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Online Tool May Improve Guideline Concordance for Patients With Lung Cancer


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An online tool that allows patients to input their clinical and pathologic features as well as explore treatment options in a structured manner based on National Comprehensive Cancer Network® Clinical Practice Guidelines in Oncology (NCCN Guidelines) may help drive smoking cessation and testing for molecular biomarkers.

Data presented at the 2019 Multidisciplinary Thoracic Cancers Symposium showed an increase in smoking cessation counseling among active smokers (80% vs 40%, P < .001) and an increase in molecular testing prior to initiation of systemic therapy in patients with metastatic non–small cell lung cancer (NSCLC) exposed to treatment guidelines.1 Results of the study also demonstrated more judicious use of adjuvant chemotherapy among patients with early-stage disease who used the interactive Web-based tool. According to the authors of the study, these findings further support the use of evidence-based decision and communication aids to meaningfully impact patient care.


The ability to educate patients and empower them to become active decision-makers is our imperative as physicians, as we guide our patients through this treatment-making process.
— Susan Y. Wu, MD

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“We were pleased to find that this tool was felt to be acceptable by most patients, with 84% accessing it after their initial consultation with an oncologist,” said lead study author, Susan Y. Wu, MD, a radiation oncology resident at the University of California, San Francisco. “Even though the development and implementation of tools like this can be quite resource-intensive, the ability to educate patients and empower them to become active decision-makers is our imperative as physicians, as we guide our patients through this treatment-making process.”

As Dr. Wu explained, for patients newly diagnosed with cancer, discussions regarding various treatment options and side effects can be complex. Although treatment frameworks such as the NCCN Guidelines are readily available to physicians, she added, they are often difficult for patients to access. Moreover, although there are data in the treatment of other malignancies that suggest decision-support tools may improve patient knowledge and satisfaction and help them better understand the nuances behind treatment options, the feasibility of such a tool for patients across all stages of NSCLC has not been studied. Furthermore, there are no studies demonstrating changes in practice patterns based on the use of such tools in patients with NSCLC.

For this study, Dr. Wu and colleagues looked to see whether structured exposure to the NCCN Guidelines influenced any of the following practice patterns compared with a cohort of patients seen prior to the use of the tool:

  • Smoking cessation counseling reinforced with a specific plan;
  • Use of adjuvant chemotherapy after surgery for stages IB, IIA, and IIB disease;
  • Pathologic staging of the mediastinum prior to initiating treatment for patients with stage III disease undergoing surgery;
  • Pathologic staging of the mediastinum prior to initiating treatment for patients with stage III disease who are not undergoing surgery;
  • Upfront concurrent chemoradiation for patients with stage III disease who are not undergoing surgery;
  • Molecular testing for EGFR and ALK mutations prior to initiation of systemic therapy for stage IV disease.

The researchers designed an interactive Web-based tool that allowed patients to input their individual clinical, radiographic, or pathologic characteristics and then explore, in a structured manner based on the NCCN Guidelines, the various treatment modalities and combinations with a corresponding timeline to better visualize different components of their total treatment package. Patients were then guided through this tool by a trained research coordinator who also facilitated discussion using the tool at the time of consultation with one of five thoracic oncologists.

Smoking Cessation Counseling, Testing for Molecular Biomarkers

As Dr. Wu reported, 76 patients were enrolled in the prospective cohort, with the majority enrolled at the time of diagnosis. The most common histologies were adenocarcinoma and squamous cell carcinoma (78% and 18%, respectively).

Among patients exposed to the evidence-based guidelines, results showed an increase in smoking cessation counseling or intervention in active smokers (80% vs 40%, P < .001).

Guideline-Based Care for Patients With Lung Cancer

  • Structured exposure to NCCN Guidelines during and after oncology consultation improved guideline concordance in smoking cessation and testing for molecular markers.
  • Exposure to NCCN Guidelines also led to more judicious use of adjuvant chemotherapy in patients with early-stage (IB–IIB) non–small cell lung cancer.

Data also demonstrated a decrease in the use of adjuvant chemotherapy for patients with stage IB, IIA, or IIB disease, with 0% of the prospective cohort electing to receive further chemotherapy compared with half of the patients in the comparison cohort (P = .02). According to the authors, this decrease was driven mostly by patients with stage IB disease who underwent resection with negative margins.

In addition, researchers found an increase in molecular testing prior to the initiation of systemic therapy in patients with metastatic NSCLC exposed to the tool (96% vs 68%, P = .01). In patients with stage III NSCLC, no differences in the frequency of pathologic mediastinal staging performed prior to surgery or nonsurgical treatment were observed. 

DISCLOSURE: Dr. Wu reported no conflicts of interest.

REFERENCE

1. Wu S, Lazar AA, Gubens MA, et al: The impact of structured, prospective exposure to the NCCN Guidelines when making treatment decisions: Improved metrics of guideline-concordant care for patients with non-small cell lung cancer. 2019 Multidisciplinary Thoracic Cancers Symposium. Abstract 5. Presented March 14, 2019.


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