Tennessee Oncology, Nashville, TN 37203, USA.
Bristol Myers Squibb, Lawrence Township, NJ 08648, USA.
J Comp Eff Res. 2022 Jun;11(8):609-619. doi: 10.2217/cer-2021-0290. Epub 2022 May 12.
The evolving treatment landscape for non-small-cell lung cancer (NSCLC) and complexities of regulations and reimbursement present challenges to community oncologists. Clinical pathways are tools to optimize care, but information on their value in the real world is limited. This retrospective study assessed treatment patterns and clinical outcomes in patients with stage I-III NSCLC pre- and post-pathways implementation at Tennessee Oncology, a large, community-based oncology practice in the USA. Chart data were abstracted for adults diagnosed with stage I-III NSCLC who received systemic treatment. Patients were divided into pre-pathways (treatment initiation 2014-2015) and post-pathways (treatment initiation 2016-2018) cohorts. Patient characteristics, treatment patterns and outcomes were summarized descriptively. Kaplan-Meier curves were used to assess time-dependent outcomes, and log-rank test was used to compare the cohorts. 291 patients were included (stage I-II: 38 pre-pathways, 55 post-pathways; stage III: 105 pre-pathways, 93 post-pathways). Duration on first-line (1L) therapy was similar for stage I-II patients pre- and post-pathways (median 1.9 months vs 2.1 months; p = 0.75), but increased for stage III patients post-pathways (2.1 months vs 1.4 months pre-pathways; p < 0.01). Achievement of a complete or partial response with 1L therapy was similar post-pathways among stage I-stage -IIII patients (60.0% vs 55.2% pre-pathways), but increased for stage III patients (56.0% vs 35.2% pre-pathways). Given that improvements in rates of treatment response post-pathways occurred only for patients diagnosed with stage III NSCLC, among whom immunotherapy uptake increased post-pathways, such improvements may be attributable to evolving practices in cancer care, including advances in treatment and care delivery, rather than clinical pathways implementation. Further research is warranted to assess the impact of clinical pathways in the current treatment era, given that immunotherapy has now become the standard of care in NSCLC.
非小细胞肺癌 (NSCLC) 的治疗领域不断发展，监管和报销的复杂性给社区肿瘤学家带来了挑战。临床路径是优化治疗的工具，但关于其在现实世界中的价值的信息有限。这项回顾性研究评估了美国田纳西肿瘤学（一家大型社区肿瘤学实践）中接受治疗的 I-III 期 NSCLC 患者在实施临床路径前后的治疗模式和临床结局。 对诊断为 I-III 期 NSCLC 并接受全身治疗的成年人进行了图表数据提取。患者分为临床路径前（治疗开始于 2014-2015 年）和临床路径后（治疗开始于 2016-2018 年）队列。总结了患者特征、治疗模式和结局的描述性数据。使用 Kaplan-Meier 曲线评估时间依赖性结局，并使用对数秩检验比较队列。 共纳入 291 例患者（I-II 期：38 例临床路径前，55 例临床路径后；III 期：105 例临床路径前，93 例临床路径后）。I-II 期患者的一线治疗持续时间在临床路径前后相似（中位数 1.9 个月与 2.1 个月；p = 0.75），但 III 期患者的一线治疗持续时间增加（2.1 个月与 1.4 个月临床路径前；p < 0.01）。临床路径后 I-III 期患者的一线治疗完全或部分缓解率相似（临床路径前 60.0%与 55.2%），但 III 期患者的缓解率增加（临床路径前 56.0%与 35.2%）。 鉴于临床路径后治疗反应率的提高仅发生在诊断为 III 期 NSCLC 的患者中，而这些患者中免疫治疗的采用增加，因此这些改善可能归因于癌症治疗中不断发展的实践，包括治疗和护理提供方面的进步，而不是临床路径的实施。鉴于免疫疗法现在已成为 NSCLC 的标准治疗方法，需要进一步研究来评估临床路径在当前治疗时代的影响。
