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.)

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.

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.

Posted: September 17, 2018