Availability of multidisciplinary treatment modalities and outcomes among patients with resected early-stage non-small cell lung cancer.

BACKGROUND

Comprehensive, multidisciplinary care is crucial for managing early-stage non-small cell lung cancer (NSCLC), typically treated via lung resection or stereotactic body radiation therapy (SBRT). We evaluated how variable access to on-site SBRT may be associated with clinical outcomes for patients with stage I NSCLC receiving surgical resection within an integrated health-care system.

METHODS

We performed a retrospective cohort study of patients with stage I NSCLC treated with lung resection at Veterans Health Administration (VHA) facilities between 2006 and 2016. The VHA provides thoracic surgery at approximately 100 facilities, whereas lung SBRT is currently available at approximately 20 facilities. We compared short- and long-term outcomes for patients treated at surgery-only facilities vs those at facilities offering surgery and SBRT.

RESULTS

We identified 6289 patients undergoing lung resection, with 4673 (74.3%) treated at surgery-only sites and 1616 (25.7%) at surgery + SBRT sites. Sociodemographic factors were similar between cohorts. Surgery + SBRT sites showed higher adherence to operative quality metrics and improved patient selection. Short-term outcomes were better at surgery + SBRT sites with lower rates of 30-day major complications, 30-day mortality, and 90-day mortality. With a median follow-up of 6.3 years, 5-year overall survival was higher at surgery + SBRT sites (59.4% vs 56.9%; adjusted hazard ratio 1.12, 95% CI = 1.02 to 1.23).

CONCLUSION

Short- and long-term outcomes were better for patients with stage I NSCLC who underwent lung resection at facilities delivering thoracic surgery and SBRT. These findings support recommendations to increase SBRT availability at medical centers offering lung resection to ensure comprehensive multidisciplinary care is provided.