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

Autor:	Ray MA; Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, Tennessee., Faris NR; Thoracic Oncology Research Group, Baptist Cancer Center, Memphis, Tennessee., Fehnel C; Thoracic Oncology Research Group, Baptist Cancer Center, Memphis, Tennessee., Derrick A; Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee., Smeltzer MP; Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, Tennessee., Meadows-Taylor MB; Thoracic Oncology Research Group, Baptist Cancer Center, Memphis, Tennessee., Ariganjoye F; Thoracic Oncology Research Group, Baptist Cancer Center, Memphis, Tennessee., Pacheco A; Thoracic Oncology Research Group, Baptist Cancer Center, Memphis, Tennessee., Optican R; Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee.; Mid-South Imaging and Therapeutics, Memphis, Tennessee., Tonkin K; Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee.; Mid-South Imaging and Therapeutics, Memphis, Tennessee., Wright J; Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee.; Memphis Lung Physicians, Memphis, Tennessee., Fox R; Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee.; Mid-South Pulmonary Specialists, Memphis, Tennessee., Callahan T; Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee.; Trumbull Laboratories, LLC, Memphis, Tennessee., Robbins ET; Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee., Walsh W; Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee., Lammers P; Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee., Satpute S; Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee., Osarogiagbon RU; Thoracic Oncology Research Group, Baptist Cancer Center, Memphis, Tennessee.; Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee.
Jazyk:	angličtina
Zdroj:	JTO clinical and research reports [JTO Clin Res Rep] 2021 Jul 03; Vol. 2 (8), pp. 100203. Date of Electronic Publication: 2021 Jul 03 (Print Publication: 2021).
DOI:	10.1016/j.jtocrr.2021.100203
Abstrakt:	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. (© 2021 The Authors.)
Databáze:	MEDLINE
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