Effect of adherence to treatment guidelines on overall survival in elderly non-small-cell lung cancer patients

Lindqvist, Jonatan; Jekunen, Antti; Sihvo, Eero; Johansson, Mikael; Andersén, Heidi

doi:10.1016/j.lungcan.2022.07.006

Cited by 15 publications

(8 citation statements)

References 34 publications

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“…The clinical significance of guideline adherence is demonstrated in several studies. Lindqvist et al 36 observed increased overall survival when lung cancer treatment was given according to guidelines. In breast cancer, non-adherence was associated with an increased risk of death 37.…”

Section: Discussionmentioning

confidence: 99%

Role of patient characteristics in adherence to first-line treatment guidelines in breast, lung and prostate cancer: insights from the Nordic healthcare system

Sandström,

Leppälä,

Jekunen

et al. 2024

BMJ Open

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ObjectivesThis study investigates the influence of socioeconomic status, health literacy, and numeracy on treatment decisions and the occurrence of adverse events in patients with breast, lung, and prostate cancer within a Nordic healthcare setting.DesignA follow-up to a cross-sectional, mixed-methods, single-centre study.SettingA Nordic, tertiary cancer clinic.ParticipantsA total of 244 participants with breast, lung and prostate cancer were initially identified, of which 138 first-line treatment participants were eligible for this study. First-line treatment participants (n=138) surpassed the expected cases (n=108).InterventionsNot applicable as this was an observational study.Primary and secondary outcome measuresThe study’s primary endpoint was the rate of guideline adherence. The secondary endpoint involved assessing treatment toxicity in the form of adverse events.ResultsGuideline-adherent treatment was observed in 114 (82.6%) cases. First-line treatment selection appeared uninfluenced by participants’ education, occupation, income or self-reported health literacy. A minority (3.6%) experienced difficulties following treatment instructions, primarily with oral cancer medications.ConclusionsThe findings indicated lesser cancer health disparities regarding guideline adherence and treatment toxicity within the Nordic healthcare framework. A causal connection may not be established; however, the findings contribute to discourse on equitable cancer health provision.

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Section: Discussionmentioning

confidence: 99%

Role of patient characteristics in adherence to first-line treatment guidelines in breast, lung and prostate cancer: insights from the Nordic healthcare system

Sandström,

Leppälä,

Jekunen

et al. 2024

BMJ Open

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“…Surgical management of the elderly presenting with early-stage NSCLC has been questioned, especially as both age at diagnosis and treatment choices have radically increased through the last decades ( 8 ). The absence of univocal guidance in older patients lead to a 10% rate of undertreated elderly patients that would have benefited from an active treatment ( 9 ). In early-stage lung cancer, curative intended surgery was limited to nearly half of the patients aged 65–75 years, and the percentage further decreased in older patients ( 24 ).…”

Section: Discussionmentioning

confidence: 99%

“…In these patients, the new diagnosis of lung cancer is added to a significant burden of smoking-related comorbidities and chronic diseases, which impair functional reserve and may lay the ground for postoperative complications ( 7 ). To minimize the perioperative risk of complications, radical treatment is often sacrificed to reduce surgical trauma regardless of the risk of undertreatment and of a poor oncological outcome ( 8 , 9 ).…”

Section: Introductionmentioning

confidence: 99%

“…Nonetheless, robotic surgery is demonstrated to improve oncological outcomes with a complication and conversion rate comparable to video-assisted surgery ( 13 ). However, the perioperative results of robotic-assisted lobectomy for early-stage lung cancer in patients older than 75 years have not been clearly assessed, and the best treatment strategy for NSCLC affecting the elderly is often omitted from guidelines and clinical trials leading to management ambiguities ( 9 ).…”

Section: Introductionmentioning

confidence: 99%

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Perioperative outcomes of robotic lobectomy for early-stage non-small cell lung cancer in elderly patients

et al. 2022

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IntroductionMinimally invasive surgery has become the standard for the early-stage non-small cell lung cancer (NSCLC). The appropriateness of the kind of lung resection for the elderly patients is still debated.MethodsWe retrospectively reviewed patients with older than 75 years who underwent robotic lobectomy between May 2016 to June 2022. We selected 103 patients who met the inclusion criteria of the study. The preoperative cardiorespiratory functional evaluations were collected, and the risk of postoperative complications was calculated according to the Charlson Comorbidity Index, the American College of Surgery surgical risk calculator (ACS-NSQIP), EVAD score, and American Society of Anesthesiology (ASA) score. The patients were divided in two groups according to the presence of postoperative complications.ResultsForty-three patients were female, and 72.8% of the total population were former or active smokers. Thirty-five patients reported postoperative complications. The analysis of the two groups showed that the predicted postoperative forced expiratory volumes in the first second (FEV1) and forced vital capacity (FVC) were significantly lower in patients presenting postoperative complications (p=0.04). Moreover, the upstaging rate and the unexpected nodal metastases were higher in the postoperative complication groups.ConclusionRobotic-assisted lobectomy for early-stage lung cancer is a safe and feasible approach in selected elderly patients. The factors that could predict the complication rate was the predicted postoperative FEV1 and the nodal disease.

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“…To improve the outcome of lung cancer care, German [2] and European evidence-based guidelines, among others, have been published [3][4][5][6]. Treatment in accordance with lung cancer guidelines is associated with increased overall survival [7][8][9][10]. However, it has been shown that there is potential for improvement in numerous aspects of guideline adherence, e. g., mediastinal staging, adjuvant treatment, lymph-node assessment and pretherapeutic PET-CT staging [8,[11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Development and Update of Guideline-based Quality Indicators in Lung Cancer

Utzig,

Hoffmann,

Reinmuth

et al. 2023

Pneumologie

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Background In 2022, an update of the German lung cancer guideline, first published in 2010 and revised in 2018, was released. This article aims to show the process of updating, developing, and implementing guideline-based quality indicators (QI) into the certification system for lung cancer centers (LCC). Methods A multidisciplinary and interprofessional working group revised the guideline QIs from 2018 using the strong recommendations of the guideline update, a systematic review for QIs, and the results of the implemented QIs from LCC. Results For 4 out of 8 indicators from the 2018 guideline, the LCC showed an improved implementation of the requirements in the last 3 years (2018–2020). For 3 indicators, the median of the results was constant at a very high level (≥96% or 100%). Only the “adjuvant cisplatin-based chemotherapy” indicator showed declining values between 2018 and 2020. The target values and plausibility limits were well achieved by LCC. After updating the guideline, one QI from 2018 was not included in the new QI set due to the small denominator population. Based on the new strong recommendations, 8 new QIs were defined. From the QI set of the guideline update, 13 of 15 indicators (7 since 2018 and 6 from 2022 on) were adopted into the certification program. Conclusions The guideline recommendations are implemented by LCC at a high level. The process presented confirms the successful implementation of the so-called quality cycle in oncology. The QIs developed by the German Guideline Program in Oncology (GGPO) are adopted by the certification program. The implementation of the QI is measured in LCC, evaluated by the German Cancer Society (DKG), and reflected back to the GGPO. The “real world” data have led to the deletion of one QI and show a high implementation of most QIs in LCC.

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Effect of adherence to treatment guidelines on overall survival in elderly non-small-cell lung cancer patients

Cited by 15 publications

References 34 publications

Role of patient characteristics in adherence to first-line treatment guidelines in breast, lung and prostate cancer: insights from the Nordic healthcare system

Role of patient characteristics in adherence to first-line treatment guidelines in breast, lung and prostate cancer: insights from the Nordic healthcare system

Perioperative outcomes of robotic lobectomy for early-stage non-small cell lung cancer in elderly patients

Development and Update of Guideline-based Quality Indicators in Lung Cancer

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