Pre- and postoperative care for stage I–III NSCLC: Which quality of care indicators are evidence-based?. (November 2016)

• Record Type: Journal Article
• Authors: Numan, Rachel C.; Berge, Martijn Ten; Burgers, Jacobus A.; Klomp, Houke M.; van Sandick, Johanna W.; Baas, Paul; Wouters, Michel W.
• Is Part Of: Lung cancer. Volume 101(2016)
• Page Start: 120
• Page End: 128
• Publication Date: 2016-11
• Subjects: Quality of Care -- Quality indicator -- Lung cancer; Lungs -- Cancer -- Periodicals; Lung Neoplasms -- Abstracts; Lung Neoplasms -- Periodicals; Poumons -- Cancer -- Périodiques; Lungs -- Cancer; Periodicals; Electronic journals; Electronic journals; 616.99424
• DOI: 10.1016/j.lungcan.2016.05.022
• Languages: English
• ISSNs: 0169-5002

Abstract

Highlights: Evidence-based quality indicators for the management of stage I–III NSCLC were identified. The use of the PET-CT and invasive endoscopic techniques are process indicators. The use of cytology in combination with histology during bronchoscopy is a process indicator. The use of preoperative chemoradiation for clinical stage III NSCLC is a process indicator. The use of postoperative chemotherapy for stage II/III NSCLC is a process indicator. Abstract: Identification of evidenced-based Quality of Care (QoC) indicators for lung cancer care is essential to quality improvement. The aim of this review was to identify evidence-based quality indicators for the pre- and postoperative care of stage I–III Non Small Cell Lung Cancer (NSCLC) provided by the lung physician. To obtain these indicators, a search in PubMed, Embase and the Cochrane library database was performed. English literature published between 1980 and 2012 was included and search terms regarding 'lung neoplasms', 'quality of care', 'pathology', 'diagnostic methods', 'preoperative and postoperative treatment' were used. The potential indicators were categorized as structure, process or outcome measures and the indicators supported by literature with high evidence level were selected. Five QoC indicators were identified. The use of the positron emission tomography-computed tomography (PET-CT) results in more accurate mediastinal staging compared to the CT scan. Endoscopic Ultrasound-Fine Needle Aspiration and Endobronchial Ultrasound-Fine Needle Aspiration are sensitive diagnostic tools for mediastinal staging and reduce futile thoracotomies. Pathological conformation of lung cancer can best be obtained by a combination of cytological and histological diagnostics used during bronchoscopy. For patients with clinical stage III NSCLC, preoperative multimodality treatment (i.e. preoperative chemoradiation) results in superior survival and increased mediastinal downstaging compared to single modality treatment (i.e. preoperative chemotherapy or radiotherapy). After surgery, the addition of chemotherapy results in a significant survival benefit for patients with pathological stage II and III NSCLC. These five QoC indicators can be used for benchmarking and ultimately quality improvement of lung cancer care.