Researchers have identified certain clinical, socioeconomic and surgeon
characteristics that are associated with a decreased likelihood of patients
with nonsmall cell lung cancer undergoing lobectomy.
Although lobectomy is considered to be the standard treatment for
patients with early stage NSCLC, prior research has shown that patients are
still commonly undergoing limited resections, which may increase a
patients likelihood for local recurrence.
In this study, researchers sought to identify what patient factors and
surgeon factors might be associated with the likelihood of undergoing a
lobectomy vs. a limited resection.
They took data from a population-based and health system-based sample of
patients with newly diagnosed stage I or stage II NSCLC between 2003 and 2005.
Patients were observed for an average of 55 months. Postoperative and long-term
outcomes were also examined.
During the study period, 23% of patients underwent limited resection vs.
77% who underwent lobectomy. Data indicated that the adjusted 30-day mortality
was no different between patients who underwent lobectomy vs. limited
resection, and that postoperative complications were also similar between the
Tumor size (P=.004), coverage under Medicare or Medicaid, having
no insurance or unknown insurance (P=.02), having more severe lung
disease (P<.001) and a history of stroke (P=.05) were all
associated with a patient undergoing limited resection of the NSCLC.
When examining surgeon characteristics, researchers found that being a
thoracic surgery specialist (P=.02), non-fee-for-service compensation
(P=.008), and NCI cancer center designation (P=.006) were also
associated with higher likelihood of a patient undergoing limited resection.
Providers should seek to reduce the impact of socioeconomic
factors such as patient insurance status and surgeon compensation type on
clinical decision making, the researchers said.
For more information:
- Billmeier SE. J Natl Cancer Inst. 2011;103:1-9.