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Hollick RJ, James WRG, Nicoll A, Locock L, Black C, Dhaun N, Egan AC, Fluck N, Laidlaw L, Lanyon PC, Little MA, Luqmani RA, Moir L, McBain M, Basu N. Identifying key health system components associated with improved outcomes to inform the re-configuration of services for adults with rare autoimmune rheumatic diseases: a mixed-methods study. THE LANCET. RHEUMATOLOGY 2024; 6:e361-e373. [PMID: 38782514 DOI: 10.1016/s2665-9913(24)00082-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Adults with rare autoimmune rheumatic diseases face unique challenges and struggles to navigate health-care systems designed to manage common conditions. Evidence to inform an optimal service framework for their care is scarce. Using systemic vasculitis as an exemplar, we aimed to identify and explain the key service components underpinning effective care for rare diseases. METHODS In this mixed-methods study, data were collected as part of a survey of vasculitis service providers across the UK and Ireland, interviews with patients, and from organisational case studies to identify key service components that enable good care. The association between these components and patient outcomes (eg, serious infections, mortality) and provider outcomes (eg, emergency hospital admissions) were examined in a population-based data linkage study using routine health-care data obtained from patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis from national health datasets in Scotland. We did univariable and multivariable analyses using Bayesian poisson and negative binomial regression to estimate incident rate ratios (IRRs), and Cox proportional hazards models to estimate hazard ratios (HRs). People with lived experiences were involved in the research and writing process. FINDINGS Good care was characterised by service components that supported timely access to services, integrated care, and expertise. In 1420 patients with ANCA-associated vasculitis identified from national health datasets, service-reported average waiting times for new patients of less than 1 week were associated with fewer serious infections (IRR 0·70 [95% credibility interval 0·55-0·88]) and fewer emergency hospital admissions (0·78 [0·68-0·92]). Nurse-led advice lines were associated with fewer serious infections (0·76 [0·58-0·93]) and fewer emergency hospital admissions (0·85 [0·74-0·96]). Average waiting times for new patients of less than 1 week were also associated with reduced mortality (HR 0·59 [95% credibility interval 0·37-0·93]). Cohorted clinics, nurse-led clinics, and specialist vasculitis multi-disciplinary team meetings were associated with fewer serious infections (IRR 0·75 [0·59-0·96] for cohorted clinics; 0·65 [0·39-0·84] for nurse-led clinics; 0·72 [0·57-0·90] for specialist vasculitis multi-disciplinary team meetings) and emergency hospital admissions (0·81 [0·71-0·91]; 0·75 [0·65-0·94]; 0·86 [0·75-0·96]). Key components were characterised by their ability to overcome professional tensions between specialties. INTERPRETATION Key service components associated with important health outcomes and underpinning factors were identified to inform initiatives to improve the design, delivery, and effectiveness of health-care models for rare autoimmune rheumatic diseases. FUNDING Versus Arthritis.
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Affiliation(s)
- Rosemary J Hollick
- Epidemiology Group, Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK.
| | - Warren R G James
- Epidemiology Group, Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Avril Nicoll
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Louise Locock
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Corri Black
- Aberdeen Centre for Health Data Science, University of Aberdeen, Aberdeen, UK; NHS Grampian, Foresterhill, Aberdeen, UK
| | - Neeraj Dhaun
- British Heart Foundation/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Allyson C Egan
- Trinity Health Kidney Centre, Tallaght University Hospital, Dublin, Ireland
| | | | - Lynn Laidlaw
- Epidemiology Group, Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Peter C Lanyon
- Department of Rheumatology, Nottingham University Hospitals NHS Trust, Nottingham, UK; Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Mark A Little
- Trinity Kidney Centre, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Raashid Ahmed Luqmani
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK
| | - Laura Moir
- Epidemiology Group, Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Maureen McBain
- Epidemiology Group, Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Neil Basu
- School of Infection and Immunity, University of Glasgow, Glasgow, UK
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2
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Nash J, Leong T, Dawkins P, Stone E, Marshall H, Brims F. The TSANZ and Lung Foundation Australia 2023 landscape survey of lung cancer care across Australia and Aotearoa New Zealand. Respirology 2024; 29:405-412. [PMID: 38431910 DOI: 10.1111/resp.14693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 02/05/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND AND OBJECTIVE Unwarranted variations in lung cancer care have been well described in both Australia and Aotearoa New Zealand, with shortfalls in hospital-based workforce and infrastructure previously demonstrated. A survey of lung cancer clinicians was performed to gain an updated understanding of current workforce and infrastructure. METHODS An online Qualtrics survey included questions on institutional demographics, estimated lung cancer case load, multidisciplinary team (MDT) characteristics including workforce and local infrastructure. We sought to obtain one response from every institution treating lung cancer in Australia and Aotearoa New Zealand. RESULTS Responses were received from 89 institutions, estimated to include 85% centres treating lung cancer in Australia and 100% of public hospitals in Aotearoa New Zealand. Lung cancer nurse specialist and Nuclear Medicine are poorly represented in multidisciplinary teams (MDTs) with just 34/88 (38%) institutions fulfilling recommended core workforce for MDT meetings. Case presentation is low with 32/88 (36%) regularly discussing all lung cancer patients at MDT. Metropolitan institutions appear to have a more comprehensive range of services on site, compared to non-metropolitan institutions. Few (4/88) institutions have embedded smoking cessation services. Compared to the previous 2021 Landscape Survey, thoracic surgery representation and core MDT workforce have improved, with modest change in specialist nurse numbers. CONCLUSION This wide-reaching survey has identified persistent deficiencies and variations in lung cancer workforce and gaps in infrastructure. Multidisciplinary collaboration and care coordination are needed to ensure all patients can access timely and equitable lung cancer care.
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Affiliation(s)
- Jessica Nash
- Curtin Medical School, Curtin University, Perth, Western Australia, Australia
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Tracy Leong
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | - Paul Dawkins
- Middlemore Hospital, Auckland, New Zealand
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Emily Stone
- Department of Thoracic Medicine and Lung Transplantation, St Vincent's Hospital, Sydney, New South Wales, Australia
- School of Clinical Medicine, UNSW, Sydney, New South Wales, Australia
| | - Henry Marshall
- Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Queensland, Australia
- The University of Queensland Thoracic Research Centre, Brisbane, Queensland, Australia
| | - Fraser Brims
- Curtin Medical School, Curtin University, Perth, Western Australia, Australia
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- Institute for Respiratory Health, Perth, Western Australia, Australia
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Blum TG, Morgan RL, Durieux V, Chorostowska-Wynimko J, Baldwin DR, Boyd J, Faivre-Finn C, Galateau-Salle F, Gamarra F, Grigoriu B, Hardavella G, Hauptmann M, Jakobsen E, Jovanovic D, Knaut P, Massard G, McPhelim J, Meert AP, Milroy R, Muhr R, Mutti L, Paesmans M, Powell P, Putora PM, Rawlinson J, Rich AL, Rigau D, de Ruysscher D, Sculier JP, Schepereel A, Subotic D, Van Schil P, Tonia T, Williams C, Berghmans T. European Respiratory Society guideline on various aspects of quality in lung cancer care. Eur Respir J 2023; 61:13993003.03201-2021. [PMID: 36396145 DOI: 10.1183/13993003.03201-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 09/23/2022] [Indexed: 11/18/2022]
Abstract
This European Respiratory Society guideline is dedicated to the provision of good quality recommendations in lung cancer care. All the clinical recommendations contained were based on a comprehensive systematic review and evidence syntheses based on eight PICO (Patients, Intervention, Comparison, Outcomes) questions. The evidence was appraised in compliance with the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Evidence profiles and the GRADE Evidence to Decision frameworks were used to summarise results and to make the decision-making process transparent. A multidisciplinary Task Force panel of lung cancer experts formulated and consented the clinical recommendations following thorough discussions of the systematic review results. In particular, we have made recommendations relating to the following quality improvement measures deemed applicable to routine lung cancer care: 1) avoidance of delay in the diagnostic and therapeutic period, 2) integration of multidisciplinary teams and multidisciplinary consultations, 3) implementation of and adherence to lung cancer guidelines, 4) benefit of higher institutional/individual volume and advanced specialisation in lung cancer surgery and other procedures, 5) need for pathological confirmation of lesions in patients with pulmonary lesions and suspected lung cancer, and histological subtyping and molecular characterisation for actionable targets or response to treatment of confirmed lung cancers, 6) added value of early integration of palliative care teams or specialists, 7) advantage of integrating specific quality improvement measures, and 8) benefit of using patient decision tools. These recommendations should be reconsidered and updated, as appropriate, as new evidence becomes available.
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Affiliation(s)
- Torsten Gerriet Blum
- Department of Pneumology, Lungenklinik Heckeshorn, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - Rebecca L Morgan
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Valérie Durieux
- Bibliothèque des Sciences de la Santé, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Joanna Chorostowska-Wynimko
- Department of Genetics and Clinical Immunology, National Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - David R Baldwin
- Department of Respiratory Medicine, Nottingham University Hospitals, Nottingham, UK
| | | | - Corinne Faivre-Finn
- Division of Cancer Sciences, University of Manchester and The Christie NHS Foundation Trust, Manchester, UK
| | | | | | - Bogdan Grigoriu
- Intensive Care and Oncological Emergencies and Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Georgia Hardavella
- Department of Respiratory Medicine, King's College Hospital London, London, UK
- Department of Respiratory Medicine and Allergy, King's College London, London, UK
| | - Michael Hauptmann
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Neuruppin, Germany
| | - Erik Jakobsen
- Department of Thoracic Surgery, Odense University Hospital, Odense, Denmark
| | | | - Paul Knaut
- Department of Pneumology, Lungenklinik Heckeshorn, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - Gilbert Massard
- Faculty of Science, Technology and Medicine, University of Luxembourg and Department of Thoracic Surgery, Hôpitaux Robert Schuman, Luxembourg, Luxembourg
| | - John McPhelim
- Lung Cancer Nurse Specialist, Hairmyres Hospital, NHS Lanarkshire, East Kilbride, UK
| | - Anne-Pascale Meert
- Intensive Care and Oncological Emergencies and Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Robert Milroy
- Scottish Lung Cancer Forum, Glasgow Royal Infirmary, Glasgow, UK
| | - Riccardo Muhr
- Department of Pneumology, Lungenklinik Heckeshorn, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - Luciano Mutti
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
- SHRO/Temple University, Philadelphia, PA, USA
| | - Marianne Paesmans
- Data Centre, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | | | - Paul Martin Putora
- Departments of Radiation Oncology, Kantonsspital St Gallen, St Gallen and University of Bern, Bern, Switzerland
| | | | - Anna L Rich
- Department of Respiratory Medicine, Nottingham University Hospitals, Nottingham, UK
| | - David Rigau
- Iberoamerican Cochrane Center, Barcelona, Spain
| | - Dirk de Ruysscher
- Maastricht University Medical Center, Department of Radiation Oncology (Maastro Clinic), GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands
- Erasmus Medical Center, Department of Radiation Oncology, Rotterdam, The Netherlands
| | - Jean-Paul Sculier
- Intensive Care and Oncological Emergencies and Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Arnaud Schepereel
- Pulmonary and Thoracic Oncology, Université de Lille, Inserm, CHU Lille, Lille, France
| | - Dragan Subotic
- Clinic for Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Paul Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | | - Thierry Berghmans
- Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Brussels, Belgium
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Sundar S, Nordin A, Morrison J, Wood N, Ghaem-Maghami S, Nieto J, Phillips A, Butler J, Burton K, Gornall R, Dobbs S, Glasspool R, Peevor R, Ledermann J, McNeish I, Ratnavelu N, Duncan T, Frost J, Lim K, Michael A, Brockbank E, Gajjar K, Taylor A, Bowen R, Andreou A, Ganesan R, Nicum S, Edmondson R, Clayton R, Balega J, Rolland P, Maxwell H, Fotopoulou C. British Gynaecological Cancer Society Recommendations for Evidence Based, Population Data Derived Quality Performance Indicators for Ovarian Cancer. Cancers (Basel) 2023; 15:337. [PMID: 36672287 PMCID: PMC9856668 DOI: 10.3390/cancers15020337] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/09/2022] [Accepted: 12/11/2022] [Indexed: 01/06/2023] Open
Abstract
Ovarian cancer survival in the UK lags behind comparable countries. Results from the ongoing National Ovarian Cancer Audit feasibility pilot (OCAFP) show that approximately 1 in 4 women with advanced ovarian cancer (Stage 2, 3, 4 and unstaged cancer) do not receive any anticancer treatment and only 51% in England receive international standard of care treatment, i.e., the combination of surgery and chemotherapy. The audit has also demonstrated wide variation in the percentage of women receiving anticancer treatment for advanced ovarian cancer, be it surgery or chemotherapy across the 19 geographical regions for organisation of cancer delivery (Cancer Alliances). Receipt of treatment also correlates with survival: 5 year Cancer survival varies from 28.6% to 49.6% across England. Here, we take a systems wide approach encompassing both diagnostic pathways and cancer treatment, derived from the whole cohort of women with ovarian cancer to set out recommendations and quality performance indicators (QPI). A multidisciplinary panel established by the British Gynaecological Cancer Society carefully identified QPI against criteria: metrics selected were those easily evaluable nationally using routinely available data and where there was a clear evidence base to support interventions. These QPI will be valuable to other taxpayer funded systems with national data collection mechanisms and are to our knowledge the only population level data derived standards in ovarian cancer. We also identify interventions for Best practice and Research recommendations.
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Affiliation(s)
- Sudha Sundar
- Pan Birmingham Gynaecological Cancer Centre, City Hospital and Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B152TT, UK
| | - Andy Nordin
- East Kent Hospitals University Foundation NHS Trust, Ethelburt Road, Canterbury CT1 3NG, UK
- National Cancer Registration & Analysis Service (NCRAS), NHS Digital, Wellington House, 133-155 Waterloo Rd., London SE1 8UG, UK
| | - Jo Morrison
- GRACE Centre, Department of Gynaecological Oncology, Musgrove Park Hospital, Somerset NHS Foundation Trust, Taunton TA1 5DA, UK
| | - Nick Wood
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston PR7 1PP, UK
| | | | - Jo Nieto
- Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK
| | - Andrew Phillips
- Derby Gynaecological Cancer Centre, University Hospitals of Derby and Burton, Royal Derby Hospital, Uttoxeter Rd., Derby DE22 3NE, UK
| | - John Butler
- Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
| | - Kevin Burton
- Glasgow Royal Infirmary, PRMH Building, Glasgow G4 0SF, UK
| | - Rob Gornall
- Department Gynaecological Oncology, Cheltenham General Hospital, Gloucestershire Hospitals NHS Foundation Trust, Gloucester GL53 7AN, UK
| | - Stephen Dobbs
- Department of Gynaecological Oncology, Belfast City Hospital, Belfast BT9 7AB, UK
| | - Rosalind Glasspool
- Beatson West of Scotland Cancer Centre, NHS Greater Glasgow and Clyde and University of Glasgow, Glasgow G12 0YN, UK
| | - Richard Peevor
- Consultant Gynaecological Oncologist, Clinical Lead for Colposcopy & Gynaecological Cancer MDT, Betsi Cadwaladr University Health Board, Bangor LL57 2PW, UK
| | - Jonathan Ledermann
- UCL Cancer Institute, University College London and UCL Hospitals, London WC1E 6DD, UK
| | - Iain McNeish
- Department of Surgery and Cancer, Imperial College, London W12 0NN, UK
| | - Nithya Ratnavelu
- Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead NE9 6SX, UK
| | - Tim Duncan
- Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK
| | - Jonathan Frost
- Royal United Hospitals Bath NHS Foundation Trust, Bath BA1 3NG, UK
| | | | - Agnieszka Michael
- University of Surrey and Royal Surrey County Hospital, Guildford GU2 7XH, UK
| | - Elly Brockbank
- Royal London Hospital, Barts Health NHS Trust, London EC1 1BB, UK
| | - Ketankumar Gajjar
- Nottingham University Hospitals NHS Trust, City Hospital, Nottingham NG5 1PB, UK
| | | | - Rebecca Bowen
- Royal United Hospitals Bath NHS Foundation Trust, Bath BA1 3NG, UK
| | - Adrian Andreou
- Department of Radiology, Royal United Hospitals Bath NHS Foundation Trust, Bath BA1 3NG, UK
| | - Raji Ganesan
- Department of Cellular Pathology, Birmingham Women’s Hospital, Birmingham SY16 4LE, UK
| | - Shibani Nicum
- UCL Cancer Institute, University College London and UCL Hospitals, London WC1E 6DD, UK
| | - Richard Edmondson
- Division of Molecular and Clinical Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester and St Mary’s Hospital, Manchester M13 9PL, UK
| | - Richard Clayton
- Manchester University NHS Foundation Trust, Manchester M13 9WL, UK
| | - Janos Balega
- Pan Birmingham Gynaecological Cancer Centre, City Hospital, West Midlands, Birmingham B15 2SQ, UK
| | - Phil Rolland
- Department Gynaecological Oncology, Cheltenham General Hospital, Gloucestershire Hospitals NHS Foundation Trust, Gloucester GL53 7AN, UK
| | - Hilary Maxwell
- Dorset County Hospital NHS Foundation Trust, Dorset DT1 2JY, UK
| | - Christina Fotopoulou
- Department of Surgery and Cancer, Gynaecologic Oncology, Imperial College London, London W12 0NN, UK
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The Relative Survival Impact of Guideline-Concordant Clinical Staging and Stage-Appropriate Treatment of Potentially Curable Non-Small Cell Lung Cancer. Chest 2022; 162:242-255. [DOI: 10.1016/j.chest.2022.01.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 01/11/2022] [Accepted: 01/18/2022] [Indexed: 12/25/2022] Open
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Clinical impact of delays in the management of lung cancer patients in the last decade: systematic review. Clin Transl Oncol 2022; 24:1549-1568. [PMID: 35257298 PMCID: PMC8900646 DOI: 10.1007/s12094-022-02796-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 12/24/2021] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Due to the importance of lung cancer early treatment because of its severity and extent worldwide a systematic literature review was conducted about the impact of delays in waiting times on the disease prognosis. MATERIALS AND METHODS We conducted a systematic search of observational studies (2010-2020) including adult patients diagnosed with lung cancer and reporting healthcare timelines and their clinical consequences. RESULTS We included 38 articles containing data on waiting times and prognosis; only 31 articles linked this forecast to a specific waiting time. We identified 41 healthcare time intervals and found medians of 6-121 days from diagnosis to treatment and 4-19.5 days from primary care to specialist visit: 37.5% of the intervals indicated better prognosis with longer waiting times. CONCLUSIONS All articles emphasized that waiting times must be reduced to achieve good management and prognosis of lung cancer. Further prospective studies are needed on the relationship between waiting times and prognosis of lung cancer.
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7
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Brims FJH, Kumarasamy C, Nash J, Leong TL, Stone E, Marshall HM. Hospital-based multidisciplinary lung cancer care in Australia: a survey of the landscape in 2021. BMJ Open Respir Res 2022; 9:9/1/e001157. [PMID: 35039312 PMCID: PMC8765035 DOI: 10.1136/bmjresp-2021-001157] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 01/05/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Lung cancer is the leading cause of cancer death in Australia and has the highest cancer burden. Numerous reports describe variations in lung cancer care and outcomes across Australia. There are no data assessing compliance with treatment guidelines and little is known about lung cancer multidisciplinary team (MDT) infrastructure around Australia. Methods Clinicians from institutions treating lung cancer were invited to complete an online survey regarding the local infrastructure for lung cancer care and contemporary issues affecting lung cancer. Results Responses from 79 separate institutions were obtained representing 72% of all known institutions treating lung cancer in Australia. Most (93.6%) held a regular MDT meeting although recommended core membership was only achieved for 42/73 (57.5%) sites. There was no thoracic surgery representation in 17/73 (23.3%) of MDTs and surgery was less represented in regional and low case volume centres. Specialist nurses were present in just 37/79 (46.8%) of all sites. Access to diagnostic and treatment facilities was limited for some institutions. IT infrastructure was variable and most sites (69%) do not perform regular audits against guidelines. The COVID-19 pandemic has driven most sites to incorporate virtual MDT meetings, with variable impact around the country. Clinician support for a national data-driven approach to improving lung cancer care was unanimous. Discussion This survey demonstrates variations in infrastructure support, provision and membership of lung cancer MDTs, in particular thoracic surgery and specialist lung cancer nurses. This heterogeneity may contribute to some of the well-documented variations in lung cancer outcomes in Australia.
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Affiliation(s)
- Fraser J H Brims
- Curtin Medical School, Curtin University, Perth, Western Australia, Australia .,Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Chellan Kumarasamy
- Curtin Medical School, Curtin University, Perth, Western Australia, Australia
| | - Jessica Nash
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
| | - Tracy L Leong
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia.,Personalised Oncology Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
| | - Emily Stone
- Department of Respiratory Medicine, St Vincent's Hospital, Sydney, New South Wales, Australia.,St Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Henry M Marshall
- Thoracic Research Centre, University of Queensland, Brisbane, Queensland, Australia
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8
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Brims F, Leong T, Stone E, Harden S, Marshall H, Navani N, Stirling R. Variations in lung cancer care and outcomes: How best to identify and improve standards of care? Respirology 2021; 26:1103-1105. [PMID: 34596924 DOI: 10.1111/resp.14155] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 09/07/2021] [Accepted: 09/13/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Fraser Brims
- Curtin Medical School, Curtin University, Perth, Western Australia, Australia.,Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,Institute for Respiratory Health, Curtin University, Perth, Western Australia, Australia
| | - Tracy Leong
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Emily Stone
- Department of Respiratory Medicine, St Vincent's Hospital, Sydney, New South Wales, Australia.,Kinghorn Cancer Centre, University of NSW, Sydney, New South Wales, Australia
| | - Susan Harden
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Henry Marshall
- Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Queensland, Australia.,The University of Queensland Thoracic Research Centre, Brisbane, Queensland, Australia
| | - Neal Navani
- Respiratory Medicine, University College London Hospitals, London, UK.,Respiratory Medicine, UCL Division of Medicine, University College London, London, UK
| | - Rob Stirling
- Department of Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, Australia
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9
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Ray MA, Faris NR, Fehnel C, Derrick A, Smeltzer MP, Meadows-Taylor MB, Ariganjoye F, Pacheco A, Optican R, Tonkin K, Wright J, Fox R, Callahan T, Robbins ET, Walsh W, Lammers P, Satpute S, Osarogiagbon RU. Survival Impact of an Enhanced Multidisciplinary Thoracic Oncology Conference in a Regional Community Health Care System. JTO Clin Res Rep 2021; 2:100203. [PMID: 34590046 PMCID: PMC8474211 DOI: 10.1016/j.jtocrr.2021.100203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 06/14/2021] [Accepted: 06/24/2021] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION We compared NSCLC treatment and survival within and outside a multidisciplinary model of care from a large community health care system. METHODS We implemented a rigorously benchmarked "enhanced" Multidisciplinary Thoracic Oncology Conference (eMTOC) and used Tumor Registry data (2011-2017) to evaluate guideline-concordant care. Because eMTOC was located in metropolitan Memphis, we separated non-MTOC patient by metropolitan and regional location. We categorized National Comprehensive Cancer Network guideline-concordant treatment as "preferred," or "appropriate" (allowable under certain circumstances). We compared demographic and clinical characteristics across cohorts using chi-square tests and survival using Cox regression, adjusted for multiple testing. We also performed propensity-matched and adjusted survival analyses. RESULTS Of 6259 patients, 14% were in eMTOC, 55% metropolitan non-MTOC, and 31% regional non-MTOC cohorts. eMTOC had the highest rates of African Americans (34% versus 28% versus 22%), stages I to IIIB (63 versus 40 versus 50), urban residents (81 versus 78 versus 20), stage-preferred treatment (66 versus 57 versus 48), guideline-concordant treatment (78 versus 70 versus 63), and lowest percentage of nontreatment (6 versus 21 versus 28); all p values were less than 0.001. Compared with eMTOC, hazard for death was higher in metropolitan (1.5, 95% confidence interval: 1.4-1.7) and regional (1.7, 1.5-1.9) non-MTOC; hazards were higher in regional non-MTOC versus metropolitan (1.1, 1.0-1.2); all p values were less than 0.05 after adjustment. Results were generally similar after propensity analysis with and without adjusting for guideline-concordant treatment. CONCLUSIONS Multidisciplinary NSCLC care planning was associated with significantly higher rates of guideline-concordant care and survival, providing evidence for rigorous implementation of this model of care.
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Affiliation(s)
- Meredith A. Ray
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, Tennessee
| | - Nicholas R. Faris
- Thoracic Oncology Research Group, Baptist Cancer Center, Memphis, Tennessee
| | - Carrie Fehnel
- Thoracic Oncology Research Group, Baptist Cancer Center, Memphis, Tennessee
| | - Anna Derrick
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee
| | - Matthew P. Smeltzer
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, Tennessee
| | | | - Folabi Ariganjoye
- Thoracic Oncology Research Group, Baptist Cancer Center, Memphis, Tennessee
| | - Alicia Pacheco
- Thoracic Oncology Research Group, Baptist Cancer Center, Memphis, Tennessee
| | - Robert Optican
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee
- Mid-South Imaging and Therapeutics, Memphis, Tennessee
| | - Keith Tonkin
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee
- Mid-South Imaging and Therapeutics, Memphis, Tennessee
| | - Jeffrey Wright
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee
- Memphis Lung Physicians, Memphis, Tennessee
| | - Roy Fox
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee
- Mid-South Pulmonary Specialists, Memphis, Tennessee
| | - Thomas Callahan
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee
- Trumbull Laboratories, LLC, Memphis, Tennessee
| | - Edward T. Robbins
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee
| | - William Walsh
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee
| | - Philip Lammers
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee
| | - Shailesh Satpute
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee
| | - Raymond U. Osarogiagbon
- Thoracic Oncology Research Group, Baptist Cancer Center, Memphis, Tennessee
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee
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10
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Stage III Non-small Cell Lung Cancer Management in England. Clin Oncol (R Coll Radiol) 2020; 31:688-696. [PMID: 31514942 DOI: 10.1016/j.clon.2019.07.020] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 07/03/2019] [Accepted: 07/26/2019] [Indexed: 12/13/2022]
Abstract
AIMS We present the first analysis of the management and outcomes of stage III non-small cell lung cancer (NSCLC) conducted in England using National Lung Cancer Audit data. MATERIALS AND METHODS Patients diagnosed with stage III NSCLC in 2016 were identified. Linked datasets (including Hospital Episode Statistics, the National Radiotherapy Dataset, the Systemic Anti-Cancer Dataset, pathology reports and death certificate data) were used to categorise the treatment received. Kaplan-Meier survival curves were obtained, with survival defined from the date of diagnosis to the date of death. RESULTS In total, 6276 cases of stage III NSCLC were analysed: 3827 stage IIIA and 2449 stage IIIB; 1047 (17%) patients were treated with radical radiotherapy with 676 (11%) of these also receiving chemotherapy. Twenty per cent of patients with stage IIIA disease underwent surgery, with half of these also receiving chemotherapy, predominantly delivered in the adjuvant setting. Of note, 2148 (34%) patients received palliative-intent treatment and 2265 (36%) received no active anti-cancer treatment. The 1-year survival was 32.9% (37.4% for stage IIIA), with the highest survival seen for those patients receiving chemotherapy and surgery. CONCLUSIONS We highlight important gaps in the optimal care of patients with stage III NSCLC in England. Multimodality treatment with either surgery or radical radiotherapy combined with chemotherapy was delivered to less than one-fifth of patients, even though these regimens are considered optimal. Timely access to specialist resources and staff, the practice of effective shared decision making and challenging preconceptions have the potential to optimise management.
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