Multidisciplinary Care Outshines Serial Care in Patients With Newly Diagnosed Lung Cancer
In a prospective effectiveness trial, care delivered to patients with lung cancer using a multidisciplinary model was compared with care delivered at a traditional serial care model.
A prospective effectiveness trial (NCT02123797) that compared the care delivered to patients with lung cancer at a colocated multidisciplinary model with the care delivered at a traditional serial care model in a community-based health care system revealed significantly more staging and delivery of guideline-concordant treatment in the multidisciplinary model.
Smeltzer et al1 established a colocated multidisciplinary thoracic oncology clinic with a large community-based health care system within Baptist Memorial Health Care Corporation in Memphis, Tennessee, and measured patient experience and outcomes of care within and outside this clinic. Care was provided and patients were evaluated jointly by a thoracic surgeon, medical oncologist, and radiation oncologist, with active radiologist support.
Newly diagnosed patients with lung cancer were evaluated in the multidisciplinary clinic and hierarchically matched with patients who received care within the same health care system without evaluation in the clinic in a 1:2 ratio. Of the 1150 potentially eligible patients, 526 were enrolled in the trial: 178 in the multidisciplinary arm and 348 in the serial care arm.
Three patients who initially consented to be enrolled in the serial care arm crossed over to the multidisciplinary arm. The investigators noted that because this was not a randomized study and crossover occurred before treatment, these patients were analyzed in the multidisciplinary arm.
Patients received bimodality staging 90% of the time in the multidisciplinary arm compared with 77% in the serial care arm (P = .0004). The investigators also reported that trimodality staging in the multidisciplinary arm (56%) was significantly higher than in the serial care arm (38%; P < .0001). The investigators noted that multimodality staging has been associated with better OS in a population-based analysis.2
Sixty-one percent of patients treated in the multidisciplinary care clinic received invasive stage confirmation compared with 48% in the serial care clinic (odds ratio, 2.0; 94% CI, 1.4-3.1).
When investigators adjusted for matching strata, age, sex, and histology, patients who received multidisciplinary care were more likely to receive stage- appropriate treatment (OR, 1.8; 95% CI, 1.1-3.0; FIGURE1). Turning to overall survival (OS), the investigators reported a 3-year OS of 35% in the multidisciplinary arm (95% CI, 28%-42%) compared with 36% in the serial arm (95% CI, 31%-41%; P = .74).
Seventy-eight percent of patients (139 of 178) progressed or died in the multidisciplinary arm vs 79% (274 of 348) in the serial care arm.
The investigators noted a number of limitations with the study. For example, despite being the largest comparative effectiveness study of multidisciplinary care to date, patients were not randomly assigned. The serial care experience in the study may not be typical of serial care that is delivered in the greater health care system. Also, because the colocated clinic was set up in a hospital-based facility, some patients were unable to receive care in the multidisciplinary clinic because of out-of-network restrictions, so their multidisciplinary care providers enrolled them in the serial care arm. Finally, this single-institution study may not be generalizable to other settings.
The investigators anticipate reporting on patient and caregiver outcomes in the future. They concluded that although multidisciplinary lung cancer treatment is widely recommended, high-quality evidence remains difficult to obtain.
REFERENCES
Smeltzer MP, Ray MA, Faris NR, et al. Prospective comparative effectiveness trial of multidisciplinary lung cancer care within a community-based health care system. JCO Oncol Pract. 2023;19(1):e15-e24. doi:10.1200/OP.21.00815
Farjah F, Flum DR, Ramsey SD, Heagerty PJ, Symons RG, Wood DE. Multi-modality mediastinal staging for lung cancer among Medicare beneficiaries. J Thorac Oncol. 2009;4(3):355-363. doi:10.1097/JTO.0b013e318197f4d9
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