Author of

• 10720

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  P1.09 - Poster Session 1 - Combined Modality (ID 212)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Combined Modality
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/28/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 10733

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    P1.09-013 - Thoracic multidisciplinary clinic (TMDC) and the treatment of stage III non-small cell lung cancer (ID 1472)

    09:30 - 16:30  |  Author(s): E.L. Friedman
    • Abstract

    Background
    Treatment of stage III NSCLC involves surgery, radiation therapy and chemotherapy. This treatment varies, depending on the size and location of the primary tumor and lymph nodes as well as the clinical status of the patient. Evaluation of these patients should take place in a multidisciplinary clinic, where all treating physicians and pulmonary medicine provide a unified treatment plan.

    Methods
    We performed a retrospective analysis of all patients with Stage III NSCLC seen at the Lehigh Valley Health Network (LVHN) between March of 2010 and March of 2012. We compared the initial treatment of patients seen in our TMDC with those patients whose treatment was arranged outside the TMDC.

    Results
    Thirty-five patients were seen in the TMDC (34 treated at LVHN) and forty-four patients were seen outside the MDC (34 treated at LVHN). The 11 patients not treated at LVHN either were not treatable or were treated elsewhere. Of patients with stage III NSCLC, 37.5% were seen in the TMDC year 1 (March 2010 – March 2011) as compared year 2 (March 2011 – March 2012) during which over 61% of patients seen in the TMDC (p = 0.05). Patients were seen by physicians from at least two specialties 100% of the time when seen in the TMDC, but only 64.7% of the time when seen outside the TMDC (p < 0.001). Mediastinal staging by either endoscopic bronchoscopic ultrasound (EBUS) or mediastinoscopy was performed more frequently in patients seen in the TMDC; 58.9% compared to 23.5% outside the TMDC (p = 0.009). The LVHN clinical pathway for stage III NSCLC recommends initial therapy with concomitant weekly chemotherapy and radiation either in the neo-adjuvant setting or as definitive treatment. Eighty-eight percent of patients seen in the TMDC followed our clinical pathway while 46% of patients seen outside the TMDC conformed to the clinical pathway (p < 0.001). The time from first contact with a treating physician to initiation of treatment was reduced by almost 30% (29.03 days outside the TMDC; 20.62 days at the TMDC).

    Conclusion
    All patients with stage III NSCLC should be seen in a multidisciplinary setting. At LVHN we saw an increase in these patients being referred to our TMDC over time. These patients were more likely to have mediastinal staging and enjoyed quicker initiation of their therapy. They were more likely to have at least two physicians involved in their initial treatment plan and were more likely to conform to our clinical pathways.