Optimizing treatment decisions and quality-adjusted life years through improved lung cancer staging

PROJECT SUMMARY The number of patients with potentially curable, stage I-III non-small cell lung cancer (NSCLC) is increasing, and appropriate treatment selection depends upon the extent of cancer spread to lymph nodes. Two lymph node biopsy procedures—endobronchial ultrasound guided transbronchial node aspiration (EBUS) and

mediastinoscopy—have equivalent ability to detect the presence of lymph node metastases, but they have not been compared in their ability to detect the extent of cancer spread or differentially influence quality-adjusted life years. The extent of cancer spread influences treatment decisions, which in turn impact patient outcomes.

Since EBUS and mediastinoscopy can both access the same mediastinal lymph nodes, but EBUS can also biopsy hilar lymph nodes, EBUS is hypothesized to have greater potential to change treatment decisions (Aim I). EBUS is also hypothesized to be associated with higher quality-adjusted life years because it has greater

potential to change treatment decisions and it is associated with fewer risks compared to mediastinoscopy (Aim II). Aim I will leverage an ongoing cohort study with granular data on ~2,200 patients with stage I-III NSCLC who underwent EBUS or mediastinoscopy in two Cancer Research Network health care systems

(R01CA258352). Trained clinicians will abstract granular data from radiology, biopsy, and pathology reports. Aim II will leverage patient-level data from Aim I, the literature, and primary data collection of health utilities associated with treatment changes in response to staging and procedure-related complications to simulate

trials using a published risk-benefit framework based on decision analytic modelling. Findings from this study will harmonize disparate national practice guidelines for first-line biopsy procedures, direct quality improvement initiatives, and motivate trials comparing patient-centered outcomes. This line of investigation is expected to

reduce diagnostic errors, optimize treatment selection, and improve patient outcomes. Dr. Rudasill will pursue a two-year research fellowship at the University of Washington (UW) free of clinical responsibilities under the mentorship of Dr. Farhood Farjah— National Cancer Institute funded thoracic surgeon-scientist and principal

investigator of the parent study. Her training goals are: 1) fulfill coursework leading to a Master of Science in Health Services Research and enroll in elective doctoral level courses at the UW School of Public Health; 2) conduct hypothesis-testing investigations addressing critical gaps in knowledge within the field of thoracic

oncology; 3) participate in mentored scientific and career development; and 4) develop a broad network of mentors and collaborators. She will be embedded within the infrastructure and research environment of an existing T32 training program at the UW Surgical Outcomes Research Center that has trained surgical

residents for 13-years. This structured, highly mentored, and diversely networked research training experience will facilitate Dr. Rudasill’s career goal of becoming an independently funded thoracic surgeon-scientist.