Elsevier

Clinical Lung Cancer

Volume 7, Issue 4, January 2006, Pages 268-272
Clinical Lung Cancer

Original Contribution
Improving the Lung Cancer Resection Rate in the US Department of Veterans Affairs Health System

https://doi.org/10.3816/CLC.2006.n.005Get rights and content

Abstract

Background

The optimal treatment for non–small-cell lung cancer (NSCLC) is surgical resection; however, most patients are ineligible because of advanced disease. Although resection rates of 25% have been reported nationally, rates in the Veterans Affairs (VA) system appear lower, perhaps because of limited access to specialized care. We hypothesized that, since the introduction of a specialized Lung Mass Clinic in 1999, the resection rate at the Birmingham VA Medical Center would be comparable with US benchmarks. We also sought to identify the medical and nonmedical factors that influenced the use of surgery.

Patients and Methods

We reviewed the electronic medical records of all veterans seen in the Lung Mass Clinic from 1999 to 2003 and identified patients with NSCLC. Demographics, comorbidities, diagnostic methods, times to diagnosis/resection, and postoperative survival were recorded. Reasons for nonresection were documented and tabulated, and differences between the resected and nonresected subgroups were examined.

Results

One hundred fifty-six patients with NSCLC were identified, and 31 (20%) underwent resection. There were no differences in age, ethnicity, or sex between those undergoing resection and those denied surgery. Patients who underwent resection were less likely to have chronic obstructive pulmonary disease and had better pulmonary function. Eighty-four percent of those who did not undergo resection had advanced disease, poor pulmonary function, or had refused therapy. Although the median time to resection was longer than expected (104 days), overall survival was comparable with other reports (65% at 3 years).

Conclusion

Since the inception of the Lung Mass Clinic, the resection rate at Birmingham VA Medical Center has improved. The primary limitation to resection was late presentation and not preoperative delays.

References (28)

  • W Fry et al.

    The national cancer data base report on lung cancer

    Cancer

    (1996)
  • P Bach et al.

    Racial differences in the treatment of early stage lung cancer

    N Engl J Med

    (1999)
  • R Damhuis et al.

    Resection rates and postoperative mortality in 7,899 patients with lung cancer

    Eur Respir J

    (1996)
  • A Gregor et al.

    Management and survival of patients with lung cancer in Scotland diagnosed in 1995: results of a national population based study

    Thorax

    (2001)
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