Monitoring concordance with evidence-based guidelines in the treatment of stage I to IIIA lung cancer: A quality improvement initiative.

Abstract

e23240 Background: The Commission on Cancer (CoC) Standard 7.2 mandates an in-depth analysis of cancer treatments to ensure concordance with national evidence-based guidelines. This study evaluates the diagnostic evaluation and treatment of Stage I-IIIA lung cancer patients at high volume community-based hospital Texas Health Fort Worth (THFW) in 2023. Additionally, it explores the incidence of neoadjuvant chemotherapy and immunotherapy (NAT), an emerging but underutilized modality in lung cancer management. The findings of Keynote 671 and CheckMate 816 trials support the potential benefits of neoadjuvant immunotherapy plus chemotherapy followed by adjuvant immunotherapy with improvement in median event free survival and pathological complete response rates in resectable non-small cell lung cancer. Methods: A retrospective analysis was conducted on 49 lung cancer patients diagnosed between January 1 and December 31, 2023, using cancer registry data at THFW. Clinical measures, including biopsy procedures, PET CT scans, tumor size, and systemic therapy, were evaluated. Concordance with evidence-based guidelines was examined for diagnostic and therapeutic procedures, including surgery and chemotherapy. Additionally, cases with resectable lung cancer were reviewed to identify where NAT could have potentially impacted patient outcomes. Results: The study population had a mean age of 68.3 years, with 40.8% males. Biopsy procedures were performed in 89.4% of patients, and PET CT scans were conducted in 89.8% of cases. 63.3 % patients were discussed in the multidisciplinary tumor board. Of the patients, 81.6% were found to be in concordance with evidence-based guidelines. 100% of the patients underwent surgery. 22.4% of the patients were found to be eligible for systemic therapy based on their staging. Of those eligible for systemic therapy only 18.2% received it . Furthermore, In 2023, only 2% of patients received neoadjuvant therapy, highlighting its limited use in the community setting. Conclusions: While most patients, 81.6%, received treatment in line with national guidelines, there appears to be an underutilization of neoadjuvant therapy in 2023. This suggests the need to continue encouraging community-based cancer physicians to utilize NAT when recommended by multidisciplinary tumor board in the management of lung cancer to improve outcomes.