Medicine has certainly changed in the last several decades. We now have such an array of physician specialties and subspecialties that it's hard as physicians ourselves to keep the fields straight.
Given such diversity, how do you choose the best doctor to handle your care? Specifically, if you are planning on having lung cancer surgery, what type of surgeon should you see? Should it be a general surgeon, a thoracic surgeon, a cardiothoracic surgeon, or some other type of surgeon?
Is there a difference in quality, and, though it's hard to talk about in the same sentence as quality of cancer surgery, is there a difference in cost as well?
The answer, looking at a few studies, seems to be yes.
A new study looked at both quality and cost of lobectomy for non-small cell lung cancer, when performed by either a cardiothoracic surgeon or a general surgeon across a system of hospitals over a period of 5 years.
It was found that quality of care was significantly better, and costs lower for people who had lobectomies performed by the cardiothoracic surgeons. Differences were found in adherence to guidelines for staging and treatment, length of hospital stay for the patients, morbidity (sickness), and operative mortality (death related to the surgery.)
Another 2012 study found mortality rates to be significantly higher for lung cancer patients who had their procedures performed by a general surgeon than by either a general thoracic or cardiothoracic surgeon.
Previous studies have also found differences in outcomes with lung cancer based on specialty.
A 2009 study looking at 500,000 lung cancer surgeries performed between 1996 and 2005, found that the risk of death was lower, and the length of hospital stay shorter, when the procedures were performed by a thoracic surgeon rather than a general surgeon. Procedures performed by cardiac surgeons were also linked with lower mortality and shorter hospital stays. It was noted, however, that the majority of thoracic operations in the U.S. are not performed by thoracic surgeons, and differences may be related more to the volume of surgeries a surgeon performs than her surgical specialty.
A 2005 study was similar. Outcomes were better when lung cancer surgery was performed by the thoracic surgery specialists, but the difference may have been related as much to volume as to specialty. In fact, in another study looking only at volume of lung cancer surgeries performed by surgeons (low-volume vs high-volume surgeons), mortality was twice as high for medium-volume, and 2.7 times higher for low-volume surgeons, as it was for high volume surgeons.
It is important to remember that these studies talk about statistics and not individual surgeons. In real life with the individual patient it very well could be that a talented general surgeon who performs a high volume of lung cancer surgeries would have better outcomes than a thoracic surgeon who performs fewer procedures.
But for those who are uncertain where to begin after hearing that lung cancer surgery is the best treatment for their lung cancer, these studies suggest finding a surgeon who performs a high volume of lung cancer surgeries is a good start.
Photo: National Cancer Institute
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Freeman, R. et al. A comparison of quality and cost indicators by surgical specialty for lobectomy of the lung. Journal of Thoracic and Cardiovascular Surgery. 2012 Oct 8. (Epub ahead of print).
Goodney, P. et al. Surgeon specialty and operative mortality with lung resection. Annals of Surgery. 2005. 241(1):179-84.
Lien, Y., Huang, M., and H. Lin. Association between surgeon and hospital volume and in-hospital fatalities after lung cancer resections: the experience of an Asian country. Annals of Thoracic Surgery. 2007. 83(5):1837-43.
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von Meyenfeldt, E. et al. The relationship between volume or surgeon specialty and outcome in the surgical treatment of lung cancer: a systematic review and meta-analysis. Journal of Thoracic Oncology. 2012. 7(7):1170-8.