Syreon Research Institute, Budapest, Hungary.
Moritz Kaposi General Hospital, Kaposvár, Hungary.
PLoS One. 2022 Oct 25;17(10):e0276719. doi: 10.1371/journal.pone.0276719. eCollection 2022.
OnkoNetwork is a patient navigation program established in the Moritz Kaposi General Hospital to improve the timeliness and completeness of cancer investigations and treatment. The H2020 SELFIE consortium selected OnkoNetwork as a promising integrated care initiative in Hungary and conducted a multicriteria decision analysis based on health, patient experience, and cost outcomes. In this paper, a more detailed analysis of clinical impacts is provided in the largest subgroup, non-small cell lung cancer (NSCLC) patients. A retrospective cohort study was conducted, enrolling new cancer suspect patients with subsequently confirmed NSCLC in two annual periods, before and after OnkoNetwork implementation (control and intervention cohorts, respectively). To control for selection bias and confounding, baseline balance was improved via propensity score weighting. Overall survival was analyzed in univariate and multivariate weighted Cox regression models and the effect was further characterized in a counterfactual analysis. Our analysis included 123 intervention and 173 control NSCLC patients from early to advanced stage, with significant between-cohort baseline differences. The propensity score-based weighting resulted in good baseline balance. A large survival benefit was observed in the intervention cohort, and intervention was an independent predictor of longer survival in a multivariate analysis when all baseline characteristics were included (HR = 0.63, p = 0.039). When post-baseline variables were included in the model, belonging to the intervention cohort was not an independent predictor of survival, but the survival benefit was explained by slightly better stage distribution and ECOG status at treatment initiation, together with trends for broader use of PET-CT and higher resectability rate. In conclusion, patient navigation is a valuable tool to improve cancer outcomes by facilitating more timely and complete cancer diagnostics. Contradictory evidence in the literature may be explained by common sources of bias, including the wait-time paradox and adjustment to intermediate outcomes.
OnkoNetwork 是在 Moritz Kaposi 综合医院建立的一个患者导航项目，旨在提高癌症检查和治疗的及时性和完整性。H2020 SELFIE 联盟选择 OnkoNetwork 作为匈牙利有前途的综合护理计划，并基于健康、患者体验和成本结果进行了多标准决策分析。在本文中，在最大的亚组——非小细胞肺癌 (NSCLC) 患者中提供了更详细的临床影响分析。进行了一项回顾性队列研究，在 OnkoNetwork 实施前后（分别为对照组和干预组），纳入随后确诊为 NSCLC 的新癌症疑似患者。为了控制选择偏差和混杂因素，通过倾向评分加权来改善基线平衡。在单变量和多变量加权 Cox 回归模型中分析了总生存期，并在反事实分析中进一步描述了效果。我们的分析包括来自早期到晚期的 123 名干预组和 173 名对照组 NSCLC 患者，两组之间存在显著的基线差异。基于倾向评分的加权产生了良好的基线平衡。干预组观察到生存获益显著，当纳入所有基线特征时，干预是多变量分析中生存时间延长的独立预测因素（HR=0.63，p=0.039）。当将基线后变量纳入模型时，属于干预组不再是生存的独立预测因素，但生存获益可通过治疗开始时的稍好分期分布和 ECOG 状态以及 PET-CT 更广泛应用和更高的可切除率趋势来解释。总之，患者导航是通过促进更及时和完整的癌症诊断来改善癌症结局的有价值工具。文献中的矛盾证据可能可以通过常见的偏倚来源来解释，包括等待时间悖论和对中间结果的调整。
