Multidisciplinary management of lung cancer: how to test its efficacy?

The multidisciplinary management of lung cancer has been universally accepted. In France, the multidisciplinary approach for cancer patients is established by law. However, the efficacy of this approach remains theoretical, given that no evaluation criteria have been made available and no previous reports have been published on the prospective follow-up of these patients. The Groupe d' Oncologie Thoracique Azuréen carried out a 1-year prospective study on patients discussed during its multidisciplinary weekly meetings, to analyze the concordance between the proposed and administered treatment, the delay of treatment, and the 1-year actuarial survival. Of the 344 patients discussed during the period considered, the therapeutic decision was chemotherapy in 183 patients, surgery in 93, radiochemotherapy in 42, radiotherapy in 14, and supportive care 12. Therapeutic discordance between the planned and the administered treatment was recorded in 15 cases (4.4%), mainly for patient's refusal (seven cases) or poor performance status (five cases). The median delay of treatment was 20 days, shorter for chemotherapy (16 days), and longer for radiotherapy (27 days). The overall 1-year survival rate was 51.4%: 80.4% for stage I, 50.3% for stage II, 37.5% for stage III, and 27.2% for stage IV. For patients for whom discordance of treatment was recorded, a lower survival rate was recorded, without reaching statistical significance (0.07). In conclusion, the efficacy of the Groupe d' Oncologie Thoracique Azuréen multidisciplinary management was confirmed, as we believe that a discordant rate of less than 5% and a delay of treatment of 4 weeks can be considered acceptable. Furthermore, a periodic survival evaluation of the population as a whole could provide additional useful information for multidisciplinary groups.