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Temporal trends in the management of potentially resectable lung cancer.

Publication ,  Journal Article
Farjah, F; Wood, DE; Yanez, D; Symons, RG; Krishnadasan, B; Flum, DR
Published in: Ann Thorac Surg
June 2008

BACKGROUND: Standardized, evidence-based guidelines recommend lung resection for patients with stage I or II nonsmall-cell lung cancer (NSCLC), and select patients with stage IIIA disease. We hypothesized that the proportion of patients operated on would increase over time coincident with increasing adherence to practice guidelines and improved patient/provider education over time. METHODS: This investigation was a cohort study of tumor-registry data linked to Medicare claims. RESULTS: Between 1992 and 2002, 24,030 patients--mean age 75 +/- 6 years, 55% men--were diagnosed with NSCLC. In each stage, the proportion of patients undergoing resection was lower in 2002 compared with 1992: stage I (68% versus 80%, p < 0.001), II (59% versus 74%, p < 0.001), and IIIA (23% versus 35%, p < 0.001). The mean age and comorbidity index of the cohort was higher in 2002 compared with 1992 (76 versus 74 years, p < 0.001; and 0.47 and 0.82, p < 0.001, respectively). The unadjusted odds of resection decreased by 6% per year (odds ratio 0.94, 99% confidence interval: 0.93 to 0.95), and adjustment for age, comorbidity index, race, and stage resulted in a slightly smaller (4% per year) but significantly decreasing trend in operative management over time (odds ratio 0.96, 99% confidence interval: 0.95 to 0.97). CONCLUSIONS: Unexpectedly, the use of resection for lung cancer has decreased dramatically over time, and this decline is not fully accounted for by an older cohort with more comorbid conditions. Future investigations should determine whether increasing unmeasured contraindications to resection, barriers to accessing specialty care, an inadequate supply of thoracic surgeons, or bias against operative therapy are responsible.

Duke Scholars

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

June 2008

Volume

85

Issue

6

Start / End Page

1850 / 1855

Location

Netherlands

Related Subject Headings

  • Utilization Review
  • United States
  • Respiratory System
  • Reoperation
  • Registries
  • Radiotherapy, Adjuvant
  • Quality Assurance, Health Care
  • Practice Guidelines as Topic
  • Pneumonectomy
  • Odds Ratio
 

Citation

APA
Chicago
ICMJE
MLA
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Farjah, F., Wood, D. E., Yanez, D., Symons, R. G., Krishnadasan, B., & Flum, D. R. (2008). Temporal trends in the management of potentially resectable lung cancer. Ann Thorac Surg, 85(6), 1850–1855. https://doi.org/10.1016/j.athoracsur.2007.12.081
Farjah, Farhood, Douglas E. Wood, David Yanez, Rebecca G. Symons, Bahirathan Krishnadasan, and David R. Flum. “Temporal trends in the management of potentially resectable lung cancer.Ann Thorac Surg 85, no. 6 (June 2008): 1850–55. https://doi.org/10.1016/j.athoracsur.2007.12.081.
Farjah F, Wood DE, Yanez D, Symons RG, Krishnadasan B, Flum DR. Temporal trends in the management of potentially resectable lung cancer. Ann Thorac Surg. 2008 Jun;85(6):1850–5.
Farjah, Farhood, et al. “Temporal trends in the management of potentially resectable lung cancer.Ann Thorac Surg, vol. 85, no. 6, June 2008, pp. 1850–55. Pubmed, doi:10.1016/j.athoracsur.2007.12.081.
Farjah F, Wood DE, Yanez D, Symons RG, Krishnadasan B, Flum DR. Temporal trends in the management of potentially resectable lung cancer. Ann Thorac Surg. 2008 Jun;85(6):1850–1855.
Journal cover image

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

June 2008

Volume

85

Issue

6

Start / End Page

1850 / 1855

Location

Netherlands

Related Subject Headings

  • Utilization Review
  • United States
  • Respiratory System
  • Reoperation
  • Registries
  • Radiotherapy, Adjuvant
  • Quality Assurance, Health Care
  • Practice Guidelines as Topic
  • Pneumonectomy
  • Odds Ratio