Assessing current diagnostic, staging, and treatment practices in community and academic centers for individuals with stage IB-IIIA non-small cell lung cancer.

Background: The 5-year survival rate for individuals with surgically resected, early-stage non-small cell lung cancer (NSCLC) is around 50%. Recent availability of biomarker-driven therapy after surgery offers the promise of improved outcomes. However, current gaps in the quality of diagnostic evaluation, delivery of evidence-based treatment, coordination of care, and availability of biomarker testing remain barriers to optimal outcomes. Methods: The Association of Cancer Care Centers (ACCC) conducted a survey of providers who treat NSCLC to assess current patterns in the diagnosis and treatment of patients with early-stage (IB-IIIA) disease. The survey, 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. It was administered in Qualtrics XM; results were analyzed using SAS 9.4 (SAS Institute). Results: There were 124 survey respondents from 33 US states. Respondents' institutions were reported as 60% urban, 23% suburban, and 17% rural; 53% were reported as community cancer programs, 37% as academic/National Cancer Institute (NCI)-designated cancer programs, and 9% as private practice. On average, an initial tissue biopsy was performed by interventional radiologists in 29% of cases, by interventional pulmonologists in 22%, and by thoracic surgeons in 16%. For patients with stage IIA-IIIA disease, 50% of respondents typically performed invasive mediastinal staging before surgery, 20% during surgery, and 20% did not typically perform invasive mediastinal staging. The most frequent barriers to optimal staging and diagnosis included scheduling (73%), cost (51%), tissue quantity (46%), limited access to tests or procedures (42%), and missed appointments (36%). Use of multidisciplinary tumor boards varied-there was 40% participation in a general cancer tumor board, 65% involvement in a thoracic-specific tumor board, and 19% engagement in a dedicated molecular tumor board. Certain sites offered multiple options. Tumor board meetings occurred weekly in 57% of institutions, 2 to 3 times per month in 22%, and once a month in 11% of institutions. In all, 66% of respondents had a standard biomarker testing protocol in place for resected NSCLC. Testing involving epidermal growth factor receptor (EGFR) was typically ordered in 51% of respondents' institutions, and programmed death ligand 1 (PD-L1) testing for patients with resected NSCLC was regularly ordered in 62%. The largest barriers to optimal care included: scheduling of procedures and surgery (23%), patient refusal (19%), communication breakdowns (17%), inadequate staffing (15%), and limited access to subspecialties (14%). Many survey respondents (83%) agreed that their cancer practice had the staff and resources to help patients in navigating the health system. However, only 45% typically assigned a nurse navigator to individuals with early-stage NSCLC. Palliative care-service referrals for early-stage NSCLC were considered in 48% of sites, while 51% of sites rarely or never referred patients. Conclusions: In this broad sample of oncology practices across the United States (US), ACCC identified several strengths and barriers to optimal care for individuals with early-stage NSCLC. Improved care coordination and standardized staging and diagnosis practices can optimize care in this dynamic treatment landscape.