IMPACT OF MULTIDISCIPLINARY TEAM IMPLEMENTATION ON SURVIVAL AND QUALITY OF CARE INDICATORS IN METASTATIC NON-SMALL CELL LUNG CANCER: A RETROSPECTIVE SINGLE-CENTER COHORT STUDY IN THAILAND
DOI:
https://doi.org/10.55374/jseamed.v10.280Keywords:
metastatic non-small cell lung cancer, multidisciplinary team, molecular testing, time to treatment initiation, real-world evidenceAbstract
Background: In resource-limited settings such as Thailand, metastatic non-small cell lung cancer (NSCLC) outcomes are adversely affected by fragmented care and delayed diagnosis and treatment. At the same time, the impact of the multidisciplinary team (MDT) remains uncertain.
Objectives: The study aimed to evaluate the effect of MDT implementation on overall survival (OS), time to treatment initiation, and molecular testing rates in patients with metastatic NSCLC at a Thai tertiary cancer center.
Methods: This retrospective study included patients with newly diagnosed metastatic NSCLC treated between 2018 and 2023. Patients were categorized according to whether their treatment was planned before or after the establishment of MDT in 2020. Baseline characteristics, molecular testing rates, and treatments were compared. The OS was the primary endpoint and was analyzed using Kaplan–Meier methods and multivariable Cox proportional hazards models.
Results: Among 248 eligible patients, 158 were managed in the MDT era and 90 in the pre-MDT era. Patients in the MDT group demonstrated a trend toward earlier treatment initiation (median 1.21 vs 1.52 months; approximately 33.8 vs 42.5 days; p = 0.18) and numerically higher EGFR testing rates (66.89 % vs 56.79 %; p = 0.09), whereas ALK testing was significantly more frequent in this group (32.10 % vs 18.03 %; p = 0.04). There was no statistically significant difference in OS between groups (median OS 10.44 vs 15.73 months; adjusted HR 1.25 (95% CI 0.94–1.67; p = 0.12). After adjustment for possible confounders, age ≥ 65 years (HR 2.09; 95% CI 1.07-4.11; p = 0.03), male sex (HR 3.90; 95% CI 1.28-11.88; p = 0.02), ECOG performance status ≥2 (HR 3.58; 95% CI 1.34-9.59; p = 0.01), non-adenocarcinoma histology (HR 12.30; 95% CI 1.44-104.44; p = 0.02), and multiple metastatic sites (HR 2.73; 95% CI 1.22-6.14; p = 0.01) were independently associated with poorer survival.
Conclusion: MDT implementation was associated with earlier treatment initiation and higher rates of molecular testing in metastatic NSCLC. Although no significant survival benefit was observed, MDTs remain important in real-world practice.
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