Faculty Collaboration Database

Penetration of recommended procedures for lung cancer staging and management in the United States over 10 years: a quality research in radiation oncology survey. Int J Radiat Oncol Biol Phys 2013 Mar 15;85(4):1082-9

Date

01/01/2013

Pubmed ID

23273996

Pubmed Central ID

PMC3897271

DOI

10.1016/j.ijrobp.2012.10.016

Scopus ID

2-s2.0-84875229755 (requires institutional sign-in at Scopus site)   46 Citations

Abstract

PURPOSE: To document the penetration of clinical trial results, practice guidelines, and appropriateness criteria into national practice, we compared the use of components of staging and treatment for lung cancer among patients treated in 2006-2007 with those used in patients treated in 1998-1999.

METHODS AND MATERIALS: Patient, staging work-up, and treatment characteristics were extracted from the process survey database of the Quality Research in Radiation Oncology (QRRO), consisting of records of 340 patients with locally advanced non-small cell lung cancer (LA-NSCLC) at 44 institutions and of 144 patients with limited-stage small cell lung cancer (LS-SCLC) at 39 institutions. Data were compared for patients treated in 2006-2007 versus those for patients treated in 1998-1999.

RESULTS: Use of all recommended procedures for staging and treatment was more common in 2006-2007. Specifically, disease was staged with brain imaging (magnetic resonance imaging or computed tomography) and whole-body imaging (positron emission tomography or bone scanning) in 66% of patients with LA-NSCLC in 2006-2007 (vs 42% in 1998-1999, P=.0001) and in 84% of patients with LS-SCLC in 2006-2007 (vs 58.3% in 1998-1999, P=.0011). Concurrent chemoradiation was used for 77% of LA-NSCLC patients (vs 45% in 1998-1999, P<.0001) and for 90% of LS-SCLC patients (vs 62.5% in 1998-1999, P<.0001). Use of the recommended radiation dose (59-74 Gy for NSCLC and 60-70 Gy as once-daily therapy for SCLC) did not change appreciably, being 88% for NSCLC in both periods and 51% (2006-2007) versus 43% (1998-1999) for SCLC. Twice-daily radiation for SCLC was used for 21% of patients in 2006-2007 versus 8% in 1998-1999. Finally, 49% of patients with LS-SCLC received prophylactic cranial irradiation (PCI) in 2006-2007 (vs 21% in 1998-1999).

CONCLUSIONS: Although adherence to all quality indicators improved over time, brain imaging and recommended radiation doses for stage III NSCLC were used in <90% of cases. Use of full thoracic doses and PCI for LS-SCLC also requires improvement.

Author List

Komaki R, Khalid N, Langer CJ, Kong FM, Owen JB, Crozier CL, Wilson JF, Wei X, Movsas B

Author

J Frank Wilson MD Professor Emeritus in the Radiation Oncology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Brain Neoplasms
Carcinoma, Non-Small-Cell Lung
Chemoradiotherapy
Cranial Irradiation
Diffusion of Innovation
Female
Guideline Adherence
Health Care Surveys
Humans
Lung
Lung Neoplasms
Magnetic Resonance Imaging
Male
Middle Aged
Neoplasm Staging
Positron-Emission Tomography
Practice Patterns, Physicians'
Radiation Oncology
Small Cell Lung Carcinoma
Time Factors
United States