Survival Impact of an Enhanced Multidisciplinary Thoracic Oncology Conference in a Regional Community Health Care System.
Survival Impact of an Enhanced Multidisciplinary Thoracic Oncology Conference in a Regional Community Health Care System.
复制标题
DOI：
10.1016/j.jtocrr.2021.100203
复制
发表时间：
2021-08
影响因子：
--
通讯作者：
Osarogiagbon RU
中科院分区：
文献类型：
--
作者：
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
我们比较了一个大型社区医疗保健系统中多学科医疗模式内外的非小细胞肺癌（NSCLC）治疗和生存情况。
我们实施了一个经过严格基准测试的“强化型”多学科胸部肿瘤会议（eMTOC），并使用肿瘤登记数据（2011 - 2017年）来评估符合指南的治疗。由于eMTOC位于孟菲斯大都市，我们根据大都市和区域位置对非MTOC患者进行了区分。我们将美国国家综合癌症网络指南相符的治疗分类为“首选”或“适当”（在某些情况下允许）。我们使用卡方检验比较不同队列的人口统计学和临床特征，并使用考克斯回归比较生存情况，同时针对多次检验进行了调整。我们还进行了倾向匹配和调整后的生存分析。
在6259名患者中，14%属于eMTOC组，55%属于大都市非MTOC组，31%属于区域非MTOC组。eMTOC组中非裔美国人比例最高（34%对比28%对比22%），I - IIIB期患者比例最高（63%对比40%对比50%），城市居民比例最高（81%对比78%对比20%），符合分期首选治疗的比例最高（66%对比57%对比48%），符合指南治疗的比例最高（78%对比70%对比63%），未治疗的比例最低（6%对比21%对比28%）；所有P值均小于0.001。与eMTOC组相比，大都市非MTOC组（风险比为1.5，95%置信区间：1.4 - 1.7）和区域非MTOC组（风险比为1.7，1.5 - 1.9）的死亡风险更高；区域非MTOC组相较于大都市非MTOC组风险更高（风险比为1.1，1.0 - 1.2）；调整后所有P值均小于0.05。在进行和不进行符合指南治疗调整的倾向分析后，结果大致相似。
多学科NSCLC治疗规划与符合指南治疗的比例和生存率显著提高相关，为严格实施这种医疗模式提供了证据。
We compared NSCLC treatment and survival within and outside a multidisciplinary model of care from a large community health care system. 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. 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. 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.
登录
查看更多内容
影响因子：
5.3
作者：
Johnson, Asal Mohamadi;Hines, Robert B.;Bayakly, A. Rana
通讯作者：
Bayakly, A. Rana
影响因子：
20.4
作者：
Leo, Francesco;Venissac, Nicolas;Mouroux, Jerome
通讯作者：
Mouroux, Jerome
影响因子：
3.4
作者：
Adizie, J. B.;Khakwani, A.;Harden, S., V
通讯作者：
Harden, S., V
影响因子：
20.4
作者：
Lau, Kelvin K. W.;Rathinam, Sridhar;Peake, Michael D.
通讯作者：
Peake, Michael D.
DOI：
10.1001/jama.2016.20324
发表时间：
2017-01-24
期刊：
JAMA
影响因子：
--
作者：
Mokdad AH;Dwyer-Lindgren L;Fitzmaurice C;Stubbs RW;Bertozzi-Villa A;Morozoff C;Charara R;Allen C;Naghavi M;Murray CJ
通讯作者：
Murray CJ