ReCAP: Impact of Multidisciplinary Care on Processes of Cancer Care: A Multi-Institutional Study [CARE DELIVERY]

QUESTION ASKED:

What is the relationship between the level of implementation of multidisciplinary care (MDC) and various processes of cancer care (eg, time to treatment receipt, evaluation for enrollment onto a clinical trial) among community cancer centers serving patients diagnosed with colon, rectal, or lung cancer? There is limited generalizable evidence on this topic. It is important to answer this question using data that can generalize across cancer patients, the majority of whom receive treatment in a community cancer center.

SUMMARY ANSWER:

Focusing on the time to receipt of cancer-directed treatment as one key process of cancer care in this patient population, we found that the answer to our question depended on the MDC assessment area and tumor site (Table 1). Among patients with colon cancer, higher MDC levels of physician engagement (ie, a higher level of physician engagement at the institutional level) were associated with a shorter time to treatment receipt, whereas higher MDC levels of case planning were associated with a longer time to treatment receipt. Among patients with rectal cancer, higher MDC levels of physician engagement were associated with a shorter time to cancer-directed treatment receipt, whereas higher MDC levels of evaluation for enrollment onto clinical trials were associated with a longer time to treatment receipt. Among patients with lung cancer, there was no association between the MDC areas of assessment and the time to cancer-directed treatment receipt.

Table 1.

Multivariable Analyses of the Associations Between MDC Implementation and Time to Cancer-Directed Treatment Receipt

VariableLung (n = 560)*Colon (n = 378)*Rectal (n = 141)*HR95% CIHR95% CIHR95% CICase planning    LowReferenceReferenceReference High0.780.471.280.650.490.851.260.662.42Physician engagement    LowReferenceReferenceReference    Moderate0.870.481.581.501.191.892.611.066.44    High0.980.462.102.661.704.174.871.4116.78Care coordination    LowReferenceReferenceReference    Moderate0.780.551.110.670.371.231.260.752.12    High0.640.241.690.550.271.100.360.111.15Clinical trial    LowReferenceReferenceReference    High0.880.571.361.480.842.580.54*0.310.95

NOTE. Hazard ratios were adjusted for patient clinical and demographic measures: age, race, ethnicity, diagnosis year, gender, and cancer center geographic classification (rural/urban). The final specification of each multivariate regression model varied with the disease site and outcome measure due to differences in sample sizes and in the performance of the statistical models (eg, model fit, convergence).

Abbreviations: HR, hazard ratio (covariate adjusted); MDC, multidisciplinary care.

*

Controlling for age, year of diagnosis, gender, cancer center location and race.

P < .05.

P< .001.

METHODS:

We collected data for patients receiving care at 14 National Cancer Institute (NCI) community cancer centers. We characterized the NCI community cancer centers according to their level of MDC implementation across seven MDC assessment areas and over time. Using statistical regression models, we investigated the relationship between the level of MDC implementation and various process measures, including time to treatment receipt, clinical trial evaluation, receipt of multimodality treatment, and adherence to treatment guidelines published by the National Comprehensive Cancer Network.

BIAS, CONFOUNDING FACTOR(S), DRAWBACKS:

In the absence of a validated MDC assessment tool, the NCI community cancer centers used a nonvalidated tool. Additional institutional-level data would have been useful for characterizing norms and practices that may have differed across cancer centers and potentially explained variation in care processes. Although we controlled for patient demographic characteristics, baseline data were not available to document patient comorbidity or performance status level. To the extent that cancer centers at higher levels of MDC implementation may have been more likely to treat clinically complex patients, the inability to control for potential confounding bias caused by patient case mix may have influenced the study results.

REAL-LIFE IMPLICATIONS:

MDC models are important decision-making forums in current oncology practice. They involve oncologists in generating a comprehensive and coordinated plan of care for patients. Although MDC is purported to offer benefits to patients, there is limited generalizable evidence regarding the benefit to individuals receiving care at community cancer centers in the United States. Across various care processes that are important for characterizing cancer care, this study's results indicate that changes in the level of MDC implementation could differentially affect the process of care, depending on the MDC area of assessment and the cancer site. In addition, the study results can be used to generate hypotheses for future studies among individuals diagnosed with colon, rectal, or lung cancer.

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