Cancer-Specific Outcomes Improved With Adherence to Quality Metrics

Dramatically improved cancer-specific outcomes were found in patients with early-stage non–small cell lung cancer (NSCLC) who, after their surgery, adhered to survivorship quality metrics, according to a study published in The Annals of Thoracic Surgery.¹ Long-term outcomes could be improved through the standardization of survivorship care.

NSCLC is the most common type of lung cancer² and lung cancer is the leading cause of death related to cancer in the US,³ with surgical resection being the preferred method of treatment in those who are still at the earliest stages of the condition. Recommendations for survivorship care are given to patients with early-stage NSCLC, including quality metrics that those receiving surgery should receive soon after the procedure. This study aimed to examine the relationship between outcomes related to cancer, adherence to postoperative quality metrics, and overall survival or incidence of recurrence.

Participants of the study were all veterans with early-stage NSCLC who received a surgical resection between 2006 and 2016 through the Veterans Health Administration. Patients who had received neoadjuvant surgery, had missing dates of diagnosis, had surgery for recurrent disease, or died within 90 days of surgery were excluded.

The quality metrics evaluated in this study included appropriate referral to oncology, appropriate cancer surveillance imaging, and management of smoking cessation. At least 1 CT scan every 12 months within the first 2 years after surgery was regarded as appropriate surveillance, management of smoking cessation was defined as being either a nonsmoker or receiving pharmacotherapy, and appropriate referral was defined as receiving a medical oncology referral within 6 months after the surgery. Overall survival and cumulative incidence of recurrence of lung cancer were the primary outcomes of the study.

There were 8137 participants in this study who had a mean (SD) age of 67.62 (7.86) years; 96.28% of the participants were men and 82.66% were White. Smokers both current (58.31%) and former (40.29%) made up the majority of the participants. A lobectomy was performed for 69.95% of the participants.

Of those with tumors of 3 cm or less and tumors greater than 3 cm, 44.9% and 40.8%, respectively, adhered to at least 2 quality metrics. A total of 45.0% of those with a tumor of 3 cm or less adhered to 1 quality metric compared with 24.2% of those with tumors greater than 3 cm. A total of 10.1% of those with a tumor of 3 cm or smaller and 4.8% of those with a tumor of greater than 3 cm had not adhered to quality metrics at all. A total of 30.3% of those with a tumor greater than 3 cm adhered to 3 quality metrics.

Older age (adjusted OR [AOR], 0.991; 95% CI, 0.948-0.998), larger tumor size (AOR, 0.456; 95% CI, 0.375-0.555), and Black race (AOR, 0.760; 95% CI, 0.664-0.871) were associated with a lower adherence to quality metrics.

Improved overall survival was associated with patients who had tumors of 3 cm or less who had better adherence (5-year survival: 50.5% in 0 quality metrics vs 66.9% in 2 quality metrics). This was also found in those with tumors greater than 3 cm (5-year survival: 44.9% in 0 quality metrics vs 63.8% in 3 quality metrics). Cumulative incidence recurrence was also decreased in those who adhered to quality metrics.

There were some limitations to this study. The study entirely consisted of veterans, which could prevent generalization. Only 3 quality metrics were assessed as part of the study. The study also had a retrospective design. Reasons for variability in adherence to quality metrics was not evaluated.

“Future efforts that standardize high-quality care in the survivorship period may disproportionately improve outcomes among patients with lung cancer,” the authors concluded.

References

1. Seyoum N, Eaton DB Jr, Tohmasi S, et al. Adherence to post-operative survivorship quality metrics in early-stage non-small cell lung cancer. Ann Thorac Surg. Published online August 27, 2025. doi:10.1016/j.athoracsur.2025.08.010

2. Non-small cell lung cancer. Cleveland Clinic. Updated January 16, 2025. Accessed September 2, 2025. https://my.clevelandclinic.org/health/diseases/6203-non-small-cell-lung-cancer

3. Key statistics for lung cancer. American Cancer Society. Updated January 16, 2025. Accessed September 2, 2025. https://www.cancer.org/cancer/types/lung-cancer/about/key-statistics.html