Assessing current diagnostic, staging, and treatment practices in community and academic centers for individuals with stage IB-IIIA non–small-cell lung cancer (NSCLC).
Authors: Smeltzer Matthew , Lee Percy , Gray Jhanelle Elaine , Studts Jamie L , Kim Joseph , Shiller Michelle , Vimolratana Marc , West Howard Jack , Le Xiuning , Cattaneo Stephen , Lile Ashley , Plotkin Elana , Boehmer Leigh 
Published: June 2023

e20608

Background: The five-year survival for individuals with surgically resected, early-stage NSCLC is around 50%. Recent availability of biomarker driven therapy after surgery has the promise of improved outcomes. However, deficits in the quality of diagnostic evaluation, evidence-based treatment delivery, care coordination, and biomarker testing are still barriers to optimal outcomes. Methods: In 2022, the Association of Community Cancer Centers (ACCC) conducted a survey of NSCLC providers to assess current patterns in the diagnosis and treatment of patients with early-stage (IB-IIIA) NSCLC. The survey, which was distributed to ACCC members and their associated networks, collected information about each respondent and their cancer program processes around diagnosis, treatment planning, and care delivery. We administered it Qualtrics and analyzed results with SAS 9.4. Results: We had 124 survey respondents from 33 US states. Respondents’ institutions were 60% urban, 23% suburban, and 17% rural, 53% community cancer programs, 37% academic/NCI designated cancer programs, 9% private practice. On average, initial tissue biopsy was performed by interventional radiologists in 29% of cases, interventional pulmonologist in 22%, and thoracic surgeons in 16%. In stage IIA-IIIA, on average 49% typically perform invasive mediastinal staging before surgery, 17% during surgery, and 18% do not typically perform invasive mediastinal staging. The most frequent barriers to optimal staging and diagnosis included scheduling (73%), cost (51%), tissue quality (46%), limited access to tests or procedures (42%), and missed appointments (36%). Multidisciplinary tumor board use included 31% with a general cancer tumor board, 50% with a thoracic specific tumor board, and 14% have a dedicated molecular tumor board. Tumor board meetings were weekly in 57%, 2-3 times a month in 22%, and once a month in 11%. 66% have a standard biomarker testing protocol for resected NSCLC. 51% typically order EGFR and 31% regularly order PDL1 testing for patients with resected NSCLC. The largest barriers to optimal care included: scheduling (23%), patient refusal (19%), communication breakdowns (17%), inadequate staffing (15%), and limited access to subspecialties (14%). 83% agree their center has the staff and resources to help patients navigating the health system. However, only 45% typically assign a nurse navigator to individuals with early-stage NSCLC. Palliative care service referrals were made sometimes or often in 48% of sites, while 51% refer rarely or never. Conclusions: In this broad sample of oncology practices across the US, we identified several strengths and barriers to optimal care for persons with early-stage NSCLC. Improved care coordination and standardized staging and diagnosis practices could optimize care in this dynamic treatment landscape.