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Enhanced recovery after thoracic surgery is associated with improved adjuvant chemotherapy completion for non-small cell lung cancer.
- Source :
-
The Journal of thoracic and cardiovascular surgery [J Thorac Cardiovasc Surg] 2019 Jul; Vol. 158 (1), pp. 279-286.e1. Date of Electronic Publication: 2019 Mar 21. - Publication Year :
- 2019
-
Abstract
- Objective: Enhanced recovery after surgery integrates multiple evidence-based interventions to accelerate postoperative recovery. We hypothesized that enhanced recovery after surgery would also facilitate adjuvant chemotherapy for non-small cell lung cancer.<br />Methods: An enhanced recovery after surgery pathway was implemented at a single institution, starting with a transitional rollout in 2012 and full rollout in 2015. Patients with clinical stage I or II non-small cell lung cancer without induction therapy and who were pathologic nodal positive or had 5-cm or larger tumor size were selected for analysis. Dates analyzed were pre-enhanced recovery after surgery (2006-2011), transitional (2012-8/2015), and enhanced recovery after surgery (9/2015-2017). Interrupted time series was used to analyze trends in time to receive adjuvant chemotherapy after resection by era. Logistic regression was used to determine factors associated with receiving 4 or more cycles of adjuvant chemotherapy.<br />Results: A total of 471 patients were identified. The interval between lung resection and commencing adjuvant chemotherapy was progressively shorter after the transition era (P = .041). The rate of receiving adjuvant chemotherapy progressively increased (from 40% pre-enhanced recovery after surgery, to 50% transition era, to 62% enhanced recovery after surgery era, P < .001). Multivariable regression revealed the enhanced recovery after surgery era (odds ratio, 3.6, P < .001), the transitional era (odds ratio, 2.01, P = .007), pN status, tumor grade and histology, age, and preoperative performance status were associated with completing adjuvant therapy. The surgical approach, whether open or thoracoscopic, was not associated with completing adjuvant chemotherapy.<br />Conclusions: Enhanced recovery after surgery was associated with facilitated delivery of adjuvant chemotherapy, with a shortened interval to receive adjuvant chemotherapy and a higher rate of receiving 4 or more cycles.<br /> (Copyright © 2019. Published by Elsevier Inc.)
- Subjects :
- Aged
Carcinoma, Non-Small-Cell Lung drug therapy
Carcinoma, Non-Small-Cell Lung surgery
Combined Modality Therapy
Female
Humans
Lung Neoplasms drug therapy
Lung Neoplasms surgery
Male
Middle Aged
Retrospective Studies
Thoracoscopy methods
Treatment Outcome
Carcinoma, Non-Small-Cell Lung therapy
Chemotherapy, Adjuvant methods
Enhanced Recovery After Surgery
Lung Neoplasms therapy
Thoracic Surgical Procedures methods
Subjects
Details
- Language :
- English
- ISSN :
- 1097-685X
- Volume :
- 158
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- The Journal of thoracic and cardiovascular surgery
- Publication Type :
- Academic Journal
- Accession number :
- 31014665
- Full Text :
- https://doi.org/10.1016/j.jtcvs.2019.03.009