Adherence to Postoperative Survivorship Quality Metrics in Early-Stage Non-Small Cell Lung Cancer.

[BACKGROUND] Previous studies assessing quality of care among patients undergoing surgery for non-small cell lung cancer (NSCLC) have largely focused on preoperative and perioperative process-based quality measures. This study sought to address this knowledge gap by studying the association between postoperative (ie, survivorship) quality metrics (QMs) and cancer-specific outcomes.

[METHODS] Using a unique Veterans Health Administration data set, study investigators performed a retrospective cohort study including patients with early-stage NSCLC treated surgically. On the basis of contemporary guidelines, 3 QMs were defined: appropriate surveillance imaging, comprehensive smoking cessation management, and appropriate referral to oncology (only for tumors >3 cm). The study assessed the relationship between QM adherence and overall survival (OS) and the cumulative incidence of cancer recurrence (CIR).

[RESULTS] Between 2006 and 2016, 8137 patients were included in the study. Among patients with tumors ≤3 cm, better adherence to QMs was associated with improved OS (5-year survival; 0 QM, 50.5%; 1 QM, 61.9%; 2 QMs, 66.9%; P < .001) and decreased CIR (5-year cumulative incidence; 0 QM, 49.2%; 1 QM, 21.8%; 2 QMs, 12.2%; P < .001). Among patients with tumors >3 cm (n = 1702,), better adherence to QMs was associated with improved OS (5-year survival; 0 QM, 44.9%; 1 QM, 49.2%; 2 QMs, 55.9%; 3 QMs, 63.8%; P < .001) and decreased CIR (5-year cumulative incidence; 0 QM, 61.3%; 1 QM, 40.7%; 2 QMs, 27.0%; 3 QMs, 13.7; P < .001).

[CONCLUSIONS] Adherence to survivorship QMs is associated with dramatically improved cancer-specific outcomes among patients with early-stage NSCLC after surgical treatment. Efforts to standardize survivorship care pathways may significantly improve long-term outcomes among patients undergoing curative-intent resection.