Abstract
BACKGROUND: Lung cancer is a heterogeneous and complex disease requiring multidisciplinary input for optimal management planning, with guidelines recommending that all patients be discussed in a multidisciplinary setting. Multidisciplinary meeting (MDM) discussion aims to enhance evidence-based management, improve treatment access, and optimize complex management plans. METHODS: We aimed to assess the extent and impacts of MDM discussion in patients with lung cancer described by the Victorian Lung Cancer Registry from 2011 to 2023 in Victoria, Australia. We identified MDM-presented and nonpresented patients and assessed the impacts of MDM presentation. OR and survival hazard ratios were assessed using Cox proportional regression analysis. Survival analysis was determined using the Kaplan-Meier product-limit method. Sensitivity analyses were conducted using landmark analysis and propensity score matching methods. RESULTS: A total of 18,597 patients were included, of whom 67% had evidence of presentation to a lung cancer MDM, with MDM presentation increasing from 59.1% to 80.6% during the study period. MDM presentation was associated with higher levels of provision of guideline-concordant treatment in NSCLC (56.2% versus 44.5%, p < 0.001), and lower levels of no treatment (10.0% versus 21.4%, p < 0.001). Modifiable factors that could increase MDM presentation include referral of patients of older age, stage IV disease, SCLC, and diagnosis at a private or regional hospital. Propensity-matched survival analysis in NSCLC revealed a median survival of 1.1 years for MDM-presented versus 0.86 years for nonpresented individuals, providing a 12% reduction in mortality hazard (hazard ratio 0.88 [0.82-0.95], p < 0.001). CONCLUSION: During the period of activity of the Victorian Lung Cancer Registry, MDM presentation increased from 59.1% to 80.6%. Management outcomes in MDM-presented patients identified multiple underserved cohorts and revealed considerable increases in treatment modalities and guideline-concordant treatment in NSCLC in this observational study, with an associated 12% improvement in survival advantage overall.