Enhanced recovery after thoracic surgery is associated with improved adjuvant chemotherapy completion for non-small cell lung cancer.

OBJECTIVE

Enhanced recovery after surgery integrates multiple evidence-based interventions to accelerate postoperative recovery. We hypothesized that enhanced recovery after surgery would also facilitate adjuvant chemotherapy for non-small cell lung cancer.

METHODS

An enhanced recovery after surgery pathway was implemented at a single institution, starting with a transitional rollout in 2012 and full rollout in 2015. Patients with clinical stage I or II non-small cell lung cancer without induction therapy and who were pathologic nodal positive or had 5-cm or larger tumor size were selected for analysis. Dates analyzed were pre-enhanced recovery after surgery (2006-2011), transitional (2012-8/2015), and enhanced recovery after surgery (9/2015-2017). Interrupted time series was used to analyze trends in time to receive adjuvant chemotherapy after resection by era. Logistic regression was used to determine factors associated with receiving 4 or more cycles of adjuvant chemotherapy.

RESULTS

A total of 471 patients were identified. The interval between lung resection and commencing adjuvant chemotherapy was progressively shorter after the transition era (P = .041). The rate of receiving adjuvant chemotherapy progressively increased (from 40% pre-enhanced recovery after surgery, to 50% transition era, to 62% enhanced recovery after surgery era, P < .001). Multivariable regression revealed the enhanced recovery after surgery era (odds ratio, 3.6, P < .001), the transitional era (odds ratio, 2.01, P = .007), pN status, tumor grade and histology, age, and preoperative performance status were associated with completing adjuvant therapy. The surgical approach, whether open or thoracoscopic, was not associated with completing adjuvant chemotherapy.

CONCLUSIONS

Enhanced recovery after surgery was associated with facilitated delivery of adjuvant chemotherapy, with a shortened interval to receive adjuvant chemotherapy and a higher rate of receiving 4 or more cycles.