Participation in a national quality-improvement collaborative may be associated with higher compliance with a lung cancer surgical operative standard across US cancer programs, researchers reported in a recent study.
In the prospective, national quality-improvement study, the researchers included 354 Commission on Cancer–accredited programs that participated in the Lung NODES National Quality Improvement Collaborative from March through December 2024. Participating sites completed guided root cause analyses, educational webinars, peer-to-peer learning, and locally tailored interventions designed to develop and implement strategies to increase lymph node assessment compliance during surgery. The researchers analyzed data from 18,513 adult patients undergoing curative-intent lung resection through programs participating in the Lung NODES collaborative.
The primary outcome was compliance with the American College of Surgeons (ACS) Commission on Cancer's Standard 5.8, which requires the sampling of at least three mediastinal lymph node stations and one hilar lymph nodal station during curative-intent lung cancer resection. The researchers evaluated hospital-level and case-level compliance using multilevel logistic regression models adjusted for patient, procedural, and hospital factors.
Hospital-level median compliance increased from about 68% at baseline to 91% during the final data collection period. The number of programs meeting the target threshold of at least 80% compliance increased from about 41% to 67%. Community programs had the largest absolute increase in compliance, improving by 37 percentage points.
Further, the researchers noted that surgeries performed following participation in the Lung NODES collaborative were associated with 2.5 times the odds of compliant lymph node assessment compared with baseline procedures. Overall, 74% of patients received compliant care. Compliance was more common among patients treated at integrated network programs and those undergoing robotic-assisted surgery, preoperative endobronchial ultrasonography, or lobectomy.
Failure to perform the required lymphadenectomy attributed for about 74% of noncompliant cases. Programs with newly achieved compliance most commonly cited surgeon buy-in, prospective specimen labeling, standardized pathology synoptic reporting, and multidisciplinary communication as facilitators of improvement.
Multilevel analyses showed improvements across all hospital types, with no statistically significant differences in adjusted odds of compliant care by program type. Compared with lobectomy, wedge resection and segmentectomy were associated with lower odds of compliant lymph node assessment. Female sex and receipt of preoperative endobronchial ultrasonography or robotic-assisted surgery were factors associated with higher odds of compliant care.
The researchers noted several limitations. Participation was limited to Commission on Cancer–accredited hospitals, potentially limiting generalizability to nonaccredited programs. Fifty-seven participating hospitals were excluded because they did not submit cases during the final collection period. The study also did not include data on survival, postoperative complications, nodal upstaging, or systemic therapy use.
In an invited commentary, Meghan C. O’Leary, PhD, of the Department of Health Policy and Management at the University of North Carolina at Chapel Hill Gillings School of Global Public Health, and colleagues, wrote that the absence of a control group made it difficult to determine “the degree of improvement that would have happened without the intervention.”
“National [quality improvement] collaboratives may represent an effective large-scale approach to address gaps in the delivery of high-quality cancer care,” wrote lead study author Kelley Chan, MD, MS, of the ACS Cancer Programs, and colleagues.
Co–study author Linda W. Martin, MD, MPH, reported advisory relationships with Genentech, AstraZeneca, Bristol Myers Squibb, and Johnson & Johnson outside the submitted work. Senior study author David D. Odell, MD, MMSc, reported grant support from the American Association for Thoracic Surgery and the Agency for Healthcare Research and Quality. No other disclosures were reported.
Source: JAMA Surgery, Invited Commentary
