JTO Clinical and Research Reports (Aug 2021)

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

  • Meredith A. Ray, PhD,
  • Nicholas R. Faris, M. Div.,
  • Carrie Fehnel, BBA,
  • Anna Derrick, CTR,
  • Matthew P. Smeltzer, PhD,
  • Meghan B. Meadows-Taylor, PhD,
  • Folabi Ariganjoye, M.B.B.S.,
  • Alicia Pacheco, MHA,
  • Robert Optican, MD, FACR,
  • Keith Tonkin, MD,
  • Jeffrey Wright, MD, PhD, FCCP,
  • Roy Fox, MD,
  • Thomas Callahan, MD,
  • Edward T. Robbins, MD,
  • William Walsh, MD,
  • Philip Lammers, MD,
  • Shailesh Satpute, MD, PhD,
  • Raymond U. Osarogiagbon, M.B.B.S.

Journal volume & issue
Vol. 2, no. 8
p. 100203

Abstract

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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.

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