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.