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Evaluating Multidisciplinary Care Among Patients With Lung Cancer Treated in a Community-Based Health Care System
Multidisciplinary lung cancer care is thought to improve delivery of care by increasing transparency, objectivity, and shared decision-making and oversight of care. “The inherent complexity of lung cancer care delivery and the well-described variation in quality and outcomes have led to a near-universal call for multidisciplinary engagement in routine care delivery,” wrote Matthew Smeltzer, PhD, Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, and colleagues.
However, they noted, high-quality evidence of the benefits of multidisciplinary care is lacking, particularly in community-based healthcare systems, where 85% of patients with lung cancer receive care. Dr Smeltzer and team established a multidisciplinary lung cancer clinic in a large, community-based healthcare system and conducted a prospective, comparative-effectiveness study to evaluate patients’ experiences with and outcomes of clinic care (JCO Oncol Pract. 2022; Published online May 24. doi:10.1200/OP.21.00815).
“The multidisciplinary clinic delivered significant improvements in evidence-based quality care on multiple levels,” wrote Dr Smeltzer and colleagues. “Multidisciplinary care provided significantly more thorough staging and delivery of guideline-concordant treatment.”
The researchers co-located the clinic within Memphis’s Baptist Memorial Healthcare Corporation, which serves 111 counties in 6 Southern states with some of the highest lung cancer mortality rates in the United States. At the weekly clinic, patients with lung cancer were jointly evaluated by a thoracic surgeon, medical oncologist, and radiation oncologist who were actively supported by a radiologist. In addition, the cases of all clinic patients were later discussed at weekly conferences in which as many as 14 key specialists participated.
Evaluations compared the thoroughness of lung cancer staging, receipt of stage-appropriate treatment, and survival outcomes between patients cared for in the multidisciplinary clinic and those who received the usual care.
The researchers enrolled 526 patients in the study: 178 in the multidisciplinary arm, and 348 in the serial care arm. They also frequency-matched patients by age, race, stage, performance status, and type of insurance.
Using these methods, the researchers found that patients in the multidisciplinary arm had greater odds of receiving trimodality staging than those in the usual care arm (odds ratio [OR], 2.3, 95% confidence interval [CI], 1.5 to 3.4). Those in the multidisciplinary arm also had greater odds of receiving invasive, histologic stage confirmation (OR, 2.0; 95% CI, 1.4 to 3.1) and mediastinal stage confirmation (OR, 1.9; 95% CI, 1.3 to 2.8) than those in the usual care arm.
Patients in the multidisciplinary arm were also more likely to receive stage-appropriate treatment than those in the usual care arm (OR, 1.8; 95% CI 1.1 to 3.0). However, overall survival and progression-free survival did not differ between study arms.
“Further studies are needed to robustly investigate the survival impact of multidisciplinary care,” the researchers acknowledged. “Nevertheless, we provide strong evidence for recommending this model of care for lung cancer on the basis of significant improvements in the rates of attainment of survival-impactful process benchmarks of quality and concordance with evidence-based guidelines,” they concluded.
