Portal de Periódicos da CAPES

P1.10: Follow-Up on Results of a Multidisciplinary Team in the Management of Non-Small Cell Lung Cancer in a Developing Country

2016; Elsevier BV; Volume: 11; Issue: 10 Linguagem: Inglês

10.1016/j.jtho.2016.08.032

1556-1380

Luis Corrales, Melissa Juárez, Allan Ramos-Esquivel, Manuel Delfín Pérez Caballero, Mónica Araya, Warner Rodríguez, Andrés Volio, Carlos Zúñiga‐Ramírez, R Valladares, Manuel Antonio Villalobos, Bruno Solís, Randall Guadamuz, Sofía Antillón, C. Cañete Campos, T Rodríguez Soto, Adriana Murillo, Alejandro J. Brenes, Tania L. Rivera, Luis Fernando Briceño Rodríguez, João Pedro Baptista, Zenén Zeledón, Pablo J. Ordoñez, Ernesto Jiménez, Ileana González,

Global Cancer Incidence and Screening

In a public health system of a developing country, NSCLC mortality rates tend to be higher due to deficits in diagnostic and professional resources, long time interval between patient's symptoms and the initiation of treatment, and low access to innovative drugs. Multidisciplinary teams (MDT) improve the care of patients with NSCLC, but this practice is not common in developing countries. In Costa Rica more than 95% of cancer patients are treated in a public hospital where resources are limited. To improve patient care a weekly multidisciplinary thoracic oncology meeting was organized in 2011 at Hospital San Juan de Dios, one of Costa Rica's three adult general hospitals. Previous results were reported in the WCLC2013. A MDT including Medical Oncology, Pneumology, Pathology, Thoracic Surgery, Radiology and Radiation Oncology met in a weekly basis starting November 2011. All patients with a possible lung cancer evaluated at the hospital were discussed by the team and recommendations were given. Data of patients with NSCLC seen by the multidisciplinary team after November 2011 and until April 2016 was compared to a historic data of NSCLC patients diagnosed in the same hospital between 2003 and 2008 when there was no multidisciplinary team involved in patient care. Exclusion criteria included insufficient clinical information. Epidemiologic data was analyzed and survival curves were obtained. OS was calculated from time of histologically confirmed diagnosis to time of death. Patients diagnosed during both periods were included for survival analysis. The first period of 2003-2008 included 87 NSCLC pts while the second period of 2011-2016 included 231 NSCLC pts. Between 2003-2008, the distribution according to the stage was as follows: stage I=10.9% (n=10), stage II=2.2% (n=2), stage III=45.7% (n=42), and stage IV=41.3% (n=38). Between 2011-2016 the distribution according to the stage was: stage I=4.1% (n=5), stage II=5.0% (n=6), stage III=25.9% (n=31), stage IV=65% (n=78). The median OS for the entire population of the first period (2003-2008) was 6.13 months (95%CI=4.75-7.51), while in the second period (2011-2016) was of 7.1 months (95%CI=6.61-9.60). This difference was statistically significant with a p=0.038 (95%CI=0.59-0.98) (Figure 1). When stage IV only patients were analyzed, in the period 2003-2008 the median OS was 5.4 months (95%CI: 2.0– 8.7) and for the period 2011-2016 the median OS was 7.6 months (95% CI: 5.1 – 10.1). This difference was not statistically significant (p=0.12). The inclusion of a MDT in the management of NSCLC has lead to an improvement in overall survival. The differences seen in the distribution of the stages probably accounts to subdiagnosis of metastatic disease in the first periord. This distribution in the second period is comparable to that published in the literature. Eventhough the percentage of metastatic disease was higher in the second period, survival including all stages was higher in this period of time, and this can be a result of a more integral management in the MDT setting. The MDT approach could be considered an option to improve the management and outcomes of NSCLC patients in a developing country.