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2019 Thoracic Cancers Symposium: Effect of Structured Patient Exposure to the NCCN Guidelines for NSCLC

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Key Points

  • Structured exposure to guidelines was associated with several positive outcomes, including increased smoking cessation counseling/intervention among active smokers and increased molecular testing for EGFR and ALK mutations prior to systemic therapy among patients with metastatic disease.
  • Use of the tool was also correlated with decreased use of chemotherapy following surgery for stage IB/IIB NSCLC.
  • Exposure to the guideline tool did not impact some outcomes, including the frequency of pathologic mediastinal staging performed prior to surgery or nonsurgical treatment in patients with stage III disease, nor did it influence the use of upfront chemoradiation therapy in stage III patients who were ineligible for surgery.

A new clinical trial found that exposing patients to tailored versions of the National Comprehensive Cancer Network (NCCN®) Guidelines for non–small cell lung cancer (NSCLC) may help drive smoking cessation, testing for potential biomarkers and, for early-stage disease, more patient-centered use of chemotherapy following surgery. Findings demonstrate how evidence-based decision and communication aids can improve cancer care. These results were presented at a presscast in advance of the 2019 Multidisciplinary Thoracic Cancers Symposium (Abstract 5).

“The process of making treatment decisions can be extremely stressful for [patients with] lung cancer, as treatment options are nuanced and may change significantly over the course of their staging workup,” said Susan Wu, MD, first author of the study and a radiation oncology resident at the University of California, San Francisco. “Educational tools can guide patients through the decision-making process and help them to synthesize the large amount of information available.”

Exposure to Guidelines

Patients in the trial used an interactive, web-based tool that presented treatment options tailored to their clinical characteristics, such as tumor stage and margin status following surgery. Options were based on NCCN Guidelines, and included information about treatment sequencing as well as a timeline to help patients visualize the treatment trajectory. All 76 patients were introduced to the tool by a trained coordinator, who also used the tool to facilitate discussion during their consultation with an oncologist. A separate cohort of 159 patients seen at the same institution before the tool was available was used as a comparison group.

Outcomes

Structured exposure to guidelines was associated with several positive outcomes, including increased smoking cessation counseling/intervention among active smokers (80% vs 4%, P < .001) and increased molecular testing for EGFR and ALK mutations prior to systemic therapy among patients with metastatic disease (96% vs 68%, P = .01). Use of the tool was also correlated with decreased use of chemotherapy following surgery for stage IB/IIB NSCLC (0% vs 50%, P = .02), particularly among patients with negative margins following resection.

“We can empower patients to make decisions that align with their priorities and goals for treatment with evidence-based tools. For example, data from patients with breast cancer suggests that those who may derive limited benefit from adjuvant therapy are more likely to forego it. We similarly found that patients with completely resected early-stage NSCLC had a tendency not to pursue additional chemotherapy,” said Dr. Wu.

Exposure to the guideline tool did not impact some outcomes, including the frequency of pathologic mediastinal staging performed prior to surgery (P = .70) or nonsurgical treatment (P = .55) in patients with stage III disease, nor did it influence the use of upfront chemoradiation therapy in stage III patients who were ineligible for surgery (P = .55).

“Our goal was to help patients feel more comfortable making treatment decisions and become more active participants in the decision-making process,” said Dr. Wu. “While implementing a decision support tool does require substantial resources—such as the time and effort to develop the tool and introduce it to patients—these tools can help empower our patients, and in some cases, meaningfully impact their care.”

Disclosure: The study presenter’s full disclosures can be found at thoracicsymposium.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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