Practice Organization

Wm, Alberts; Bepler, Gerald; Hazelton, Todd R.; Jc, Ruckdeschel; Jh, Williams

doi:10.1378/chest.123.1_suppl.332s

Cited by 70 publications

(41 citation statements)

References 7 publications

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“…Documented reasons for not making a referral appear largely non-modifiable at the time of referral ( Figure 4); however, other complex systematic factors also likely contribute. Despite guidelines that assist primary care physicians in referring advanced lung cancer patients, therapeutic nihilism among primary care physicians might be persistent 21,[26][27][28] . A delay in diagnosis might also have contributed, because data suggest that, within the current Canadian infrastructure, wait time from abnormal imaging to diagnosis and treatment of lung cancer remains in excess of 60-90 days across the country [29][30][31][32] .…”

Section: Discussionmentioning

confidence: 99%

Reasons for Lack of Referral to Medical Oncology for Systemic Therapy in Stage Iv Non-small-cell Lung Cancer: Comparison of 2003–2006 with 2010–2011

Tudor

et al. 2017

Current Oncology

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Introduction Only approximately 25% of stage iv non-small-cell lung cancer (nsclc) patients receive systemic therapy. For such patients, we examined factors affecting referral to a cancer centre (cc) and to medical oncology (mo), and use of systemic therapy. were referred to a cc, with 22% and 23% receiving traditional chemotherapy (tctx). Referral to a cc or mo and use of tctx correlated with survival (p < 0.0001): The mos duration was 11.2 months in those receiving tctx and 1.0 months in those not referred to a cc. The overall mos duration was similar in the two cohorts (4.1 months vs. 3.9 months, p = 0.47). Major reasons for lack of referral to mo included poor functional status, rapid decline, and patient wish, which were similar to the reasons for forgoing tctx. In the two cohorts, 87 (9.4%) and 42 (7.5%) patients received epidermal growth factor inhibitors, with a mos duration of 16.2 months. Multivariable analysis showed that male sex [hazard ratio (hr): 1.16; p = 0.008] and pulmonary embolus (hr: 1.2; p = 0.002) correlated with worse survival. In contrast, receipt of chemotherapy (hr: 0.5; p < 0.001) and enrolment in a clinical trial (hr: 0.76; p = 0.049) correlated with better survival. Methods ConclusionsOur experience confirms that, over time, uptake of systemic therapy, including tctx and targeted therapy, changed little despite their established efficacy. Most of the factors limiting systemic therapy uptake appear to be non-modifiable at the time of referral. Rapid diagnosis and the availability of well-tolerated drugs for all nsclc patients will likely be the most important factors in increasing systemic therapy uptake in this population.

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Section: Discussionmentioning

confidence: 99%

Reasons for Lack of Referral to Medical Oncology for Systemic Therapy in Stage Iv Non-small-cell Lung Cancer: Comparison of 2003–2006 with 2010–2011

Tudor

et al. 2017

Current Oncology

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“…A multidisciplinary team approach involving both surgeons and oncologists in the care process may help to minimize such delay. 2 Overall, guideline-concordant appropriate care was only received by fewer than half of all patients. This proportion was higher than observed in one study (44.7%), 18 but lower than that reported in other previous studies (range: 52%-76%).…”

Section: Discussionmentioning

confidence: 99%

“…To that end, specific strategies for the management and treatment of lung cancer have been recommended in guidelines by the American College of Chest Physicians (ACCP), American Society for Clinical Oncology, National Cancer Institute (NCI), and others. [2][3][4][5][6][7] These guidelines ensure uniformity of care, and are thought to be capable of improving quality and appropriateness of care. Standards for timely lung cancer care also have been recommended through clinical opinion-based guidelines by the British Thoracic Society (BTS), the RAND Corporation, and by the ACCP.…”

Section: Introductionmentioning

confidence: 99%

Disparities in Lung Cancer Care and Outcomes among Elderly in a Medically Underserved State Population—A Cancer Registry-Linked Database Study

Nadpara

Madhavan

Tworek

2016

Population Health Management

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Despite availability of guidelines for lung cancer care, variations in lung cancer care among the elderly exist across the nation and are a cause for concern in rural and medically underserved areas. Therefore, the purpose of this study was to evaluate the patterns of lung cancer care and associated health outcomes among elderly residing in a rural and medically underserved area. The authors identified 1924 elderly lung cancer patients from the West Virginia Cancer Registry-Medicare linked database (2002)(2003)(2004)(2005)(2006)(2007) and categorized them by receipt of guideline-concordant (appropriate and timely) care using guidelines from the American College of Chest Physicians, British Thoracic Society, and the RAND Corporation. Hierarchical generalized logistic models were constructed to identify variables associated with receipt of guideline-concordant care. KaplanMeier analysis and log-rank test were used to compare 3-year survival outcomes. Multivariate Cox proportional hazards models were constructed to estimate lung cancer mortality risk associated with nonreceipt of guidelineconcordant care. Although guideline-concordant appropriate care was received by fewer than half of all patients (46.5%), of those receiving care, 78.7% received it in a timely manner. Delays in diagnosis and treatment varied significantly. Survival outcomes significantly improved with appropriate care (799 vs. 366 days; P £ 0.05), but did not improve with timely care. This study highlights the critical need to address disparities in receipt of guideline-concordant lung cancer care among the elderly residing in rural and medically underserved areas. Although lung cancer diagnostic and management services are covered under the Medicare program, underutilization of these services is a concern.

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“…1 The use of MDT may be particularly important for patients with thoracic malignancies. 2,3 However, research demonstrating the effectiveness of MDT in improving cancer outcomes is scarce. 1,4 One such study, which compared the treatment and survival of patients with inoperable non-small cell lung cancer (NSCLC) at a single institution treated before and after the introduction of a MDT, found an increase in the use of chemotherapy from 7% to 23% and an association with an increase in median survival from 3.2 to 6.6 months.…”

mentioning

confidence: 99%

The impact of case discussion at a multidisciplinary team meeting on the treatment and survival of patients with inoperable non‐small cell lung cancer

Bydder

Nowak

Marion³

et al. 2009

Internal Medicine Journal

116

126

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Patients with inoperable non-small cell lung cancer diagnosed and managed at a single institution over a one-year period were identified. Those whose case had been discussed at a multidisciplinary meeting had better survival than those whose case was not discussed (mean survival; 280 days vs. 205 days, log-rank P = 0.048).The management of patients with cancer is complex. Formal multidisciplinary team (MDT) meetings have been widely promoted to improve coordination, communication and decision making in cancer management.

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Practice Organization

Cited by 70 publications

References 7 publications

Reasons for Lack of Referral to Medical Oncology for Systemic Therapy in Stage Iv Non-small-cell Lung Cancer: Comparison of 2003–2006 with 2010–2011

Reasons for Lack of Referral to Medical Oncology for Systemic Therapy in Stage Iv Non-small-cell Lung Cancer: Comparison of 2003–2006 with 2010–2011

Disparities in Lung Cancer Care and Outcomes among Elderly in a Medically Underserved State Population—A Cancer Registry-Linked Database Study

The impact of case discussion at a multidisciplinary team meeting on the treatment and survival of patients with inoperable non‐small cell lung cancer

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