Patient Access to Lung Cancer Treatment Guidelines May Improve Quality of Care

Use of cancer treatment guidelines is not in conflict with shared decision-making, therefore increasing patients’ access to guidelines may improve the quality of oncologic care, according to study results published in JAMA Network Open.

Patients with non-small cell lung cancer (NSCLC) often have to navigate a complicated sequence of diagnostic tests and choices of treatment. Decision support tools can improve patient knowledge regarding options, prognosis, and selection of treatment that best balances their goals of care, but most tools have been developed for patients with breast and prostate cancer or advanced/metastatic cancer.

Therefore, researchers conducted a nonrandomized clinical trial at a tertiary care academic institution that included 76 patients with NSCLC seen at diagnosis or disease progression and a retrospective cohort of 157 patients treated before the trial began (ClinicalTrials.gov Identifier: NCT03982459). Researchers sought to evaluate the association of exposure to the National Comprehensive Cancer Center (NCCN) guidelines with guideline-concordant care and patients’ decisional conflict in the 76 patients with NSCLC.

Researchers evaluated adherence to 6 recommendations from the NCCN: smoking cessation counseling, adjuvant chemotherapy for patients with stage IB to IIB NSCLC after surgery, pathologic mediastinal staging in patients with stage III NSCLC before surgery, pathologic mediastinal staging in patients with stage III NSCLC before nonsurgical treatment, definitive chemoradiotherapy for patients with stage III NSCLC not having surgery, and molecular testing for epidermal growth factor receptor and anaplastic lymphoma kinase alterations for patients with stage IV NSCLC.

The researchers found that exposure to the NCCN guidelines was associated with increased smoking cessation counseling (P <.001) and decreased use of adjuvant chemotherapy after resection of early-stage disease (P =.012). They also found that use of the tool during consultation was associated with decreased decisional conflict and greater satisfaction with their decision by the patients.

Study limitations included the small sample size, being conducted at a tertiary academic medical center that may not be representative of the larger population, and the low baseline rate of smoking cessation counseling in the retrospective cohort.

“Despite the limitations of this study, these findings suggest that evidence-based decision and communication tools have potential to improve the quality of cancer care delivered,” the researchers concluded.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Wu SY, Lazar AA, Gubens MA, et al. Evaluation of a National Comprehensive Cancer Network guidelines-based decision support tool in patients with non-small cell lung cancer. A nonrandomized clinical trial. JAMA Network Open. Published online September 30, 2020. doi: 10.1001/jamanetworkopen.2020.9750