EXPERT ANALYSIS FROM WCLC 2016
VIENNA (FRONTLINE MEDICAL NEWS) – A grassroots, patient-centric program aimed at encouraging U.S. community hospitals in underserved areas to adopt a comprehensive centers-of-excellence model for treatment of lung cancer has demonstrated that community cancer centers can achieve quality of care comparable to that found in academic medical centers, Raymond Osarogiagbon, MD, declared at the World Congress on Lung Cancer.
One major reason why aggregate lung cancer survival in the United States has barely inched upward during the past 3 decades is there is often a huge gap between the quality of care patients get at academic research centers – including access to clinical trials – and what they can get in community hospitals. Eighty percent of lung cancer patients receive their care in these community cancer centers, where not all physicians and surgeons may be up to speed with guideline-recommended best practices, observed Dr. Osarogiagbon, a medical oncologist and director of the multidisciplinary thoracic oncology program at Baptist Cancer Center in Memphis.
“Lung cancer is a devil of a problem right now. The disparities in outcome are worse than in most other cancers. There is a prevailing sense of nihilism about lung cancer in many community cancer centers ranging from nontreatment of some patients who have eminently treatable disease to widely disparate methods of treatment, some of which may not be appropriate. If you’re going to move the needle at the population level and help more people survive lung cancer, it seems you’re going to have to interfere at the level of the places patients choose to go to receive their care,” he explained at the meeting, which was sponsored by the International Association for the Study of Lung Cancer.
The centers of excellence program, supported by the Bonnie J. Addario Lung Cancer Foundation, is an attempt to address this disparity. In 3 years, 13 hospitals in areas with large underserved patient populations in nine states have qualified. Dr. Osarogiagbon anticipates that the competitive advantage this designation provides will spur more and more community hospitals with cancer centers to get on board.
To qualify, community cancer centers have to commit to following specific best practices as standards of care in accord with guidelines issued by groups including the National Comprehensive Cancer Network and the American Society of Clinical Oncology. Requirements include the use of multidisciplinary teams for treatment decisions, routine use of molecular diagnostics and targeted therapies, patient access to clinical trials, longitudinal institutional data tracking, patient and caregiver education programs, and minimally invasive surgical and staging techniques. A lung cancer screening program is required. So is a systematic program for management of all incidentally detected lung nodules, many of which today fall between the cracks.
In an interview, Dr. Osarogiagbon shared several examples of how achieving the foundation’s center of excellence designation enables community cancer centers to achieve top-quality care on a par with academic medical centers. At Memorial Cancer Institute in Hollywood, Fla., which serves large Hispanic and black populations, implementation of a lung cancer screening program and other measures has resulted in 40% of patients with lung cancer being diagnosed with stage 1 or 2 disease amenable to curative surgery. The overall U.S. rate is significantly lower at 29%.
And in an area composed of western Tennessee, northern Mississippi, and eastern Arkansas, Dr. Osarogiagbon and coinvestigators at the Baptist Cancer Center conducted a study demonstrating that the use of two complementary surgical staging interventions resulted in improved rates of guideline-recommended surgical staging quality.
The observational study, presented elsewhere at the world congress by Nicholas Faris, MD, of the Thoracic Oncology Research Group, Baptist Cancer Center, Memphis, entailed analysis of curative-intent resections in 2,094 patients with non–small-cell lung cancer during 2004-2016. A novel anatomically sound gross dissection protocol was provided to assist pathologists in retrieving the intrapulmonary lymph nodes required for staging in 161 patients undergoing curative resection. A special lymph node specimen collection kit was utilized in 152. Another 289 resections utilized both interventions. And 1,492 patients received neither intervention.
Use of the interventions was associated with higher rates of adherence to various professional organizations’ guidelines for high-quality surgical staging. For example, the American College of Surgeons Commission on Cancer recommends that at least 10 lymph nodes be examined in patients with stage 1a-2b NSCLC. This was achieved in 71% of patients who had both interventions, 56% of those where the lymph node specimen collection kit was utilized but not the pathology intervention, 48% of patients where the pathology intervention but not the kit was employed, and in only 25% of patients where neither was used.
Similarly, more than three mediastinal lymph node stations were sampled in accord with National Comprehensive Cancer Network guidelines in 96% of patients with both interventions, 90% with the lymph node collection kit, 54% with the pathology intervention, and only 44% with neither, Dr. Osarogiagbon said in the interview.
Dr. Osarogiagbon reported serving as a consultant to Eli Lilly, Genentech, and the Association of Community Cancer Centers.