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L. McHugh



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    MA 04 - Advocacy: Listen to the Patients (ID 655)

    • Event: WCLC 2017
    • Type: Mini Oral
    • Track: Patient Advocacy
    • Presentations: 1
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      MA 04.01 - Prospective Comparative Evaluation of Patient and Caregiver Perspectives on a Multidisciplinary Model of Lung Cancer Care (ID 10279)

      11:00 - 12:30  |  Author(s): L. McHugh

      • Abstract
      • Presentation
      • Slides

      Background:
      Coordinated multidisciplinary (MD) lung cancer care, with all key specialists concurrently providing early input to develop a consensus care plan in collaboration with patients and their caregivers, may improve patient-centered outcomes over the usual serial care (SC) model, but needs rigorous evaluation.

      Method:
      Prospective, longitudinal study comparing newly-diagnosed lung cancer patients receiving MD vs. SC within the same US healthcare system. The MD intervention was implemented from lung cancer care initiation until definitive treatment decision. After that, both cohorts of patients received their actual cancer treatments within the same environments. At baseline and 6 months, patients completed treatment-related satisfaction measures from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) and the Functional Assessment of Cancer Therapy- Lung (FACT-L) quality of life instrument. All measures were coded so that larger scores are better. Time-specific comparisons were made with the Wilcoxon-Mann-Whitney test and changes from baseline to 6 months were compared between MD vs. SC patients in mixed linear models.

      Result:
      The 463 patients who participated (156 MD, 307 SC) were similar in sex and health insurance. MD cohort was slightly older (69 v 66 years), with more racial minorities (37% v 29%). Patients receiving MD care reported greater satisfaction with the treatment plan (p=0.0266) and overall quality of care (p<0.0010) at 6 months. Additionally, satisfaction with the treatment plan showed greater improvement over time for MD vs. SC (p-value for trend=0.0046). SC patients showed more improvement in satisfaction with overall care than MD patients, but did not reach the level of satisfaction of MD patients at 6 months (p-value for trend=0.0018). Caregivers of MD patients perceived receiving better quality of care compared to other lung cancer patients than caregivers of SC patients (p=0.0049). Caregiver satisfaction did not differ between MD and SC in the communication measures or overall quality, and did not have significant differences in the trend over time. Patient reported Health-Related Quality of Life (HRQOL) improved from baseline to 6 months for the lung cancer-specific scale compared with no change with SC (p-value for trend= 0.0334). Other HRQOL scales were similar between groups

      Conclusion:
      Compared with SC patients, MD patients experienced improved lung cancer-specific HRQOL and greater satisfaction with both treatment plan and quality of care received. MD patients’ caregivers were more likely than SC patients’ caregivers to think their care was better than that of other patients.

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    P1.13 - Radiology/Staging/Screening (ID 699)

    • Event: WCLC 2017
    • Type: Poster Session with Presenters Present
    • Track: Radiology/Staging/Screening
    • Presentations: 1
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      P1.13-011 - Prospective Cohort Study of Patterns of Staging and Treatment Selection with or Without Multidisciplinary (MD) Care (ID 10099)

      09:30 - 16:00  |  Author(s): L. McHugh

      • Abstract
      • Slides

      Background:
      Lung cancer survival depends on accurate staging and treatment selection. Because staging and treatment are increasingly multi-modal, we examined staging and treatment selection practices with or without MD care in a single healthcare system.

      Method:
      Eligible patients had untreated lung cancer, ECOG performance status of 0-2, and gave informed consent. Comparisons were made between patients seen in a co-located MD clinic (MDC) and those receiving standard care (SC). Some SC patients were discussed at a multidisciplinary tumor conference (MDTC), thus allowing comparison of MD care to pure SC and MDTC. Diagnostic, staging, treatment procedures and patient outcomes were prospectively recorded. Staging thoroughness was defined as biopsy of stage-defining lesion; bimodality staging (PET+CT or CT+invasive staging biopsy); trimodality staging (PET+CT+invasive staging biopsy). Stage migration was determined comparing baseline stage (from first radiologic scan) to final clinical stage prior to treatment. Stage-appropriate treatment was defined by NCCN guidelines using final, pre-treatment stage. Chi-squared test and multivariable logistic regressions adjusted for age, sex, and histology were used to examine differences between patient cohorts.

      Result:
      Of 527 patients, 178 were MDC, 77 MDTC, 272 SC. Race and gender were similar but median age (67 v 66 v 69 (p=0.0032) and insurance distribution (p=0.0021) differed across groups. MDC tended to have more thorough staging than MDTC and SC. Significant differences were observed in staging migration and appropriate treatment, favoring MDC and MDTC patients (Table 1). After adjusting for age, sex, and histology, MCD and MDTC were 2-3 times more likely to have more thorough staging and overall stage appropriate treatment (Table 1). Figure 1



      Conclusion:
      Care within a structured MDC environment (whether co-located MDC or MDTC) was associated with significantly more thorough staging processes and higher rates of stage-appropriate use of treatment modalities than usual care. Survival analysis will be reported when data are mature.

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