland, New York and Wisconsin.
Appendicitis is the most common surgical diagnosis, affecting more than 250,000 Americans annually. Delays in diagnosis are associated with increased rates of progression to perforated (or ruptured) appendicitis, which leads to more infections after surgery, increases time in the hospital and raises the likelihood someone will return to the hospital after surgery.
The study will be published Jan. 18 in JAMA Surgery.
Care for Black patients has historically been concentrated in a relatively small proportion of U.S. hospitals. There is prior evidence that minority patients more frequently receive care at lower-quality hospitals.
“Yet, there is clearly a benefit to patients being treated in predominantly minority-serving hospitals when they are having symptoms of appendicitis,” said senior author Dr. Anne Stey, assistant professor of surgery at Northwestern University Feinberg School of Medicine and a Northwestern Medicine surgeon.
Stey suggested a reason for that benefit.
“It may be hospitals that are more used to serving racial-ethnic minority patients are better at diagnosing them, because they’re more culturally informed and have a better understanding of these patients,” Stey said.
The structure of U.S. health care system financing provides lower reimbursements to hospitals serving a higher proportion of uninsured or publicly insured patients, who are frequently minorities, the study authors said.
“The lower reimbursements to hospitals serving Medicaid patients creates an unsustainable system,” Stey said. “We have a two-tiered health system. By racially integrating hospitals, our health care system would be able to provide better clinical care to all patients, but also create a more sustainable health care system.”
In future research, the investigators plan to quantify the cost implications of delayed diagnosis of appendicitis.
Other Northwestern authors on the study are Joe Feinglass and former Northwestern post-doctoral research and clinical fellows Dr. Ana Reyes, Dr. Regina Royan and Arielle Thomas.
The research was funded by the American College of Surgeons and grant K23HL157832-01 from the National Heart, Lung, and Blood Institute of the National Institutes of Health.
JOURNAL
JAMA Surgery
METHOD OF RESEARCH
Observational study
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Patient and Hospital Characteristics Associated With Delayed Diagnosis of Appendicitis
ARTICLE PUBLICATION DATE
18-Jan-2023
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