Multidisciplinary management improves survival at 1 year after surgical treatment for non-small-cell lung cancer: a propensity score-matched study.

OBJECTIVES: The management of patients affected by lung cancer requires the expertise of specialists from different disciplines. Although the advantages of multidisciplinary team discussions seem obvious, there are limited studies evaluating the influence of this approach on postoperative outcomes in non-small-cell lung cancer (NSCLC). The aim of this study is to examine the impact of a multidisciplinary approach on survival of patients undergoing surgery for NSCLC. METHODS: A retrospective analysis was performed on consecutive patients who underwent surgery for NSCLC between January 2008 and December 2015. Data were compared between patients treated before the implementation of a multidisciplinary tumour board (MTB), between 2008 and 2012, and those who received treatment after the implementation of the MTB, between 2012 and 2015. Patients were matched one to one according to the discussion of the MTB and on the basis of a propensity score built using several patient characteristics. A propensity score-matched analysis was performed to compare patient outcomes. RESULTS: A total of 246 patients were treated prior to the initiation of the MTB and 231 patients after the initiation of the MTB. Based on the propensity score, 2 well-matched groups of 170 patients were identified. Patients who were discussed at the MTB were noted to have better outcomes when compared with those who were not discussed at the MTB on different terms including complete staging evaluation, early tumour, node and metastasis (TNM) stages and 1-year survival rate. CONCLUSIONS: Implementation of a multidisciplinary thoracic malignancy conference increased the 1-year survival rate of patients who underwent a surgical resection for NSCLC.

Educational intervention in cancer outpatient clinics on routine screening for emotional distress: an observational study.

PURPOSE: To examine the possible effect of an educational model on distress screening in newly diagnosed cancer patients referred to Psycho-oncology service (POS). METHODS: We examined the differences in distress and problems among newly diagnosed cancer patients referred to POS by cancer care professionals' according to their clinical judgement (2-year period; Study-1) and after an educational intervention on the Distress Thermometer (DT) and Problem List (PL), with referral to those reporting cut-off scores indicative of 'caseness' (DT>4) (1-year period; Study-2). RESULTS: In Study-1, 153 (6.7%) of 2268 new patients were referred and seen by the POS, which submitted each patient to the DT/PL. About one-third of the patients (31%) were not DT-cases (scores < 4) and showed lower levels of emotional and relational problems than those who resulted DT-cases. In Study-2, of all newly diagnosed cancer patients (n = 1107), 583 (52.6%) were administered to the DT/PL by nurses. Two-hundred and eighty-four (52.2%) resulting DT-cases were referred to POS and, of these, 133 (12% of all new patients; 22.81% of those screened; 46.8% of cases) were seen by the POS. There were significant differences in problems between not referred (DT-non-cases) and referred patients (DT-cases). CONCLUSIONS: Because of the observational nature of the study, the conclusions should be drawn with caution. The implementation of the routine use of DT/PL seemed to determine a higher (79% increase) and more accurate referral of patients but the rate of acceptance was not high, confirming that more effort is necessary in implementing optimal psychosocial care in oncology.