About 60,000 individuals undergo surgery for lung cancer in the US annually. For these patients, whether, or not, cancer has spread to their lymph nodes is the main determinant of their prognosis and guides post- operative treatment decision-making. Unfortunately, most lung cancer operations done in the US do not provide a sufficient sample of lymph nodes to make an accurate determination of pathologic lymph node stage. Therefore, a larger number of patients die of lung cancer than would have been predicted by their post- operative stage. Examination of the quality of lung cancer surgical resections in the greater Memphis Metropolitan Area reveals close approximation to the US national quality-of-care gap. Deploying a specially designed lymph node specimen collection kit for use in lung cancer resections significantly improves the quality of pathologic lymph node staging and increases the detection of patients with lymph node metastasis. We now want to test the implementation of the routine use of this unique specimen collection kit in the tri-state area of Eastern Arkansas, Northern Mississippi and Western Tennessee, which has the combination of challenging socio-economic demographics and some of the highest lung cancer mortality rates in the US. Based on our prior work, we hypothesize that successful implementation of this surgical lymph node specimen collection kit will improve the quality of pathologic staging of lung cancer and increase the detection of lymph node metastasis in a diverse mix of patients operated on by a diverse mix of surgeons in a diverse mix of institutions. Our objective is to study the implementation process of routine use of this kit in a demographically diverse, high lung cancer incidence region of the US, in order to maximize its impact in future dissemination. We propose to achieve this by performing the following Specific Aims: 1.) Recruit at least 90% of eligible hospitals (those within our defined catchment area with >5 lung resection operations annually) and surgeons to participate in an implementation study of the lymph node specimen collection kit for lung cancer resections;2.) Evaluate the effectiveness of the kit in surgery performed in a diverse mix of institutions, using a staggered implementation, multiple baseline study design;3.) Study the implementation process using the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework. Our study will demonstrate the practical possibility of significantly improving the quality and outcomes of surgical lung cancer care across heterogeneity of practice settings. General improvement in pathologic staging will set the stage for future translational work on development of independently prognostic gene and protein expression profiles by optimizing the use of the Tumor, Node, and Metastasis (TNM) staging system, which is currently our best risk stratification system. The ultimate goal of this project i to provide the clinical infrastructure to support future studies of such prognostic molecular signatures that will supplement, and eventually supersede the current TNM staging system.

Public Health Relevance

This is a quality improvement project designed to examine the process of implementing the routine use of a special lymph node specimen collection kit. The goal is to improve the pathologic staging of surgically operable lung cancer in a high lung cancer incidence and mortality region of the US. This study uses a team-based approach involving multiple stakeholders, in an effort to improve the quality of surgical care for potentially curable lung cancer, the most commonly lethal cancer worldwide and in the U.S.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Research Project (R01)
Project #
1R01CA172253-01
Application #
8422430
Study Section
Dissemination and Implementation Research in Health Study Section (DIRH)
Program Officer
Breen, Nancy
Project Start
2013-04-01
Project End
2018-03-31
Budget Start
2013-04-01
Budget End
2014-03-31
Support Year
1
Fiscal Year
2013
Total Cost
$461,765
Indirect Cost
$131,952
Name
University of Memphis
Department
Type
Schools of Public Health
DUNS #
055688857
City
Memphis
State
TN
Country
United States
Zip Code
38152
Ray, Meredith A; Faris, Nicholas R; Smeltzer, Matthew P et al. (2018) Effectiveness of Implemented Interventions on Pathologic Nodal Staging of Non-Small Cell Lung Cancer. Ann Thorac Surg 106:228-234
Faris, Nicholas R; Smeltzer, Matthew P; Lu, Fujin et al. (2017) Evolution in the Surgical Care of Patients With Non-Small Cell Lung Cancer in the Mid-South Quality of Surgical Resection Cohort. Semin Thorac Cardiovasc Surg 29:91-101
Campbell, Joshua D; Lathan, Christopher; Sholl, Lynette et al. (2017) Comparison of Prevalence and Types of Mutations in Lung Cancers Among Black and White Populations. JAMA Oncol 3:801-809
Smeltzer, Matthew P; Lin, Chun Chieh; Kong, Feng-Ming Spring et al. (2017) Survival impact of postoperative therapy modalities according to margin status in non-small cell lung cancer patients in the United States. J Thorac Cardiovasc Surg 154:661-672.e10
Lin, Chun Chieh; Smeltzer, Matthew P; Jemal, Ahmedin et al. (2017) Risk-Adjusted Margin Positivity Rate as a Surgical Quality Metric for Non-Small Cell Lung Cancer. Ann Thorac Surg 104:1161-1170
Osarogiagbon, Raymond U; Ray, Meredith A; Faris, Nicholas R et al. (2017) Prognostic Value of National Comprehensive Cancer Network Lung Cancer Resection Quality Criteria. Ann Thorac Surg 103:1557-1565
Osarogiagbon, Raymond U; Smeltzer, Matthew P; Faris, Nicholas et al. (2016) Comment on the Proposals for the Revision of the N Descriptors in the Forthcoming Eighth Edition of the TNM Classification for Lung Cancer. J Thorac Oncol 11:1612-4
Smeltzer, Matthew P; Faris, Nicholas; Yu, Xinhua et al. (2016) Missed Intrapulmonary Lymph Node Metastasis and Survival After Resection of Non-Small Cell Lung Cancer. Ann Thorac Surg 102:448-53
Osarogiagbon, Raymond U; Lin, Chun Chieh; Smeltzer, Matthew P et al. (2016) Prevalence, Prognostic Implications, and Survival Modulators of Incompletely Resected Non-Small Cell Lung Cancer in the U.S. National Cancer Data Base. J Thorac Oncol 11:e5-16
Osarogiagbon, Raymond U (2016) Strategic approach to minimally invasive mediastinal nodal staging-a brave new world? Lancet Respir Med 4:926-927

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