WEDNESDAY, July 18, 2001 (HealthDayNews) -- If you've got lung cancer and you need surgery, you'd better get the operation at a hospital that does a lot of them, a new study suggests.
Lung cancer patients who have part -- or all -- of their lung removed at a hospital that performs larger numbers of the procedures are more likely to survive and have fewer complications following surgery, researchers say. Understanding why there are disparities in care at different hospitals should be studied next, the researchers add.
"We were interested in a study of hospital volume, and survival and outcome of patients, because lung resection is extremely common," says lead author Dr. Peter Bach, an assistant professor and epidemiologist at Memorial Sloan-Kettering Cancer Center in New York City. "Surgical removal of the cancer and the lung surrounding it -- it could be a portion of the lobe of the lung or the entire lung --- is the primary and only curative procedure in lung cancer."
To see whether there were differences in outcomes among hospitals, Bach and his colleagues examined the surgical records of more than 2,000 patients in 10 different geographical areas around the country. The patients, all 65 or older, had been diagnosed with lung cancer between 1985 and 1996. The researchers examined survival rates at 30 days, two years and five years after the operation.
"We expected a large amount of variation between hospitals because lung cancer is a complicated cancer to treat, and the surgery is also very complicated," Bach explains.
"We saw very large differences," he says. "After 30 days, if you went to a hospital who did a low volume of these surgeries -- under eight a year -- the likelihood of post-operative death was twice as high as a hospital who performed more than 65 of the lung resections a year. And after five years, there was an 11 percent difference in survival between hospitals that had the lowest volume and hospitals that had the highest."
Average five-year survival rates after surgery for lung cancer was 38 percent, Bach reports, but patients who went to high-volume hospitals had a 44 percent survival rate, compared to 33 percent at low-volume hospitals.
"Complication rates were also twice as high in the lowest volume hospitals, when compared to the highest volume," Bach says.
Unfortunately, most hospitals in the United States that perform this surgery are low-volume hospitals, Bach adds. Of the 76 hospitals Bach studied, 34 performed betwen one surgery and eight surgeries a year, while 14 performed nine to 14 a year. Only two of the hospitals were high-volume providers -- performing 67 to 100 surgeries each year.
The findings appear in the July 19 issue of The New England Journal of Medicine.
Dr. Norman Edelman, president of the American Lung Association, says the findings are not surprising.
"It is pretty well known among professionals that this is true," he says. "The more complicated the surgery, the more true it is that hospitals with high volumes have the best outcomes. And it is important to point out that the biggest differences are early on, within 30 days. When you get out to five years, the differences are not that radical."
Lung cancer is the second most common cancer and the leading cause of cancer deaths for both sexes, according to the National Cancer Institute. The American Cancer Society estimates there will about 160,000 new cases of lung cancer this year and more than 157,000 people will die from it this year. Tobacco use causes 90 percent of all lung cancers.
So what should a patient with lung cancer do?
"For an individual patient, it's hard to give guidance," says Bach. "But this should not be taken as an alarm that all patients across the United States should not get their surgeries at low-volume hospitals."
"What this really is, is a public health issue," he adds. "To improve the outcomes for patients, we should determine the processes of care that are responsible for these differences in outcome and attempt to improve the quality of care at those hospitals which do not have optimum practices."
"We did see the complication rates were twice as high in the low-volume hospitals versus high volume, and that suggests differences in patient care, before and after surgery," Bach says. "But our study did not pin that information down."
What To Do:
For more information on lung cancer, see the American Cancer Center or CancerNet.
