# Optimizing treatment decisions and quality-adjusted life years through improved lung cancer staging

> **NIH NIH F32** · MASSACHUSETTS GENERAL HOSPITAL · 2024 · $81,256

## Abstract

PROJECT SUMMARY
The number of patients with potentially curable, stage I-III non-small cell lung cancer (NSCLC) is increasing,
and appropriate treatment selection depends upon the extent of cancer spread to lymph nodes. Two lymph
node biopsy procedures—endobronchial ultrasound guided transbronchial node aspiration (EBUS) and
mediastinoscopy—have equivalent ability to detect the presence of lymph node metastases, but they have not
been compared in their ability to detect the extent of cancer spread or differentially influence quality-adjusted
life years. The extent of cancer spread influences treatment decisions, which in turn impact patient outcomes.
Since EBUS and mediastinoscopy can both access the same mediastinal lymph nodes, but EBUS can also
biopsy hilar lymph nodes, EBUS is hypothesized to have greater potential to change treatment decisions (Aim
I). EBUS is also hypothesized to be associated with higher quality-adjusted life years because it has greater
potential to change treatment decisions and it is associated with fewer risks compared to mediastinoscopy
(Aim II). Aim I will leverage an ongoing cohort study with granular data on ~2,200 patients with stage I-III
NSCLC who underwent EBUS or mediastinoscopy in two Cancer Research Network health care systems
(R01CA258352). Trained clinicians will abstract granular data from radiology, biopsy, and pathology reports.
Aim II will leverage patient-level data from Aim I, the literature, and primary data collection of health utilities
associated with treatment changes in response to staging and procedure-related complications to simulate
trials using a published risk-benefit framework based on decision analytic modelling. Findings from this study
will harmonize disparate national practice guidelines for first-line biopsy procedures, direct quality improvement
initiatives, and motivate trials comparing patient-centered outcomes. This line of investigation is expected to
reduce diagnostic errors, optimize treatment selection, and improve patient outcomes. Dr. Rudasill will pursue
a two-year research fellowship at the University of Washington (UW) free of clinical responsibilities under the
mentorship of Dr. Farhood Farjah— National Cancer Institute funded thoracic surgeon-scientist and principal
investigator of the parent study. Her training goals are: 1) fulfill coursework leading to a Master of Science in
Health Services Research and enroll in elective doctoral level courses at the UW School of Public Health; 2)
conduct hypothesis-testing investigations addressing critical gaps in knowledge within the field of thoracic
oncology; 3) participate in mentored scientific and career development; and 4) develop a broad network of
mentors and collaborators. She will be embedded within the infrastructure and research environment of an
existing T32 training program at the UW Surgical Outcomes Research Center that has trained surgical
residents for 13 years. This structured, highly mentored, and diversely ...

## Key facts

- **NIH application ID:** 10899827
- **Project number:** 1F32CA290759-01
- **Recipient organization:** MASSACHUSETTS GENERAL HOSPITAL
- **Principal Investigator:** Sarah Elizabeth Rudasill
- **Activity code:** F32 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $81,256
- **Award type:** 1
- **Project period:** 2024-07-01 → 2026-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10899827

## Citation

> US National Institutes of Health, RePORTER application 10899827, Optimizing treatment decisions and quality-adjusted life years through improved lung cancer staging (1F32CA290759-01). Retrieved via AI Analytics 2026-05-28 from https://api.ai-analytics.org/grant/nih/10899827. Licensed CC0.

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