Management and treatment of patients (pts) with stage III unresected non-small cell lung cancer (NSCLC) at UPMC: A quality initiative by Integra Connect PrecisionQ.

Abstract

579 Background: In 2019, the University of Pittsburgh Medical Center (UPMC) and Integra Connect (IC) initiated a QI to improve immunotherapy (IO) use post CRT. Baseline analysis assessed scanning and treatment patterns post-CRT and duration of treatment (DOT) with durvalumab (durva). Drawing on this analysis, IC and UPMC conducted a focus group to address gaps in care and initiated improvements. This real-world study aims to assess the change in IO use post-CRT, the time to scan (TTS), time to treatment (TTT), DOT compared to baseline. The DOT of durva was compared between pts initiated <14 days of CRT and those who started ≥14 days. Methods: From the UPMC and IC real-world databases, we identified 555 pts with stage 3 unresectable NSCLC for manual chart abstraction. Pts received CRT between 2/16/2018 and 12/31/2021. TTS was calculated from the last day of CRT to the 1st scan and the TTT obtained from the last day of CRT to the 1st durva dose. The baseline period was from 2/16/2018 to 8/31/2020 and the post-intervention stage from 9/1/2020 to 12/31/2021 based on CRT start date. Pts were excluded if they had no scan data, a 1st scan ≥90 days post CRT (TTS analyses), a duration of zero days (DOT analyses) or a TTT >120 days (TTT analyses). At least 1 yr of follow up was required for DOT comparisons. Descriptive analyses were used. A two-tailed 2 sample z-test was used for proportions and the nonparametric Wilcoxon rank sum test was used for TTS, TTT and DOT comparisons. Results: The baseline pts were 46% female with an average age of 67.7 years; post-intervention patients were 47% female with an average age of 69.4 years. The rate of durva use post CRT in pts who did not progress increased from 66% (n =128/194) at baseline to 83% (n =96/116) post intervention (p < 0.01). The baseline median TTS decreased from 22.5 days (n=174) to 20 days (n=121) post intervention (p <0.05), and median TTT decreased from 35 days (n=121) to 28 days (n=90) (p < 0.05). The median DOT increased from 6 (n=127) to 8.2 months (n=76) (p >0.05). During the study period, 8% (n =17/223) of pts started durva < 14 days post CRT and 92% started ≥14 days (n =206/223). The median DOT in the < 14 days group was 10.8 months versus 6.2 months in ≥14 days (p >0.05). Median overall survival (OS) was 36.5 months in the <14 days vs. 27.8 months in the ≥14 days group (p > 0.05). Conclusions: NSCLC QIs are effective tools to improve IO utilization, TTT, and DOT in eligible pts. Practices that assess clinical performance can identify gaps in care and act. In this Stage III study, a superior OS, though lacking statistical significance, was seen in the group that started IO <14 days post CRT compared to ≥14 days. Further studies with larger sample size are needed to validate these findings.