Thoracic Surgeon and Patient Focus Groups on Decision-Making in Early-Stage Lung Cancer Surgery

Abstract

As early-stage lung cancer mortality rates are improving, surgeons and patients can prioritize surgical approaches and postsurgical care that enhance quality of life.

Initiative for Early Lung Cancer Research on Treatment: Development of Study Design and Pilot Implementation

“…53 RCTs typically enroll a highly selected subgroup of eligible patients, as many patients and/or physicians decide not to participate, particularly when deciding on curative treatment for a deadly disease. [43][44][45] Most of the 126 T1a and T1b patients in our feasibility study of the past year would have been eligible at our institution for the RCT comparing lobectomy to sublobar resection, whereas with multiple participating institutions it took 6 years to recruit 247 patients for the completed RCT and 12 years to recruit 692 for the currently ongoing RCT. 3,10 These recruitment concerns, as well as the length of time and cost to complete an RCT, limit the external validity of its results as pointed out by Visvanathan et al 26 Concerns about biases of cohort design, including selection bias, are addressed in IELCART by analyses that take into consideration known and unknown confounders.…”

“…The benefits of this design are amply shown by I-ELCAP, as with its updated protocol, it has to provide clinically relevant diagnostic and treatment information that has been incorporated in a continually updated CT screening program. [12][13][14][15][16][17][18][19][20]30,[37][38][39][40][41][42][43][44][45]54 The IELCART prospective cohort design provides a powerful paradigm for continued accrual of evidence on early lung cancer treatment. Once protocol procedures are integrated within a hospital's routine procedures, data can be collected on a broad spectrum of patients and thus allow continued evaluation of treatment alternatives.…”

“…IELCART examines the patient-physician decision process which has been shown in our focus sessions to play an important role in postoperative care. [43][44][45] Our focus groups found that stigma, anxiety, and depression are associated with poor QoL. Lung cancer patients found themselves alienated from family, friends, and society due to the consequences of smoking.…”

“…Focus groups held with surgeons and patients further informed our choices of questions and QoL questionnaires. [43][44][45] For surgeons, choice of appropriate surgical procedure for each patient was a primary concern, followed by how to present the treatment plan to the patient. By contrast, patients placed their high levels of trust in their surgeon and did not feel the need to be very involved in the surgical decision-making process, but focused instead on postsurgical physical and mental health concerns.…”

Review of the future of lung cancer screening

“…None of these, however, have had critical assessment, and often there is only limited data for small lung cancers. Published cohort studies using the I-ELCAP database (114,(135)(136)(137)(138) have already provided timely outcome results and Quality of Life measures which will become an increasingly important consideration in treatment determination given the high long-term cure rates of screen-diagnosed lung cancer (139)(140)(141)(142)(143).…”