Needs with Regard to Decision Support Systems for Treating Patients with Incurable Non-small Cell Lung Cancer

Dóra Révész,Ellen G Engelhardt,Franz M N H Schramel,Bregje D Onwuteaka-Philipsen,Henrica C.W De Vet,Johannes J Tamminga,Veerle M H Coupé,Ewoudt M W Van De Garde,Ewout W Steyerberg

doi:10.1007/s13187-019-1471-8

Abstract

Treatment decision-making for patients with incurable non-small cell lung cancer (NSCLC) is complex due to the rapidly increasing number of treatments and discovery of new biomarkers. Decision support systems (DSS) could assist thoracic oncologists (TO) weighing of the pros and cons of treatments in order to arrive at an evidence-based and personalized treatment advice. Our aim is to inventory (1) TO’s needs with regard to DSS in the treatment of incurable (stage IIIB/IV) NSCLC patients, and (2) preferences regarding the development of future tools in this field. We disseminated an online inventory questionnaire among all members of the Section of Oncology within the Society of Physicians in Chest Medicine and Tuberculosis. Telephone interviews were conducted to better contextualize the findings from the questionnaire. In total, 58 TO completed the questionnaire and expressed a need for new DSS. They reported that it is important for tools to include genetic and immune markers, to be sufficiently validated, regularly updated, and time-efficient. Also, future DSS should incorporate multiple treatment options, integrate estimates of toxicity, quality of life and cost-effectiveness of treatments, enhance communication between caregivers and patients, and use IT solutions for a clear interface and continuous updating of tools. With this inventory among Dutch TO, we summarized the need for new DSS to aid treatment decision-making for patients with incurable NSCLC. To meet the expressed needs, substantial additional efforts will be required by DSS developers, above already existing tools.

Highlights

MethodsLung cancer, of which roughly 80–85% is non-small cell lung cancer (NSCLC) [1], is one of the leading causes of cancer mortality worldwide [2]
We developed an online inventory questionnaire
Most respondents worked in academic medical centers, and had access to a palliative care team at their hospital

Summary

Introduction

MethodsLung cancer, of which roughly 80–85% is non-small cell lung cancer (NSCLC) [1], is one of the leading causes of cancer mortality worldwide [2]. Incurable NSCLC patients (stages IIIB and IV) have a very short life expectancy with 1-year survival probabilities ranging between 22 and 47% [3]. Palliative treatment in this setting aims to preserve or improve quality of life, lengthen life, or decrease disease burden. Decision-making in the palliative phase is complex due to the large heterogeneity in this population with regard to histological tumor type, biomarker profile, treatment response, and the marginal expected treatment benefit and the potentially severe toxicity of systemic therapy. With the rapid developments and breakthroughs in the fields of genomic technologies and molecular therapies for lung cancer, treatment decisions will become more multi-factorial and personalized, and it will become increasingly important to support thoracic oncologists (TO) in staying up-to-date

Objectives

Results

Conclusion