Grant Number:	5R01CA172253-08 Interpret this number
Primary Investigator:	Osarogiagbon, Raymond
Organization:	Baptist Memorial Hospital - Tipton
Project Title:	Improving Pathologic Nodal Staging of Resected Lung Cancer
Fiscal Year:	2020

More than half of the 60,000 individuals who undergo surgery for lung cancer in the US each year die of lung cancer within 5 years. Although whether, or not, cancer has spread to their lymph nodes is the strongest predictor of survival in this population, 46% of patients with no lymph node metastasis die within 5 years. We have shown the existence of a gap between recommended lymph node examination of lung cancer and actual practice. In our existing grant, R01 CA 172253, we successfully deployed routine use of a lymph node specimen collection kit to improve the quality of lymph node collection during surgery. We now want to extend this quality improvement work to overcome the demonstrated inadvertent discarding of most cancer-containing lymph nodes present within lung resection specimens. Indeed 29% of all patients and 12% of patients ‘without nodal metastasis’ have discarded lymph nodes involved with cancer. Such patients have a much higher than expected death rate within 3 years. We conservatively estimate that 4800 – 6200 lives would be saved annually if we raised the quality of pathologic nodal staging to achieve the 5-year survival rates of Japanese patients. We have developed an improved method of retrieving lymph nodes within the lungs and now want to study the process of implementing this new method in a diverse group of 8 community-based pathology practices working within 13 hospitals in 7 different healthcare systems in 5 contiguous Dartmouth Hospital Referral Regions in 3 states with the highest US lung cancer mortality rates: North MS, Eastern AR, Western TN. From our prior work, we hypothesize that successful implementation of this novel pathology gross dissection process will eliminate the practice of mistakenly discarding lymph nodes without examination. Our objective is to study the process of implementing this practice change in a diverse group of pathology practices as a step toward future national and international dissemination. We propose to achieve this through the following Specific Aims: 1.) Train pathology staff on our novel lung dissection protocol using a stepped-wedge cluster study design; 2.) Use the RE-AIM framework to study the implementation process; 3.) Perform a cost- effectiveness analysis of the new method. Our study will demonstrate the practical possibility of significantly improving lung cancer patients’ long-term survival by accurately sorting them into risk groups for various levels of post-operative management; generate new knowledge about contextual factors that influence the spread of new, improved clinical care standards; and help institutions learn how to achieve evidence-based quality guidelines for staging lung cancer. Our ultimate goal is to improve lung cancer patients’ survival by improving their placement into correct risk categories, so that those at residually high risk can be identified and given the life-saving treatments they need. 1




Rurality, Stage-Stratified Use of Treatment Modalities, and Survival of Non-small Cell Lung Cancer.
Authors: Ray M.A. , Faris N.R. , Derrick A. , Smeltzer M.P. , Osarogiagbon R.U. .
Source: Chest, 2020 Aug; 158(2), p. 787-796.
EPub date: 2020-05-06.
PMID: 32387525
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Beyond Margin Status: Population-Based Validation of the Proposed International Association for the Study of Lung Cancer Residual Tumor Classification Recategorization.
Authors: Osarogiagbon R.U. , Faris N.R. , Stevens W. , Fehnel C. , Houston-Harris C. , Ojeabulu P. , Akinbobola O.A. , Lee Y.S. , Ray M.A. , Smeltzer M.P. .
Source: Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, 2020 03; 15(3), p. 371-382.
EPub date: 2019-11-26.
PMID: 31783180
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County-Level Variations in Receipt of Surgery for Early-Stage Non-small Cell Lung Cancer in the United States.
Authors: Sineshaw H.M. , Sahar L. , Osarogiagbon R.U. , Flanders W.D. , Yabroff K.R. , Jemal A. .
Source: Chest, 2020 01; 157(1), p. 212-222.
EPub date: 2019-12-05.
PMID: 31813533
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Invasive mediastinal staging for resected non-small cell lung cancer in a population-based cohort.
Authors: Osarogiagbon R.U. , Lee Y.S. , Faris N.R. , Ray M.A. , Ojeabulu P.O. , Smeltzer M.P. .
Source: The Journal of thoracic and cardiovascular surgery, 2019 10; 158(4), p. 1220-1229.e2.
EPub date: 2019-05-02.
PMID: 31147169
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Early-Stage NSCLC: Advances in Thoracic Oncology 2018.
Authors: Osarogiagbon R.U. , Veronesi G. , Fang W. , Ekman S. , Suda K. , Aerts J.G. , Donington J. .
Source: Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, 2019 06; 14(6), p. 968-978.
EPub date: 2019-03-07.
PMID: 30851441
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Survival Before and After Direct Surgical Quality Feedback in a Population-Based Lung Cancer Cohort.
Authors: Smeltzer M.P. , Faris N.R. , Ray M.A. , Fehnel C. , Houston-Harris C. , Ojeabulu P. , Akinbobola O. , Lee Y.S. , Meadows M. , Signore R.S. , et al. .
Source: The Annals of thoracic surgery, 2019 05; 107(5), p. 1487-1493.
EPub date: 2018-12-27.
PMID: 30594579
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Effectiveness of Implemented Interventions on Pathologic Nodal Staging of Non-Small Cell Lung Cancer.
Authors: Ray M.A. , Faris N.R. , Smeltzer M.P. , Fehnel C. , Houston-Harris C. , Levy P. , Wiggins L. , Sachdev V. , Robbins T. , Spencer D. , et al. .
Source: The Annals of thoracic surgery, 2018 07; 106(1), p. 228-234.
EPub date: 2018-03-11.
PMID: 29534956
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Risk-Adjusted Margin Positivity Rate as a Surgical Quality Metric for Non-Small Cell Lung Cancer.
Authors: Lin C.C. , Smeltzer M.P. , Jemal A. , Osarogiagbon R.U. .
Source: The Annals of thoracic surgery, 2017 Oct; 104(4), p. 1161-1170.
EPub date: 2017-07-12.
PMID: 28709665
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Survival impact of postoperative therapy modalities according to margin status in non-small cell lung cancer patients in the United States.
Authors: Smeltzer M.P. , Lin C.C. , Kong F.S. , Jemal A. , Osarogiagbon R.U. .
Source: The Journal of thoracic and cardiovascular surgery, 2017 08; 154(2), p. 661-672.e10.
EPub date: 2017-04-04.
PMID: 28483267
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Comparison of Prevalence and Types of Mutations in Lung Cancers Among Black and White Populations.
Authors: Campbell J.D. , Lathan C. , Sholl L. , Ducar M. , Vega M. , Sunkavalli A. , Lin L. , Hanna M. , Schubert L. , Thorner A. , et al. .
Source: JAMA oncology, 2017-06-01; 3(6), p. 801-809.
PMID: 28114446
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Prognostic Value of National Comprehensive Cancer Network Lung Cancer Resection Quality Criteria.
Authors: Osarogiagbon R.U. , Ray M.A. , Faris N.R. , Smeltzer M.P. , Fehnel C. , Houston-Harris C. , Signore R.S. , McHugh L.M. , Levy P. , Wiggins L. , et al. .
Source: The Annals of thoracic surgery, 2017 May; 103(5), p. 1557-1565.
EPub date: 2017-03-31.
PMID: 28366464
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Evolution in the Surgical Care of Patients With Non-Small Cell Lung Cancer in the Mid-South Quality of Surgical Resection Cohort.
Authors: Faris N.R. , Smeltzer M.P. , Lu F. , Fehnel C.L. , Chakraborty N. , Houston-Harris C.L. , Robbins E.T. , Signore R.S. , McHugh L.M. , Wolf B.A. , et al. .
Source: Seminars in thoracic and cardiovascular surgery, 2017 Spring; 29(1), p. 91-101.
EPub date: 2016-10-14.
PMID: 28684006
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Strategic approach to minimally invasive mediastinal nodal staging-a brave new world?
Authors: Osarogiagbon R.U. .
Source: The Lancet. Respiratory medicine, 2016 12; 4(12), p. 926-927.
EPub date: 2016-10-20.
PMID: 27773664
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Comment on the Proposals for the Revision of the N Descriptors in the Forthcoming Eighth Edition of the TNM Classification for Lung Cancer.
Authors: Osarogiagbon R.U. , Smeltzer M.P. , Faris N. , Rami-Porta R. , Goldstraw P. , Asamura H. .
Source: Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, 2016 10; 11(10), p. 1612-4.
PMID: 27663398
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Improving post-resection risk stratification in non-small cell lung cancer: 'wit, whither wander you?'
Authors: Osarogiagbon R.U. .
Source: Journal of thoracic disease, 2016 Sep; 8(9), p. 2315-2318.
PMID: 27746964
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Missed Intrapulmonary Lymph Node Metastasis and Survival After Resection of Non-Small Cell Lung Cancer.
Authors: Smeltzer M.P. , Faris N. , Yu X. , Ramirez R.A. , Ramirez L.E. , Wang C.G. , Adair C. , Berry A. , Osarogiagbon R.U. .
Source: The Annals of thoracic surgery, 2016 Aug; 102(2), p. 448-53.
EPub date: 2016-06-03.
PMID: 27266421
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Survival Implications of Variation in the Thoroughness of Pathologic Lymph Node Examination in American College of Surgeons Oncology Group Z0030 (Alliance).
Authors: Osarogiagbon R.U. , Decker P.A. , Ballman K. , Wigle D. , Allen M.S. , Darling G.E. .
Source: The Annals of thoracic surgery, 2016 Aug; 102(2), p. 363-9.
EPub date: 2016-06-02.
PMID: 27262908
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Prevalence, Prognostic Implications, and Survival Modulators of Incompletely Resected Non-Small Cell Lung Cancer in the U.S. National Cancer Data Base.
Authors: Osarogiagbon R.U. , Lin C.C. , Smeltzer M.P. , Jemal A. .
Source: Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, 2016 Jan; 11(1), p. e5-16.
PMID: 26762752
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Enhancing the Evidence for Behavioral Counseling: A Perspective From the Society of Behavioral Medicine.
Authors: Alcántara C. , Klesges L.M. , Resnicow K. , Stone A. , Davidson K.W. .
Source: American journal of preventive medicine, 2015 Sep; 49(3 Suppl 2), p. S184-93.
PMID: 26296553
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Improving the pathologic evaluation of lung cancer resection specimens.
Authors: Osarogiagbon R.U. , Hilsenbeck H.L. , Sales E.W. , Berry A. , Jarrett R.W. , Giampapa C.S. , Finch-Cruz C.N. , Spencer D. .
Source: Translational lung cancer research, 2015 Aug; 4(4), p. 432-7.
PMID: 26380184
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Improving lung cancer outcomes by improving the quality of surgical care.
Authors: Osarogiagbon R.U. , D'Amico T.A. .
Source: Translational lung cancer research, 2015 Aug; 4(4), p. 424-31.
PMID: 26380183
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Measuring improvement in populations: implementing and evaluating successful change in lung cancer care.
Authors: Yu X. , Klesges L.M. , Smeltzer M.P. , Osarogiagbon R.U. .
Source: Translational lung cancer research, 2015 Aug; 4(4), p. 373-84.
PMID: 26380178
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Editorial preface to this special issue "Improving the quality and outcomes of lung cancer care: an interdisciplinary approach".
Authors: Osarogiagbon R.U. .
Source: Translational lung cancer research, 2015 Aug; 4(4), p. 322-6.
PMID: 26380173
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Innovations in public health education: promoting professional development and a culture of health.
Authors: Levy M. , Gentry D. , Klesges L.M. .
Source: American journal of public health, 2015 Mar; 105 Suppl 1, p. S44-5.
PMID: 25706016
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Audit of lymphadenectomy in lung cancer resections using a specimen collection kit and checklist.
Authors: Osarogiagbon R.U. , Sareen S. , Eke R. , Yu X. , McHugh L.M. , Kernstine K.H. , Putnam J.B. , Robbins E.T. .
Source: The Annals of thoracic surgery, 2015 Feb; 99(2), p. 421-7.
EPub date: 2014-12-19.
PMID: 25530090
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The impact of a novel lung gross dissection protocol on intrapulmonary lymph node retrieval from lung cancer resection specimens.
Authors: Osarogiagbon R.U. , Eke R. , Sareen S. , Leary C. , Coleman L. , Faris N. , Yu X. , Spencer D. .
Source: Annals of diagnostic pathology, 2014 Aug; 18(4), p. 220-6.
EPub date: 2014-04-26.
PMID: 24866232
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Size and histologic characteristics of lymph node material retrieved from tissue discarded after routine pathologic examination of lung cancer resection specimens.
Authors: Osarogiagbon R.U. , Ramirez R.A. , Wang C.G. , Miller L.E. , McHugh L. , Adair C.A. , Smeltzer M.P. , Yu X. , Berry A. .
Source: Annals of diagnostic pathology, 2014 Jun; 18(3), p. 136-9.
EPub date: 2014-02-10.
PMID: 24636044
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Number of lymph nodes associated with maximal reduction of long-term mortality risk in pathologic node-negative non-small cell lung cancer.
Authors: Osarogiagbon R.U. , Ogbata O. , Yu X. .
Source: The Annals of thoracic surgery, 2014 Feb; 97(2), p. 385-93.
EPub date: 2013-11-20.
PMID: 24266949
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