Variation Between Multidisciplinary Tumor Boards in Clinical Staging and Treatment Recommendations for Patients With Locally Advanced Non-small Cell Lung Cancer

Hoeijmakers, Fieke; Heineman, David J.; Daniëls, Hans; Beck, Naomi; Tollenaar, Rob A.E.M.; Wouters, Michel W.J.M.; Mheen, P.J. Marang-van de; Schreurs, Wilhelmina H.; Barlo, Nicole P.; Hoppe, Bart P.C.; Jacobs, Wouter; Cornelissen, Robin; Janssen, JP; Smulders, Sietske A.; Claessens, Niels; Westeinde, Susan C. van 't; Rutgers, S.R.; Schramel, Franz M.N.H.

doi:10.1016/j.chest.2020.07.054

Cited by 20 publications

(12 citation statements)

References 25 publications

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“…In NSCLC, precise diagnosis and adequate staging are essential to ensure uniform allocation to the best treatment strategy, but these parameters may differ among MDTs. In 2020, Dutch investigators showed a high grade of variability in T and N staging and treatment recommendation in a series of 110 patients with stage IIIA NSCLC among MDTs in different hospitals [30]. Agreement on clinical staging and treatment recommendations was rated using Randolph's free-marginal multi-rater kappa as a chance-adjusted index.…”

Section: Stage III Nsclc: a Mtb Paradigmmentioning

confidence: 99%

Virtual Multidisciplinary Tumor Boards: A Narrative Review Focused on Lung Cancer

Gebbia

Guarini

Piazza³

et al. 2021

Pulm Ther

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To date, the virtual multidisciplinary tumor boards (vMTBs) are increasingly used to achieve high-quality treatment recommendations across health-care regions, which expands and develops the local MTB team to a regional or national expert network. This review describes the process of lung cancer-specific MTBs and the transition process from face-to-face tumor boards to virtual ones. The review also focuses on the project organization's description, advantages, and disadvantages. Semi-structured interviews identified five major themes for MTBs: current practice, attitudes, enablers, barriers, and benefits for the MTB. MTB teams exhibited positive responses to modeled data feedback. Virtualization reduces time spent for travel, allowing easier and timely patient discussions. This process requires a secure web platform to assure the respect of patients' privacy and presents the same unanswered prob-

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Section: Stage III Nsclc: a Mtb Paradigmmentioning

confidence: 99%

Virtual Multidisciplinary Tumor Boards: A Narrative Review Focused on Lung Cancer

Gebbia

Guarini

Piazza³

et al. 2021

Pulm Ther

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“…A notable strength of our analysis is the access to all patient records and the written MDT deliberations for each patient. An important study limitation is the fact that treatment recommendation for stage III NSCLC may vary considerably between Dutch MDTs, 21 making our findings less representative for Dutch national practice. In addition, full capture of all eligible patients was ensured using both Netherlands Cancer Registry data and hospital records, but we cannot exclude the possibility that some cases of stage III NSCLC might have been missed, such as patients who may not have been staged appropriately or who were not registered in the Netherlands Cancer Registry or MDT notes.…”

Section: Discussionmentioning

confidence: 85%

The Impact of the Availability of Immunotherapy on Patterns of Care in Stage III NSCLC: A Dutch Multicenter Analysis

Ronden

Claessens

Barlo

et al. 2021

JTO Clinical and Research Reports

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Introduction Treatment patterns in stage III NSCLC can vary considerably between countries. The PACIFIC trial reported improvements in progression-free and overall survival with adjuvant durvalumab after concurrent chemoradiotherapy (CCRT). We studied treatment decision-making by three Dutch regional thoracic multidisciplinary tumor boards between 2015 and 2019, to identify changes in practice when adjuvant durvalumab became available. Methods Details of patients presenting with stage III NSCLC were retrospectively collected. Both CCRT and multimodality schemes incorporating planned surgery were defined as being radical-intent treatment (RIT). Results Of 855 eligible patients, most (95%) were discussed at a thoracic multidisciplinary tumor board, which recommended a RIT in 63% (n = 510). Only 52% (n = 424) of the patients finally received a RIT. Predictors for not recommending RIT were age greater than or equal to 70 years, WHO performance score greater than or equal to 2, Charlson comorbidity index greater than or equal to 2 (excluding age), forced expiratory volume in 1 second less than 80% of predicted value, N3 disease, and period of diagnosis. Between 2015 to 2017 and 2018 to 2019, the proportion of patients undergoing CCRT increased from 34% to 42% ( p = 0.02) and use of sequential chemoradiotherapy declined (21%–16%, p = 0.05). Rates of early toxicity and 1-year mortality were comparable for both periods. After 2018, 57% of the patients who underwent CCRT (90 of 159) received adjuvant durvalumab. Conclusions After publication of the PACIFIC trial, a significant increase was observed in the use of CCRT for patients with stage III NSCLC with rates of early toxicity and mortality being unchanged. Since 2018, 57% of the patients undergoing CCRT went on to receive adjuvant durvalumab. Nevertheless, approximately half of the patients were still considered unfit for a RIT.

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“…With this in mind, it is reasonable to assume that outcomes reflect the composition and expertise of the treatment team. For example, a recent study showed considerable variation in clinical staging and treatment recommendation among multidisciplinary tumor boards (MTB), largely attributable to T-staging, in particular in patients with locally advanced lung cancer, which is the case for most SST patients [29]. The input of experienced and knowledgeable clinicians during MTB discussions is important, especially when deciding things like the feasibility and usefulness of an extensive operation after multi-modal induction treatment [30].…”

Section: Discussionmentioning

confidence: 99%

A nationwide population-based cohort study of surgical care for patients with superior sulcus tumors: Results from the Dutch Lung Cancer Audit for Surgery (DLCA-S)

Winkelman¹,

Woude²,

Heineman³

et al. 2021

Lung Cancer

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Data on national patterns of care for patients with superior sulcus tumors (SST) is currently lacking. We investigated the distribution of surgical care and outcome for patients with SST in the Netherlands. Material and methods: Data was retrieved from the Dutch Lung Cancer Audit for Surgery (DLCA-S) for all patients undergoing resection for clinical stage IIB-IV SST from 2012 to 2019. Because DLCA-S is not linked to survival data, survival for a separate cohort (2015)(2016)(2017) was obtained from the Netherlands Cancer Registry (NCR). Results: In the study period, 181 patients had SST surgery, representing 1.03% (181/17488) of all lung cancer pulmonary resections. For 2015-2017, the SST resection rate was 14.4% (79/549), and patients with stage IIB/III SST treated with trimodality had a 3-year overall survival of 67.4%. 63.5% of patients were male, and median age was 60 years. Almost 3/4 of tumors were right sided. Surgery was performed in 20 hospitals, with average number of annual resections ranging from ≤ 1 (n = 17) to 9 (n = 1). 39.8% of resections were performed in 1 center and 63.5% in the 3 most active centers. 12.7% of resections were extended (e.g. vertebral resection). 85.1% of resections were complete (R0). Morbidity and 30-day mortality were 51.4% and 3.3% respectively. Despite treating patients with a higher ECOG performance score and more extended resections, the highest volume center had rates of morbidity/mortality, and length of hospital stay that were comparable to those of the medium volume (n = 2) and low-volume centers (n = 1). Conclusion: In the Netherlands, surgery for SST accounts for about 1% of all lung cancer pulmonary resections, the number of SST resections/hospital/year varies widely, with most centers performing an average of ≤ 1/year. Morbidity and mortality are acceptable and survival compares favourably with the literature. Although further centralisation is possible, it is unknown whether this will improve outcomes.

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Variation Between Multidisciplinary Tumor Boards in Clinical Staging and Treatment Recommendations for Patients With Locally Advanced Non-small Cell Lung Cancer

Cited by 20 publications

References 25 publications

Virtual Multidisciplinary Tumor Boards: A Narrative Review Focused on Lung Cancer

Virtual Multidisciplinary Tumor Boards: A Narrative Review Focused on Lung Cancer

The Impact of the Availability of Immunotherapy on Patterns of Care in Stage III NSCLC: A Dutch Multicenter Analysis

A nationwide population-based cohort study of surgical care for patients with superior sulcus tumors: Results from the Dutch Lung Cancer Audit for Surgery (DLCA-S)

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