ASCO Abstract: What Defines Quality Lung Cancer Care?

At the recent American Society of Clinical Oncology (ASCO) 2020 Virtual Scientific Program, ACCC presented seven abstracts that capture data spanning the organization’s diverse provider education portfolio. The abstracts feature clinical and non-clinical studies in lung cancer care delivery, comprehensive cancer care services, BRCA testing in the context of breast cancer, and consistent biomarker terminology.

One abstract—What Constitutes High-Quality NSCLC Care? Overarching Quality Considerations for Improving NSCLC Care at U.S. Cancer Centers—establishes a benchmark for ideal care for non-small cell lung cancer (NSCLC) in response to the need for guidance for multidisciplinary practice and quality improvement initiatives.

To help meet this need, ACCC convened an expert steering committee of multidisciplinary NSCLC specialists and patient advocacy representatives. The committee assembled a series of quality-focused recommendations for the care coordination, diagnosis, and treatment of NSCLC based on a thorough review of available clinical and quality care guidelines and metrics.

The Challenge of NSCLC

NSCLC accounts for more than 84 percent of all lung cancer diagnoses in the U.S. As a locally advanced and metastatic disease, it has a poor prognosis and a high mortality rate. Treatment of NSCLC is complex, and patient access to care is inconsistent. While existing guidelines for the treatment of NSCLC recommend a multidisciplinary team approach, ACCC has found that guidance spanning the complete care pathway is lacking. In response, ACCC has established a new benchmark for ideal NSCLC care through a national quality care initiative for patients with advanced (stage III/IV) NSCLC.

Mark A. Socinski, MD, Executive Medical Director at AdventHealth Cancer Institute in Orlando, Florida, co-authored abstract e19181 with Leigh M. Boehmer, PharmD, BCOP, Medical Director at ACCC. Dr. Socinski says that although the U.S. cancer rate experienced its largest one-year drop ever in 2017—propelled by gains in the fight against lung cancer—NSCLC remains a significant problem.

“There are far too few therapeutic options for NSCLC,” says Dr. Socinski. “Because most lung cancer cases are diagnosed at an advanced stage, high-quality, consistent multidisciplinary care is needed.”

Dr. Socinski adds that research reveals that not all lung cancer patients are receiving the same recommended treatment. “So our effort was to look at all of the guidelines we could find—coupled with interviews with lung cancer experts who know the latest and greatest in the research and what is considered quality care—and come up with guidelines for ideal management of the disease. There have been advances made in the treatment of NSCLC, and patients should be given the opportunity to be given the latest in care.”

Subsequent to its research, ACCC’s expert panel identified 32 recommendations for the care coordination, diagnosis, and treatment of NSCLC (manuscript pending). Of these, nine were considered key quality recommendations for ideal management of stage III/IV NSCLC, spanning diagnosis and biomarker testing, treatment planning, care coordination, and patient education (See Table 1). Recommendations include multidisciplinary evaluation of suspicious findings, biomarker testing to inform all treatment-related decisions, access to care navigators for information on financial aspects of treatment, and patient education on all aspects of NSCLC management.

While Dr. Socinski says these recommendations did not surprise him, he was alarmed by the survey findings reported in a complementary ACCC abstract also presented at the ASCO 2020 virtual meeting, Improving Care for Patients with Stage III/IV NSCLC: Learnings for Multidisciplinary Teams From the ACCC National Quality Survey [e19195]. This abstract, authored by Ravi Salgia, MD, PhD, et al., describes a comprehensive, double-blind, web-based national survey that ACCC conducted from January 2019 to April 2019 in an effort to obtain a better understanding of how patients with stage III/IV NSCLC are being diagnosed and managed across different practice settings.

Out of 1,211 questionnaires, 639 responses affiliated with 160 unique cancer programs across 44 U.S. states were suitable for analysis. Among the key findings: 41 percent of respondents report having no thoracic multidisciplinary clinic at their cancer programs, and newly diagnosed patients wait an average of four weeks for their first therapeutic interview. Respondents indicated that the most challenging barriers they face in providing high-quality NSCLC care include lack of community awareness, lack of patient interest, and transportation issues (See Table 2).

“I was surprised by how often recommendations for quality care are not followed,” says Dr. Socinski. “For example, the relatively low percentage of people who are eligible for lung cancer screening who actually get screened, and the high number of people who should get molecular screening but do not.” Dr. Socinski says these two measures can go a long way toward fighting a disease that is most often detected at a late stage. “Early detection and treatment are key to successful outcomes,” he affirms. “This is what is lacking in lung cancer programs.”

Dr. Socinski says the nine key quality recommendations presented at ASCO by ACCC can lead to high-quality NSCLC care and serve as a useful resource for providers to inform multidisciplinary practice and quality improvement initiatives.

Taken together, abstract e19181 and abstract e19195 help delineate quality care for patients with stage III/IV NSCLC and the real-world challenges that impede the uniform achievement of key quality recommendations. With the guidance of an expert Steering Committee, ACCC will build on this foundation. In the coming months, six ACCC member cancer programs will develop paths to overcome identified barriers. Through process improvement initiatives, these programs will test the effectiveness of these approaches in optimizing care delivery and outcomes for patients with locally advanced stage III and IV NSCLC.

ACCC’s additional ASCO abstracts can be viewed here.