scholarly journals The Impact of Multidisciplinary Team Meetings on Patient Management in Oncologic Thoracic Surgery: A Single-Center Experience

Cancers ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 228
Author(s):  
Francesco Petrella ◽  
Davide Radice ◽  
Juliana Guarize ◽  
Gaia Piperno ◽  
Cristiano Rampinelli ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Thoracic Surgery ◽  
Pulmonary Nodule ◽  
Multidisciplinary Team ◽  
Patient Management ◽  
Solitary Pulmonary Nodule ◽  
Advanced Lung Cancer ◽  
Clinical Settings ◽  
Suspected Recurrence ◽  
The Impact

Background: the aim of this paper is to quantify multidisciplinary team meeting (MDT) impact on the decisional clinical pathway of thoracic cancer patients, assessing the modification rate of the initial out-patient evaluation. Methods: the impact of MDT was classified as follows: confirmation: same conclusions as out-patient hypothesis; modification: change of out-patient hypothesis; implementation: definition of a clear clinical track/conclusion for patients that did not receive any clinical hypothesis; further exams required: the findings that emerged in the MDT meeting require further exams. Results: one thousand consecutive patients evaluated at MDT meetings were enrolled. Clinical settings of patients were: early stage lung cancer (17.4%); locally advanced lung cancer (27.4%); stage IV lung cancer (9.8%); mesothelioma (1%); metastases to the lung from other primary tumors (4%); histologically proven or suspected recurrence from previous lung cancer (15%); solitary pulmonary nodule (19.2%); mediastinal tumors (3.4%); other settings (2.8%). Conclusions: MDT meetings impact patient management in oncologic thoracic surgery by modifying the out-patient clinical hypothesis in 10.6% of cases; the clinical settings with the highest decisional modification rates are “solitary pulmonary nodule” and “proven or suspected recurrence” with modification rates of 14.6% and 13.3%, respectively.

scholarly journals Malignant melanoma without primary, presenting as solitary pulmonary nodule: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
George Tsaknis ◽  
Muhammad Naeem ◽  
Advitya Singh ◽  
Siddharth Vijayakumar
Keyword(s):  
Lung Cancer ◽  
Malignant Melanoma ◽  
Pulmonary Nodule ◽  
Solitary Pulmonary Nodule ◽  
Past History ◽  
White Male ◽  
Pulmonary Nodules ◽  
Metastatic Malignant Melanoma ◽  
Unknown Primary ◽  
Solitary Pulmonary Nodules

Abstract Background Solitary pulmonary nodules are the most common incidental finding on chest imaging. Their management is very well defined by several guidelines, with risk calculators for lung cancer being the gold standard. Solitary intramuscular metastasis combined with a solitary pulmonary nodule from malignant melanoma without a primary site is rare. Case presentation A 57-year-old white male was referred to our lung cancer service with solitary pulmonary nodule. After positron-emission tomography, we performed an ultrasound-guided core needle biopsy of an intramuscular solitary lesion, not identified on computed tomography scan, and diagnosed metastatic malignant melanoma. The solitary pulmonary nodule was resected and also confirmed metastatic melanoma. There was no primary skin lesion. The patient received oral targeted therapy and is disease-free 5 years later. Conclusions Clinicians dealing with solitary pulmonary nodules must remain vigilant for other extrathoracic malignancies even in the absence of obvious past history. Lung metastasectomy may have a role in metastatic malignant melanoma with unknown primary.

scholarly journals P1.16-07 Real World Evidence of the Impact of Immunotherapy in Patients with Advanced Lung Cancer

2019 ◽  
Vol 14 (10) ◽  
pp. S588
Author(s):  
C. Pettengell ◽  
J. Law ◽  
L. Le ◽  
M. Sung ◽  
S. Lau ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Real World ◽  
Advanced Lung Cancer ◽  
Real World Evidence ◽  
The Impact

scholarly journals Multidisciplinary team care in advanced lung cancer

2020 ◽  
Vol 9 (4) ◽  
pp. 1690-1698 ◽  
Author(s):  
Anna Kowalczyk ◽  
Jacek Jassem
Keyword(s):  
Lung Cancer ◽  
Multidisciplinary Team ◽  
Advanced Lung Cancer ◽  
Team Care

Treatment of Lung Cancer in Medically Compromised Patients

2016 ◽  
pp. e484-e491
Author(s):  
Jeffrey Crawford ◽  
Paul Wheatley-Price ◽  
Josephine Louella Feliciano
Keyword(s):  
Lung Cancer ◽  
Socioeconomic Status ◽  
Clinical Trials ◽  
Molecular Mechanisms ◽  
Early Stage ◽  
Care Delivery ◽  
Advanced Lung Cancer ◽  
Early Stage Disease ◽  
Major Barrier ◽  
The Impact

Outcomes for patients with lung cancer have been improved substantially through the integration of surgery, radiation, and systemic therapy for patients with early-stage disease. Meanwhile, advances in our understanding of molecular mechanisms have substantially advanced our treatment of patients with advanced lung cancer through the introduction of targeted therapies, immune approaches, improvements in chemotherapy, and better supportive care. However, the majority of these advances have occurred among patients with good functional status, normal organ function, and with the social and economic support systems to be able to benefit most from these treatments. The aim of this article is to bring greater attention to management of lung cancer in patients who are medically compromised, which remains a major barrier to care delivery. Impaired performance status is associated with poor outcomes and correlates with the high prevalence of cachexia among patients with advanced lung cancer. CT imaging is emerging as a research tool to quantify muscle loss in patients with cancer, and new therapeutics are on the horizon that may provide important adjunctive therapy in the future. The benefits of cancer therapy for patients with organ failure are poorly understood because of their exclusion from clinical trials. The availability of targeted therapy and immunotherapy may provide alternatives that may be easier to deliver in this population, but clinical trials of these new agents in this population are vital. Patients with lower socioeconomic status are disproportionately affected by lung cancer because of higher rates of tobacco addiction and the impact of socioeconomic status on delay in diagnosis, treatment, and outcomes. For all patients who are medically compromised with lung cancer, multidisciplinary approaches are particularly needed to evaluate these patients and to incorporate rapidly changing therapeutics to improve outcomes.

scholarly journals Evaluation of Omics-Based Strategies for the Management of Advanced Lung Cancer

2020 ◽  
pp. OP.20.00117
Author(s):  
Ravi Salgia ◽  
Isa Mambetsariev ◽  
Rebecca Pharaon ◽  
Jeremy Fricke ◽  
Angel Ray Baroz ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Decision Making ◽  
Targeted Therapy ◽  
Predictive Value ◽  
Advanced Nsclc ◽  
Therapeutic Options ◽  
Advanced Lung Cancer ◽  
Molecular Testing ◽  
Cox Regression Analysis ◽  
The Impact

PURPOSE: Omic-informed therapy is being used more frequently for patients with non–small-cell lung cancer (NSCLC) being treated on the basis of evidence-based decision-making. However, there is a lack of a standardized framework to evaluate those decisions and understand the association between omics-based management strategies and survival among patients. Therefore, we compared outcomes between patients with lung adenocarcinoma who received omics-driven targeted therapy versus patients who received standard therapeutic options. PATIENTS AND METHODS: This was a retrospective study of patients with advanced NSCLC adenocarcinoma (N = 798) at City of Hope who received genomic sequencing at the behest of their treating oncologists. A thoracic oncology registry was used as a clinicogenomic database to track patient outcomes. RESULTS: Of 798 individuals with advanced NSCLC (median age, 65 years [range, 22-99 years]; 60% white; 50% with a history of smoking), 662 patients (83%) had molecular testing and 439 (55%) received targeted therapy on the basis of the omic-data. A fast-and-frugal decision tree (FFT) model was developed to evaluate the impact of omics-based strategy on decision-making, progression-free survival (PFS), and overall survival (OS). We calculated that the overall positive predictive value of the entire FFT strategy for predicting decisions regarding the use of tyrosine kinase inhibitor–based targeted therapy was 88% and the negative predictive value was 96%. In an adjusted Cox regression analysis, there was a significant correlation with survival benefit with the FFT omics-driven therapeutic strategy for both PFS (hazard ratio [HR], 0.56; 95% CI, 0.42 to 0.74; P < .001) and OS (HR, 0.51; 95% CI, 0.36 to 0.71; P < .001) as compared with standard therapeutic options. CONCLUSION: Among patients with advanced NSCLC who received care in the academic oncology setting, omics-driven therapy decisions directly informed treatment in patients and was correlated with better OS and PFS.

Electronic prompt to improve outpatient code status documentation for advanced lung cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 6048-6048
Author(s):  
Jennifer S. Temel ◽  
Joseph A. Greer ◽  
Emily R. Gallagher ◽  
Vicki A. Jackson ◽  
Inga Tolin Lennes ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Focus Groups ◽  
Chemotherapy Regimen ◽  
Academic Medical Center ◽  
Advanced Lung Cancer ◽  
Code Status ◽  
One Year ◽  
Study Participants ◽  
The Impact ◽  
Historical Controls

6048 Background: Rates of documentation of end-of-life care preferences in the medical record remain low, even among patients with incurable malignancies.  The goal of this study was to assess the impact of electronic prompts to encourage oncology clinicians to document code status in the outpatient electronic health record (EHR) of patients with advanced lung cancers. Methods: We conducted two clinician focus groups (n=15) at an affiliated academic medical center to determine the appropriate content and timing of the electronic reminders.  Based on the focus groups, we developed email reminders that were timed to the start of each new chemotherapy regimen.  Between 6/09 and 1/11, 102 eligible patients with advanced lung cancer were approached, and 100 (98%) agreed to participate in the prospective study.  Email reminders were sent to oncology clinicians at the patient's next outpatient visit and with each new chemotherapy regimen.  Using a pre-post design, we compared study participants to a retrospective cohort of 100 consecutive historical controls who began chemotherapy for advanced lung cancer at least one year prior to the start of this study.  The primary outcome measure was the documentation of code status in the EHR.   Results: Study participants were similar to historical controls, with no significant differences in age, gender, performance status, histology or initial cancer therapy received.  At one year follow-up, 33/98 (34%) of participants had a code status documented in the outpatient EHR compared with 12/83 (15%) of historical controls, p=0.003.  Mean time to code status documentation was significantly shorter in study participants (8.6 months [95% CI 7.6-9.5]) compared with controls (10.5 months [95% CI 9.8-11.3]), p=0.004. Conclusions: Email prompts triggered by changes in chemotherapy improved the rate and timing of code status documentation in the EHR.

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