Fragmented Care, Commission on Cancer Accreditation, and Overall Survival in Patients Receiving Surgery and Chemotherapy for Lung Cancer

IF 3.9 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Annals of Thoracic Surgery Pub Date : 2024-11-12 DOI:10.1016/j.athoracsur.2024.11.004

Ayham Odeh MD , Raymond Verm MD , Simon Park BS, PhD , James Swanson BS , Marshall Baker MD, MBA , Zaid Abdelsattar MD, MS

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Abstract

Background

Patients may receive their adjuvant therapy at a facility different from where they had their lung cancer operation. Whether this fragmentation of care affects outcomes is unclear.

Methods

We used the National Cancer Database to identify lung cancer patients undergoing resection and adjuvant chemotherapy from 2006-2020. We stratified patients into those receiving fragmented care or not, and further divided fragmented care patients by the Commission on Cancer (CoC) accreditation status of the hospital. Fragmented care refers to patients receiving surgery and chemotherapy at different institutions. These institutions can be either CoC accredited or not. The main outcome was overall survival. We used Kaplan-Meier analysis to estimate survival and multivariable and Cox proportional models to identify associations.

Results

Of 65,369 patients, 32,494 (49.7%) had fragmented care, with the majority (70.4%) receiving their chemotherapy at a non-CoC accredited facility. Factors associated with fragmented care were White race (adjusted odds ratio [aOR], 1.34; P < .001), lower comorbidity index (aOR, 1.11; P < .001), having private insurance (aOR, 1.11; P < .001), and a higher median income (aOR, 1.24 P < .001). Fragmented care was associated with worse overall survival (median survival, 60 vs 65 months; P < .001) compared with single-center care. When care was fragmented, receiving adjuvant chemotherapy at CoC-accredited centers had higher 5-year overall survival rates compared with those with fragmented care at non-CoC centers (median survival, 71 vs 55 months; P < .001).

Conclusions

The majority of lung cancer patients have their care fragmented to non-CoC-accredited centers and this is associated with worse outcomes. Regionalization, achieving CoC accreditation, or improved patient access may be necessary to allow select patients to receive closer care while maintaining outcomes.

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肺癌手术和化疗患者的分散护理、癌症评审委员会和总生存率。

背景：患者接受辅助治疗的地点可能与肺癌手术地点不同。这种分散治疗是否会影响治疗效果尚不清楚：我们利用国家癌症数据库对 2006-2020 年间接受切除术和辅助化疗的肺癌患者进行了识别。我们将患者分为接受碎片化治疗和未接受碎片化治疗两类，并根据医院的癌症委员会（CoC）认证状况进一步划分碎片化治疗患者。碎片化治疗是指患者在不同的机构接受手术和化疗。这些机构既可以是通过CoC认证的，也可以是未通过CoC认证的。主要结果是总生存率。我们使用 Kaplan-Meier 分析法估算生存率，并使用多变量模型和 Cox 比例模型确定相关性：在65,369名患者中，有32,494人（49.7%）接受了分散治疗，其中大多数（70.4%）患者在未经CoC认证的机构接受化疗。与分散治疗相关的因素有：白人（调整后的几率比（aOR）=1.34；p结论：大多数肺癌患者的化疗都是在未经CoC认证的机构进行的：大多数肺癌患者在未经CoC认证的中心接受分散治疗，这与较差的治疗效果有关。区域化、获得CoC认证或改善患者就医条件可能是在保证治疗效果的前提下让部分患者接受更近距离治疗的必要条件。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of Thoracic Surgery 医学-呼吸系统

CiteScore

6.40

自引率

13.00%

发文量

1235

审稿时长

42 days

期刊介绍： The mission of The Annals of Thoracic Surgery is to promote scholarship in cardiothoracic surgery patient care, clinical practice, research, education, and policy. As the official journal of two of the largest American associations in its specialty, this leading monthly enjoys outstanding editorial leadership and maintains rigorous selection standards. The Annals of Thoracic Surgery features: • Full-length original articles on clinical advances, current surgical methods, and controversial topics and techniques • New Technology articles • Case reports • "How-to-do-it" features • Reviews of current literature • Supplements on symposia • Commentary pieces and correspondence • CME • Online-only case reports, "how-to-do-its", and images in cardiothoracic surgery. An authoritative, clinically oriented, comprehensive resource, The Annals of Thoracic Surgery is committed to providing a place for all thoracic surgeons to relate experiences which will help improve patient care.