Wei Liao PhD , Meredith Ray PhD , Carrie Fehnel BBA , Jordan Goss MA , Catherine J. Shepherd MFA , Anita Patel MHA , Talat Qureshi BS , Federico Caro BA , Jessica Roma AS , Anna Derrick AA , Anberitha T. Matthews PhD , Nicholas R. Faris M. Div , Matthew Smeltzer PhD , Raymond U. Osarogiagbon M.B.B.S., FACP
{"title":"基于计划的肺癌治疗:一项前瞻性观察性肿瘤登记关联研究。","authors":"Wei Liao PhD , Meredith Ray PhD , Carrie Fehnel BBA , Jordan Goss MA , Catherine J. Shepherd MFA , Anita Patel MHA , Talat Qureshi BS , Federico Caro BA , Jessica Roma AS , Anna Derrick AA , Anberitha T. Matthews PhD , Nicholas R. Faris M. Div , Matthew Smeltzer PhD , Raymond U. Osarogiagbon M.B.B.S., FACP","doi":"10.1016/j.jtocrr.2023.100629","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><p>Low-dose computed tomography screening (LDCT) and lung nodule programs (LNP) promote early lung cancer detection, improve survival; Multidisciplinary Care Programs (MDC) promote guideline-concordant care. The impact of such program-based care on “real-world” lung cancer survival is unquantified. We evaluated outcomes of lung cancer care delivered through structured programs in a community health care system.</p></div><div><h3>Methods</h3><p>We conducted a cohort study linking institutional prospective observational LDCT, LNP and MDC databases with Tumor Registry of Baptist Cancer Center facilities. We categorized all patients diagnosed with lung cancer between 2011 and 2021 into program-based care versus non-program-based care cohorts. We compared patient characteristics, stage distribution, treatment modalities, survival and mortality in each pathway of care.</p></div><div><h3>Results</h3><p>Of 12,148 patients, 237, 1,165, 1,140 and 9,606 were diagnosed through the LDCT, LNP, MDC or no program, respectively; non-program-based care sequentially diminished from 96.3% to 66.5%, diagnosis through LDCT increased from 0.5% to 7.1%, LNP from 3.5% to 20.8%; and MDC alone decreased from a high of 12.8% in 2014 to 5.6% in 2021. Program-based care was associated with earlier stage (p < 0.001), higher surgical resection rates (<em>p</em> < 0.001), greater use of adjuvant therapy (<em>p</em> < 0.001), better aggregate and stage-stratified survival (<em>p</em> < 0.001), and lower all-cause and lung cancer-specific mortality (<em>p</em> < 0.001). Recipients of non-program-based care were considerably less likely to receive lung cancer treatment; results remained consistent when patients receiving no treatment were excluded.</p></div><div><h3>Conclusions</h3><p>Program-based care was associated with substantially better survival. Increasing access to program-based care should be explored as a matter of urgent public policy.</p></div>","PeriodicalId":17675,"journal":{"name":"JTO Clinical and Research Reports","volume":null,"pages":null},"PeriodicalIF":3.0000,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666364323001728/pdfft?md5=7ab7677cbe150ebddf7b7d191080ff6f&pid=1-s2.0-S2666364323001728-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Program-Based Lung Cancer Care: A Prospective Observational Tumor Registry Linkage Study\",\"authors\":\"Wei Liao PhD , Meredith Ray PhD , Carrie Fehnel BBA , Jordan Goss MA , Catherine J. Shepherd MFA , Anita Patel MHA , Talat Qureshi BS , Federico Caro BA , Jessica Roma AS , Anna Derrick AA , Anberitha T. Matthews PhD , Nicholas R. Faris M. Div , Matthew Smeltzer PhD , Raymond U. Osarogiagbon M.B.B.S., FACP\",\"doi\":\"10.1016/j.jtocrr.2023.100629\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction</h3><p>Low-dose computed tomography screening (LDCT) and lung nodule programs (LNP) promote early lung cancer detection, improve survival; Multidisciplinary Care Programs (MDC) promote guideline-concordant care. The impact of such program-based care on “real-world” lung cancer survival is unquantified. We evaluated outcomes of lung cancer care delivered through structured programs in a community health care system.</p></div><div><h3>Methods</h3><p>We conducted a cohort study linking institutional prospective observational LDCT, LNP and MDC databases with Tumor Registry of Baptist Cancer Center facilities. We categorized all patients diagnosed with lung cancer between 2011 and 2021 into program-based care versus non-program-based care cohorts. We compared patient characteristics, stage distribution, treatment modalities, survival and mortality in each pathway of care.</p></div><div><h3>Results</h3><p>Of 12,148 patients, 237, 1,165, 1,140 and 9,606 were diagnosed through the LDCT, LNP, MDC or no program, respectively; non-program-based care sequentially diminished from 96.3% to 66.5%, diagnosis through LDCT increased from 0.5% to 7.1%, LNP from 3.5% to 20.8%; and MDC alone decreased from a high of 12.8% in 2014 to 5.6% in 2021. Program-based care was associated with earlier stage (p < 0.001), higher surgical resection rates (<em>p</em> < 0.001), greater use of adjuvant therapy (<em>p</em> < 0.001), better aggregate and stage-stratified survival (<em>p</em> < 0.001), and lower all-cause and lung cancer-specific mortality (<em>p</em> < 0.001). Recipients of non-program-based care were considerably less likely to receive lung cancer treatment; results remained consistent when patients receiving no treatment were excluded.</p></div><div><h3>Conclusions</h3><p>Program-based care was associated with substantially better survival. 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Program-Based Lung Cancer Care: A Prospective Observational Tumor Registry Linkage Study
Introduction
Low-dose computed tomography screening (LDCT) and lung nodule programs (LNP) promote early lung cancer detection, improve survival; Multidisciplinary Care Programs (MDC) promote guideline-concordant care. The impact of such program-based care on “real-world” lung cancer survival is unquantified. We evaluated outcomes of lung cancer care delivered through structured programs in a community health care system.
Methods
We conducted a cohort study linking institutional prospective observational LDCT, LNP and MDC databases with Tumor Registry of Baptist Cancer Center facilities. We categorized all patients diagnosed with lung cancer between 2011 and 2021 into program-based care versus non-program-based care cohorts. We compared patient characteristics, stage distribution, treatment modalities, survival and mortality in each pathway of care.
Results
Of 12,148 patients, 237, 1,165, 1,140 and 9,606 were diagnosed through the LDCT, LNP, MDC or no program, respectively; non-program-based care sequentially diminished from 96.3% to 66.5%, diagnosis through LDCT increased from 0.5% to 7.1%, LNP from 3.5% to 20.8%; and MDC alone decreased from a high of 12.8% in 2014 to 5.6% in 2021. Program-based care was associated with earlier stage (p < 0.001), higher surgical resection rates (p < 0.001), greater use of adjuvant therapy (p < 0.001), better aggregate and stage-stratified survival (p < 0.001), and lower all-cause and lung cancer-specific mortality (p < 0.001). Recipients of non-program-based care were considerably less likely to receive lung cancer treatment; results remained consistent when patients receiving no treatment were excluded.
Conclusions
Program-based care was associated with substantially better survival. Increasing access to program-based care should be explored as a matter of urgent public policy.