M Evison1, J Edwards2, F McDonald3, S Popat3. 1. Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK. Electronic address: m.evison@nhs.net. 2. Department of Thoracic Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK. 3. Department of Thoracic Oncology, Royal Marsden Hospital, London, UK.
Abstract
AIMS: The optimal management of stage III non-small cell lung cancer (NSCLC) is widely debated and is a rapidly evolving area. However, less than one in five stage III patients in England receive optimal multimodality treatment. The aim of this study was to map commonalities and differences in clinician judgement as well as infrastructure and resources for managing stage III NSCLC. MATERIALS AND METHODS: We carried out a national survey of practice in stage III NSCLC management in the UK using a 30-min web-based survey. Invitations were sent via e-mail to the British Thoracic Oncology Group and the Society of Cardiothoracic Surgery membership and a healthcare professional market research panel. RESULTS: In total, 160 respondents completed the survey. Although opinion was variable, there was a preference for surgery and adjuvant chemotherapy in stage III N2 (single station) NSCLC that could be treated with lobectomy, but this preference switched to chemoradiotherapy in single-station N2 requiring a pneumonectomy or multi-station N2. The PD-L1 status influenced the treatment decision in 'potentially resectable' N2 for a number of clinicians who opted for concurrent chemoradiotherapy with adjuvant durvalumab when PD-L1 ≥ 1%. A joint clinic with surgeons and oncologists was considered the most important factor for shared decision making with patients. There are barriers to recommending trimodality treatment, e.g. concerns over the negative impact on quality of life. A proportion of clinicians favoured palliative treatment in certain clinical scenarios, including supraclavicular fossa lymph node metastases, patients with borderline fitness or high PD-L1 expressors >50%. DISCUSSION: This survey has highlighted the need for infrastructure development, such as reflex PD-L1 testing and joint surgical and oncology clinics. Further research into the impact of multimodality treatment on quality of life and education to improve confidence in multimodality treatment could all drive improvements in stage III NSCLC management.
AIMS: The optimal management of stage III non-small cell lung cancer (NSCLC) is widely debated and is a rapidly evolving area. However, less than one in five stage III patients in England receive optimal multimodality treatment. The aim of this study was to map commonalities and differences in clinician judgement as well as infrastructure and resources for managing stage III NSCLC. MATERIALS AND METHODS: We carried out a national survey of practice in stage III NSCLC management in the UK using a 30-min web-based survey. Invitations were sent via e-mail to the British Thoracic Oncology Group and the Society of Cardiothoracic Surgery membership and a healthcare professional market research panel. RESULTS: In total, 160 respondents completed the survey. Although opinion was variable, there was a preference for surgery and adjuvant chemotherapy in stage III N2 (single station) NSCLC that could be treated with lobectomy, but this preference switched to chemoradiotherapy in single-station N2 requiring a pneumonectomy or multi-station N2. The PD-L1 status influenced the treatment decision in 'potentially resectable' N2 for a number of clinicians who opted for concurrent chemoradiotherapy with adjuvant durvalumab when PD-L1 ≥ 1%. A joint clinic with surgeons and oncologists was considered the most important factor for shared decision making with patients. There are barriers to recommending trimodality treatment, e.g. concerns over the negative impact on quality of life. A proportion of clinicians favoured palliative treatment in certain clinical scenarios, including supraclavicular fossa lymph node metastases, patients with borderline fitness or high PD-L1 expressors >50%. DISCUSSION: This survey has highlighted the need for infrastructure development, such as reflex PD-L1 testing and joint surgical and oncology clinics. Further research into the impact of multimodality treatment on quality of life and education to improve confidence in multimodality treatment could all drive improvements in stage III NSCLC management.
Authors: Merle I Ronden; Idris Bahce; Niels J M Claessens; Nicole Barlo; Max R Dahele; Johannes M A Daniels; Caroline Tissing-Tan; Edo Hekma; Sayed M S Hashemi; Antoinet van der Wel; Femke O B Spoelstra; Wilko F A R Verbakel; Marian A Tiemessen; Marjolein van Laren; Annemarie Becker; Svitlana Tarasevych; Cornelis J A Haasbeek; Karen Maassen van den Brink; Chris Dickhoff; Suresh Senan Journal: JTO Clin Res Rep Date: 2021-06-06
Authors: Sally Taylor; Janelle Yorke; Selina Tsim; Neal Navani; David Baldwin; Ian Woolhouse; John Edwards; Seamus Grundy; Jonathan Robson; Sarah Rhodes; Fabio Gomes; Fiona Blackhall; Corinne Faivre-Finn; Matthew Evison Journal: BMJ Open Respir Res Date: 2021-07