Five-year, $2.7 million grant could help determine best treatment for lung cancer patients

The goal: to improve the survival rates of patients with lung cancer.

The question the researchers want to answer: Are there new ways to determine the best treatment for these patients?

That’s what UW Medicine researchers hope to find out with a five-year, $2.7 million grant from the National Cancer Institute.

“Diagnostic tests have known error rates,” said Dr. Farhood Farjah, associate professor of surgery, Division of Cardiothoracic Surgery, and associate medical director of the Center for Surgical Outcomes Research at UW Medicine.

CT scans and PET scans both have false positives and false negatives, he said. So, if doctors rely solely on imaging, the stage of the cancer or determining the spread of the disease could be misclassified. This misclassification can inadvertently result in patients being provided with the wrong or less than optimal treatments, he said.

For example, understaging can lead to unnecessary surgery or missed chemotherapy. Exceeding can lead to unnecessary chemotherapy and the omission of surgery. Either can result in lower survival rates.

Biopsies of the lymph nodes in the chest can reduce these errors. But they can also have drawbacks, including false negatives and procedural risks such as a collapsed lung, Farjah said.

While there are guidelines that help clinicians determine when to do biopsies, the evidence “is admittedly weak,” he said.

“As well-intentioned as the guidelines are, many smart clinicians will question them and stray from them,” Farjah said. Still, some patients who need biopsies don’t get them when they’re needed, he said.

“The hallmark of clinical and scientific uncertainty is inexplicable variability in care,” he added.

When biopsies are needed, they help determine next steps for treatment, such as surgery, radiation therapy, and chemotherapy.

Farjah and other researchers believe the path to better diagnosis may lie in micro-statistical analysis with maximized safeguards to protect patient confidentiality. This would be performed on 4,000 lung cancer patient records from Kaiser Permanente in Northern California and the Marshfield Clinic in Wisconsin.

Other medical systems and universities participating in the research are the Medical University of South Carolina and the Kaiser Permanente Bernard J. Tyson School of Medicine.

Within UW Medicine, project collaborators include experts in thoracic surgery, pulmonary medicine, radiology, medical and radiation oncology, biostatistics, and health economics. Researchers look for trends in patient treatments, survival rates, and whether current treatment guidelines were followed.

The study will test a risk prediction model that estimates the likelihood that a patient actually has cancer that has spread to the lymph nodes. If found useful, this model could guide decisions about whether to perform a biopsy. The analytical tool will estimate the results under different treatment scenarios. Researchers will test whether this tool performs as well as current guidelines for predicting long-term survival while reducing the number of unnecessary biopsies. The study will also determine if the statistical model can accurately predict the best treatment options.

Where we can do better is by doing fewer procedures on people who will ultimately have no lymph node disease.”

Dr. Farhood Farjah, Associate Professor of Surgery, Division of Cardiothoracic Surgery, and Associate Medical Director of the Center for Surgical Outcomes Research at UW Medicine

“Getting the right treatment is the best strategy for getting the best outcomes,” he said, including long-term survival and good quality of life.

While advances in screening and treatments often receive national attention, getting cancer staged right “never feels like enough of a spotlight,” Farjah said.

“Sometimes the most important things in our lives are right in front of us,” he said. “We just don’t pay attention.”

The grant number for this National Cancer Institute-funded project is R01CA258351-01A1.

Some state lung cancer statistics: In Washington, 26% of patients are alive five years after being diagnosed with lung cancer, according to the American Lung Association, although early detection significantly increases that figure to 60%. According to the 2021 study, Asian Americans or Pacific Islanders in Washington are the least likely to be diagnosed early.

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