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Grant spurs lung cancer surgery research

Sep. 18, 2014, 10:25 AM

Joe B. (Bill) Putnam Jr., M.D., Ingram Professor of Cancer Research and chair of the Department of Thoracic Surgery, and colleague Felix Fernandez, M.D., assistant professor of Surgery, Emory University School of Medicine, Atlanta, have received a grant to investigate the most effective forms of surgery to treat lung cancer patients.

Joe B. (Bill) Putnam Jr., M.D.

The award from the Agency for Healthcare Research and Quality (AHRQ), a division of the U.S. Department of Health and Human Services, will provide $954,000 in funding over four years.

Lung cancer is the leading cause of cancer death among men and women in the United States, with an estimated 224,210 new cases and 159,260 deaths expected in 2014. In addition to the human toll from the disease, there is an economic burden of an estimated $12 billion in direct costs annually.

While most patients are diagnosed when their disease is at an advanced stage, surgery provides cure rates between 77 and 92 percent when the disease is found early.

However, there is a lack of information about what type of surgery is most effective, with the lowest complication rates, and the financial costs associated with different types of surgery.

The standard surgical approach to treating lung cancer involves a thoracotomy, a major invasive procedure that involves dividing chest wall muscles and spreading the ribs to remove portions of the diseased lung. However, surgeons are increasingly using the less invasive video assisted thoracic surgery (VATS), during which they make three or four small incisions and use a video camera to help find and remove the cancerous tissue.

VATS does not require rib spreading and is associated with fewer complications, less pain and shorter recovery periods.

“While we know that VATS has many post-surgical advantages in terms of pain and recovery time, it is not clear if this minimally invasive approach provides the same level of accuracy when it comes to identifying lymph nodes that may harbor cancerous cells,” said Putnam. “It is crucial that we identify metastatic lymph nodes to ensure that a patient has the best chance of surviving their cancer.”

There is also a gap in knowledge about the effectiveness of removing an entire lung lobe, versus partial lobe removal.

To help determine the effectiveness of different surgical approaches, the AHRQ research led by Putnam and Fernandez will study information from the Society of Thoracic Surgeons General Thoracic Surgery Database (GTSD) which includes patient-level clinical details not found in any other database.

That data will be linked with disease and mortality outcomes information from the Centers for Medicare and Medicaid Services (CMS).

This research is innovative because linkage of the STS-GTSD information with the largest national administrative database of the Centers for Medicaid Services will create a longitudinal data source that is well suited for comparative effectiveness studies in lung cancer surgery.

Putnam said it is crucial to determine the most effective treatment methods based on individual patient characteristics because high-risk patients with a lengthy smoking history are now being encouraged to undergo lung cancer screening.

“As a result of these new screening guidelines, we expect to see far more patients who may be surgical candidates and we need accurate information to guide us in developing treatment guidelines that produce superior cancer outcomes, as well as prudent use of health care resources,” said Putnam.

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