Survival Impact of an Enhanced Multidisciplinary Thoracic Oncology Conference in a Regional Community Health Care System

JTO Clinical and Research Reports

Edward T. Robbins, MD¹  Roy Fox, MD²  Keith Tonkin, MD²  Philip Lammers, MD³  Raymond U. Osarogiagbon, M.B.B.S.⁴  Meredith A. Ray, PhD⁵  Matthew P. Smeltzer, PhD⁵  William Walsh, MD⁶  Jeffrey Wright, MD, PhD, FCCP⁶  Thomas Callahan, MD⁶  Robert Optican, MD, FACR⁶  Anna Derrick, CTR⁶  Shailesh Satpute, MD, PhD⁶  Folabi Ariganjoye, M.B.B.S.⁷  Alicia Pacheco, MHA⁷  Nicholas R. Faris, M. Div.⁷  Meghan B. Meadows-Taylor, PhD⁷  Carrie Fehnel, BBA⁷ 

[1] Memphis Lung Physicians, Memphis, Tennessee;Mid-South Imaging and Therapeutics, Memphis, Tennessee;Mid-South Pulmonary Specialists, Memphis, Tennessee;Trumbull Laboratories, LLC, Memphis, Tennessee;Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, Tennessee;Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee;Thoracic Oncology Research Group, Baptist Cancer Center, Memphis, Tennessee;

关键词: Multidisciplinary care;    Multidisciplinary Thoracic Oncology Conference;    Outcomes;    Quality of care;    Guideline-concordant treatment;    Survival;   

DOI  :  

来源: DOAJ

【 摘 要 】

Introduction: We compared NSCLC treatment and survival within and outside a multidisciplinary model of care from a large community health care system. Methods: We implemented a rigorously benchmarked “enhanced” Multidisciplinary Thoracic Oncology Conference (eMTOC) and used Tumor Registry data (2011–2017) to evaluate guideline-concordant care. Because eMTOC was located in metropolitan Memphis, we separated non-MTOC patient by metropolitan and regional location. We categorized National Comprehensive Cancer Network guideline-concordant treatment as “preferred,” or “appropriate” (allowable under certain circumstances). We compared demographic and clinical characteristics across cohorts using chi-square tests and survival using Cox regression, adjusted for multiple testing. We also performed propensity-matched and adjusted survival analyses. Results: Of 6259 patients, 14% were in eMTOC, 55% metropolitan non-MTOC, and 31% regional non-MTOC cohorts. eMTOC had the highest rates of African Americans (34% versus 28% versus 22%), stages I to IIIB (63 versus 40 versus 50), urban residents (81 versus 78 versus 20), stage-preferred treatment (66 versus 57 versus 48), guideline-concordant treatment (78 versus 70 versus 63), and lowest percentage of nontreatment (6 versus 21 versus 28); all p values were less than 0.001. Compared with eMTOC, hazard for death was higher in metropolitan (1.5, 95% confidence interval: 1.4–1.7) and regional (1.7, 1.5–1.9) non-MTOC; hazards were higher in regional non-MTOC versus metropolitan (1.1, 1.0–1.2); all p values were less than 0.05 after adjustment. Results were generally similar after propensity analysis with and without adjusting for guideline-concordant treatment. Conclusions: Multidisciplinary NSCLC care planning was associated with significantly higher rates of guideline-concordant care and survival, providing evidence for rigorous implementation of this model of care.

【 授权许可】

Unknown