Multidisciplinary Care

Integrating supportive care into the multidisciplinary management of lung cancer: we can't wait any longer

INTRODUCTION

Due to important achievements in terms of diagnostic and therapeutic tools and the complexity of the disease itself, lung cancer management needs a multidisciplinary approach. To date, the classical multidisciplinary team involves different healthcare providers mainly dedicated to lung cancer diagnosis and treatments. Nevertheless, the underlying disease and related treatments significantly impact on patient function and psychological well-being. In this sense, supportive care may offer the best approach to relieve and manage patient symptoms and treatment-related adverse events.

AREAS COVERED

Evidence report that exercise, nutrition, smoking cessation and psychological well-being bring many benefits in patients with lung cancer, from both a physical and socio-psychological points of view, and potentially improving their survival. Nevertheless, supportive care is rarely offered to patients, and even less frequently these needs are discussed within the multidisciplinary meeting.

EXPERT OPINION

Integrating supportive care as part of the standard multidisciplinary approach for lung cancer involves a series of challenges, the first one represented by the daily necessity of specialists, such as kinesiologists, dietitians, psycho-oncologists, able to deliver a personalized approach. In the era of precision medicine this is an essential step forward to guarantee comprehensive and patient-centered care for all patients with lung cancer.

Survival Outcomes Among Lung Cancer Patients Treated Using a Multidisciplinary Team Approach

BACKGROUND

Evidence favoring a multidisciplinary team (MDT) approach in the treatment of lung cancer is scarce, especially in the United States. The purpose of the present investigation was to evaluate survival outcomes of lung cancer patients treated with an MDT compared with a traditional care model.

PATIENTS AND METHODS

The Stony Brook Cancer Center Registry was used to identify all lung cancer cases diagnosed between 2002 and 2016. We compared survival outcomes among 1956 lung cancer patients participating in our institution's Lung Cancer Evaluation Center's (LCEC) MDT program and 2315 lung cancer patients receiving traditional care. Log-ranks tests were used to evaluate differences in the 1-, 3-, 5-, and 10-year survival outcomes between the 2 groups. To address inherent biases, Cox proportional hazard models were used to estimate the effects on survival outcomes and adjust for possible confounders. Propensity matching was also performed to account for the effects of selection bias.

RESULTS

The 5-year survival rates in the propensity-matched sample were one third greater among LCEC patients compared with those receiving a traditional care approach (33.6% vs. 23.0%; P < .001). After adjusting for potential confounders in the multivariable propensity-matched analyses, the LCEC model demonstrated a significant beneficial effect on 5-year survival outcomes compared with the standard treatment model (hazard ratio, 0.65; 95% confidence interval, 0.54-0.77).

CONCLUSION

The results of the present investigation suggest an improved survival benefit from usage of an MDT model versus a traditional care model in the treatment of lung cancer. Despite the use of sophisticated statistical methods to mitigate bias in a nonrandomized study, additional research is needed to determine the extent to which an MDT approach for lung cancer influences patient outcomes.

The Role of Palliative Care in Oncology

Palliative care is a powerful adjunct to oncology that adds distinct value to the physical, mental, and psychosocial well-being of patients living with cancer. Its expanding role and integration with standard oncologic care has proven clinical benefit, as the practice of palliative care can help alleviate symptom burden, enhance illness and prognostic understanding, and improve both the quality of life and overall survival for patients. The primary aim of this review article is to highlight the significant interplay between palliative care and oncology and, in doing so, shed light on the areas for improvement and modern challenges that exist to meet the complex palliative care needs of patients with cancer.