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lung cancer, Thoracic Surgery News

Lung Resection in the Elderly – the Harvard/ Keating experience

Re-posting an article on the benefits of early surgical intervention on elderly patients with early stage lung cancers from Medscape.com. This is a nice article summarizing the research study conducted by Dr. Nancy Keating at Harvard Medical School in Boston, MA.  A link to the original research abstract is here, but no free full-text available.

This article that highlights the importance of surgery – even for patients that primary care physicians and others may not immediately think of as great surgical candidates (frail elderly, COPD, other illnesses.)

Unfortunately, they didn’t address WHO was doing the surgeries – was it thoracic surgeons in high resection geographic areas (on the higher risk patients) as is often the case?  Were surgeries in the areas with lower resection rates more likely to be done by general surgeons who are less experienced in operating on more frail thoracic patients?  [all thoracic patients are frail to some decrease given the nature of the condition - so specialty trained thoracic surgeons are usually much more experienced in caring for these patients].  It would have been nice to know.

Surgery Rates tied to Lung Cancer Outcomes in the Elderly

David Douglas (Medscape)

NEW YORK (Reuters Health) Aug 24 – People with early non-small cell lung cancer (NSCLC) live longer if they’re in regions of the U.S. where doctors perform more surgeries for that indication, according to a new study.

The link between higher surgery rates and better survival held true even for frailer patients.

“We found that areas with high rates of surgery tended to operate on older and sicker patients, yet still had better outcomes for early-stage lung cancer than areas with lower use of surgery,” said senior investigator Dr. Nancy L. Keating in an email to Reuters Health.

“These data suggest that areas with lower surgery rates may benefit from higher rates of surgery,” she said.

Dr. Keating, from Harvard Medical School in Boston, said, “Resection has by far the highest chance of cure.”

But, she noted, “It may be that fear of harm (surgeons being concerned about causing poor outcomes) may be leading to relative underuse of this effective treatment.”

“While there are some patients for whom the risks certainly outweigh the benefits,” she added, “those patients may be fewer than some physicians recognize.”

Dr. Keating and colleagues studied a population-based cohort of more than 17,000 Medicare beneficiaries at least 66 years old who were diagnosed with stage I or II NSCLC during 2001 to 2005.

Using Surveillance, Epidemiology, and End Results (SEER) data, they compared areas with high and low rates of curative surgery for early stage lung cancer.

Fewer than 63% of patients had operations in low-surgery areas, whereas more than 79% did in high-surgery areas, according to a July 28th online paper in Cancer.

The high-surgery areas saw more operations on older patients and in those with chronic obstructive pulmonary disease (COPD).

The one-year lung-cancer-specific mortality rate was 12% in the high-surgery regions and 17% in low-surgery. The adjusted odds ratio for each 10% increase in the surgery rate was 0.86. There were similar findings for all-cause mortality.

Original article reference information:

Cancer. 2011 Jul 28. doi: 10.1002/cncr.26363. [Epub ahead of print]. Improved outcomes associated with higher surgery rates for older patients with early stage nonsmall cell lung cancer.  Gray SW, Landrum MB, Lamont EB, McNeil BJ, Jaklitsch MT, Keating NL.

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