Wilshire CL, et al. Ann Thorac Surg 2020.
BACKGROUND: Recent studies have identified poor adherence to recommended guidelines in diagnosing and staging patients with non-small cell lung cancer (NSCLC), which has been associated with numerous negative downstream effects. However, these reports are comprised predominantly of large administrative databases with inherent limitations. We aimed to describe guideline-inconsistent care and identify any associated factors within our healthcare system.
METHODS: A review of patients diagnosed with primary NSCLC between 1/1/2014 and 12/31/2014 within our community hospital network was performed. Univariate and multivariable logistic regression analyses were performed to identify factors associated with guideline-inconsistent care.
RESULTS: Guideline-inconsistent care was identified in 24% (98/406) of patients: 58% (46/81) in clinical stage III and 29% (52/179) in stage IV. Of the 46 clinical stage III patients with guideline-inconsistent care, 43% (20) had no invasive mediastinal lymph node sampling prior to treatment initiation. Patients with guideline-inconsistent care more frequently underwent additional invasive procedures and a delay in management. Regression analyses identified clinical stage III disease, stage IV with distant metastases and specialty ordering the diagnostic test to be associated with guideline-inconsistent care.
CONCLUSIONS: Guideline-inconsistent diagnosis and staging of patients with NSCLC, particularly those with stage III disease, is highly prevalent. This is associated with incomplete staging, a higher number of additional procedures and a delay in management. The identification of this vulnerable population may serve as a target for quality improvement interventions aimed to increase adherence to guidelines, while decreasing unnecessary procedures and time to treatment.