Lung Cancer.pdf

82 Y. De Jesus and G.L. Walsh
Chapter Overview
Over the past decade, many health care institutions have developed and
implemented clinical practice guidelines and clinical pathways as a means
of standardizing patient care and managing costs while preserving the
quality of services delivered. A clinical practice guideline is a framework
for treating a specific disease entity and includes all treatment modalities
supported by the medical literature, current practice standards, and expert
opinion. Guidelines are often presented in the form of flowcharts.
Clinical pathways are detailed, step-by-step descriptions of how to deliver
the various treatments that form a practice guideline.
At M.D. Anderson Cancer Center, guidelines and pathways are used to
guide care for patients with non–small cell lung cancer and small cell lung
cancer. Use of these tools has enabled us to standardize our approach to
patient care, analyze differences in patient outcomes between physicians,
and discover where current practice patterns need to be changed. Guidelines
and pathways also serve as valuable educational tools for residents
and fellows training at our institution and help to optimize trainees’ clinical
practice behavior, leading to optimal patient care with minimal unnecessary
laboratory and radiographic testing.
Introduction
More than 180,000 patients will be diagnosed with lung cancer in 2002,
and nearly 85% of these patients will ultimately die of their disease. The
initial evaluation, clinical staging, and treatment of these patients must
be conducted in a structured and cost-effective manner to ensure that
optimum care is delivered with the most efficacious use of health care resources.
Over the past decade, the expansion in managed care coverage
has put health care institutions increasingly under pressure to monitor
costs while preserving the quality of their services. Many facilities have
accomplished this by developing and implementing evidence-based
tools such as clinical practice guidelines and clinical pathways. The purpose
of using these evidence-based tools is to enhance, manage, and
evaluate patient care while maintaining appropriate outcomes using a
cost-effective approach. Clinical practice guidelines and clinical pathways
have proven to be highly effective for managing patient populations
with varying medical and oncologic diagnoses and different stages
of disease.
This chapter will describe our collective efforts at M.D. Anderson Cancer
Center in the development and implementation of guidelines for evaluating
and treating patients with lung cancer. We will describe our pathway
for pulmonary resection to illustrate how pathways can streamline
the daily care of patients who undergo thoracic surgery.