September 2018—As PCORI-funded studies produce results of interest to patients and those who care for them, we are updating the stories of those projects. You can read the original story here.

Lung cancer is one of the most common and deadly cancers and is expected to cause more than 150,000 deaths in 2018—more than colon, breast, and prostate cancers combined, according to the American Cancer Society. Treatment requires an array of specialists. One promising approach is multidisciplinary care, in which all of the specialists involved in a patient’s care work together to develop a coordinated treatment plan. Leading cancer organizations recommend this approach, but questions remain about its effectiveness and how to best implement it.

Now, early results from a PCORI-funded study at Baptist Memorial Hospital-Memphis in Tennessee suggest patients receiving multidisciplinary care get more-thorough procedures to pinpoint the stage of their cancer than those who see specialists through a sequence of referrals. As a result, the multidisciplinary treatment that patients receive is more appropriate for their stage of cancer. Finally, patients who received multidisciplinary care and their caregivers also were more satisfied with their overall care.

Testing Coordinated Care

There are only a few multidisciplinary cancer care programs in the country, and few studies have tested how well they work compared with traditional approaches. This PCORI-funded project studied a multidisciplinary lung cancer clinic where specialists including pulmonologists, oncologists, radiologists, and surgeons meet to design a care plan with patients and their families. (See original story, Under One Roof: Pulling Specialists Together to Improve Lung Cancer Care.)

With multidisciplinary care, patients can get a more comprehensive and objective evaluation of their cancer, and the most safe and appropriate treatments.

Raymond Osarogiagbon, MD Lung cancer specialist, Baptist Memorial Hospital; PCORI-funded study principal investigator

Led by lung cancer specialist Raymond Osarogiagbon, MD, the study tested multidisciplinary care against usual referral-based care at Baptist Memorial, a community hospital serving a diverse population.

In establishing and evaluating the clinic, Osarogiagbon and his research group used recommendations from a wide range of stakeholders, including patients, family caregivers, lung cancer specialists, physicians who refer patients to those specialists, and hospital and insurance executives.

Stage-Appropriate Care

In the study, there were two groups of patients. Osarogiagbon and his team compared the outcomes of 159 patients who received care in the multidisciplinary care clinic with the outcomes of 297 patients who received conventional serial care.

Patients in the multidisciplinary care clinic were far more likely to receive thorough staging—the process of determining how much cancer is in the body and where it is located. For example, 51 percent of multidisciplinary care patients received PET scans, CT scans, and biopsies, compared with 29 percent of those in serial care. And because clinicians coordinated lab work and other tests, patients in the multidisciplinary care group didn’t repeat those procedures when going from one clinician to the next, which often happens to patients in serial care.

Because of the staging, patients who went to the clinic received treatments calibrated for the severity of their cancer. “There was an enormous gap between the two groups both in the thoroughness of staging and stage-appropriate treatment,” Osarogiagbon says.

The investigators discovered that among patients in the conventional serial care group, one in five patients were also referred by their physicians to a multidisciplinary conference, at which various specialists discussed their case and made treatment recommendations. Unlike in the multidisciplinary clinic, the specialists did not meet with the patients. This small subset of patients who had serial care ended up as likely to receive staging and appropriate treatment as those patients in the multidisciplinary clinic. This suggests to Osarogiagbon that perhaps a videoconference could save time for doctors and money for health systems without the resources to start their own multidisciplinary clinics.

“You don’t have to spend a million dollars constructing a clinic,” Osarogiagbon says. “You can do it in a videoconference. Now, suddenly, the doctor’s commitment is not a half day but an hour, and I don’t even have to be in a specific space to do it.”

Slower Care?

While most of the study’s results were not a surprise to Osarogiagbon, one did catch his eye. Patients at the multidisciplinary clinic began treatment, on average, a few days later than the patients in the serial-care group. He soon realized the delay occurred because the specialists were creating a coordinated treatment plan. “The team was taking pains to find out what treatment was best for patients,” Osarogiagbon says.

This kind of health care is more efficient. It relieves the stress of patients and caregivers, who don't have to go from doctor to doctor for treatment.

Orion Osborne Patient partner, PCORI-funded research study

Patients reported that coordination among the clinicians felt like a built-in second opinion. And caregivers liked having a central point of contact at the multidisciplinary clinic for scheduling appointments and answering questions.

“This kind of health care is more efficient,” says Orion Osborne, 75, a patient diagnosed with lung cancer in 2012, who served as a patient partner for the study. “It relieves the stress of patients and caregivers, who don’t have to go from doctor to doctor for treatment.”

What's not yet clear is whether multidisciplinary care affects patients’ health outcomes, including survival. The researchers will continue following the patients to find out, while also comparing quality of care and outcomes with results at other hospitals in the United States. And that information could contribute to better health care for lung cancer patients.

“With multidisciplinary care, patients can get a more comprehensive and objective evaluation of their cancer, and the most safe and appropriate treatments,” Osarogiagbon says.

At a Glance

Building a Multidisciplinary Bridge across the Quality Chasm in Thoracic Oncology

Principal Investigator: Raymond U. Osarogiagbon, MD

Goal: Create a multidisciplinary care model for lung cancer treatment in a community setting, and compare patient-centered outcomes from that program with those of patients managed with conventional care.

View Project Details | View Related Materials | Read Original Story

Posted: September 17, 2018


Health Conditions Health Conditions These are the broad terms we use to categorize our funded research studies; specific diseases or conditions are included within the appropriate larger category. Note: not all of our funded projects focus on a single disease or condition; some touch on multiple diseases or conditions, research methods, or broader health system interventions. Such projects won’t be listed by a primary disease/condition and so won’t appear if you use this filter tool to find them. View Glossary
Populations Populations PCORI is interested in research that seeks to better understand how different clinical and health system options work for different people. These populations are frequently studied in our portfolio or identified as being of interest by our stakeholders. View Glossary

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