Improving care for patients with stage III/IV NSCLC: Learnings for multidisciplinary teams from the ACCC National Quality Survey.

Abstract

228 Background: Refinement of the multidisciplinary team (MDT) approach continues to offer significant potential for improving the quality of non-small cell lung cancer (NSCLC) care and adherence to guideline-recommended protocols. This opportunity arises, in part, from insufficient characterization of MDT practice patterns and barriers to optimal care provision within U.S. cancer programs. The Association of Community Cancer Centers (ACCC), therefore, conducted a national survey to improve understanding on how patients with stage III/IV NSCLC were diagnosed and managed across different practice settings, with the aim of informing the design and execution of process-improvement plans to address identified barriers. Methods: ACCC convened an expert steering committee of multidisciplinary specialists, including oncologists, thoracic surgeons, pathologists, pulmonologists, and representation from patient advocacy, for a comprehensive, double-blind, web-based survey (January–April 2019) to obtain insights on cancer care delivery for patients with NSCLC in a diverse set of U.S. community cancer programs. Results: Of 1211 questionnaires, 639 responses affiliated to 160 unique cancer programs across 44 U.S. states were suitable for analysis. In total, 41% (n = 261) of respondents indicated that their cancer program did not have a thoracic multidisciplinary clinic. Nurse navigators (P = 0.03) and radiation oncologists (P = 0.04) were significantly more likely to engage in shared decision-making practices than other disciplines. The average time to first therapeutic intervention in newly diagnosed patients was 4 weeks (range = 1–10 weeks; n = 298). A significant negative correlation between frequency of tumor board meetings and time to complete disease staging (P = 0.03) was observed. The most challenging barriers to delivering high-quality NSCLC care are listed (Table). Conclusions: Multiple opportunities exist to improve the delivery and quality of care for patients with stage III/IV NSCLC, including reducing barriers to effective care coordination and patient education, screening, diagnosis and biomarker testing, and adherence to evolving standards of care. [Table: see text]