Prospective Comparative Effectiveness Trial of Multidisciplinary Lung Cancer Care Within a Community-Based Health Care System

Abstract

PURPOSE: Multidisciplinary lung cancer care is assumed to improve care delivery by increasing transparency, objectivity, and shared decision making; however, there is a lack of high-level evidence demonstrating its benefits, especially in community-based health care systems. We used implementation and team science principles to establish a colocated multidisciplinary lung cancer clinic in a large community-based health care system and evaluated patient experience and outcomes within and outside this clinic. METHODS: We conducted a prospective frequency-matched comparative effectiveness study (ClinicalTrials.gov identifier: NCT02123797 ) evaluating the thoroughness of lung cancer staging, receipt of stage-appropriate treatment, and survival between patients receiving care in the multidisciplinary clinic and those receiving usual serial care. Target enrollment was 150 patients on the multidisciplinary arm and 300 on the serial care arm. We frequency-matched patients by clinical stage, performance status, insurance type, race, and age. RESULTS: A total of 526 patients were enrolled: 178 on the multidisciplinary arm and 348 on the serial care arm. After adjusting for other factors, multidisciplinary patients had significantly higher odds (odds ratio [OR]: 2.3 [95% CI, 1.5 to 3.4]) of trimodality staging compared with serial care. Patients on the multidisciplinary arm also had higher odds of receiving invasive 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]). Additionally, patients receiving multidisciplinary care were significantly more likely to receive stage-appropriate treatment (OR: 1.8 [95% CI, 1.1 to 3.0]). We found no significant difference in overall or progression-free survival between study arms. CONCLUSION: The multidisciplinary clinic delivered significant improvements in evidence-based quality care on multiple levels. Even in the absence of a demonstrable survival benefit, these findings provide a strong rationale for recommending this model of care.

Program-Based Lung Cancer Care: A Prospective Observational Tumor Registry Linkage Study

“…We defined the MDC cohort strictly as patients whose care had been prospectively reviewed in a structured Multidisciplinary Thoracic Oncology Conference which we implemented with rigorous Team Science principles. 14 , 18 , 19 , 20 , 21 , 22 Only such patients were captured in the MDC database. Patients outside this structured program were categorized as non-program-based care recipients, irrespective of discussion in other forums within or outside BMHCC.…”

Improving the quality of patient care in lung cancer: key factors for successful multidisciplinary team working

“…Many advantages, and some disadvantages, are associated with the multidisciplinary meeting model [ 26 ]. MDTs can evaluate diagnostic and treatment options with a decision-making process more adherent to cancer guidelines [ 27 ] which could increase patient survival rates [ 1 ], although some authors demonstrated that improved care processes due to MDT activity do not necessarily result in better clinical outcomes [ 3 , 27 – 29 ]. MDTs also increase patient satisfaction and quality of life.…”

“…The literature describes three main approaches for lung cancer care: the sequential referral model, the multidisciplinary meeting model, and the multidisciplinary clinic model (Table 1) [2]. The difference depends on if multidisciplinary involvement is continuous throughout the patient pathway or whether it is fragmented or "on demand" [15].…”

“…Treatment of lung cancer patients is increasingly complex, because of the advanced treatment options and the large number of healthcare providers involved [ 1 ]. Additionally, continuous innovation in diagnostic, staging, and treatment options adds complexity to the problem of healthcare delivery [ 2 , 3 ] and multidisciplinary care (MDC) has been identified as a key factor in the provision of high-quality service for cancer patients [ 4 ]. Multidisciplinary team (MDT) meetings have become an indispensable component in oncology care [ 5 ] and MDC has been advocated in several international guidelines for lung cancer management in the USA [ 6 , 7 ], UK [ 8 ], Australia [ 9 ], and France [ 10 ].…”

Teams, Teaming, and Complex Systems in Cancer Care

“…Research has found that there is a premium on coordination with the core member(s) of a team 27 and among core team representatives in more complex MTS arrangements, such as AYA multidisciplinary teams (Wolfson), 28 main and community affiliate sites in the same health care system (Roberts). 29,30 Mechanisms such as the interoperability of health information technology 31 and dedicated program coordinators with integrated screening tools have shown promise (Fleege), 32 whereas the colocation of multidisciplinary care versus serial care (Majumdar, Smeltzer) 33,34 and other structural arrangements (O'Malley) 35 have yielded mixed results.…”