Perspectives on Commission on Cancer Standard 5.8 on Lung Cancer: A Qualitative Study

In 2021, the Commission on Cancer implemented Standard 5.8, which requires that lymph nodes be sampled from ≥1 hilar and ≥3 different mediastinal lymph node stations for all curative-intent lung cancer resections. While 80% compliance is expected of all Commission on Cancer-accredited hospitals, recent data illustrates only half of sites are currently meeting criteria. We evaluated perceived barriers and facilitators in implementing Standard 5.8.

In this multicenter qualitative study, 20 semistructured interviews were conducted across academic and community-based institutions. We interviewed key stakeholders, including thoracic surgeons, pathologists, operating room staff, a cancer liaison physician, and clinical data analysts. Thematic analysis was facilitated by the tailored implementation for chronic disease checklist.

Themes were mapped to six tailored implementation for chronic disease domains. Most participants felt the guideline was not burdensome and did not alter their clinical practices. Although many agreed that a minimum threshold for lymph node evaluation should exist, some participants were uncertain of the supporting evidence and identified potential technical and clinical barriers to implementation. Interdisciplinary collaboration was a key facilitator to compliance, as well as alignment with professional society guidelines. Higher compliance rates were thought to be driven by increased monitoring and performance feedback, in addition to departmental leadership and support.

Mixed opinions regarding Standard 5.8 align with currently low national compliance rates. Participants emphasized the need for additional evidence to support the standard, underscoring the importance of future prospective studies. Support for strong interdisciplinary communication, regularly scheduled feedback, endorsement by cardiothoracic societies and departmental leadership may improve compliance.