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BACKGROUND/RATIONALE:
Lung cancer is the leading cause of cancer death for both men and women in the United States. Lung cancer is also common in VA, accounting for almost 20% of all reported cancer cases. Fewer than 15% of lung cancer patients are still alive 5 years after diagnosis. While the high incidence and case-fatality rates make it clear that lung cancer is a major health problem in veterans, little is known about the quality of care that veterans with lung cancer receive. This is especially true for diagnostic tests and staging procedures. Although best practices for diagnosis and staging have been formulated by consensus panels and the use of decision analysis, current practices have not been fully described, and gaps between best practices and current practices have not been examined. In addition, very few studies have focused attention on the timeliness of care in lung cancer, an important dimension of health care quality.
OBJECTIVE(S):
In collaboration with investigators from the VA Colon Cancer Quality Enhancement Research Initiative (QUERI) and the Cancer Care Outcomes Research and Surveillance (CanCORS) Consortium of the National Cancer Institute, we aim to:
1)Describe variation in time to diagnosis and treatment (wait times) in veterans with lung cancer, and identify patient-related and institutional barriers to timely diagnosis and treatment.
2)Examine the effect of wait times on pre-treatment resource utilization, stage distribution and survival.
3)Characterize variation in use of imaging tests and invasive mediastinal biopsy procedures for lung cancer staging, and identify factors associated with the use of tests for staging.
4)Determine the effect of imaging tests and invasive mediastinal biopsy procedures on pre-treatment resource utilization, survival and the rate of thoracotomy without cure.
METHODS:
VA CanCORS is a population-based, prospective, observational study of practices and outcomes in several hundred veterans with lung cancer. We shall supplement CanCORS data collection by reviewing electronic medical records and VA administrative databases. Because this is an observational study, we will use stratification, multivariable adjustment, propensity scores and instrumental variable methods to control for differences between groups when we examine the effect of wait time and staging practices on lung cancer outcomes.
FINDINGS/RESULTS:
We have no findings to report at this time. Data collection is nearing completion.
IMPACT:
By accomplishing our research aims, we will better understand how current practices for lung cancer diagnosis and staging in VA deviate from recommended practices, as well as how VA practices differ from practices in non-VA settings. In future research, we will apply our results by designing, pilot-testing and implementing a multi-faceted intervention for quality improvement. We will identify specific targets for quality improvement, design tailored interventions to better align current practices for diagnosis and staging with best practices, and thereby improve the effectiveness and timeliness of care for veterans with lung cancer.
PUBLICATIONS:
None at this time.
DRA:
Chronic Diseases, Health Services and Systems, Substance Abuse, Addictive Disorders
DRE:
Diagnosis and Prognosis, Epidemiology, Prevention
Keywords:
Decision support, Research method, Risk adjustment
MeSH Terms:
none
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