Structured multidisciplinary decision making and survival in the prospective observational Detecting Early Lung Cancer (DELUGE) in the Mississippi Delta cohort.
Authors: Liao Wei , Smeltzer Matthew Paul , Ray Meredith , Goss Jordan , Patel Anita , Stevenson Christine , Fehnel Carrie , Ogbeide Osarenren , Mehrotra Anurag , Wollak Istvan , Lammers Philip Edward , Tonkin Keith , Machin Jim , Azmi Syed , Ng Thomas , Zhao Jane , Bishop Ann , Osarogiagbon Raymond U. 
Published: September 2024

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Background:
Lung cancer screening (LCS) and incidental lung nodule programs (LNP) are associated with improved lung cancer survival (OS); multidisciplinary care (MDC) enhances guideline concordance. We evaluated the outcomes of patients with LCS- or LNP-detected lung cancer who received care with, versus without, structured program-based multidisciplinary decision-making within a large, tri-state regional community healthcare system.
Methods:
Prospective observational study of patients enrolled into LCS and LNP in the DELUGE cohort. Data on patients diagnosed with lung cancer was linked to a prospective institutional MDC database to classify care delivery as MDC or non-MDC. We compared patient demographic and clinical characteristics, including stage distribution with chi-square tests, OS with the log-rank test, and used proportional hazards models for death with hazard ratios adjusted for age, sex, race, smoking history, insurance status and histologic type.
Results:
From 2015 to 2023, 504 patients were diagnosed through LCS, 195 (39%) had MDC; 1714 through LNP, 712 (42%) had MDC; 2,218 in total through both early detection programs, 907 (41%) had MDC (Table). 89% of MDC recipients resided in metropolitan areas, compared to 60% of non-MDC patients (p<0.0001). There was a median of 1 (Interquartile range: 1-2) comorbidity across all subsets. Adenocarcinoma was more common among the MDC subsets: 46% v 35% LCS, 56% v 43% LNP; small cell lung cancer was more common among the non-MDC subsets: 11% v 18% LCS, 9% v 14% LNP (p=0.0005). Clinical Stage I was more frequent among MDC v non-MDC subsets for LCS, LNP, and both (all p<0.001, Table). OS was significantly higher in MDC v non-MDC (p<0.0001), aggregate 3-year OS was 75% v 55% (LCS), 60% v 42% (LNP), 63% v 45% (both); and 5-year OS was 65% v 51% (LCS), 49% v 34% (LNP), 52% v 37% (both), respectively. Sensitivity analysis restricting the cohorts to metropolitan patients only or to patients who received care within the institutions where the MDC was active yielded similar results.
Conclusions:
Structured multidisciplinary decision-making was strongly associated with significant stage re-distribution and better OS among patients diagnosed with lung cancer through screening or lung nodule programs. The MDC structure needs to be embedded within early lung cancer detection programs for optimal results.

Variable
LCS: MDC?
LNP: MDC?
Both Programs: MDC?

Yes; n=195
No; n=309
Yes; n=712
No; n=1002
Yes; n=907
No; n=1311

Median age, years
68
68
69
71
69
70

Female, %
49
48
51
50
50
49

Black race, %
13
20
30
22
26
22

Medicaid/uninsured, %
2
5
7
7
6
7

Actively smoking, %
70
74
46
52
51
57

Stage I v IV, %
66 v 11
47 v 21
52 v 19
33 v 34
55 v 17
36 v 31

Surgical resection, %
52
32
45
20
46
23

Adjusted HR for death
Ref
1.9 (1.3, 2.7)
Ref
1.6 (1.4, 1.9)
Ref
1.7 (1.4, 1.9)