Lung Cancer Multidisciplinary Team Research Articles

Similarities and differences of lung cancer (LC) multidisciplinary teams (MDTs) in China compared to Europe and Canada.

e13562 Background: LC MDTs involve a collaborative approach where specialists work together to analyze individual cases, discuss treatment options, and tailor comprehensive care plans for patients. Implementing MDTs can be challenging, especially for developing countries with limited resources and high disease burden. China, with approximately 820,000 new patients with lung cancer in 2020 accounting for 37% of the total number in the world, bears the responsibility of treating the largest lung cancer patient population worldwide. The global MDT Aid Program (MAP) in LC has been including China to gather insights on the challenges, best practices, similarities, and differences of China LC MDT processes compared to other countries, so as to improve the outcome and cost-efficiency of global MDTs. Methods: In this study, we learned about the status, best practices, challenges of LC MDT development in China through virtual semi-structured healthcare professional (HCP) interviews, on-site masterclasses, and internal data sharing with 3 Chinese leading hospitals in LC - Guangdong Provincial People’s Hospital, West China Hospital and Xiangya Hospital. Similarities and differences were gathered based on previous MAP experience and insights from HCP discussions in LC across the Netherlands, Italy, Spain, Switzerland, Denmark, Norway, and Canada. To build a global collaboration on LC MDTs, three international knowledge exchange (IKE) sessions were organised to include China and all participating countries. Results: We identified seven main differences between China, Europe and Canada, including the enrolment criteria of patients in MDT that China MDTs focus on challenging cases such as resistance to multi-lines of therapy, multiple primary lung cancer and stage III lung cancer, while Europe and Canada MDTs mainly for routine patients. Other differences include setup and composition of MDT teams, digitalization of MDTs, incentives and reimbursement for MDT attendance, cross-institutional patient referral to the MDT, time spent per patient, patient follow-up after MDT discussion. Similarities identified include the MDT development model from both hospital and national level, experience sharing to educate junior physicians, hospital willingness to learn at global level, and challenges of high pressure with limited medical resources. Best practices of leveraging innovative digital capabilities to improve MDT efficiency and to support decision-making have been shared by China participants during the IKEs. Conclusions: Global collaboration to identify synergies within LC MDT communities can help China and other regions learn from each other and share China expertise in large-volume data-based practices globally. Alongside China’s rapid development of digital health, the digitalization of MDTs is likely to follow.

12 Understanding reasons for deviation from lung cancer multidisciplinary team meeting (MDM) recommendations – an audit in a large NHS Foundation Trust

12 Understanding reasons for deviation from lung cancer multidisciplinary team meeting (MDM) recommendations – an audit in a large NHS Foundation Trust

Enhancing Multidisciplinary Team Processes in Lung Cancer Care: A Self-Assessment Toolkit and Best Practices

Multidisciplinary teams (MDTs) play a pivotal role in the comprehen­sive management of cancer. MDT meetings (MDTMs) bring together specialized experts across the entire patient care spectrum, convening regularly to discuss patient cases, select optimal diagnostic strategies, and determine the most ap­propriate treatment modalities. By fostering cross-disciplinary interaction, MDTs aim to enhance patient outcomes and elevate the collective proficiency within a health care institution, promoting knowledge dissemination and ensuring health care practitioners remain abreast of the latest clinical insights. This study’s methods comprised an extensive review of existing literature coupled with in­terviews involving lung cancer MDTs from 24 medical centers across Europe and Canada. The research focused on elucidating dynamics and variations observed among lung cancer MDTs, outlining an optimal MDT process, identifying varianc­es in the study sample, and introducing a comprehensive self-assessment tool­kit for continuous evaluation and improvement. The report discusses how these results should be used to self-optimize hospital MDTs, promote standardization, and encourage increased cross-hospital best practices sharing. With this, MDTs will be better positioned to deliver on the key goal of improved patient outcomes while promoting equality of access to health care.

Clinicians’ Evaluation of Lung Cancer Clinical Quality Indicators and Comparative Performance Data in Practice

Objective. Lung cancer is commonly diagnosed and is the leading cause of cancer-related death, morbidity, and burden of disease globally. There is an ongoing need to ensure patients receive optimal evidence-based care and to identify and reduce unwarranted clinical variation to achieve best possible outcomes. The EnRICH program has developed evidence-based clinical quality indicators to measure processes and outcomes of lung cancer care, and a feedback dashboard to report comparative performance data, which highlight variation in both care and outcomes. The aims of this study were to evaluate the acceptability and utility of the quality indicators and feedback dashboard and identify benchmarks for performance monitoring and priorities for future quality improvement interventions to address observed clinical variation. Method. Clinicians from lung cancer multidisciplinary teams (MDTs) at six tertiary clinical sites across regional and metropolitan NSW were invited to participate in evaluation interviews. Interviews were conducted via videoconference and recorded with consent. Data were analysed thematically using framework methods. Results. Thirteen clinicians participated in interviews, with representation from each clinical site and specialty. All participants considered the quality indicators to be clinically meaningful. Three main themes were identified: (i) the importance of timely, local, quality data; (ii) implementable versus nonimplementable clinical practice changes; and (iii) the need for ongoing performance monitoring. Clinicians prioritised two areas of unwarranted clinical variation that could be immediately addressed through easily implementable quality improvement interventions to positively impact patient care: (i) a process to ensure that all stage III patients are discussed by a multidisciplinary team prior to commencing treatment; (ii) a referral pathway to palliative care within eight weeks for patients diagnosed with stage IV disease. The importance of lung cancer nurse specialists for improved care coordination was highlighted. Conclusion. Clinicians would like to continue to receive close-to-real-time quality data for ongoing performance monitoring to identify and address unwarranted clinical variation.

Virtually the same? Examining the impact of the COVID-19 related shift to virtual lung cancer multidisciplinary team meetings in the UK National Health Service: a mixed methods study

ObjectivesTo evaluate the impact of the shift to virtual lung cancer multidisciplinary team meetings (MDTMs) in response to the COVID-19 pandemic, specifically in relation to the magnitude of information technology...

Lung Cancer resection in the absence of pre-operative histology: The Accuracy of Multidisciplinary Team Consensus

BackgroundLung resection remains the gold-standard of treatment for non-small cell lung cancer (NSCLC). British Thoracic Society (BTS) guidelines recommends the pursuit of pre-operative histological diagnosis and staging where possible. In the absence of pre-operative histology, surgical treatment can be offered in conjunction with multidisciplinary team (MDT) and patient consensus. We undertook a single-centre analysis of the accuracy of the lung cancer MDT in recommending surgical resection for those with suspected lung malignancy in the absence of pre-operative histological diagnosis over a six-year period. MethodsA retrospective review was performed of patients undergoing any pulmonary oncological resection with therapeutic intent without pre-operative histological diagnosis at the recommendation of the lung cancer MDT in our unit between May 2016 and July 2022. Results270 consecutive patients underwent lung resection for a lung nodule of indeterminate significance. This accounted for 45% of the oncological resections performed over this period. The mean age of the cohort was 67.9 years, and 47.4% were male. Overall, 10% of resected specimens (n = 27) were benign on final histopathology. 93% of those undergoing a lobectomy received a malignant diagnosis. Across the study cohort, surgical resection was well tolerated with a low complication rate. ConclusionsLung cancer resection in the absence of pre-operative histological diagnosis is feasible in a select patient cohort. This approach requires an experienced multi-disciplinary team and careful patient counselling. Our study demonstrates this adapted approach to be a pragmatic solution to the management of indeterminate pulmonary nodules in centres where biopsy is not routinely available due to existing constraints on the health system.

7 - The utility of high-fidelity simulation in improving trainee confidence within the lung cancer multi-disciplinary team setting

7 - The utility of high-fidelity simulation in improving trainee confidence within the lung cancer multi-disciplinary team setting

Prescreening in oncology trials using medical records. Natural language processing applied on lung cancer multidisciplinary team meeting reports.

Defining profiles of patients that could benefit from relevant anti-cancer treatments is essential. An increasing number of specific criteria are necessary to be eligible to specific anti-cancer therapies. This study aimed to develop an automated algorithm able to detect patient and tumor characteristics to reduce the time-consuming prescreening for trial inclusions without delay. Hence, 640 anonymized multidisciplinary team meetings (MTM) reports concerning lung cancers from one French teaching hospital data warehouse between 2018 and 2020 were annotated. To automate the extraction of eight major eligibility criteria, corresponding to 52 classes, regular expressions were implemented. The RegEx's evaluation gave a F1-score of 93% in average, a positive predictive value (precision) of 98% and sensitivity (recall) of 92%. However, in MTM, fill rates variabilities among patient and tumor information remained important (from 31% to 100%). Genetic mutations and rearrangement test results were the least reported characteristics and also the hardest to automatically extract. To ease prescreening in clinical trials, the PreScIOUs study demonstrated the additional value of rule based and machine learning based methods applied on lung cancer MTM reports.

Risk Management Activities in a Lung Cancer Multidisciplinary Team at a Comprehensive Cancer Center: Results of a Prospective Analysis.

The objective of the study was to highlight sources of harm that could negatively affect the lung cancer multidisciplinary team (MDT) activities to reduce the level of risk of each factor. A modified Delphi approach was used by a board of multi-health care professionals of the lung cancer MDT to identify the main processes, subprocesses, and risk factors of the multidisciplinary pathway of patients with lung cancer. A semiquantitative matrix was built with a five-point scale for probability of harm (likelihood) and severity of harm (consequences) according to the international risk management standards (ISO 31000-2018). The risk level was calculated by multiplying likelihood × consequences. Mitigation strategies have been identified and applied by the MDT to reduce risks to acceptable levels. Three main processes (outpatient specialist visit, MDT discussion, and MDT program implementation), eight related subprocesses, and 16 risk factors were identified. Four risk factors (25%) were related to outpatient specialist visit, seven (43.75%) to case discussion, and five (31.25%) to program implementation. Overall, two risk factors were assigned a low-risk level (12.5%), 11 a moderate-risk level (68.75%), one (6.25%) a high-risk level, and two (12.5%) a very high-risk level. After the implementation of mitigation measures, the new semiquantitative risk analysis showed a reduction in almost all hazardous situations: two risk factors (12.5%) were given a very low level, six (37.5%) a low level, seven (43.75%) a moderate level, and one (6.25%) a very high level. An interdisciplinary risk assessment analysis is applicable to MDT activities by using an ad hoc risk matrix: if the hazard is identified and monitored, the risk could be reduced and managed in a short time.

Implementing Genomic Testing for Lung Cancer Into Routine Clinical Practice – The Welsh Experience

AimsOver the last decade there has been a rapid expansion of clinically actionable driver mutations in non-small cell lung cancer (NSCLC), with an unprecedented number of corresponding targeted therapies approved and funded for use in the clinic. Here we summarise the approach taken in Wales to embed a NSCLC biomarker testing pathway within the National Optimal Pathway for Lung Cancer. Materials and methodsThe Welsh Thoracic Oncology Group established a working group tasked with progressing the standardisation of genomic testing. In July 2021, the 10 lung cancer multidisciplinary teams (MDTs) were invited to take part in a national survey of current biomarker testing practices and a retrospective audit of the next generation sequencing (NGS) pathway in Wales was conducted. ResultsSeventy per cent of MDTs completed the survey, which confirmed variability in the approach to testing with respect to timing of requests, patient selection and testing technologies used. Only 43% reported having pathology-initiated reflex testing, but 87% had adopted DNA and RNA NGS testing as their standard-of-care genomic testing strategy. Data from 53 patients with stage III–IV NSCLC with genomic testing requested between October 2020 and May 2021 were analysed in the NGS pathway audit. Forty (75.5%) patients had both DNA and RNA NGS requested, with a median turnaround time from biopsy to results of 26 days (range 19–37 days) and 25 days (range 16–38 days), respectively. The geographical location of MDT did not influence turnaround times and MDTs with reflex testing had shorter biopsy-to-result times. DNA NGS testing was successful in 51 (96.2%) patients; in those who had RNA NGS, testing was successful in 30 (75%) patients. ConclusionSignificant progress has been made within Wales to implement a national biomarker testing pathway, with reflex testing becoming standard of care. However, challenges remain in optimising the quantity and quality of tissue available for testing, together with a need to reduce turnaround times. This will need to be addressed to ensure all eligible patients are tested at the right time in the diagnostic pathway to facilitate optimal treatment strategies and ultimately improve outcomes.

EP15.01-001 Ask, Advise, Help (AAH) Smoking Cessation Brief Advice Delivery in Patients with Diagnosed Lung Cancer: A Retrospective Audit

Smoking cessation has important benefits in people diagnosed with lung cancer, regardless of TNM stage. However, the majority of patients diagnosed with cancer continue to smoke following diagnosis. A systematic model of care, as per 2020 Clinical Oncology Society of Australia guidelines, could enhance smoking cessation rates and improve patient outcomes. Our lung cancer multidisciplinary team treats ∼300 new patients per annum, but does not offer a systematic smoking cessation model of care. To benchmark current practice and consider areas for improvement, we undertook an audit of smoking prevalence and smoking cessation brief intervention (Ask, Advise, Help (AAH) smoking cessation brief advice model), among patients with newly diagnosed lung cancer.

Improving Cancer Care Delivery: Learnings for Oncology Nurses and Patient Navigation From a National Quality Survey.

Background:Although implementation of patient navigation programs in clinical practice is widespread, heterogeneity exists in the design and delivery of these services. Greater clarity is required on competencies of personnel, delineation of their roles in multidisciplinary cancer care teams, navigation service components that positively impact patient outcomes, and associated metrics.Methods:A national, double-blind, online survey was implemented between January 24, 2019, and April 25, 2019, to investigate care coordination for advanced (stage III/IV) non–small cell lung cancer (NSCLC). Respondents included multidisciplinary team (MDT) members, such as oncologists, pathologists, oncology nurses, advanced practice nurses, and patient navigators, from US cancer programs. Customized questions covered NSCLC screening, diagnosis, treatment, and care coordination, with a focus on oncology nurses, advanced practice nurses, and patient navigation. Descriptive statistics were computed. Subanalyses examined relationships between care delivery and outcomes such as shared decision-making (SDM) through statistical testing.Results:Across programs, there was a lack of patient (nurse or lay) navigators (22.3%, 101/452) to assist patients with NSCLC. Most respondents (90.1%, 100/111) worked in programs with no formal health literacy assessments. Significantly higher mean SDM scores (p < .05) were observed in programs with patient navigators compared with programs without these specialists.Conclusion:Patient navigation is pivotal to enhancing the patient experience along the lung cancer care continuum and should be strategically integrated within lung cancer MDTs. These findings, along with survey inputs from other MDT disciplines, can help support process improvement plans for patient-centered advanced NSCLC care delivery.

Understanding clinical decision-making in mesothelioma care: a mixed methods study

IntroductionMalignant pleural mesothelioma is a rare, incurable cancer arising from previous asbestos exposure; patients have a poor prognosis, with a median survival rate of 8–14 months. Variation in mesothelioma clinical...

Hospital-based multidisciplinary lung cancer care in Australia: a survey of the landscape in 2021

IntroductionLung cancer is the leading cause of cancer death in Australia and has the highest cancer burden. Numerous reports describe variations in lung cancer care and outcomes across Australia. There...

Rehabilitation for lung cancer patients undergoing surgery: results of the PUREAIR randomized trial.

Surgery for non-small cell lung cancer is proven to be the most effective treatment in early stages, although concerns exist on its negative impact on patients' overall fitness. To establish whether intensive pulmonary rehabilitation, preoperative and postoperative, improves exercise capacity in patients undergoing lung resection. Single center, unblinded, designed for superiority, 1:1 randomized controlled trial with two parallel arms. S. Maria Nuova Hospital of Reggio Emilia (Reggio Emilia, Italy). Patients referred from local lung cancer multidisciplinary team for lung resection. Patients were randomized to either standard of care (SC) or SC + intensive perioperative pulmonary rehabilitation (SC+PR). The primary aim was to investigate the effectiveness of pulmonary rehabilitation in improving exercise capacity six months after surgery. Additionally, we wanted to investigate the same effect shortly after surgery (at one month), as well as the overall impact of rehabilitation on lung function, postoperative complications and length of stay, quality of life, mood disturbances and pain. Sample was sized based on the primary outcome assuming a minimal clinically significant difference of 25 meters in exercise tolerance, measured with 6 minutes walking test. The exercise tolerance at 6 months after surgery was significantly higher in patients undertaking PR compared to SC (+48.9 meters vs. -7.5 meters respectively, difference: +56.4 meters, 95% CI: 29.6-83.0, P<0.001) and it showed significantly lower impairment at 1 month after surgery in the intervention group (-3.0 meters vs. -30.1 meters difference: +27.1 meters, 95% CI: 3.4-50.8, P=0.025). No other significant differences between groups were found. Comparison between groups showed that pulmonary rehabilitation, administered pre and postoperatively, significantly improved exercise capacity at 6 months in patients undergoing lung resection; it also significantly reduced the decrease in exercise tolerance observed 1 month after surgery. The PUREAIR trial highlights the importance of combined preoperative and postoperative rehabilitation in reducing physical deconditioning in lung cancer patients undergoing surgery. Comprehensive pulmonary rehabilitation improves exercise capacity at 1 and 6 months after surgery. The PUREAIR trial results increase knowledge on comprehensive rehabilitation's outcomes in the first six months after surgery.

A prospective evaluation of treatment recommendations compared to outcomes for a lung cancer multidisciplinary team and legal implications

This cross-sectional study compared treatment recommendations made by a respiratory multi-disciplinary team with the treatment received by those patients in practice. The aim was to evaluate the rate at which patients were treated in keeping with MDT recommendations. It was hypothesised that most patients would be treated in accordance with these recommendations. These data were then used to provide a practical basis to consider the potential legal liability of multi-disciplinary teams. All patients discussed in the Princess Alexandra Hospital Lung MDT over a three-month period were included. The recommendations made by the MDT were compared with the treatment received. Where available, the reason for any change in management plan was recorded. 74/109 evaluable patients were treated in accordance with the MDT recommendation. A further 7 patients had commenced treatment prior to MDT discussion. The most common reasons for change in management were patient choice (n=6) or deterioration in clinical condition prior to treatment (n=6). As hypothesised, there was a high rate of treatment in accordance with recommendations made by the MDT. Changes in management are mostly related to patient preference or change in condition after MDT discussion. In practice, there are only limited opportunities for an MDT to be liable for patient outcomes. It is suggested however that careful documentation and representation of cases where appropriate could further mitigate this risk.

Barriers and Facilitators for Implementation of a Computerized Clinical Decision Support System in Lung Cancer Multidisciplinary Team Meetings-A Qualitative Assessment.

Simple SummaryOncological computerized clinical decision support systems (CCDSSs) are currently being developed to facilitate workflows of multidisciplinary team meetings (MDTMs). To successfully implement these systems in MDTMs, the aim of this qualitative assessment was to identify barriers and facilitators for implementation and to provide actionable findings for an implementation strategy. The main facilitators for implementation of the CCDSS were considered to be easy access to well-structured data, and reducing time spent by clinicians on MDTM preparation and duration of the MDTMs. Main barriers for adoption were seen in incomplete or non-trustworthy output generated by the system and insufficient adaptability of the system to local and contextual needs. Actionable findings for an implementation strategy were a usability test and validation study involving key users in the organization’s real-life setting. Given the growing interest in CCDSSs in oncology care, insight in barriers and facilitators for successful implementation seems highly relevant.Background: Oncological computerized clinical decision support systems (CCDSSs) to facilitate workflows of multidisciplinary team meetings (MDTMs) are currently being developed. To successfully implement these CCDSSs in MDTMs, this study aims to: (a) identify barriers and facilitators for implementation for the use case of lung cancer; and (b) provide actionable findings for an implementation strategy. Methods: The Consolidated Framework for Implementation Science was used to create an interview protocol and to analyze the results. Semi-structured interviews were conducted among various health care professionals involved in MDTMs. The transcripts were analyzed using a thematic analysis following a deductive approach. Results: Twenty-six professionals participated in the interviews. The main facilitators for implementation of the CCDSS were considered to be easy access to well-structured patient data, and the resulting reduction of MDTM preparation time and of duration of MDTMs. Main barriers for adoption were seen in incomplete or non-trustworthy output generated by the system and insufficient adaptability of the system to local and contextual needs. Conclusion: Using a CCDSS in lung cancer MDTMs was expected to increase efficiency of workflows. Successful implementation was seen as dependent on the reliability and adaptability of the CCDSS and involvement of key users in the implementation process.

Chinses expert consensus on the multidisciplinary team diagnosis and treatment of lung cancer

Lung cancer is by far the most common cancer and the leading cause of cancer death in China. Through multidimensional discussion and analysis of disease, the multidisciplinary team (MDT) diagnosis and treatment brings lots of benefits for cancer patients, including increasing patient satisfaction, reducing hospitalization expense, shortening treatment waiting time, providing more reasonable diagnosis and treatment pathways and strategies, relieving medical disputes, increasing enrollment opportunities for patients in high-quality clinical trials, patients'prognosis and life quality and so on. Presently, lung cancer MDT in China needs to be improved, including guideline following, democratic decision, landing performance and feedback, meeting records, patient follow-up and so on. So this consensus combines lung cancer MDT experience of China with leading-edge global oncology MDT experience to construct patient-centered lung cancer MDT diagnosis and treatment model, including MDT responsibility and obligations, organizational framework, working modality, standard procedures, assessment methods, and encouragement mechanisms and so on. Chinese Thoracic Oncology Group; Chinese Society of Lung Cancer; Lung Cancer Group of Oncology Branch, Chinese Medical Association; Multidisciplinary Team Diagnosis and Treatment Committee, Chinses Medical Doctor Association jointly publish this consensus. The purpose of this consensus is to provide procedures and criteria for lung cancer MDT of China.

Implementation of lung cancer multidisciplinary teams: a review of evidence-practice gaps.

Multidisciplinary care (MDC) is considered best practice in lung cancer care. Health care services have made significant investments in MDC through the establishment of multidisciplinary team (MDT) meetings. This investment is likely to be sustained in future. It is imperative that MDT meetings are efficient, effective, and sufficiently nimble to introduce new innovations to enable best practice. In this article, we consider the ‘evidence-practice gaps’ in the implementation of lung cancer MDC. These gaps were derived from the recurrent limitations outlined in existing studies and reviews. We address the contributions that implementation science and quality improvement can make to bridge these gaps by increasing translation and improving the uptake of innovations by teams.

A mixed methods study for the evaluation of a digital health solution for cancer multidisciplinary team meetings using simulation-based research methods.

e14063 Background: Simulation-based research (SBR) methods involve setting up structured scenarios to replicate real-world situations, with the aim of eliciting real-world reactions and behaviours. SBR is useful for the evaluation of new healthcare solutions without compromising patient safety or navigating complex ethical review processes. However, there are few trials using SBR methods for the evaluation of digital health interventions (DHIs), the adoption of which has been hindered in the NHS due to a lack of evidence-base for their efficacy. SBR methods could be an appropriate tool for testing digital solutions. Methods: The Institute of Global Health Innovation (IGHI) developed a series of simulated lung cancer multidisciplinary team (MDT) meetings to test the NAVIFY Tumor Board solution by Roche Diagnostic Information Solutions, a digital solution for the preparation and conduct of cancer MDTs. To provide an environment for participants to evaluate the capabilities of the NAVIFY Tumor Board solution, 10 simulation sessions were organised in which groups of five to six clinicians were recruited to discuss up to 10 mock patient cases across two simulated MDTs, first using standard tools commonly used to conduct MDTs and then using the NAVIFY Tumor Board solution. The cases were developed by the study team at IGHI and consultants in respiratory medicine and oncology. 56 healthcare professionals (respiratory physicians, oncologists, radiologists, histopathologists, clinical nurse specialists and thoracic surgeons) were recruited. The sessions were video recorded and observations were noted by the study team, followed by a focus group in which participants provided feedback about their experience of the simulated MDTs. Results: Through this study we were able to generate evidence and multi-professional recommendations for Roche regarding the functionality, usability and applicability of the solution in the NHS, as well as beneficial features and those which could be improved. Participants reported that the simulations were realistic and a meaningful way of conducting evaluations of digital health solution without impacting clinical practice or patient safety. Conclusions: This study demonstrated the utility and validity of testing commercial tools in simulated settings to generate meaningful insights from endusers. SBR methods were shown to be an acceptable way for frontline practicing clinicians to participate in the testing and development of digital health tools in a standardised setting.