title: Thoroughness of mediastinal staging in stage IIIA non-small cell lung cancer.
abstract: BACKGROUND
  Guidelines recommend that patients with clinical stage IIIA non-small cell lung cancer (NSCLC) undergo histologic confirmation of pathologic lymph nodes. Studies have suggested that invasive mediastinal staging is underutilized, although practice patterns have not been rigorously evaluated.
  
  
  METHODS
  We used the Surveillance, Epidemiology, and End Results-Medicare database to identify patients with stage IIIA NSCLC diagnosed from 1998 through 2005. Invasive staging and use of positron emission tomography (PET) scanning were assessed using Medicare claims. Multivariable logistic regression was used to identify patient characteristics associated with use of invasive staging.
  
  
  RESULTS
  Of 7583 stage IIIA NSCLC patients, 1678 (22%) underwent invasive staging. Patients who received curative intent cancer treatment were more likely to undergo invasive staging than patients who did not receive cancer-specific therapy (30% versus 9.8%, adjusted odds ratio, 3.31; 95% confidence interval, 2.78-3.95). The oldest patients (age, 85-94 years) were less likely to receive invasive staging than the youngest (age, 67-69 years; 27.6% versus 11.9%; odds ratio, 0.46; 95% confidence interval, 0.34-0.61). Sex, marital status, income, and race were not associated with the use of the invasive staging. The use of invasive staging was stable throughout the study period, despite an increase in the use of PET scanning from less than 10% of patients before 2000 to almost 70% in 2005.
  
  
  CONCLUSIONS
  Nearly 80% of Medicare beneficiaries with stage IIIA NSCLC do not receive guideline adherent mediastinal staging; this failure cannot be entirely explained by patient factors or a reliance on PET imaging. Incentives to encourage use of invasive staging may improve care.
authors: Department of Internal Medicine, Section of Pulmonary and Critical Care Medicine, Yale Comprehensive Cancer Center, New Haven, Connecticut, USA. michael.vest@yale.edu
authors: Michael T
authors: MT
authors: Vest
authors: Lynn
authors: L
authors: Tanoue
authors: Pamela R
authors: PR
authors: Soulos
authors: Anthony W
authors: AW
authors: Kim
authors: Frank
authors: F
authors: Detterbeck
authors: Daniel
authors: D
authors: Morgensztern
authors: Cary P
authors: CP
authors: Gross
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle / Q000706:statistics & numerical data; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology* / Q000628:therapy; D015331:Cohort Studies; D015897:Comorbidity; D016001:Confidence Intervals; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology* / Q000628:therapy; D008198:Lymph Nodes / Q000473:pathology*; D008481:Mediastinoscopy / Q000706:statistics & numerical data; D008482:Mediastinum; D006278:Medicare / Q000706:statistics & numerical data; D015999:Multivariate Analysis; D009367:Neoplasm Staging / Q000379:methods / Q000706:statistics & numerical data* / Q000639:trends; D016017:Odds Ratio; D049268:Positron-Emission Tomography / Q000706:statistics & numerical data / Q000639:trends; D018426:SEER Program / Q000706:statistics & numerical data; D016019:Survival Analysis; D014481:United States