The Relative Survival Impact of Guideline-Concordant Clinical Staging and Stage-Appropriate Treatment of Potentially Curable Non-Small Cell Lung Cancer

Meadows‐Taylor, Meghan; Faris, Nicholas R.; Smeltzer, Matthew; Ray, Meredith; Fehnel, Carrie; Akinbobola, Olawale; Ariganjoye, Folabi; Patel, Anita; Pacheco, Alicia; Mehrotra, Anurag; Fox, Roy; Optican, Robert J.; Tonkin, Keith; Machin, James; Wright, Jeffrey; Robbins, Edward; Osarogiagbon, Raymond U.

doi:10.1016/j.chest.2022.01.046

Cited by 6 publications

(4 citation statements)

References 35 publications

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“…Therefore, providing both GCD and GCT to patients with stage I NSCLC may have higher benefits for them, especially with the development of lung cancer screening programs in recent years, increasing numbers of cases are being detected at an early stage, with 63.7% of patients in this study being in stage I ( 57 ). Although the results of this study show that GCT has a greater survival benefit compared to GCD in almost all stages of NSCLC, as mentioned earlier about the positive impact of molecular pathology testing on survival, proper staging and pathology testing prior to treatment is also important for the survival of NSCLC patients ( 51 ).…”

Section: Discussionmentioning

confidence: 54%

“…A study by Meadows-Taylor et al. showed that these rates for NSCLC in Tennessee from 2014 to 2019 were 61.2%, 12.7%, 17.2% and 8.9%, respectively ( 51 ). This indicates that the overall procedures in the first course of diagnosis and treatment of lung cancer in China are poorly adherent to the guidelines and require enhanced supervision and management.…”

Section: Discussionmentioning

confidence: 99%

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Three-year follow-up study reveals improved survival rate in NSCLC patients underwent guideline-concordant diagnosis and treatment

Mu,

Yang,

et al. 2024

Front. Oncol.

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BackgroundNo studies in China have assessed the guideline-concordance level of the first-course of non-small cell lung cancer (NSCLC) diagnosis and treatment and its relationship with survival. This study comprehensively assesses the current status of guideline-concordant diagnosis (GCD) and guideline-concordant treatment (GCT) of NSCLC in China and explores its impact on survival.MethodsFirst course diagnosis and treatment data for NSCLC patients in Liaoning, China in 2017 and 2018 (n=1828) were used and classified by whether they underwent GCD and GCT according to Chinese Society of Clinical Oncology (CSCO) guidelines. Pearson’s chi-squared test was used to determine unadjusted associations between categorical variables of interest. Logistic models were constructed to identify variables associated with GCD and GCT. Kaplan–Meier analysis and log-rank tests were used to estimate and compare 3-year survival rates. Multivariate Cox proportional risk models were constructed to assess the risk of cancer mortality associated with guideline-concordant diagnosis and treatment.ResultsOf the 1828 patients we studied, 48.1% underwent GCD, and 70.1% underwent GCT. The proportions of patients who underwent both GCD and GCT, GCD alone, GCT alone and neither GCD nor GCT were 36.7%, 11.4%, 33.5% and 18.4%, respectively. Patients in advanced stage and non-oncology hospitals were significantly less likely to undergo GCD and GCT. Compared with those who underwent neither GCD nor GCT, patients who underwent both GCD and GCT, GCD alone and GCT alone had 35.2%, 26.7% and 35.7% higher 3-year survival rates; the adjusted lung cancer mortality risk significantly decreased by 29% (adjusted hazard ratio[aHR], 0.71; 95% CI, 0.53–0.95), 29% (aHR, 0.71; 95% CI, 0.50–1.00) and 32% (aHR, 0.68; 95% CI, 0.51–0.90).ConclusionThe 3-year risk of death is expected to be reduced by 29% if patients with NSCLC undergo both GCD and GCT. There is a need to establish an oncology diagnosis and treatment data management platform in China to monitor, evaluate, and promote the use of clinical practice guidelines in healthcare settings.

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Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Three-year follow-up study reveals improved survival rate in NSCLC patients underwent guideline-concordant diagnosis and treatment

Mu,

Yang,

et al. 2024

Front. Oncol.

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“…Kammer and colleagues also recently reported a 63% rate of invasive procedures in those with benign nodules [ 20 ]. However, there are recent reports indicating improvement in guideline-concordant care [ 21 ]. Nonetheless, invasive procedures and thoracic surgery are not without complications and these data support the need for additional tools to better manage patients with undiagnosed PN’s.…”

Section: Discussionmentioning

confidence: 99%

Assessing a biomarker’s ability to reduce invasive procedures in patients with benign lung nodules: Results from the ORACLE study

Pritchett

Sigal²,

Bowling

et al. 2023

PLoS ONE

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A blood-based integrated classifier (IC) has been clinically validated to improve accuracy in assessing probability of cancer risk (pCA) for pulmonary nodules (PN). This study evaluated the clinical utility of this biomarker for its ability to reduce invasive procedures in patients with pre-test pCA ≤ 50%. This was a propensity score matching (PSM) cohort study comparing patients in the ORACLE prospective, multicenter, observational registry to control patients treated with usual care. This study enrolled patients meeting the intended use criteria for IC testing: pCA ≤ 50%, age ≥40 years, nodule diameter 8–30 mm, and no history of lung cancer and/or active cancer (except for non-melanomatous skin cancer) within 5 years. The primary aim of this study was to evaluate invasive procedure use on benign PNs of registry patients as compared to control patients. A total of 280 IC tested, and 278 control patients met eligibility and analysis criteria and 197 were in each group after PSM (IC and control groups). Patients in the IC group were 74% less likely to undergo an invasive procedure as compared to the control group (absolute difference 14%, p <0.001) indicating that for every 7 patients tested, one unnecessary invasive procedure was avoided. Invasive procedure reduction corresponded to a reduction in risk classification, with 71 patients (36%) in the IC group classified as low risk (pCA < 5%). The proportion of IC group patients with malignant PNs sent to surveillance were not statistically different than the control group, 7.5% vs 3.5% for the IC vs. control groups, respectively (absolute difference 3.91%, p 0.075). The IC for patients with a newly discovered PN has demonstrated valuable clinical utility in a real-world setting. Use of this biomarker can change physicians’ practice and reduce invasive procedures in patients with benign pulmonary nodules. Trial registration: Clinical trial registration: ClinicalTrials.gov NCT03766958.

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“…Patients with more advanced disease stages were more likely to receive guideline-discordant treatment Wilshire et al, 2020). It has also been shown that patients who receive guideline-concordant staging were more likely to receive GCT (Meadows-Taylor et al, 2022). However, some studies have shown either a poor adherence rate or underperformance in guideline-concordant staging (…”

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confidence: 99%

Evaluation of guideline-concordant treatment and clinical outcomes in non-small cell lung cancer: A study at a National-Referral Hospital in Indonesia

Ariyanto,

Wirawan,

Pangarsa

et al. 2024

Multidiscip. Sci. J.

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Non-adherence to guidelines has been demonstrated to affect clinical outcomes. With more than half of the global incidence of lung cancer occurring in Asia, this study aims to evaluate the guideline-concordant treatment (GCT) among Asian patients based on the 2018 NCCN-Asia consensus statements on NSCLC. Patients diagnosed with NSCLC between December 2018 and 2019 were identified from electronic medical records. Patients with complete data were divided into GCT-positive and negative groups. Statistical analyses were performed to analyze survival distributions and the associations between covariates and GCT status. Out of 50 patients, 90% were in stage IV. No patients underwent PET scans nor stereotactic radiotherapy due to the absence of facilities. Overall, 44% of patients were GCT-positive. Most GCT-negative patients did not receive chemotherapy due to poor performance scores. There was a significant difference in the survival distribution between groups (72.7% vs 39.3%, p=0.006). Age and sex were not significantly associated with GCT status (p>0.05). After accounting for other covariates including histology, GCT-negative was still associated with an increased hazard of all-cause mortality (HR 3.07 [1.15-8.12]; p=0.025). Despite limitations, concordance with Asian-specific guidelines independently and significantly improved OS among patients at a national-referral hospital in Indonesia.

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The Relative Survival Impact of Guideline-Concordant Clinical Staging and Stage-Appropriate Treatment of Potentially Curable Non-Small Cell Lung Cancer

Cited by 6 publications

References 35 publications

Three-year follow-up study reveals improved survival rate in NSCLC patients underwent guideline-concordant diagnosis and treatment

Three-year follow-up study reveals improved survival rate in NSCLC patients underwent guideline-concordant diagnosis and treatment

Assessing a biomarker’s ability to reduce invasive procedures in patients with benign lung nodules: Results from the ORACLE study

Evaluation of guideline-concordant treatment and clinical outcomes in non-small cell lung cancer: A study at a National-Referral Hospital in Indonesia

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