- Email: [email protected]
Caregiver Perspectives
S1560 insurance status which suggests that patients intending to seek better care will frequently migrate. They are more likely to receive treatment and live longer if they are insured. Considering the current landscape of changing healthcare policy, it is notable that insurance status plays such a significant role in enabling lung cancer patients to find effective treatment.
Journal of Thoracic Oncology
Vol. 12 No. 11S1
4B.03 Prospective Evaluation of Multidisciplinary Lung Cancer Care: Timeliness, Thoroughness, and Patient/ Caregiver Perspectives Topic: Medical Oncology
4B.02 Increasing Survival in Stage IV NSCLC in Academic versus Community Based Centers in the National Cancer Database Topic: Medical Oncology S. Ramalingam,1 M. Dinan,1 J. Crawford2 1Duke University, Durham, NC/US, 2Medical Oncology, Duke University, Durham, NC/US Background: Overall survival of patients in the United States with advanced Non-small cell lung cancer (NSCLC) remains poor. However, improved outcomes are expected from recent advances in management from optimized chemotherapy and biomarker driven personalized therapies. With the increased early use of emerging regimens, we hypothesized that survival differences between academic and community centers are widening over time. Methods: We did a retrospective analysis of patients diagnosed with stage IV NSCLC between 1998 and 2010 within the 2012 National Cancer Database (NCDB). The primary end point was 2-year survival; analysis was limited to patients diagnosed up to 2010 to allow at least 2 years of follow-up. We restricted our analysis to hospitals present in the dataset throughout the study period. Overall survival was compared by academic versus community site of treatment controlling for the year of diagnosis, age, gender, histology, and insurance status. Results: In our multivariable analysis of 193,279 patients with stage IV NSCLC, 2-year survival differentially improved over time between academic and community-based centers (p¼0.0005) at a rate of 0.15% per year with 99.9% confidence interval (0.008%,0.3%). Patients treated in community centers tended to be older (mean 64 versus 62 years) and on average traveled 15 miles less for treatment. These patient differences between community and academic centers were stable over time. Conclusion: We found a widening gap in 2-year survival between academic and community centers in the NCDB. Further research is needed to understand and address widening disparities in outcomes between academic and community centers, and the potential impact of immune approaches on these outcomes.
M. Smeltzer,1 F.E. Rugless,2 H.K. Lee,3 K. Ward,1 N.R. Faris,2 M.A. Ray,1 M. Meadows,1 B. Jiang,2 B. Jackson,2 C. Foust,2 A. Patel,2 N. Boateng,2 S. Kedia,1 K. Roark,2 C. Houston-Harris,2 C. Fehnel,2 R.S. Signore,2 R. Fox,2 E.T. Robbins,2 J. Li,3 R.U. Osarogiagbon2 1 School Of Public Health, University of Memphis, Memphis, TN/US, 2 Baptist Cancer Center, Memphis, TN/US, 3Dept Of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI/US Background: The process of care for Non-small Cell Lung Cancer (NSCLC) patients provides many challenges. A Multidisciplinary (MD) model may improve outcomes, but its value has been difficult to quantify, with most studies being retrospective pre-post analyses. Timeliness of care is one MD advantage that studies consistently demonstrate, but more timely care does not necessarily translate to improved survival. However, timeliness is a patient-centered value, affirmed in our pre-study focus groups. We prospectively evaluated timeliness, staging activities, stage-based treatment selection, and patient/caregiver perspectives in MD vs. usual serial care (SC). Methods: This comparative effectiveness trial evaluated MD clinic vs. SC on multiple patient-centered endpoints with mixed-methods. Timeliness was evaluated by process engineering with bottleneck analyses. The 5-step process of care was: lesion identification, diagnostic biopsy, non-invasive staging, invasive staging, and definitive treatment. Quality of staging endpoints included bimodal staging (CT and PET or invasive biopsy) and trimodal staging (using all 3). Stage based treatments were compared with NCCN recommendations. Patient/caregiver satisfaction with quality of care and timeliness was measured by patient/caregiver surveys at baseline, 3-months, and 6months. Statistical methods: Chi-Square test, Wilcoxon-Mann-Whitney test. Results: The study enrolled 527 patients (178 MD, 349 SC). Average waiting times between steps were 48.8 days (MD) and 43.3 days (SC). Bottlenecks included time from: lesion identification to diagnostic biopsy, invasive or noninvasive staging to definitive treatment. MD patients received higher rates of bimodal staging (89% vs. 76%, p-value<0.001) and tri-modal staging (55% vs. 37%, pvalue<0.001) than SC patients. Ultimately, MD patients received more stage appropriate treatment than SC (79% vs. 68%, p-value<0.01). Overall, patients on MD and SC reported satisfaction with timeliness measures at baseline, 3-, and 6-months, scoring most items similarly high (between 2.7/3.0 and 2.9/3.0; individual question response rates 48-86%). At 6-months, MD patients were more satisfied with overall time from diagnosis to treatment completion (4.9/5.0 vs. 4.6/5.0, pvalue¼0.03). MD patients also reported higher satisfaction with combined quality of care from team members at all 3 time points (6Month: 15.9/16.0 vs. 14.4/16.0, p<0.0001). MD Caregivers were more satisfied with overall quality of care compared with other NSCLC patients at baseline (p<0.01) and 6-months (p<0.01). Conclusion: Despite the additional time to treatment initiation, MD patients received more thorough staging, more stage-appropriate treatment, and were more satisfied with the timeliness of their care. Timeliness is not an absolute quantity, but may be a relative value based on patients’ satisfaction with their level of engagement in the care-delivery process.
Journal of Thoracic Oncology
Vol. 12 No. 11S1
4B.03 Prospective Evaluation of Multidisciplinary Lung Cancer Care: Timeliness, Thoroughness, and Patient/ Caregiver Perspectives Topic: Medical Oncology
4B.02 Increasing Survival in Stage IV NSCLC in Academic versus Community Based Centers in the National Cancer Database Topic: Medical Oncology S. Ramalingam,1 M. Dinan,1 J. Crawford2 1Duke University, Durham, NC/US, 2Medical Oncology, Duke University, Durham, NC/US Background: Overall survival of patients in the United States with advanced Non-small cell lung cancer (NSCLC) remains poor. However, improved outcomes are expected from recent advances in management from optimized chemotherapy and biomarker driven personalized therapies. With the increased early use of emerging regimens, we hypothesized that survival differences between academic and community centers are widening over time. Methods: We did a retrospective analysis of patients diagnosed with stage IV NSCLC between 1998 and 2010 within the 2012 National Cancer Database (NCDB). The primary end point was 2-year survival; analysis was limited to patients diagnosed up to 2010 to allow at least 2 years of follow-up. We restricted our analysis to hospitals present in the dataset throughout the study period. Overall survival was compared by academic versus community site of treatment controlling for the year of diagnosis, age, gender, histology, and insurance status. Results: In our multivariable analysis of 193,279 patients with stage IV NSCLC, 2-year survival differentially improved over time between academic and community-based centers (p¼0.0005) at a rate of 0.15% per year with 99.9% confidence interval (0.008%,0.3%). Patients treated in community centers tended to be older (mean 64 versus 62 years) and on average traveled 15 miles less for treatment. These patient differences between community and academic centers were stable over time. Conclusion: We found a widening gap in 2-year survival between academic and community centers in the NCDB. Further research is needed to understand and address widening disparities in outcomes between academic and community centers, and the potential impact of immune approaches on these outcomes.
M. Smeltzer,1 F.E. Rugless,2 H.K. Lee,3 K. Ward,1 N.R. Faris,2 M.A. Ray,1 M. Meadows,1 B. Jiang,2 B. Jackson,2 C. Foust,2 A. Patel,2 N. Boateng,2 S. Kedia,1 K. Roark,2 C. Houston-Harris,2 C. Fehnel,2 R.S. Signore,2 R. Fox,2 E.T. Robbins,2 J. Li,3 R.U. Osarogiagbon2 1 School Of Public Health, University of Memphis, Memphis, TN/US, 2 Baptist Cancer Center, Memphis, TN/US, 3Dept Of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI/US Background: The process of care for Non-small Cell Lung Cancer (NSCLC) patients provides many challenges. A Multidisciplinary (MD) model may improve outcomes, but its value has been difficult to quantify, with most studies being retrospective pre-post analyses. Timeliness of care is one MD advantage that studies consistently demonstrate, but more timely care does not necessarily translate to improved survival. However, timeliness is a patient-centered value, affirmed in our pre-study focus groups. We prospectively evaluated timeliness, staging activities, stage-based treatment selection, and patient/caregiver perspectives in MD vs. usual serial care (SC). Methods: This comparative effectiveness trial evaluated MD clinic vs. SC on multiple patient-centered endpoints with mixed-methods. Timeliness was evaluated by process engineering with bottleneck analyses. The 5-step process of care was: lesion identification, diagnostic biopsy, non-invasive staging, invasive staging, and definitive treatment. Quality of staging endpoints included bimodal staging (CT and PET or invasive biopsy) and trimodal staging (using all 3). Stage based treatments were compared with NCCN recommendations. Patient/caregiver satisfaction with quality of care and timeliness was measured by patient/caregiver surveys at baseline, 3-months, and 6months. Statistical methods: Chi-Square test, Wilcoxon-Mann-Whitney test. Results: The study enrolled 527 patients (178 MD, 349 SC). Average waiting times between steps were 48.8 days (MD) and 43.3 days (SC). Bottlenecks included time from: lesion identification to diagnostic biopsy, invasive or noninvasive staging to definitive treatment. MD patients received higher rates of bimodal staging (89% vs. 76%, p-value<0.001) and tri-modal staging (55% vs. 37%, pvalue<0.001) than SC patients. Ultimately, MD patients received more stage appropriate treatment than SC (79% vs. 68%, p-value<0.01). Overall, patients on MD and SC reported satisfaction with timeliness measures at baseline, 3-, and 6-months, scoring most items similarly high (between 2.7/3.0 and 2.9/3.0; individual question response rates 48-86%). At 6-months, MD patients were more satisfied with overall time from diagnosis to treatment completion (4.9/5.0 vs. 4.6/5.0, pvalue¼0.03). MD patients also reported higher satisfaction with combined quality of care from team members at all 3 time points (6Month: 15.9/16.0 vs. 14.4/16.0, p<0.0001). MD Caregivers were more satisfied with overall quality of care compared with other NSCLC patients at baseline (p<0.01) and 6-months (p<0.01). Conclusion: Despite the additional time to treatment initiation, MD patients received more thorough staging, more stage-appropriate treatment, and were more satisfied with the timeliness of their care. Timeliness is not an absolute quantity, but may be a relative value based on patients’ satisfaction with their level of engagement in the care-delivery process.