Cardiothoracic Surgery Registrar, Department of Cardiothoracic Surgery, Dunedin Public Hospital, Dunedin, Otago.
N Z Med J. 2022 Jun 10;135(1556):11-22.
Multidisciplinary team (MDT) meetings are a standard of care for lung cancer management in many regions around the world. Clinical quality indicators (CQIs) can be used to assess the proficiency of these multidisciplinary teams and compare their performance against those recommended by local and international guidelines. The effectiveness of the lung cancer MDT meeting at Dunedin Public Hospital has been evaluated using CQIs with a focus on the timeliness of surgical management.
Medical records for all 108 patients who underwent curative intent oncological lung surgery at Dunedin Public Hospital between 2014-2020 were obtained. All patients were discussed at the lung cancer MDT meeting. Performance in six CQIs were evaluated as per the results below.
The CQI for timing of referral to first contact with a respiratory medicine specialist was met in all years studied by mean days. In all years bars for 2014 and 2017, the standard for time by mean days from referral date to surgery was met. In 2017, the mean time to surgery exceeded this standard by only one day. The mean time between respiratory specialist review and surgery was less than 56 days in all years except for 2014. By mean days, 2018 was the only year that surgery was performed within 31 days of discussion at the lung cancer MDT. Computed tomography (CT) guided biopsies and endobronchial ultrasound (EBUS) were only performed within a mean of seven days in only two years (2015 and 2017) out of the seven years of data. The target of all patients with curative small or non-small cell lung cancer receiving a positron emission tomography (PET) scan was not achieved in any year. Post-operative upstaging was more frequent than downstaging (19.4% vs 14.8%), and 71.4% of those upstaged received a PET scan pre-operatively. Māori patients and those with significant socio-economic deprivation were less likely to meet standards of lung cancer care.
Between 2014-2020, the standards for lung cancer management in surgical patients were frequently achieved as measured by mean days. However, a target of ≥95% (90% for CQI 2; 100% for CQI 6) of patients receiving care at the standard was rarely met. Timing of CT biopsy and EBUS was consistently longer than recommended, and pre-operative PET utilisation was less than 100%. Thus, there is still room for improvement in surgical lung cancer management in the Southern Health District.
多学科团队（MDT）会议是世界许多地区肺癌管理的标准。临床质量指标（CQI）可用于评估这些多学科团队的熟练程度，并将其绩效与当地和国际指南推荐的绩效进行比较。达尼丁公立医院的肺癌 MDT 会议使用 CQI 进行了评估，重点是手术管理的及时性。
获取了 2014-2020 年期间在达尼丁公立医院接受根治性肿瘤学肺癌手术的 108 名患者的所有病历。所有患者均在肺癌 MDT 会议上进行了讨论。根据以下结果评估了六个 CQI 的表现。
在所有研究年份中，通过平均天数，转诊至首次与呼吸内科专家接触的 CQI 均达到标准。在 2014 年和 2017 年的所有年份中，从转诊日期到手术的标准时间的平均天数都达到了标准。在 2017 年，手术时间仅比该标准长一天。除了 2014 年之外，所有年份的呼吸专家审查和手术之间的平均时间都小于 56 天。按平均天数计算，只有 2018 年在肺癌 MDT 会议讨论后 31 天内进行了手术。在 7 年的数据中，只有在 2015 年和 2017 年这两年中，CT 引导活检和支气管内超声（EBUS）的平均时间才在 7 天内完成。在任何一年，均未达到所有可治愈的小细胞或非小细胞肺癌患者接受正电子发射断层扫描（PET）扫描的目标。术后分期升高的频率高于分期降低（19.4%比 14.8%），且 71.4%的分期升高患者术前接受了 PET 扫描。毛利人和社会经济地位显著低下的患者不太可能达到肺癌护理标准。
在 2014-2020 年期间，根据平均天数衡量，外科患者的肺癌管理标准经常得到满足。然而，很少有患者达到 95%以上（CQI2 的 90%；CQI6 的 100%）的治疗标准。CT 活检和 EBUS 的时间明显长于推荐时间，术前 PET 的使用率低于 100%。因此，南十字星区的外科肺癌管理仍有改进空间。
