Trends in the pattern of care for lung cancer and their correlation with new clinical evidence: experiences in a university-affiliated medical center.
The authors surveyed the pattern of care (POC) of lung cancer (LC) using data on 4565 patients from the cancer registry of their university-affiliated hospital institution for the period of 1991 to 2002. New clinical evidence was retrieved from the citations used in the level 1 recommendations in guidelines and textbooks. Using this evidence, indexes (1-6) were chosen, including stage I to II non-small-cell LC (NSCLC): no adjuvant radiotherapy (ART; I); stage III NSCLC: equivocal ART (II), neoadjuvant chemotherapy (C/T; III), and chemoradiotherapy (CRT; IV); stage 4 NSCLC: C/T (V) and limited-stage small-cell LC: CRT (VI). Odds ratios of these index events in the postevidence period versus preevidence period were calculated to show trends in the POC. Trends in the POC were consistent with new clinical evidence with statistical significance. The age and gender adjustment odds ratio was 2.22 to 7.06 for beneficial indexes (3-6) and 0.12 to 0.4 for detrimental indexes (1-2).
Chien
Chun-Ru
CR
Institute of Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
Lai
Mei-Shu
MS
D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D004059:Diffusion of Innovation; D019983:Guideline Adherence; D006785:Hospitals, University; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'