WCLC 2025 - Posters & ePosters-EP.08.28 Referral Rates to Medical Oncology Before Lung Cancer Surgery: A Quality Improvement Study in the Era of Perioperative Chemoimmunotherapy

EP.08.28 Referral Rates to Medical Oncology Before Lung Cancer Surgery: A Quality Improvement Study in the Era of Perioperative Chemoimmunotherapy

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This quality improvement study at Northwell Health/Zuckerberg Cancer Center evaluated referral rates to medical oncology before lung cancer surgery in the context of perioperative chemoimmunotherapy for resectable non-small cell lung cancer (NSCLC). NSCLC patients with localized or loco-regional disease (stages IB-IIIB) can benefit from neoadjuvant chemoimmunotherapy, which improves pathologic response and two-year event-free survival. Despite this, referral rates remain suboptimal.<br /><br />The retrospective review included 49 patients treated from January to May 2024. Only 22% were referred to medical oncology for neoadjuvant therapy evaluation before surgery, and 29% were presented at the thoracic tumor board. Referral rates were higher for stages IIB-IIIB (up to 40%), with only 15% ultimately receiving neoadjuvant chemoimmunotherapy, mostly stage III patients. Biopsy and presurgical next-generation sequencing (NGS) were performed in 43% and 33% of patients, respectively. The low referral and treatment rates contrast with clinical trial evidence supporting perioperative chemoimmunotherapy benefits.<br /><br />The authors highlight underutilization of multidisciplinary evaluation and perioperative systemic therapy in resectable NSCLC, consistent with external real-world data citing 3% use in stage I and 40% in stage III. They propose quality interventions including focus groups, questionnaires, Pareto charts, and root cause analyses to identify barriers to referral and optimize care pathways. Plan-Do-Study-Act (PDSA) cycles will then be used to implement and refine improvements.<br /><br />In conclusion, the study reveals important gaps in referral to medical oncology and application of neoadjuvant chemoimmunotherapy before lung cancer surgery, underscoring the need for focused quality initiatives to align practice with emerging standards and improve patient outcomes. These efforts may benefit other institutions facing similar challenges in integrating perioperative chemoimmunotherapy into lung cancer management.

Asset Subtitle

Juliet Meir

Meta Tag

Speaker Juliet Meir

Topic Local-Regional Non-small Cell Lung Cancer

Keywords

non-small cell lung cancer

NSCLC

perioperative chemoimmunotherapy

neoadjuvant therapy

medical oncology referral

lung cancer surgery

quality improvement

multidisciplinary evaluation

next-generation sequencing

PDSA cycles