Study offers new insights on patient care and lung cancer surveillance rates

Despite recommendations for posttreatment surveillance in lung cancer patients, there is wide variability in the follow-up care that lung cancer patients receive. A recent study, led by senior author Leah Backhus, MD, MPH, Professor of Cardiothoracic Surgery (Thoracic Surgery) in the Stanford Department of Cardiothoracic Surgery, offers new insights on patient care and lung cancer surveillance rates.

The study, titled, Adherence to Posttreatment Surveillance Guidelines in Non-Small Cell Lung Cancer (NSCLC): Retrospective Cohort Study, was published October 2025 in the Journal of Medical Internet Research (JMIR) Cancer. Its objective was to examine posttreatment surveillance to estimate the true surveillance rates and predictors of guideline-concordant care in patients with early-stage NSCLC. 

The retrospective study examined 1,888 Veterans with stage I to III non-small cell lung cancer who survived for ≥ 6 months following curative treatment. As Chief of Thoracic Surgery at the Veterans Affairs Palo Alto Health Care System, Dr. Backhus utilized robust data sources at the VA to inform her studies. The database of oncology data includes comprehensive cancer variables, clinical data, and radiology text reports. Radiology reports were examined using a novel hybrid approach for clinical abstraction which combines both computerized search methods and manual review for strict clinical validation.

In the study, we estimated the cumulative probability of receiving guideline-concordant surveillance, defined as chest computed tomography imaging within 4 to 9 months after treatment, accounting for competing risks and censoring."

Dr. Leah Backhus, MD, MPH, Professor of Cardiothoracic Surgery (Thoracic Surgery), Stanford Department of Cardiothoracic Surgery

The team developed a competing risk framework to describe the patterns and predictors of imaging surveillance for NSCLC. This approach allowed researchers to use a multivariable cause-specific Cox regression to estimate associations between patient factors and guideline-concordant surveillance and to distinguish between imaging ordered for surveillance versus imaging ordered for symptoms of recurrence.

"By applying this unique use of a competing risk framework, we discovered the rate of guideline concordant surveillance in this national cohort was lower than what has been reported in many previous studies," said Dr. Backhus. She further noted that there is a need to develop efficient strategies to monitor the rate of guideline-concordant surveillance as well as a need to improve patient education and health care professional advocacy to improve posttreatment care.

These findings reveal a potentially substantial gap in surveillance among asymptomatic lung cancer survivors. While more research is needed, it could help future generations of NSCLC patients receive better surveillance after cancer treatment.

Dr. Backhus recently presented findings related to this work on surveillance after lung cancer treatment, discussing the current state of surveillance, roadblocks, and next steps in lung cancer surveillance research.

Dr. Backhus is the Thelma and Henry Doelger Professor of Cardiovascular Surgery at Stanford. She co-directs the Stanford Thoracic Surgery Clinical Research Program, which uses a variety of health services research methodologies geared towards assessing the quality and effectiveness of thoracic surgical interventions for individual patients as well as population-based research.

The paper features several authors affiliated with the department, including first author Ryan Randle, MD, and co-author Nicole Lin, MD, who are both previous fellows in the division's Thoracic Surgery Clinical Research Program. The publication is a collaboration with researchers from the Stanford Departments of Radiology and Medicine, the University of Washington, the VA Palo Alto Health Care System, and the VA Puget Sound Health Care System.