Multiple evidence-based therapies are combined in Enhanced Recovery After Surgery to speed up postoperative recovery. Researchers expected improved post-surgery recovery would make adjuvant treatment for non–small cell lung cancer easier. Starting with a transitional rollout in 2012 and a complete rollout in 2015, a single institution developed an enhanced recovery after surgery pathway. Patients with non–small cell lung cancer in clinical stages I or II who had not received induction therapy and were pathologic nodal positive or had a tumor size of 5 cm or larger were included in the study. Pre-improved recovery after surgery (2006-2011), transitional (2012-8/2015), and enhanced recovery after surgery (9/2015-2017) were the periods studied. Trends in time to get adjuvant chemotherapy after resection were analyzed using interrupted time series by era. The researchers used logistic regression to find the factors linked to receiving four or more cycles of adjuvant chemotherapy. They found a total of 471 patients. After the changeover era, the time between lung resection and the start of adjuvant treatment became increasingly shorter (P =.041). Adjuvant chemotherapy was given to a higher percentage of patients (from 40% pre-improved recovery after surgery to 50% transition era, to 62% enhanced recovery after surgery, P < .001).
Multivariable regression revealed that completing adjuvant therapy was linked with the accelerated recovery after surgery era (odds ratio, 3.6, P < .001), the transitional period (odds ratio, 2.01, P =.007), pN status, tumor grade and histology, age, and preoperative performance status. Whether open or thoracoscopic, the surgical method had little bearing on whether or not adjuvant chemotherapy was completed. With a shorter delay between adjuvant chemotherapy treatments and a higher incidence of receiving four or more cycles, improved recovery after surgery was linked to easier delivery of adjuvant chemotherapy.