Guideline-consistent care for patients with suspected lung cancer with mediastinal lymphadenopathy without distant metastases varies by region and physician characteristics, say researchers.
Multiple factors, including physician specialty and how recently they graduated, affected patients’ chances of undergoing mediastinal sampling as stipulated in current guidelines, report David Ost (University of Texas MD Anderson Cancer Center, Houston, USA) and co-workers.
“Addressing the root causes of the quality gap in lung cancer will require educational initiatives as well as fundamental reforms that facilitate more effective training,” they comment in Chest.
In line with other studies, the team found that guideline-consistent care – with mediastinal sampling as the first invasive procedure – was low. It occurred in just 21% of 15,316 patients drawn from two databases, and ranged from 12% to 29% according to the region.
The researchers note that ideal care is unlikely to be found via databases, because of frequent inaccuracies, but add that “based on the available data, we can say that the incidence of guideline consistent care is low enough to warrant attention.”
The most common first invasive procedure was bronchoscopy without transbronchial needle aspiration (TBNA), which was performed in 46.7% of patients, followed by computed tomography-guided biopsy in 32.7%. Indeed, 44% of patients with non-small-cell lung cancer did not undergo mediastinal sampling before treatment, varying by region from 34% to 59%.
Geographic region remained associated with the likelihood for guideline-consistent care after accounting for confounders, as did patient age below 76 years, living outside a large metropolitan area, lower poverty level, and lower T stage.
Physician factors independently associated with guideline-consistent care were specialty, being male and trained in the USA, and seeing a larger number of lung cancer patients.
Among pulmonary medicine specialists, those who had graduated more recently were more likely to care for patients as per the guidelines, and were also more likely to perform TBNA, implying an impact of training on care quality.
“However, graduation year did not impact practice patterns for other disciplines,” say Ost et al. “This suggests that the effectiveness of knowledge dissemination for this particular problem has not been equal between disciplines.”
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