Research for Successful Surgery and Outcomes
NIH-funded project continues to support research on ensuring surgical quality for lung cancer.
Lung cancer is the leading cause of cancer-related death globally. However, with good quality surgical resection many people survive long term after being diagnosed with lung cancer. To help ensure that quality surgery is available to everyone who could benefit, researchers in Memphis, TN have been among the international leaders in identifying and addressing quality deficits in lung cancer surgery for over a decade. Baptist Cancer Center and the University of Memphis recently received a tenth year of funding from the National Cancer Institute to study surgical quality in lung cancer (PI: Raymond Osarogiagbon MD). Through this ongoing project, the team has established the Mid-South Quality of Surgical Resection (MSQSR) cohort.
Dr. Matthew Smeltzer, associate professor of Epidemiology, and Dr. Meredith Ray, associate professor of Biostatistics of the University of Memphis School of Public Health, lead the analytic team for the MSQSR. This prospective observational cohort is population-based, including 95% of lung cancer resections in four contiguous hospital referral regions in the mid-south (Arkansas, Tennessee, and Mississippi). These states consistently rank among the highest in the U.S. in terms of cancer occurrence and death from cancer. The MSQSR is internationally recognized among the most detailed lung cancer databases in the world.
Using data from the MSQSR, the research team has identified multiple markers of good quality surgery with a particular focus on accurate cancer staging.[1] This data identified several areas for improvement in lung cancer surgery. To address these quality gaps, the team has applied implementation science principles to introduce and study the effect of a lymph node collection kit used during lung cancer surgery at MSQSR institutions. This study found better quality surgery and longer patient survival after surgery when the lymph node kit was used.[2,3] The MSQSR team is also working with pathologists in the region to study novel dissection techniques and the value of synoptic methods for reporting results after lung cancer surgery.[4]
The MSQSR project has resulted in more than 20 impactful scientific publications and 30 international meeting presentations. The findings from this study have contributed to the revised American College of Surgeons Operative Standards for Cancer Surgery and the upcoming revisions to the American Joint Committee on Cancer (AJCC) international lung cancer staging system. Recent data show broadly improved surgical quality and longer survival for individuals after lung cancer surgery in the mid-south since the implementation of the MSQSR project.[5,6] In addition to Smeltzer and Ray, more than ten graduate students and five additional faculty from the School of Public Health have collaborated with Osarogiagbon and Baptist Cancer Center on related projects.
For more information on this research contact Smeltzer at msmltzer@memphis.edu, or Ray at maray@memphis.edu.
References
1. Smeltzer MP, Faris NR, Ray MA, Osarogiagbon RU. Association of pathologic nodal staging quality with survival among patients with non–small cell lung cancer after resection with curative intent. JAMA Oncol. 2018: 4(1)1-8. Published September 28, 2017. doi:10.1001/jamaoncol.2017.2993
2. Osarogiagbon RU, Smeltzer MP, Faris NR, Ray MA, Fehnel C, Ojeabulu P, Akinbobola O, Meadows-Taylor M, McHugh LM, Halal AM, Levy P, Sachdev V, Talton R, Wiggins L, Shu X, Shyr Y, Robbins ET, Klesges LM. Outcomes Following Use of a Lymph Node Collection Kit for Lung Cancer Surgery: A Pragmatic, Population-Based, Multi-Institutional, Staggered Implementation Study. J Thorac Oncol. 2021 Apr;16(4):630-642. doi: 10.1016/j.jtho.2020.12.025. Epub 2021 Feb 16.PMID: 33607311
3. Ray MA, Fehnel C, Akinbobola O, Faris NR, Meadows-Taylor M , Smeltzer MP, Osarogiagbon RU. Comparative Effectiveness of a Lymph Node Collection kit Versus ‘Heightened Awareness’ on Lung Cancer Surgery Quality and Outcomes. J Thorac Oncol. 2021 May;16(5):774-783. doi: 10.1016/j.jtho.2021.01.1618. Epub 2021 Feb 12.PMID: 33588112
4. Smeltzer MP, Lee YS, Faris NR, Fehnel C, Akinbobola O, Meadows-Taylor M, Spencer D, Sales E, Okun S, Giampapa C, Anga A, Pacheco A, Ray M, Osarogiagbon RU. Trends in Accuracy and Comprehensiveness of Pathology Reports for Resected Non-small Cell Lung Cancer (NSCLC) in a High Mortality Area of the United States. J Thorac Oncol. 2021 Oct;16(10):1663-1671. doi: 10.1016/j.jtho.2021.06.027. Epub 2021 Jul 16.PMID: 34280563
5. Akinbobola O, Ray MA, Fehnel C, Saulsberry A, Dortch K, Smeltzer MP, Faris NR, Osarogiagbon RU. Institution-Level Evolution of Lung Cancer Resection Quality with Implementation of a Lymph Node Specimen Collection Kit. J Thorac Oncol. In press.
6. Smeltzer MP, Faris NR, Ray MA, Fehnel C, Houston-Harris C, Ojeabulu P, Akinbobola O, Lee YS, Meadows M, Signore S, Wiggins L, Talton D, Owen E, Deese LE, Eubanks R, Wolf BA, Levy P, Robbins ET, Osarogiagbon RU. Survival before and after direct surgical quality feedback in a population-based lung cancer cohort. Ann Thorac Surg. 2018 Dec 27. pii: S0003-4975(18)31859-9.