Riedel Richard F, Wang Xiaofei, McCormack Meg, Toloza Eric, Montana Gustavo S, Schreiber Gilbert, Kelley Michael J
Department of Medicine, Durham Veterans Affairs Medical Center and Duke University Medical Center, Durham, North Carolina, USA.
J Thorac Oncol. 2006 Sep;1(7):692-6.
Multidisciplinary clinics have been recommended for the evaluation of patients with lung cancer. Evidence to support this recommendation, however, is limited. A single-center, retrospective review of lung cancer patients at a Veterans Affairs hospital was performed comparing timeliness of diagnostic and treatment decisions during the operation of a multidisciplinary thoracic oncology clinic (MTOC) with a period after it closed (non-MTOC), during which only a weekly multidisciplinary conference was held.
Patients were identified from a tumor registry. Manual chart reviews were performed on all patients. Outcome measures included time from initial presentation to diagnosis (TTD) and time from diagnosis to treatment initiation (TTT).
Three hundred forty-five patients (244 in MTOC, 101 in non-MTOC) diagnosed with lung cancer between 1999 and 2003 were included in the study. Baseline characteristics were similar between the two groups. Median TTD was 48 days (95% confidence interval [CI]: 37-61) and 47 days (95% CI: 39-55) in the MTOC (n = 164) and non-MTOC cohorts (n = 89), respectively (p = 0.09). Median TTT was 22 days (95% CI: 20-27) and 23 days (95% CI: 20-34) in the MTOC (n = 165) and non-MTOC cohorts (n = 89), respectively (p = 0.71). There was no difference in overall survival.
Retrospective comparison of sequential cohorts failed to reveal benefit in the timeliness of care measures during the time period of MTOC operation. Potential confounders include the absence of a surgeon in the MTOC setting, an ongoing weekly multidisciplinary conference in the non-MTOC cohort, and existing infrastructures based on previous MTOC experiences and past provider experience. Confirmation of these findings in other health care settings is warranted, preferably in a prospective fashion.
多学科诊所已被推荐用于肺癌患者的评估。然而，支持这一推荐的证据有限。我们对一家退伍军人事务医院的肺癌患者进行了单中心回顾性研究，比较了多学科胸肿瘤诊所（MTOC）运营期间与关闭后（非MTOC）的诊断和治疗决策及时性，关闭后仅举行每周一次的多学科会议。
从肿瘤登记处识别患者。对所有患者进行手工病历审查。结果指标包括从首次就诊到诊断的时间（TTD）和从诊断到开始治疗的时间（TTT）。
1999年至2003年间诊断为肺癌的345例患者（MTOC组244例，非MTOC组101例）纳入研究。两组的基线特征相似。MTOC组（n = 164）和非MTOC队列（n = 89）的中位TTD分别为48天（95%置信区间[CI]：37 - 61）和47天（95%CI：39 - 55）（p = 0.09）。MTOC组（n = 165）和非MTOC队列（n = 89）的中位TTT分别为22天（95%CI：20 - 27）和23天（95%CI：20 - 34）（p = 0.71）。总生存率无差异。
对连续队列的回顾性比较未能揭示MTOC运营期间护理措施及时性方面的益处。潜在的混杂因素包括MTOC环境中没有外科医生、非MTOC队列中持续进行的每周多学科会议以及基于先前MTOC经验和既往提供者经验的现有基础设施。有必要在其他医疗环境中以前瞻性方式对这些发现进行证实。
