Department of Medical Oncology and Therapeutics Research, City of Hope, Comprehensive Cancer Center and National Medical Center, Duarte, CA.
Association of Community Cancer Centers, Rockville, MD.
JCO Oncol Pract. 2021 Aug;17(8):e1120-e1130. doi: 10.1200/OP.20.00899. Epub 2021 Mar 9.
Insufficient characterization of the optimal multidisciplinary team and lack of understanding of barriers to quality care are unmet needs in the management of stage III or IV non-small-cell lung cancer (NSCLC). A national survey was conducted to inform the design and execution of process improvement plans and address identified barriers.
A steering committee of multidisciplinary specialists and representation from patient advocacy collaborated for a comprehensive, double-blind, web-based survey (January-April 2019) to obtain insights on care delivery for patients with advanced NSCLC in a diverse set of US community cancer programs.
Overall, 639 responses (160 unique cancer programs across 44 US states) were included; 41% (n = 261) of respondents indicated an absence of a thoracic multidisciplinary clinic in their cancer program. Engagement in shared decision making was significantly associated with the presence of navigation and radiation oncology disciplines ( ≤ .04); 19.2% and 33.3% of respondents belonged to cancer programs with no lung cancer screening and no protocol for biomarker testing, respectively. The frequency of tumor board meetings negatively correlated with time to complete disease staging ( = .03); the average time to first therapeutic intervention in newly diagnosed patients was 4 weeks. The most challenging barriers to quality care included insufficient quantity of biopsy material for biomarker testing, lack of primary care provider referrals, and diagnostic costs.
Improving the quality of advanced NSCLC care, including optimization of a multidisciplinary team framework, may surmount barriers to care coordination, diagnosis and staging, and treatment planning, consequently improving adherence to evolving standards of care.
在 III 期或 IV 期非小细胞肺癌（NSCLC）的管理中，对最佳多学科团队的特征描述不足以及对高质量护理障碍的认识不足是尚未满足的需求。进行了一项全国性调查，以告知设计和执行过程改进计划，并解决已确定的障碍。
一个多学科专家指导委员会和患者权益代表合作进行了一项全面的、双盲的、基于网络的调查（2019 年 1 月至 4 月），以了解美国不同社区癌症计划中晚期 NSCLC 患者的护理提供情况。
共有 639 份回复（44 个美国州的 160 个独特癌症计划）被纳入研究；41%（n = 261）的受访者表示其癌症计划中没有胸科多学科诊所。参与共同决策与导航和放射肿瘤学学科的存在显著相关（≤.04）；19.2%和 33.3%的受访者分别来自没有肺癌筛查和没有生物标志物检测方案的癌症计划。肿瘤委员会会议的频率与完成疾病分期的时间呈负相关（=.03）；新诊断患者首次治疗干预的平均时间为 4 周。高质量护理的最具挑战性障碍包括生物标志物检测的活检材料数量不足、初级保健提供者转诊不足和诊断费用。
改善晚期 NSCLC 护理质量，包括优化多学科团队框架，可能克服护理协调、诊断和分期以及治疗计划方面的障碍，从而提高对不断发展的护理标准的依从性。
