Adherence to Postoperative Survivorship Quality Metrics in Early-Stage Non-Small Cell Lung Cancer.

Abstract

Previous studies assessing quality of care among patients undergoing surgery for non-small cell lung cancer (NSCLC) have largely focused on preoperative and perioperative process-based quality measures. This study sought to address this knowledge gap by studying the association between postoperative (ie, survivorship) quality metrics (QMs) and cancer-specific outcomes. Using a unique Veterans Health Administration data set, study investigators performed a retrospective cohort study including patients with early-stage NSCLC treated surgically. On the basis of contemporary guidelines, 3 QMs were defined: appropriate surveillance imaging, comprehensive smoking cessation management, and appropriate referral to oncology (only for tumors >3 cm). The study assessed the relationship between QM adherence and overall survival (OS) and the cumulative incidence of cancer recurrence (CIR). Between 2006 and 2016, 8137 patients were included in the study. Among patients with tumors ≤3 cm, better adherence to QMs was associated with improved OS (5-year survival; 0 QM, 50.5%; 1 QM, 61.9%; 2 QMs, 66.9%; P < .001) and decreased CIR (5-year cumulative incidence; 0 QM, 49.2%; 1 QM, 21.8%; 2 QMs, 12.2%; P < .001). Among patients with tumors >3 cm (n = 1702,), better adherence to QMs was associated with improved OS (5-year survival; 0 QM, 44.9%; 1 QM, 49.2%; 2 QMs, 55.9%; 3 QMs, 63.8%; P < .001) and decreased CIR (5-year cumulative incidence; 0 QM, 61.3%; 1 QM, 40.7%; 2 QMs, 27.0%; 3 QMs, 13.7; P < .001). Adherence to survivorship QMs is associated with dramatically improved cancer-specific outcomes among patients with early-stage NSCLC after surgical treatment. Efforts to standardize survivorship care pathways may significantly improve long-term outcomes among patients undergoing curative-intent resection.