Advances in Thoracic Oncology Multidisciplinary Care

Dear Colleagues,

Cancer care is complex. A multidisciplinary approach results in a more efficient and effective patient-centered care.  Advances in systemic therapy (immunotherapy and target therapy) for lung cancer have improved survival in advanced stages. Recent clinical trials are also demonstrating improved survival in patients with locoregional advanced lung cancer with the combination of chemotherapy, immunotherapy, and surgery. In addition, robotic technology is increasingly being used in the diagnosis and treatment of lung cancer. This Special Issue aims to add to the body of literature reporting the results of current multimodality therapy for locoregional advanced lung cancer in combination with robotic technology. The scope of this Special Issue would include the evaluation of safety and accuracy of robotic navigational bronchoscopy, cost-effectiveness of 3D software to plan complex robotic operations including complex segmentectomy and Pancoast tumors, experience with adoption of virtual platforms for multidisciplinary clinics, safety and oncologic outcomes associated with induction chemo-immunotherapy, and target therapy followed by robotic anatomic resections.

Dr. Nestor Villamizar
Guest Editor

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• thoracic oncology
• lung cancer
• cancer care
• immunotherapy and target therapy
• robotic technology

Title: Silver lining of COVID pandemia: Thoracic Oncology Virtual Multidisciplinary Clinic
Authors: Nestor Villamizar
Affiliation: Division of Cardiothoracic Surgery, The DeWitt Daughtry Department of Surgery, University of Miami, Miami, FL, USA
Abstract: Purpose：Multidisciplinary Clinics (MDC) offer a uniformed assessment of key specialists to develop a plan of care. (1) However, establishing MDC clinical visits at our institution has been challenging. Telemedicine is helping to overcome barriers to implementation. (2) We aim to describe our experience developing a virtual MDC. Methods：A Thoracic Surgeon, a Medical Oncologist and a Radiation Oncologist agreed to schedule patients for 2 hours once a week after Thoracic Oncology Tumor Board, to evaluate patients at a virtual MDC. Criteria was selected to identify patients who would benefit from MDC. Depending on the patients’ clinical needs, other physician specialists were at times included in the virtual visit. A database was created for future analysis. The 1st virtual MDC was conducted in June 2020. In February 2022, participating physicians and patients were invited to complete a survey about their level of satisfaction with the virtual MDC experience. Results：A total of 137 patients were seen at virtual MDC during the study period. A total of 33 physicians of 15 different specialties participated. The most common reason for referral to MDC was review of routine surveillance imaging studies after multidisciplinary therapy (Table 1). The most common diagnosis was non-small cell lung cancer; the most common clinical stage evaluated at the MDC was Stage III. A total of 87 patients (63.5%) were discussed at tumor board before virtual MDC. Changes in treatment plan from tumor board recommendation took place in 3 patients (3.4%) after their input during virtual MDC. A total of 50 (36%) patients completed the survey; 90% (45/50) preferring telehealth visit with all providers at once as opposed to multiple in person meetings spread out over days; 68% (34/50) maintaining this preference even in the absence of a pandemia. A total of 21 (64%) physicians completed the survey; 81% (17/21) preferring a telehealth visit with all providers at once as opposed to multiple in person meetings spread out over days; 71% (15/21) maintaining this preference even in the absence of a pandemia. Conclusions：Implementation of a virtual MDC has been very positive for physicians and patients. Flexibility of this platform allows simultaneous inclusion of multiple providers from several different specialties. We plan on evaluating its cost-effectiveness and impact on time to treatment and clinical trial enrollment in comparison with the traditional care model.