Title

Prospective Comparative Effectiveness Trial of Multidisciplinary Lung Cancer Care Within a Community-Based Health Care System

Authors

Matthew P. Smeltzer, Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN.
Meredith A. Ray, Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN.
Nicholas R. Faris, Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN.
Meghan B. Meadows-Taylor, Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN.
Fedoria Rugless, Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN.
Courtney Berryman, Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN.
Bianca Jackson, Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN.
Carrie Fehnel, Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN.
Alicia Pacheco, Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN.
Laura McHugh, Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN.
Edward T. Robbins, Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN.
Kenneth D. Ward, Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN.
Lisa M. Klesges, Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN.
Raymond U. Osarogiagbon, Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN.

Abstract

PURPOSE: Multidisciplinary lung cancer care is assumed to improve care delivery by increasing transparency, objectivity, and shared decision making; however, there is a lack of high-level evidence demonstrating its benefits, especially in community-based health care systems. We used implementation and team science principles to establish a colocated multidisciplinary lung cancer clinic in a large community-based health care system and evaluated patient experience and outcomes within and outside this clinic. METHODS: We conducted a prospective frequency-matched comparative effectiveness study (ClinicalTrials.gov identifier: NCT02123797) evaluating the thoroughness of lung cancer staging, receipt of stage-appropriate treatment, and survival between patients receiving care in the multidisciplinary clinic and those receiving usual serial care. Target enrollment was 150 patients on the multidisciplinary arm and 300 on the serial care arm. We frequency-matched patients by clinical stage, performance status, insurance type, race, and age. RESULTS: A total of 526 patients were enrolled: 178 on the multidisciplinary arm and 348 on the serial care arm. After adjusting for other factors, multidisciplinary patients had significantly higher odds (odds ratio [OR]: 2.3 [95% CI, 1.5 to 3.4]) of trimodality staging compared with serial care. Patients on the multidisciplinary arm also had higher odds of receiving invasive stage confirmation (OR: 2.0 [95% CI, 1.4 to 3.1]) and mediastinal stage confirmation (OR: 1.9 [95% CI, 1.3 to 2.8]). Additionally, patients receiving multidisciplinary care were significantly more likely to receive stage-appropriate treatment (OR: 1.8 [95% CI, 1.1 to 3.0]). We found no significant difference in overall or progression-free survival between study arms. CONCLUSION: The multidisciplinary clinic delivered significant improvements in evidence-based quality care on multiple levels. Even in the absence of a demonstrable survival benefit, these findings provide a strong rationale for recommending this model of care.

Publication Title

JCO oncology practice

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