Adherence to Posttreatment Surveillance Guidelines in Non–Small Cell Lung Cancer: Retrospective Cohort Study
Notice bibliographique
Résumé
Background: Several guidelines recommend posttreatment surveillance for non-small cell lung cancer (NSCLC). However, studies evaluating surveillance patterns often cannot distinguish between imaging ordered for surveillance versus for symptoms suggestive of recurrence. Moreover, early recurrences and other competing events hamper efforts to determine true surveillance rates because of wide variability in reported guideline adherence in clinical practice. Leveraging comprehensive Veterans Health Administration data, we developed a novel competing risks framework to describe the patterns and predictors of NSCLC imaging surveillance. Objective: This study aims to examine posttreatment surveillance to estimate the true surveillance rates and predictors of guideline-concordant care in patients with early-stage NSCLC. Methods: The study cohort comprised veterans who were treated for stage 1 to 3 NSCLC between 2008 and 2016 and who survived for ≥6 months. Clinical documents and radiology reports were abstracted for image indication and clinical information. We estimated the cumulative probability of receiving guideline-concordant surveillance, defined as chest computed tomography imaging within 4 to 9 months after treatment, accounting for competing risks and censoring. Multivariable cause-specific Cox regression was used to estimate associations between patient factors and guideline-concordant surveillance, with adjustments made for multiple comparisons. Results: The cohort consisted of 1888 patients. The mean age of the analysis cohort was 66.4 (SD 7.9) years; 95.9% (1811/1888) of the patients were male, 71.1% (1342/1888) of the patients were White, and 43.1% (814/1888) were married. Of the 1888 patients, 57% (n=1076) presented with stage 1 disease, and the most common treatment modality was surgery alone (n=1068, 56.6%). The most common type of imaging performed during the initial 120- to 270-day window was chest computed tomography (1460/3278, 44.5%). Chest X-rays accounted for 36.3% (1190/3278) of all imaging performed, while the remaining 11.8% (386/3278) and 7.4% (242/3278) were positron emission tomography scans or other imaging modalities, respectively. Compared to the years 2008 to 2010, patients treated for NSCLC from 2014 to 2016 had a significantly higher likelihood of receiving guideline-concordant surveillance (hazard ratio 1.42, P<.001). Conclusions: In this unique application of a competing risks framework, the rate of guideline-concordant surveillance in this national cohort was lower than that reported in many previous studies. This finding highlights a potentially substantial gap in surveillance among eligible, asymptomatic lung cancer survivors. More strategies are needed to measure the true rate of guideline-concordant surveillance, along with education and advocacy to ensure guideline-concordant care.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».