PS01.01 Treatment Planning in Non-Small Cell Lung Cancer shows Variable Utilization of Multidisciplinary Tumor Board Topic: Surgery

Publication Title

Journal of Thoracic Oncology

Document Type

Conference Proceeding

Publication Date

11-1-2017

Keywords

washington; swedish; swedish thoracic surgery

Abstract

Background

With competing treatment options for early stage non-small cell lung cancer (NSCLC), and controversies over patient selection and management of later stage disease, multidisciplinary tumor board (MDTB) is a critical decision-making forum for management plans. Studies encompassing several cancer domains have shown the benefit of MDTBs on operative mortality, 5-year survival, and patient satisfaction. We aimed to determine the timing and utilization of MDTBs, relative to the initiation of treatment, for patients with NSCLC within a large community healthcare system.

Methods

We reviewed cI-III patients who underwent work-up for primary NSCLC during 6/2013-6/2015 in a hospital network of 7 institutions. This network offers mature multidisciplinary care with dedicated thoracic oncologic services collaborating for formal, weekly MDTBs. Only patients who underwent oncologic treatment were included, and were stratified based on initial treatment type: surgical versus chemotherapy (CHT) and/or radiation therapy (RT). Stage was defined as clinical stage established prior to MDTB, or treatment initiation.

Results

We identified 203 patients; the figure depicts MDTB timing and utilization stratified by stage for each initial treatment type. Sixty seven percent (24/36) of cI patients did not have a MDTB prior to receiving stereotactic ablative radiotherapy (SABR). In addition, 33% (2/6) of the cIII patients did not receive a MDTB prior to surgical resection.

Conclusion

Variable utilization of MDTB was demonstrated for all clinical stages of NSCLC. In cI NSCLC where competing treatment options of surgery and SABR exist, less than half of the patients received multidisciplinary discussion. MDTB was also underutilized in cIII where treatment controversy exists. Although time constraints, referral patterns and provider bias challenge clinical practice, greater study and quality initiatives are necessary to ensure patients have access to MDTB discussion in the rapidly evolving landscape of NSCLC care.

Clinical Institute

Cancer

Specialty/Research Institute

Oncology

Specialty/Research Institute

Pulmonary Medicine

Specialty/Research Institute

Surgery

DOI

10.1016/j.jtho.2017.09.032

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