| Autor: |
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. |
| Jazyk: |
angličtina |
| Rok vydání: |
2021 |
| Předmět: |
|
| Zdroj: |
JTO Clinical and Research Reports, Vol 2, Iss 8, Pp 100203- (2021) |
| Druh dokumentu: |
article |
| ISSN: |
2666-3643 |
| DOI: |
10.1016/j.jtocrr.2021.100203 |
| Popis: |
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. |
| Databáze: |
Directory of Open Access Journals |
| Externí odkaz: |
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