Structured multidisciplinary decision making and survival in the prospective observational Detecting Early Lung Cancer (DELUGE) in the Mississippi Delta cohort.

35 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)