VA oncologist Dr. Bruce Montgomery meets with Navy Veteran Allen Petchnick at the VA Puget Sound Health Care System in Seattle. (Photo by Christopher Pacheco)
ST. LOUIS — The VALCAN-O score, which uses a data set from the VHA, was developed for patients diagnosed with resectable early-stage nonsmall-cell lung cancer (NSCLC).
The more practical easy-to-calculate surgical quality score takes into account surgical quality measures, such as timely surgery, anatomic resection, surgical approach, adequate nodal sampling and negative surgical margin, as well as long-term overall survival. The score was developed in a cohort of nearly 10,000 veterans and then validated in a cohort of more than 100,000 U.S. adults from the NCDB.
“Our data suggest that efforts to standardize and optimize surgical quality may have disproportionate repercussions for patients diagnosed with early-stage NSCLC who are receiving curative-intent surgical treatment,” according to a study in JAMA Surgery.1
The authors from Washington University School of Medicine, the VA St. Louis Healthcare System and colleagues point out, “Although these QMs are widely considered guideline-concordant standards of care, it is striking to note the relatively poor adherence to these measures within both the VHA and civilian hospitals (National Cancer Database (NCDB).) For example, we found that only 34.0% (35.2% NCDB) of the patients in either cohort received adequate nodal sampling; similarly, only 41.4% (39.2% NCDB) of the patients received minimally invasive resections and 21.8% (21.3% NCDB) of the patients received non-anatomic wedge resections.”
While adherence to the QMs improved over time at the VHA, the study team found wide variability as recently as 2019, adding, “Our findings clearly indicate that further efforts are needed to improve the dissemination and implementation of guideline-concordant practices in thoracic surgery to improve lung cancer outcomes in both VHA and non-VHA settings.”
The study notes that surgical resection remains the preferred treatment for patients who are both functionally fit and have early-stage NSCLC. The researchers sought to develop a practical surgical quality score for patients diagnosed with clinical Stage I NSCLC who received definitive surgical treatment.
Using a cohort of veterans who received surgery after NSCLC diagnosis from October 2006 through September 2016, the retrospective cohort study analyzed the data from April 1 to Sept. 1, 2022. Based on contemporary treatment guidelines,
The researchers defined five surgical QMs:
- timely surgery,
- minimally invasive approach,
- anatomic resection,
- adequate lymph node sampling, and
- negative surgical margin.
Those were used to develop a surgical quality score.
The cohort receiving surgery included 1,446 patients who had a mean (SD) age of 67.6 (7.9) years; most, 96.4%, were men, and 58.4% were smokers.
The authors report that the QMs were met as follows:
- timely surgery (6633 [68.9%]),
- minimally invasive approach (3986 [41.4%]),
- lobectomy (6843 [71.1%]) or segmentectomy (532 [5.5%]),
- adequate lymph node sampling (3278 [34.0%]), and
- negative surgical margin (9312 [96.7%]).
“The findings of this study suggest that adherence to intraoperative QMs may be associated with improved OS and RFS. Efforts to improve adherence to surgical QMs may improve patient outcomes following curative-intent resection of early-stage lung cancer,” the authors wrote.
- Heiden BT, Eaton DB Jr, Chang SH, Yan Y, et. al. Association Between Surgical Quality Metric Adherence and Overall Survival Among US Veterans With Early-Stage Non-Small Cell Lung Cancer.. 2023 Jan 18. doi: 10.1001/jamasurg.2022.6826. Epub ahead of print. PMID: 36652269.