Long-term assessment of efficacy with a novel Thoracic Survivorship Program for patients with lung cancer Journal Article
| Authors: | Keshava, H. B.; Tan, K. S.; Dycoco, J.; Huang, J.; Berkowitz, A.; Sumner, D.; Devigne, A.; Adusumilli, P.; Bains, M.; Bott, M.; Isbell, J.; Downey, R.; Molena, D.; Park, B.; Rocco, G.; Sihag, S.; Jones, D. R.; Rusch, V. W. |
| Article Title: | Long-term assessment of efficacy with a novel Thoracic Survivorship Program for patients with lung cancer |
| Abstract: | Objective: We developed a novel, nurse practitioner–run Thoracic Survivorship Program to aid in long-term follow-up. Patients with non–small cell lung cancer who were disease-free at least 1 year after resection could be referred to the Thoracic Survivorship Program by their surgeon. Our objectives were to summarize follow-up compliance and assess long-term outcomes between Thoracic Survivorship Program enrollment and non–Thoracic Survivorship Program. Methods: Patients who underwent R0 resection for stages I to IIIA between 2006 and 2016 were stratified by enrollment in Thoracic Survivorship Program versus surgeon only follow-up (non–Thoracic Survivorship Program). Follow-up included 6-month chest computed tomography scans for 2 years and then annually. Lack of follow-up compliance was defined by 2 or more consecutive delayed annual computed tomography scans/visits ± 90 days. Relationships between Thoracic Survivorship Program and second primary non–small cell lung cancers, extrathoracic cancers, and survival were quantified using multivariable Cox proportional hazards regression with time-varying covariate reflecting timing of enrollment. Results: A total of 1162 of 3940 patients (29.5%) were enrolled in the Thoracic Survivorship Program. The median time to enrollment was 2.3 years; 3279 of 3940 (83%) had complete computed tomography scan data, and 60 of 3279 (1.8%) had 2 or more delayed scans; 323 of 9082 (3.6%) non–Thoracic Survivorship Program visits were noncompliant versus 132 of 4823 (2.7%) of Thoracic Survivorship Program visits (P =.009); 136 of 1146 Thoracic Survivorship Program patients developed second primary non–small cell lung cancer, and 69 of 1123 developed extrathoracic cancer, whereas 322 of 2794 of non–Thoracic Survivorship Program patients developed second primary non–small cell lung cancer and 225 of 2817 patients developed extrathoracic cancer. In multivariable analyses, Thoracic Survivorship Program enrollment was associated with improved disease-free survival (hazard ratio, 0.57; 95% confidence interval, 0.48-0.67; P <.001). Conclusions: Our novel nurse practitioner–run Thoracic Survivorship Program is associated with high patient compliance and outcomes not different from those seen with physician-based follow-up. These results have important implications for health care resource allocation and costs. © 2021 The American Association for Thoracic Surgery |
| Keywords: | carcinoma, non-small-cell lung; lung neoplasms; proportional hazards models; tomography, x-ray computed; diagnostic imaging; lung tumor; proportional hazards model; survivorship; non small cell lung cancer; humans; human; x-ray computed tomography; lung cancer follow-up |
| Journal Title: | Journal of Thoracic and Cardiovascular Surgery |
| Volume: | 163 |
| Issue: | 5 |
| ISSN: | 0022-5223 |
| Publisher: | Mosby Elsevier |
| Date Published: | 2022-05-01 |
| Start Page: | 1645 |
| End Page: | 1653.e4 |
| Language: | English |
| DOI: | 10.1016/j.jtcvs.2021.11.026 |
| PUBMED: | 34922758 |
| PROVIDER: | scopus |
| PMCID: | PMC9018489 |
| DOI/URL: | |
| Notes: | Conference Paper -- Export Date: 1 July 2022 -- Source: Scopus |
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