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Exposure to guidelines for non-small cell lung cancer impacts patient decisions
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Patients with non-small cell lung cancer exposed to National Comprehensive Cancer Network guidelines through a web-based tool appeared more likely to follow their recommendations regarding smoking cessation, testing for molecular markers and use of adjuvant chemotherapy, according to study results presented at Multidisciplinary Thoracic Cancers Symposium.
The findings show that communication aids can help patients with cancer make evidence-based decisions, thus improving care, according to researchers.
“In patients newly diagnosed with cancer, discussions regarding various treatment options and their side effects are complex,” Susan Y. Wu, MD, radiation oncology resident at University of California, San Francisco, said during a press cast. “Treatment framework such as the NCCN guidelines are readily available to physicians, but often are difficult for patients to access.
“Decision support tools may improve patient knowledge and satisfaction and help patients better understand the nuances behind treatment options. ... [This enables] them to be more active partners in the decision-making process.”
Wu and colleagues conducted the prospective trial to investigate differences in NCCN guideline concordance before and after use of a web-based tool among 76 patients (median age, 67.5 years; interquartile range [IQR], 14 years) with newly diagnosed or newly progressed NSCLC. The tool presented treatment options tailored to each patient’s clinical and pathologic features. Trained coordinators introduced patients to the tool and used it to foster discussion during oncologist consultations.
The researchers determined guideline concordance based on six metrics, including:
- smoking cessation counseling reinforced with a specific plan;
- use of adjuvant chemotherapy for patients with stage IB, IIA or IIB disease;
- pathologic mediastinal staging before surgery for patients with stage III disease;
- pathologic mediastinal staging before nonsurgical treatment for patients with stage III disease;
- definitive chemoradiation upfront for patients with stage III disease; and
- molecular testing for EGFR and ALK mutations before systemic therapy for patients with stage IV disease.
Researchers also retrospectively analyzed guideline concordance among 159 patients who were assessed before the tool was available.
More than three-quarters (78%) of the patients in the prospective group had adenocarcinoma vs. 67% in the retrospective group, whereas 18% of each group had squamous cell carcinoma. Results showed that exposure to the NCCN guidelines appeared associated with an increase in smoking cessation counseling/intervention among active smokers (80% in the prospective group vs. 4% in the retrospective group; P < .001) and a decrease in use of adjuvant chemotherapy following surgery for stage IB to IIB disease (0% vs. 50%; P = .04), led by decreased use of adjuvant chemotherapy for stage IB disease resected with negative margins.
Researchers also observed an increase in molecular testing prior to the systemic therapy in patients with metastatic NSCLC who used the tool (96% vs. 68%; P = .01).
There appeared to be no significant differences between the groups in the frequency of pathologic mediastinal staging performed before surgery or nonsurgical treatment for stage III disease, nor in the use of upfront chemoradiation in nonoperative candidates with stage III disease.
“Patients who had the evidence-based guidelines discussed with them were more likely to receive guideline-based therapy, particularly patients with very early-stage disease or those with very advanced-stage disease,” Charles B. Simone, MD, chief medical officer of New York Proton Center who was not involved with the study, said during the press cast. “They also importantly found that there was a higher rate of smoking cessation counseling and intervention for patients exposed to the guidelines. These findings support the importance of patient education and informed decision-making among patients with lung cancer.” – by John DeRosier
Reference:
Wu SY, et al. Abstract 3. Presented at: Multidisciplinary Thoracic Cancers Symposium; March 14-16, 2019; San Diego.
Disclosures: Wu reports employment at Stanford University. Please see the abstract for all other authors’ relevant financial disclosures. Simone reports no relevant financial disclosures.