718 Global quantitative patient chart review of multidisciplinary team (MDT) care and treatment use in early-stage non-small-cell lung cancer (NSCLC)
Bibliographic record
Abstract
Background MDT care is increasingly important in the evolving early-stage NSCLC treatment landscape. Here, as part of an ongoing global MDT study, we conducted a review of early-stage NSCLC patient charts to capture demographics, MDT care, treatment use, and biomarker information.Methods Oncologists, surgeons, pulmonologists, radiation oncologists, and chest physicians (UK only) from 11 countries who managed ≥5 patients with stage I-IIIB NSCLC (AJCC 8th ed.) in the year prior to screening (2024), had practiced ≥3 years, were licensed and board certified/eligible, and spent >60% (community) or >30% (academic) of their time in clinical practice were each invited to provide deidentified patient information for three early-stage NSCLC patients via medical chart abstraction. Eligible patients were ≥18 years old, had stage I-IIIB disease at initial diagnosis of NSCLC, received the initial diagnosis 6–18 months prior to data extraction, and are currently treated by the physician. Findings were summarized descriptively; multivariable logistic regression was used to assess the association of MDT discussion with neoadjuvant treatment.Results Baseline characteristics are summarized in table 1. Overall, 80.6% of patients had biomarker testing at diagnosis. Among resected patients (n=926), the most common treatment pathway was surgery followed by adjuvant therapy (37.6%), while 17.1% and 21.9% received neoadjuvant and perioperative treatment, respectively; for unresected patients (n=469), the most common treatment pathway was chemoradiotherapy followed by consolidation therapy (44.1%) (table 2). Notably, 12.1% of the patients reviewed were not discussed at an MDT meeting; this was most common in Canada (31.4%), Mexico (21.8%), Japan (20.1%) and Brazil (19.6%), and in a community (13.9%) versus academic (9.9%) setting. The most cited reasons for patients not being discussed at an MDT meeting included: the physician being confident in the treatment plan without MDT input (49.4%, particularly the case for stage I patients); MDT meeting was scheduled but did not occur (17.4%); delays in diagnostic information or results that were needed for an MDT discussion (17.4%); limited physician availability (15.1%); and administrative issues/errors (9.3%). Multivariable regression among resected patients showed MDT discussion before treatment is a key predictor of receiving therapy before surgery (odds ratio [OR] 2.08, 95% confidence interval [CI] 1.34–3.27), along with disease stage IIIA/IIIB (OR 8.09, 95% CI 5.40–12.32) and presence of comorbidities (OR 1.98, 95% CI 1.35–2.95).Conclusions MDT discussion is impactful for the management of early-stage NSCLC. However, variation in access remains across countries and between academic versus community settings.Acknowledgements This study was funded by AstraZeneca. Medical writing support for the development of this abstract, under the direction of the authors, was provided by James Holland, PhD, of Ashfield MedComms (Manchester, UK), an Inizio company, in accordance with Good Publication Practice (GPP) guidelines (http://www.ismpp.org/gpp-2022), and was funded by AstraZeneca.Abstract 718 Table 1Patient demographicsAJCC, American Joint Committee on Cancer; ALK, anaplastic lymphoma kinase; EGFR, epidermal growth factor receptor; PD-L1, programmed death ligand 1.Abstract 718 Table 2Summary of key findings from patient chart review by disease stage aAll patients discussed by MDT. bIncludes MDT coordinator, general surgeon, radiologist, clinical oncologist, pulmonary oncologist, hematology-oncologist, chest physician/respiratory physician (UK only), cancer nurse specialist, nuclear medicine physician, ‘other,’ and don’t know.Adj, surgery plus adjuvant therapy; CRT, chemoradiotherapy; CRT+cons, chemoradiotherapy followed by consolidation therapy; MDT, multidisciplinary team; Neoadj, neoadjuvanttherapy plus surgery; Periop, perioperative (neoadjuvant therapy, followed by surgery and adjuvant therapy); SBRT, stereotactic body radiotherapy; SBRT+CT, stereotactic body radiotherapy plus chemotherapy.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.010 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".