2018 Oncology Annual Report

OUTCOMES (continued)

MONITORING COMPLIANCEWITH EVIDENCE-BASED GUIDELINES FOR NON-SMALL CELL LUNG CARCINOMA

Reporting year: 2018 Accession year reviewed: 2017 Number of cases reviewed: 8 Guideline: NCCN Guidelines® for Non-Small Cell Lung Cancer Version 1.2019 Reviewer: Vasthi ChristensenWilson, MD, MSc Date presented: November 29, 2018 Vital to the success of the AtlantiCare Cancer Care Institute is continuous evaluation of performance in order to improve patient outcomes, emphasizing a professional commitment to safety and quality. This year, the Cancer Committee designated stage III non-small cell lung carcinoma for an in-depth analysis to assess and verify that cancer programpatients are evaluated and treated according to evidence-based national treatment guidelines. Lung cancer is the most common cause of cancer death in the United States. Lung cancers are classified as either small

Vasthi Christensen Wilson, MD, MSc

cell lung cancer (SCLC) or non-small cell lung cancer (NSCLC). This distinction is required for proper staging, treatment, and prognosis. This formal reviewwith analysis results represents a full evaluation of patients diagnosed with NSCLC between February and October 2017. Results were presented to the Cancer Committee and documented in Cancer Committee minutes. Initial evaluation of patients presenting to the AtlantiCare Cancer Care Institute with the diagnosis of NSCLC was considered appropriate when the following criteria were documented/met: history/physical examination, pulmonary function test (PFT), bronchoscopy, mediastinal lymph node evaluation, FDG PET/CT imaging, brain MRI with contrast, and standard blood work. Patients were staged appropriately utilizing American Joint Committee on Cancer (AJCC) stagingmethods. Review of the workup of these patients was concordant with evidence-based national guidelines in all cases. Treatment for this patient cohort included standard systemic chemotherapy consisting of either weekly carboplatin with paclitaxel or carboplatin with pemetrexed delivered every 21 days during the course of the radiation followed by durvalumab where indicated. Thoracic external beam radiation therapy (EBRT) was prescribed to a dose of 61.2Gy, divided into planned revision phases to account for tumor reduction during treatment with respect to normal organ tolerances (such as heart, esophagus, and spinal cord). Treatment plan criteria were consideredmet if the recommended surgery, systemic therapy, and radiotherapy was documented as completed, or as recommended but not completed as planned for reasons stated in the medical record (i.e. contraindication, comorbidities, treatment toxicity, patient death, refusal or non-compliance). Review of treatment plans for these patients was concordant with evidence-based national guidelines in all cases. In summary, this analysis confirms compliance with national guidelines. Collaborative coordination of care betweenmedical oncology, thoracic surgery, pathology, diagnostic radiology, and radiation oncology was evident during case review at monthly multidisciplinary Thoracic Oncology Conference. High quality clinical services – including state-of the-art pretreatment evaluation, staging, individualized treatment, and clinical follow up were verified as provided for AtlantiCare NSCLC patients.

14 AtlantiCare Cancer Care Institute: Annual Report 2018