CHEST Guidelines-Still-Guideline-Discordant-After-All-These-Years

Still-Guideline-Discordant-After-All-These-Years_c

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In "Still Guideline-Discordant After All These Years," Dr. Farhood Farjah discusses a study by Dr. Ost and colleagues, who analyzed cancer registry data linked to Medicare claims to evaluate lung cancer diagnosis and staging. Their research highlighted that less than half of the patients received guideline-concordant care, which is linked to fewer adverse events and a quicker start to treatment. Despite increases in guideline-concordant staging, issues remain due to EBUS's diagnostic variabilities and the inherent limitations of data sources like SEER, which does not provide details on whether the staging was pathologic or clinical. This limitation hinders accurate identification of patients who need invasive staging.<br /><br />Another challenge in the field is differentiating between complications from surgical staging and those from surgical therapy, as seen in cases where pulmonary resection leads to more significant morbidity. This makes assessing procedure-associated adverse events complex and potentially misleading.<br /><br />Farjah emphasizes that variations in healthcare practices often correlate more with clinician preferences than with evidence-based guidelines, reflecting gaps in the underpinning evidence. This leads to underutilization of invasive staging, as many clinicians feel guidelines overly recommend it. Efforts to promote high-quality lung cancer staging pursue standardization through initiatives by organizations such as the ACCP, Society of Thoracic Surgeons, and the National Lung Cancer Roundtable.<br /><br />The piece underscores the tension between guidelines, clinician judgment, and patient outcomes in lung cancer staging and diagnosis, advocating for data enhancements to address existing research gaps and for utilizing Dr. Ost's study insights as a resource to understand staging impact on patient outcomes.

Keywords

lung cancer

guideline-concordant care

EBUS

SEER data limitations

invasive staging

surgical complications

clinician preferences

evidence-based guidelines

ACCP

patient outcomes