Tiffany Lin1, Jonathan Pham1, Eldho Paul2, Matthew Conron3, Gavin Wright4, David Ball5, Paul Mitchell6, Nicola Atkin7, Margaret Brand2, John Zalcberg2, Robert G Stirling8. 1. Department of Respiratory Medicine, Alfred Hospital, Melbourne, Australia. 2. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia. 3. Department of Respiratory Medicine, St Vincent's Hospital, Melbourne, Australia. 4. Victorian Comprehensive Cancer Centre, Melbourne, Australia. 5. Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia. 6. Olivia Newton-John Cancer and Wellness Centre, Melbourne, Australia. 7. Parkville Integrated Palliative Care Service, Peter MacCallum Cancer Centre, Melbourne, Australia. 8. Department of Respiratory Medicine, Alfred Hospital, Melbourne, Australia; Department of Medicine, Monash University, Melbourne, Australia. Electronic address: r.stirling@alfred.org.au.
Abstract
INTRODUCTION: Multidisciplinary Meetings (MDM) are recommended in routine lung cancer care, however its broader impacts demand further evaluation. We assessed the drivers and impacts of MDM presentation in the Victorian Lung Cancer Registry (VLCR). METHODS: We examined the effect of MDM presentation on receipt of treatment and survival in VLCR patients diagnosed between 2011 and 2020. We compared patient characteristics, drivers of MDM discussion and survival between the two groups. RESULTS: Of 9,628 patients, 5,900 (61.3%) were discussed at MDM, 3,728 (38.7%) were not. In the non-MDM group, a lower proportion received surgery (22.1% vs. 31.2%), radiotherapy (34.2% vs. 44.4%) and chemotherapy (44.7% vs. 49.0%). Patients were less likely to be discussed if ≥80 years (OR 0.73, p < 0.001), of ECOG performance status (PS) 4 (OR 0.23, p < 0.001), clinical stage IV (OR 0.34, p < 0.001) or referred from regional (OR 0.52, p < 0.001) or private hospital (OR 0.18, p < 0.001). MDM-presented patients had better median survival (1.70 vs 0.75 years, p < 0.001) and lower adjusted mortality risk (HR 0.75; 0.71-0.80, p < 0.001), a protective effect consistent across all hospital types. Undocumented PS, histopathology and clinical stage were associated with lower likelihood of MDM discussion and worse mortality. CONCLUSIONS: In the VLCR, being male, ≥80 years, of poorer PS, advanced clinical stage and poor clinical characterisation significantly disadvantaged patients in relation to MDM discussion. MDM-discussed patients were more likely to undergo treatment and had a 25% lower risk of mortality. This study supports the use of MDMs in lung cancer and identifies areas of inequity to be addressed.
INTRODUCTION: Multidisciplinary Meetings (MDM) are recommended in routine lung cancer care, however its broader impacts demand further evaluation. We assessed the drivers and impacts of MDM presentation in the Victorian Lung Cancer Registry (VLCR). METHODS: We examined the effect of MDM presentation on receipt of treatment and survival in VLCR patients diagnosed between 2011 and 2020. We compared patient characteristics, drivers of MDM discussion and survival between the two groups. RESULTS: Of 9,628 patients, 5,900 (61.3%) were discussed at MDM, 3,728 (38.7%) were not. In the non-MDM group, a lower proportion received surgery (22.1% vs. 31.2%), radiotherapy (34.2% vs. 44.4%) and chemotherapy (44.7% vs. 49.0%). Patients were less likely to be discussed if ≥80 years (OR 0.73, p < 0.001), of ECOG performance status (PS) 4 (OR 0.23, p < 0.001), clinical stage IV (OR 0.34, p < 0.001) or referred from regional (OR 0.52, p < 0.001) or private hospital (OR 0.18, p < 0.001). MDM-presented patients had better median survival (1.70 vs 0.75 years, p < 0.001) and lower adjusted mortality risk (HR 0.75; 0.71-0.80, p < 0.001), a protective effect consistent across all hospital types. Undocumented PS, histopathology and clinical stage were associated with lower likelihood of MDM discussion and worse mortality. CONCLUSIONS: In the VLCR, being male, ≥80 years, of poorer PS, advanced clinical stage and poor clinical characterisation significantly disadvantaged patients in relation to MDM discussion. MDM-discussed patients were more likely to undergo treatment and had a 25% lower risk of mortality. This study supports the use of MDMs in lung cancer and identifies areas of inequity to be addressed.
Authors: Shantelle Smith; Margaret Brand; Susan Harden; Lisa Briggs; Lillian Leigh; Fraser Brims; Mark Brooke; Vanessa N Brunelli; Collin Chia; Paul Dawkins; Ross Lawrenson; Mary Duffy; Sue Evans; Tracy Leong; Henry Marshall; Dainik Patel; Nick Pavlakis; Jennifer Philip; Nicole Rankin; Nimit Singhal; Emily Stone; Rebecca Tay; Shalini Vinod; Morgan Windsor; Gavin M Wright; David Leong; John Zalcberg; Rob G Stirling Journal: BMJ Open Date: 2022-08-29 Impact factor: 3.006