A comparison of two models of multidisciplinary lung cancer care within a community-based healthcare system.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 36-36
Author(s):  
Meghan Meadows ◽  
Meredith Ray ◽  
Matthew Smeltzer ◽  
Nicholas Faris ◽  
Carrie Fehnel ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Care ◽  
Cox Regression ◽  
Care Delivery ◽  
Smoking Status ◽  
Multidisciplinary Care ◽  
Chi Square ◽  
Community Healthcare ◽  
Lung Cancer Patients ◽  
Chi Square Test

36 Background: The Multidisciplinary Thoracic Oncology Conference (MTOC) model is easier to implement than the Multidisciplinary Clinic (MDC) model, but does not directly involve patients in decision-making. We compared the processes and outcomes of lung cancer care between patients discussed in a weekly MTOC versus those seen in a MDC. Methods: Prospective observational study of thoroughness of staging, stage confirmation (defined as biopsy of the stage-defining lesion), National Comprehensive Cancer Network guideline-concordant treatment, overall (OS) and event-free (EFS) survival of lung cancer patients in a community healthcare system’s MDC and MTOC from 2014-2019. We used the chi-square test and multivariable logistic regression to evaluate guideline-concordant treatment and stage confirmation; Kaplan-Meier curves and multivariable Cox regression were used to evaluate OS and EFS. We adjusted models for age, sex, race, insurance, smoking status, and histology. Results: 614 patients received care in MDC; 571 in MTOC. MDC patients were older (median age: 69 vs. 67); less likely to be active smokers (44% vs. 47%; p=0.03); more likely to have bimodal (98% v 95%, p=0.02) and trimodal staging (60% v 46%, p<0.0001). The stage-confirmation rate (OR: 1.55; 95% CI: 1.22-1.96) and mediastinal stage confirmation rate (OR: 1.55; 95% CI: 1.23-1.95) were both significantly higher in MDC, even after adjustment (aOR: 1.60; 95% CI: 1.25-2.03); (aOR: 1.58, 95% CI: 1.25-2.00). A higher proportion of patients received guideline-concordant treatment in MDC than in MTOC (82% vs. 73%; OR: 1.63; 95% CI: 1.21-2.20) even after adjustment (aOR: 1.64; 95% CI: 1.20-2.24). However, MTOC patients had significantly better OS (p=0.03) and EFS (p=0.001) than MDC patients and a lower hazard of death (HR: 0.81; 95% CI: 0.67-0.98), even after adjusting for confounding variables (aHR: 0.79 95%CI: 0.66-0.95). Conclusions: Although the processes of lung cancer care delivery were better in MDC than in MTOC, survival was better in MTOC. Patient selection may have played a role in these survival differences. The MTOC model, as implemented, seems competitive with the MDC model and is worthy of further exploration as a more feasible model of multidisciplinary care. [Table: see text]

Lung cancer: Significance of place of diagnosis.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 60-60
Author(s):  
Rohit Bishnoi ◽  
Chintan Shah ◽  
Jacobo Hincapie Echeverri ◽  
Katherine Robinson ◽  
Yu Wang ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Emergency Department ◽  
Cox Regression ◽  
Health Care Cost ◽  
Small Cell ◽  
Cost Of Care ◽  
Chi Square ◽  
Kaplan Meier ◽  
Therapy Cost ◽  
Chi Square Test

60 Background: Patients who are diagnosed with lung cancer through emergency department tend to do poorly. We conducted a retrospective study to examine the effect of place of diagnosis on various cancer outcomes including survival, health care cost, and end-of-life (EOL) care. Methods: Patients who died from lung cancer between January 2015 and July 2017 were reviewed. Initial place of diagnosis was determined (Emergency Department/Urgent clinic (ED/UC) or Outpatient). Descriptive statistics, exact Pearson chi-square test, Kaplan-Meier method, and multivariable Cox regression model were used to compare the two groups. Results: 227 patients were included in the analysis. Median age at diagnosis was 65 years. 52% were male; 85% were white. 57% of patients were diagnosed through ED/UC, whereas 43% were diagnosed as part of an outpatient workup. Age, gender, race, and histology (small cell vs. non-small cell) did not vary significantly between the two groups. Rates of palliative care intervention and advance directives were similar. Patients diagnosed through ED/UC were more likely to be metastatic, have symptoms, and not receive any cancer directed therapy. Cost of care was similar between the two groups. Median survival in those who presented to ED/UC was significantly shorter (2.5 vs. 6.5 mo; p<0.001) with a hazard ratio of 1.7 (95% CI:1.3-2.3), even after adjusting for potential confounding factors (age, metastasis, insurance, smoking, treatment). Conclusions: Patients diagnosed with lung cancer through the ED/UC have worse outcomes than those diagnosed as an outpatient. Despite similar cost of care, survival outcomes are worse. This variable remains significant despite controlling for confounders in multivariate analysis.[Table: see text]

scholarly journals Profile of patients with lung cancer assisted at the National Cancer Institute, according to their smoking status, from 2000 to 2007

2014 ◽  
Vol 17 (1) ◽  
pp. 175-188 ◽  
Author(s):  
Mirian Carvalho de Souza ◽  
Ana Glória Godoi Vasconcelos ◽  
Marise Souto Rebelo ◽  
Paulo Antonio de Paiva Rebelo ◽  
Oswaldo Gonçalves Cruz
Keyword(s):  
Lung Cancer ◽  
National Cancer Institute ◽  
Multiple Correspondence Analysis ◽  
Smoking Status ◽  
Lung Cancer Mortality ◽  
Two Dimensions ◽  
Chi Square ◽  
Data Variability ◽  
Chi Square Test

INTRODUCTION: Tobacco use is directly related to the future incidence of lung cancer. In Brazil, a growing tendency in age-adjusted lung cancer mortality rates was observed in recent years. OBJECTIVE: To describe the profile of patients with lung cancer diagnosed and treated at the National Cancer Institute (INCA) in Rio de Janeiro, Brazil, between 2000 and 2007 according to their smoking status. METHODS: An observational study was conducted using INCA's database of cancer cases. To assess whether the observed differences among the categories of sociodemographic variables, characterization of the tumor, and assistance - pertaining to smokers and non-smokers - were statistically significant, a chi-square test was applied. A multiple correspondence analysis was carried out to identify the main characteristics of smokers and non-smokers. RESULTS: There was a prevalence of smokers (90.5% of 1131 patients included in the study). The first two dimensions of the multivariate analysis explained 72.8% of data variability. Four groups of patients were identified, namely smokers, non-smokers, small-cell tumors, and tumors in early stages. CONCLUSION: Smoking cessation must be stimulated in a disseminated manner in the population in order to avoid new cases of lung cancer. The Tumors in Initial Stages Group stood out with greater chances of cure.

scholarly journals THOTTIP is Associated with Prognosis of Lung Cancer in the Chinese Population

2020 ◽  
Author(s):  
Yue Zhao ◽  
Xiangjun Kong ◽  
Hongbing Wang
Keyword(s):  
Lung Cancer ◽  
Prognostic Value ◽  
Cox Regression ◽  
Survival Curve ◽  
Expression Patterns ◽  
Rank Test ◽  
Chi Square ◽  
Cox Regression Analysis ◽  
Lung Cancer Patients ◽  
High Level

Abstract Background: Lung cancer is a prevent malignancy with high mortality. Long noncoding RNAs (lncRNAs) have been reported to play important roles in tumorigenesis. The purpose of this study was to explore the prognostic value of lncRNA HOTTIP in lung cancer.Methods: The expression of HOTTIP in lung cancer tissues was measured by quantitative real-time PCR (qRT-PCR). Chi-square test was applied to assess the correlation of HOTTIP with clinicopathological features. Overall survival curve was built by Kaplan-Meier method with log rank test. Cox regression analysis was used to explore the prognostic value of HOTTIP in lung cancer.Results: The expression of HOTTIP was significantly increased in lung cancer samples compared with paired noncancerous samples (P<0.001). Moreover, its expression patterns were correlated with lymph node metastasis (P=0.039) and TNM stage (P=0.007). Survival curve demonstrated that lung cancer patients with high level of HOTTIP had poor survival rate (log-rank P=0.011). HOTTIP might be an independent prognostic factor for lung cancer (HR=1.916, 95%CI=1.133-3.238, P=0.015).Conclusions: HOTTIP is up-regulated in lung cancer, and associated with aggressive tumor progression. HOTTIP may be a potential prognostic biomarker for lung cancer.

Deploying Team Science Principles to Optimize Interdisciplinary Lung Cancer Care Delivery: Avoiding the Long and Winding Road to Optimal Care

2016 ◽  
Vol 12 (11) ◽  
pp. 983-991 ◽  
Author(s):  
Raymond U. Osarogiagbon ◽  
Hector P. Rodriguez ◽  
Danielle Hicks ◽  
Raymond S. Signore ◽  
Kristi Roark ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Care ◽  
Performance Monitoring ◽  
Care Delivery ◽  
Multidisciplinary Care ◽  
Team Science ◽  
Coordinated Care ◽  
Optimal Care ◽  
Diverse Range ◽  
Quality And Outcomes

The complexity of lung cancer care mandates interaction between clinicians with different skill sets and practice cultures in the routine delivery of care. Using team science principles and a case-based approach, we exemplify the need for the development of real care teams for patients with lung cancer to foster coordination among the multiple specialists and staff engaged in routine care delivery. Achieving coordinated lung cancer care is a high-priority public health challenge because of the volume of patients, lethality of disease, and well-described disparities in quality and outcomes of care. Coordinating mechanisms need to be cultivated among different types of specialist physicians and care teams, with differing technical expertise and practice cultures, who have traditionally functioned more as coactively working groups than as real teams. Coordinating mechanisms, including shared mental models, high-quality communication, mutual trust, and mutual performance monitoring, highlight the challenge of achieving well-coordinated care and illustrate how team science principles can be used to improve quality and outcomes of lung cancer care. To develop the evidence base to support coordinated lung cancer care, research comparing the effectiveness of a diverse range of multidisciplinary care team approaches and interorganizational coordinating mechanisms should be promoted.

Survival impact of multidisciplinary thoracic oncology care in a regional healthcare system.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 2004-2004
Author(s):  
Raymond U. Osarogiagbon ◽  
Nicholas Ryan Faris ◽  
Matthew Smeltzer ◽  
Anna Derrick ◽  
Philip Edward Lammers ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Healthcare System ◽  
Cox Regression ◽  
Nsclc Patient ◽  
Multidisciplinary Care ◽  
Patient Characteristics ◽  
Community Healthcare ◽  
Large Community ◽  
Bonferroni Adjustment ◽  
Incidence And Mortality

2004 Background: Much-advocated, the value and impact of multidisciplinary care and planning (MDC) needs greater evidence. We compared non-small cell lung cancer (NSCLC) patient characteristics, treatment patterns and survival in a large community healthcare system spanning 3 US states with some of the highest lung cancer incidence and mortality rates. Methods: We identified MDC patients in the Tumor Registry NSCLC data from 2011-2017. Because the MDC program was located in metropolitan Memphis, we separated non-MDC patients by location of care resulting in 3 cohorts: MDC, non-MDC metropolitan care and non-MDC regional care. Using National Comprehensive Cancer Network guidelines, we categorized treatment by stage as ‘preferred’, ‘appropriate’ (allowable under certain circumstances). We compared demographic and clinical characteristics across cohorts using chi-squared tests and compared survival using Cox regression with Bonferroni adjustment. We repeated survival analysis with propensity matched cohorts. Results: Of 6259 patients, 14% received MDC, 56% metro care and 30% regional care; MDC had the highest rates of African Americans (34% v 28% v 22%), stage I-IIIB (63 v 40 v 50), urban residents (81 v 78 v 20), stage-preferred treatment rates (66 v 57 v 48), stage-appropriate treatment rates (78 v 70 v 63;), and lowest non-treatment rates (6 v 21 v 28). All p<0.001. Compared to MDC, the hazard for death was higher in metro (1.4, 95% confidence interval 1.3-1.6) and regional (1.7, 1.5-1.9); hazards were higher in regional care v metro (1.2, 1.1-1.3); all p<0.001 after adjustment. Results were similar for MDC comparisons after propensity matching with and without adjusting for preferred treatment. No differences in regional and metro cohorts. Conclusions: In this large community-based healthcare system, receipt of MDC for NSCLC was associated with significantly higher rates of guideline-concordant care and survival, providing strong evidence for recommending rigorous implementation of MDC. [Table: see text]

scholarly journals Prognostic Analysis and Clinical Characteristics of Dual Primary Lung Cancer: A Population Study Based on Surveillance, Epidemiology, and End Results (SEER) Database

2021 ◽  
Author(s):  
Guanghui Wang ◽  
Yukai Zeng ◽  
Haotian Zheng ◽  
Xiaogang Zhao ◽  
Yadong Wang ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Prognostic Factors ◽  
Clinical Characteristics ◽  
Prognostic Model ◽  
Cox Regression ◽  
Primary Lung Cancer ◽  
Chi Square ◽  
Training Cohort ◽  
Cox Regression Analysis ◽  
Chi Square Test

Abstract Background: The peculiarity and the lack of clinical studies of dual primary lung cancer (DPLC) led to limited knowledge about its clinical characteristics and prognosis. The current study performed a retrospective analysis and established a prognostic nomogram to assess the prognostic factors and clinical characteristics of DPLC.Methods: A total of 1419 DPLC patients with pathological confirmation from SEER were selected and analyzed by univariate and multivariable Cox regression analyses. The independent prognostic factors were included to establish a nomogram. The accuracy and reliability of prognostic model were evaluated by C-indexes, calibration plots, receiver operating characteristic (ROC) curves, decision curve analyses (DCA) and integrated discrimination improvement (IDI) scores. Chi-square test was used to assess the differences between DPLC and single primary lung cancer (SPLC) or synchronous DPLC (sDPLC) and metachronous DPLC (mDPLC).Results: Cox regression analysis showed that age, sex, histological type, stage, LN metastasis, surgery, chemotherapy were independent prognostic factors, we included these factors to establish a prognostic model. In the training cohort, the C-index was 0.690, and the area under curves (AUC) of 3- and 5-year survival time were 0.720 and 0.723. The calibration plots in training cohort and validation cohort were in excellent agreement. DCA and IDI showed that the predictive effect of the novel prognostic model was better than the model based on 8th AJCC TNM system. Chi-square test indicated that DPLC and SPLC had statistical differences on pathological and clinical features.Conclusions: The clinical and pathological characteristics of DPLC were different from the SPLC. The nomogram based on significant factors could provide accurate and individualized survival predictions for DPLC.

scholarly journals Demographic Pattern and Hospitalization Outcomes of Depression among 2.1 Million Americans with Four Major Cancers in the United States

2018 ◽  
Vol 6 (4) ◽  
pp. 93 ◽  
Author(s):  
Rikinkumar Patel ◽  
Kuang-Yi Wen ◽  
Rashi Aggarwal
Keyword(s):  
Lung Cancer ◽  
The United States ◽  
Cross Sectional Study ◽  
Cancer Type ◽  
Chi Square ◽  
Cross Sectional ◽  
Severe Morbidity ◽  
Lung Cancer Patients ◽  
The Us ◽  
Chi Square Test

Objective: To compare the prevalence of depression in the four most common cancers in the US and evaluate differences in demographics and hospital outcomes. Methods: This was a cross-sectional study using the Nationwide Inpatient Sample (2010–2014). We selected patients who had received ICD-9 codes of breast, lung, prostate, and colorectal cancers and major depressive disorder (MDD). Pearson’s chi-square test and independent sample t-test were used for categorical and continuous data, respectively. Results: MDD prevalence rate was highest in lung cancer (11.5%), followed by breast (10.3%), colorectal (8.1%), and prostate cancer (4.9%). Within colorectal and lung cancer groups, patients with MDD were significantly older (>80 years, p < 0.001) than non-MDD patients. Breast, lung, and colorectal cancer showed a higher proportion of female and Caucasian in the MDD group. Severe morbidity was seen in a greater proportion of the MDD group in all cancer types. The mean inpatient stay and cost were higher in the MDD compared to non-MDD group. Conclusion: Particular attention should be given to elderly, female, and to lung cancer patients with depression. Further studies of each cancer type are needed to expand our understanding of the different risk factors for depression as a higher proportion of patients had severe morbidity.

scholarly journals TOBACCO SMOKING

2015 ◽  
Vol 22 (04) ◽  
pp. 460-465
Author(s):  
Muhammad Aslam ◽  
Muhammad Asif ◽  
Saima Altaf
Keyword(s):  
Lung Cancer ◽  
Tobacco Cessation ◽  
Smoking Status ◽  
Control Design ◽  
Case Control ◽  
Chi Square ◽  
Cancer Disease ◽  
Data Set ◽  
Quit Smoking ◽  
Chi Square Test

Objective: To assess the risk of different cancer sites among the male smokersof the Southern Punjab, Pakistan. Study Design: Case-control design. Period: March - July2012. Setting: A data set of 596 males, belonging to the Southern Punjab was collectedfrom the Outdoor Ward of Cancer, Oncology Ward of Nishtar Hospital and Multan Institute ofNuclear Medicine and Radiotherapy (MINAR) Hospital. Method: Through a self-administeredquestionnaire, smoking status and respondent’s history and medical record of various typesof cancers were noted. The Chi-square test was used to assess the association betweentobacco smoking and cancer disease. For the risk analysis, odds ratios and attributable riskwere computed. Results: Among the respondents, 49.0% smoked tobacco. From the medicalrecord, 438 respondents were confirmed cancerous. The average age to start tobacco wasnoted to be 23.41 ± 4.85 while the age was 45.29 ± 12.24 years for tobacco cessation. Thepercentage of lung cancer among smokers is 24.01 which is highest among all the statedcancer sites. The risk of a smoker getting all types of the stated cancers is at least three times.The risk of lung cancer attributed to smoking is 17.65 and 50.7% of all the stated cancers.Conclusions: Smokers in the Southern Punjab can greatly reduce their risk (more than 50%)of cancer if they quit smoking.

Would screening benefit 75- to 84-year-old patients with non-small cell lung cancer (NSCLC)?

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 7055-7055
Author(s):  
Jessica Lake ◽  
John Charles Flickinger ◽  
John M. Varlotto ◽  
Abram Recht ◽  
Malcolm M. DeCamp ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cox Regression ◽  
Lung Cancer Screening ◽  
Lung Cancer Mortality ◽  
Chi Square ◽  
Old Patients ◽  
Aggressive Therapy ◽  
Significant Difference ◽  
The Usa ◽  
Chi Square Test

7055 Background: The Lung Cancer Screening Trial has shown an overall survival (OS) benefit and reduced lung cancer mortality in the 55-74 age group (gp). We chose to evaluate whether NSCLC patients aged 75-84 are increasing in the USA and whether they would benefit from aggressive therapy. Methods: SEER-17 was used to calculate NSCLC rates during the years 2000-2008. SEER-9 was used to estimate the proportional change in both 55-74 and 75-84 gp from 1973-2008. OS was analyzed in a modern population from SEER-17 (2004-2008) to assess the effects of increasingly aggressive therapy (observation(Ob), radiation (RT) or lobectomy (LB)) for a proposed screening population with T1N0 tumors. Chi-square test and Cox Regression (CR) were used to evaluate OS. Paired T-tests assessed changes in rates and proportions over time. Results: The 55-74 gp rose from 64.4% in 1973 to 67.25% in 1984, but fell to 58.8% by 2008, while the 75-84 gp rose from 12.1% in 1973 to 24% in 2008 (p<0.01), similar in both sexes. The rates/100,000 have been increasing in the 75-84 gp (p=0.02), mainly in females (p=0.003) while the rates in the 55-74 gp did not vary, but fell for men (p=0.03). In the Ob gp (n=1344), NSCLC was the most common cause of death (COD) in the 55-74 (29.8%) and 75-84 gp (40.6%), more than all other CODs combined (median survival (MS) = 11mn). CR revealed that OS was associated with the 55-74 gp (0.59) and females (0.62) (p < 0.001). In the RT gp (n=1870), MS was 14mn and lung cancer was the most common COD at 27.7% (55-74) and 28.8% (75-84), again more than all other CODs combined. CR found that females (0.68) and black race (0.72) had better OS (p<0.017), but age was not. MS was 24 mn in the LB group (n=9384). COD from NSCLC and all other CODs was 8.2% and 6.1% (55-74) and 10.9% and 11.4% (75-84). CR showed that 55-74 (0.36), females (0.58), and Asians (0.73) had lower death rates (all p<0.015). Mean OS between the 55-74 (26.0) and 75-84 (24.2) gp showed a small yet significant difference. Conclusions: Rates and proportions of NSCLC have been steadily increasing in the 75-84 gp. These data show that COD by lung cancer decreased significantly with increasingly aggressive treatment and treatment reduced the effects of age gp on survival. We feel that screening may be of benefit to the 75-84 gp.

Patient and caregiver’s satisfaction with multidisciplinary vs. serial lung cancer care in a community setting.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 200-200
Author(s):  
Huibo Shao ◽  
Nicholas Faris ◽  
Meghan Brooke Taylor ◽  
Carrie Fehnel ◽  
Anita Patel ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Patients ◽  
Cancer Care ◽  
Care Delivery ◽  
Financial Burden ◽  
Treatment Plan ◽  
Hospital System ◽  
Team Members ◽  
Lung Cancer Patients

200 Background: Few existing studies examined lung cancer patients and caregivers’ satisfaction with the team-based multidisciplinary care (MD) in comparison to the usual serial care (SC). We hypothesized that MD, by providing early and concurrent input from key specialists collaborating as a team with patients and caregivers to develop a consensus care plan, can improve patients and caregivers’ satisfaction with care, compared to SC, in which multiple specialists independently screen, diagnose, and treat patients through a fragmented sequence of referrals. Methods: Data on newly diagnosed lung cancer patients, enrolled in a prospective matched cohort comparative effectiveness trial of MD or SC between Oct. 9th, 2014 and July 5th, 2017 in a Mid-South community hospital system, were collected at baseline, 3- and 6-month periods to assess patient and caregiver’s satisfaction with these two care-delivery models. Measures of satisfaction were adapted from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. Multivariate mixed linear models were used to examine the cross-group differences, the time-related variances, and how the interaction between groups and time-periods influenced patients’ and caregivers’ satisfaction. Results: Compared with SC (N = 297), patients in MD (N = 159) were older (66 vs. 69 years), more in an early cancer stage (33% vs. 41% in stage I or II), and lower in performance score (35% vs. 45% asymptomatic). Demographic and social-economic characteristics of caregivers in MD (N = 97) and SC (N = 122) were not significantly different. Patients and caregivers in MD were more likely than those in SC to perceive their care to be better than that received by other patients (p =.003 and p <.001 respectively). Greater satisfaction with their treatment plan at 6-month was observed among the MD patients (p =.004). Also, MD patients reported better overall satisfaction with team members (p =.038). Consistent with the findings among the patients in MD, caregivers in MD were more satisfied with the quality of care (p <.001) and with care received from team members (p <.001) than that reported by caregivers in SC. Conclusions: Coordinated MD care improved patients and caregivers’ satisfaction with lung cancer care in a community healthcare system. Further research will compare the quality of life and financial burden on patients in the MD and SC treatment models to provide more evidence for stakeholders to refine cancer care models.

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