Invited Commentary

Abstract

Faris and associates [1Faris N. Yu X. Sareen S. et al.Preoperative evaluation of lung cancer in a community health care setting.Ann Thorac Surg. 2015; 100: 394-400Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar] report on lung cancer care delivery in a 2-hospital health system that provides care for patients across several Southern states. Their overall findings and conclusions mirror those revealed through analyses of national cancer registries—there are significant gaps in the quality of lung cancer care. The authors plan to bridge this gap with a multidisciplinary team of thoracic oncology experts and systems engineers. An important limitation of this study is that the denominator consists of patients selected to undergo pulmonary resection. The authors recognize this limitation and intend to evaluate all patients with suspected or confirmed non-small cell lung cancer in the future. This key aspect of their future plans deserves emphasis—the authors intend to pursue a disease-based rather than treatment-based approach to quality improvement. A disease-based approach to quality improvement is impactful in two ways. First, by moving “proximally” on the cancer care continuum, more individuals can reap the potential benefits of quality improvement. A simple, linear conceptualization of the cancer care continuum is prevention, screening, diagnosis/staging, treatment, and survivorship/end-of-life care. More “proximal” aspects of the care continuum have a larger denominator. For example, up to 94 million former or current smokers are eligible to undergo evidence-based smoking cessation or lung cancer screening, or both. By contrast, there are approximately 240,000 newly diagnosed lung cancer patients each year, of which approximately 50,000 undergo surgical therapy. Ensuring high-quality prevention and screening will affect a greater number of people than those undergoing surgical therapy. However, impact cannot and should not be judged by numbers alone. Moving “proximally” on the cancer care continuum can reveal other important detrimental departures from optimal care. For instance, patients with suspected or confirmed non-small cell lung cancer should undergo rigorous preoperative nodal staging. Many would agree that an overstaged patient falsely presumed to have locally advanced disease and deprived a curative-intent resection is a significant departure from optimal care. Evaluating only surgical patients precludes an understanding of how many patients are inappropriately denied an opportunity for a cure. Moving “proximally” towards a disease-based approach to quality improvement allows for such efforts to better realize their potential of positively influencing individuals and the general population. Preoperative Evaluation of Lung Cancer in a Community Health Care SettingThe Annals of Thoracic SurgeryVol. 100Issue 2PreviewWe examined the presurgical evaluation of suspected lung cancer patients in a community-based health care system to establish current benchmarks of care that will lay the groundwork for an evidence-based quality improvement project. Full-Text PDF