{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T04:52:13Z","timestamp":1781067133957,"version":"3.54.1"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T00:00:00Z","timestamp":1761868800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000738","name":"United States Department of Veterans Affairs","doi-asserted-by":"publisher","award":["#1I01HX002475-01A2"],"award-info":[{"award-number":["#1I01HX002475-01A2"]}],"id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000738","name":"United States Department of Veterans Affairs","doi-asserted-by":"publisher","award":["5T32HL007776-25"],"award-info":[{"award-number":["5T32HL007776-25"]}],"id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Stanley Iezman and Nancy Stark Endowment for Thoracic Radiation Oncology Research"},{"DOI":"10.13039\/100000738","name":"Department of Veterans Affairs","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"NIH","doi-asserted-by":"publisher","award":["5T32HL007776-25"],"award-info":[{"award-number":["5T32HL007776-25"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"NIH","doi-asserted-by":"publisher","award":["1 I01 HX002475-01A2"],"award-info":[{"award-number":["1 I01 HX002475-01A2"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Stanley Iezman and Nancy Stark Endowment for Thoracic Radiation Oncology Research"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,11,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Comprehensive, multidisciplinary care is crucial for managing early-stage non-small cell lung cancer (NSCLC), typically treated via lung resection or stereotactic body radiation therapy (SBRT). We evaluated how variable access to on-site SBRT may be associated with clinical outcomes for patients with stage I NSCLC receiving surgical resection within an integrated health-care system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a retrospective cohort study of patients with stage I NSCLC treated with lung resection at Veterans Health Administration (VHA) facilities between 2006 and 2016. The VHA provides thoracic surgery at approximately 100 facilities, whereas lung SBRT is currently available at approximately 20 facilities. We compared short- and long-term outcomes for patients treated at surgery-only facilities vs those at facilities offering surgery and SBRT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We identified 6289 patients undergoing lung resection, with 4673 (74.3%) treated at surgery-only sites and 1616 (25.7%) at surgery + SBRT sites. Sociodemographic factors were similar between cohorts. Surgery + SBRT sites showed higher adherence to operative quality metrics and improved patient selection. Short-term outcomes were better at surgery + SBRT sites with lower rates of 30-day major complications, 30-day mortality, and 90-day mortality. With a median follow-up of 6.3\u2009years, 5-year overall survival was higher at surgery + SBRT sites (59.4% vs 56.9%; adjusted hazard ratio 1.12, 95% CI = 1.02 to 1.23).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Short- and long-term outcomes were better for patients with stage I NSCLC who underwent lung resection at facilities delivering thoracic surgery and SBRT. These findings support recommendations to increase SBRT availability at medical centers offering lung resection to ensure comprehensive multidisciplinary care is provided.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jncics\/pkaf104","type":"journal-article","created":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T12:46:00Z","timestamp":1761655560000},"source":"Crossref","is-referenced-by-count":0,"title":["Availability of multidisciplinary treatment modalities and outcomes among patients with resected early-stage non-small cell lung cancer"],"prefix":"10.1093","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0116-7377","authenticated-orcid":false,"given":"Brendan T","family":"Heiden","sequence":"first","affiliation":[{"name":"Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine , St. Louis, MO,","place":["United States"]},{"name":"VA St Louis Health Care System , St. Louis, MO,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9819-2159","authenticated-orcid":false,"suffix":"Jr.","given":"Daniel B","family":"Eaton","sequence":"additional","affiliation":[{"name":"VA St Louis Health Care System , St. Louis, MO,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9764-7414","authenticated-orcid":false,"given":"Jatinder","family":"Palta","sequence":"additional","affiliation":[{"name":"National Radiation Oncology Program, Veterans Health Administration , Washington, DC,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5872-9556","authenticated-orcid":false,"given":"Su-Hsin","family":"Chang","sequence":"additional","affiliation":[{"name":"VA St Louis Health Care System , St. Louis, MO,","place":["United States"]},{"name":"Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine , St. Louis, MO,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Yan","sequence":"additional","affiliation":[{"name":"VA St Louis Health Care System , St. Louis, MO,","place":["United States"]},{"name":"Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine , St. Louis, MO,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4523-0147","authenticated-orcid":false,"given":"Ana A","family":"Baumann","sequence":"additional","affiliation":[{"name":"Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine , St. Louis, MO,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theodore S","family":"Thomas","sequence":"additional","affiliation":[{"name":"VA St Louis Health Care System , St. Louis, MO,","place":["United States"]},{"name":"Division of Oncology, Washington University School of Medicine , St. Louis, MO,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6388-5553","authenticated-orcid":false,"given":"Martin W","family":"Schoen","sequence":"additional","affiliation":[{"name":"VA St Louis Health Care System , St. Louis, MO,","place":["United States"]},{"name":"Division of Hematology and Medical Oncology, Department of Internal Medicine, Saint Louis University School of Medicine , St. Louis, MO,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0904-6692","authenticated-orcid":false,"given":"Steven","family":"Tohmasi","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine , St. Louis, MO,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5218-0902","authenticated-orcid":false,"given":"Nikki","family":"Rossetti","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine , St. Louis, MO,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-9413-318X","authenticated-orcid":false,"given":"Mayank R","family":"Patel","sequence":"additional","affiliation":[{"name":"VA St Louis Health Care System , St. Louis, MO,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Kreisel","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine , St. Louis, MO,","place":["United States"]},{"name":"VA St Louis Health Care System , St. Louis, MO,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5685-9445","authenticated-orcid":false,"given":"Ruben G","family":"Nava","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine , St. Louis, MO,","place":["United States"]},{"name":"VA St Louis Health Care System , St. Louis, MO,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2720-0312","authenticated-orcid":false,"given":"Bryan F","family":"Meyers","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine , St. Louis, MO,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin D","family":"Kozower","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine , St. Louis, MO,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Varun","family":"Puri","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine , St. Louis, MO,","place":["United States"]},{"name":"VA St Louis Health Care System , St. Louis, MO,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5129-2184","authenticated-orcid":false,"given":"Drew","family":"Moghanaki","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, University of California Los Angeles , Los Angeles, CA,","place":["United States"]},{"name":"Radiation Oncology Service, VA Greater Los Angeles Medical Center , Los Angeles, CA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,10,31]]},"reference":[{"key":"2025120911280539800_pkaf104-B1","doi-asserted-by":"publisher","first-page":"e634","DOI":"10.1097\/SLA.0000000000005725","article-title":"Development and validation of the VA Lung Cancer Mortality (VALCAN-M) score for 90-day mortality following surgical treatment of clinical stage I lung cancer","volume":"278","author":"Heiden","year":"2023","journal-title":"Ann Surg"},{"key":"2025120911280539800_pkaf104-B2","doi-asserted-by":"publisher","first-page":"e235","DOI":"10.1016\/j.cllc.2020.04.017","article-title":"Oncologic outcomes of surgery versus SBRT for non\u2013small-cell lung carcinoma: a systematic review and meta-analysis","volume":"22","author":"Ijsseldijk","year":"2021","journal-title":"Clin Lung Cancer"},{"key":"2025120911280539800_pkaf104-B3","first-page":"18S","article-title":"The availability of advanced radiation oncology technology within the Veterans Health Administration radiation oncology centers","volume":"33","author":"Dawson","year":"2016","journal-title":"Fed Pract"},{"key":"2025120911280539800_pkaf104-B4","doi-asserted-by":"publisher","first-page":"1236","DOI":"10.7205\/MILMED-D-13-00342","article-title":"Non-VA primary care providers\u2019 perspectives on comanagement for rural veterans","volume":"179","author":"Gaglioti","year":"2014","journal-title":"Mil Med"},{"key":"2025120911280539800_pkaf104-B5","doi-asserted-by":"publisher","first-page":"471","DOI":"10.1016\/j.jtcvs.2022.07.030","article-title":"Impact of stereotactic body radiation therapy volume on surgical patient selection, short-term survival, and long-term survival in early-stage non\u2013small cell lung cancer","volume":"165","author":"Till","year":"2023","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2025120911280539800_pkaf104-B6","doi-asserted-by":"publisher","first-page":"833","DOI":"10.1016\/j.chest.2021.11.004","article-title":"Surgical outcomes for early stage non-small cell lung cancer at facilities with stereotactic body radiation therapy programs","volume":"161","author":"Syed","year":"2022","journal-title":"Chest"},{"key":"2025120911280539800_pkaf104-B7","doi-asserted-by":"publisher","first-page":"768","DOI":"10.1001\/jamasurg.2018.0504","article-title":"Practical guide to surgical data sets: Veterans Affairs Surgical Quality Improvement Program (VASQIP)","volume":"153","author":"Massarweh","year":"2018","journal-title":"JAMA Surg"},{"key":"2025120911280539800_pkaf104-B8","author":"Heiden","year":"2023"},{"key":"2025120911280539800_pkaf104-B9","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtho.2022.08.009","article-title":"Assessment of updated commission on cancer guidelines for intraoperative lymph node sampling in early-stage NSCLC","author":"Heiden","year":"2022","journal-title":"J Thorac Oncol."},{"key":"2025120911280539800_pkaf104-B10","doi-asserted-by":"publisher","first-page":"e2111613","DOI":"10.1001\/jamanetworkopen.2021.11613","article-title":"Analysis of delayed surgical treatment and oncologic outcomes in clinical stage I non\u2013small cell lung cancer","volume":"4","author":"Heiden","year":"2021","journal-title":"JAMA Netw Open"},{"key":"2025120911280539800_pkaf104-B11","doi-asserted-by":"publisher","first-page":"e664","DOI":"10.1097\/SLA.0000000000004928","article-title":"Comparison between veteran and non-veteran populations with clinical Stage I non-small cell lung cancer undergoing surgery","volume":"277","author":"Heiden","year":"2023","journal-title":"Ann Surg"},{"key":"2025120911280539800_pkaf104-B12","doi-asserted-by":"publisher","first-page":"1810","DOI":"10.1016\/j.athoracsur.2022.05.047","article-title":"Access to care metrics in stage I lung cancer: improved access is associated with improved survival","volume":"114","author":"Heiden","year":"2022","journal-title":"Ann Thorac Surg"},{"key":"2025120911280539800_pkaf104-B13","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1093\/jnci\/djac208","article-title":"Association between imaging surveillance frequency and outcomes following surgical treatment of early-stage lung cancer","volume":"115","author":"Heiden","year":"2023","journal-title":"J Natl Cancer Inst"},{"key":"2025120911280539800_pkaf104-B14","doi-asserted-by":"publisher","first-page":"920","DOI":"10.1016\/j.chest.2022.03.045","article-title":"Racial disparities in the surgical treatment of clinical stage I non-small cell lung cancer among veterans","volume":"162","author":"Heiden","year":"2022","journal-title":"Chest"},{"key":"2025120911280539800_pkaf104-B15","doi-asserted-by":"publisher","first-page":"1687","DOI":"10.1016\/j.chest.2021.12.634","article-title":"The impact of persistent smoking after surgery on long-term outcomes following stage I non-small cell lung cancer resection","volume":"161","author":"Heiden","year":"2022","journal-title":"Chest"},{"key":"2025120911280539800_pkaf104-B16","doi-asserted-by":"crossref","first-page":"e933","DOI":"10.1097\/SLA.0000000000005312","article-title":"Assessment of duration of smoking cessation prior to surgical treatment of non-small cell lung cancer","volume":"277","author":"Heiden","year":"2023","journal-title":"Ann Surg"},{"key":"2025120911280539800_pkaf104-B17","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1001\/jamasurg.2022.6826","article-title":"Association between surgical quality metric adherence and overall survival among US veterans with early-stage non-small cell lung cancer","volume":"158","author":"Heiden","year":"2023","journal-title":"JAMA Surg"},{"key":"2025120911280539800_pkaf104-B18","author":"National Comprehensive Cancer Network"},{"key":"2025120911280539800_pkaf104-B19","doi-asserted-by":"publisher","first-page":"392","DOI":"10.1016\/j.athoracsur.2021.03.017","article-title":"Impact of a thoracic multidisciplinary conference on lung cancer outcomes","volume":"113","author":"Gaudioso","year":"2022","journal-title":"Ann Thorac Surg"},{"key":"2025120911280539800_pkaf104-B20","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1186\/S12913-020-4930-3","article-title":"The impact of tumor board on cancer care: evidence from an umbrella review","volume":"20","author":"Specchia","year":"2020","journal-title":"BMC Health Serv Res"},{"key":"2025120911280539800_pkaf104-B21","doi-asserted-by":"publisher","first-page":"5086","DOI":"10.21037\/JTD-24-508\/PRF","article-title":"Effectiveness of multi-disciplinary team management on 5-year overall survival for patients with stage III lung cancer","volume":"16","author":"Valsecchi","year":"2024","journal-title":"J Thorac Dis"},{"key":"2025120911280539800_pkaf104-B22","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1200\/OP.22.00475","article-title":"Stereotactic body radiotherapy for the management of early-stage non\u2013small-cell lung cancer: a clinical overview","volume":"19","author":"Buchberger","year":"2023","journal-title":"J Clin Oncol Oncol Pract"},{"key":"2025120911280539800_pkaf104-B23","doi-asserted-by":"publisher","first-page":"1033","DOI":"10.1200\/JCO.21.02875","article-title":"Keeping a safe distance from surgical volume standards","volume":"40","author":"Heiden","year":"2022","journal-title":"J Clin Oncol"},{"key":"2025120911280539800_pkaf104-B24","doi-asserted-by":"publisher","first-page":"1067","DOI":"10.1016\/j.chest.2025.05.001","article-title":"Practice patterns and patient travel distances for lung cancer surgery in the United States: analyses of the Veterans Health Administration and the national cancer database","volume":"168","author":"Tohmasi","year":"2025","journal-title":"Chest."},{"key":"2025120911280539800_pkaf104-B25","year":"2019"},{"key":"2025120911280539800_pkaf104-B26","doi-asserted-by":"publisher","first-page":"S8","DOI":"10.12788\/FP.0308","article-title":"Consensus statement supporting the presence of onsite radiation oncology departments at VHA medical centers","volume":"39","author":"Gutt","year":"2022","journal-title":"Fed Pract"}],"container-title":["JNCI Cancer Spectrum"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jncics\/advance-article-pdf\/doi\/10.1093\/jncics\/pkaf104\/65050279\/pkaf104.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jncics\/article-pdf\/9\/6\/pkaf104\/65050279\/pkaf104.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jncics\/article-pdf\/9\/6\/pkaf104\/65050279\/pkaf104.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T16:28:16Z","timestamp":1765297696000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jncics\/article\/doi\/10.1093\/jncics\/pkaf104\/8307536"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,31]]},"references-count":26,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025,11,3]]}},"URL":"https:\/\/doi.org\/10.1093\/jncics\/pkaf104","relation":{},"ISSN":["2515-5091"],"issn-type":[{"value":"2515-5091","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,12]]},"published":{"date-parts":[[2025,10,31]]},"article-number":"pkaf104"}}