title: Impact of a multidisciplinary thoracic oncology clinic on the timeliness of care.
abstract: BACKGROUND
  Multidisciplinary clinics have been recommended for the evaluation of patients with lung cancer. Evidence to support this recommendation, however, is limited. A single-center, retrospective review of lung cancer patients at a Veterans Affairs hospital was performed comparing timeliness of diagnostic and treatment decisions during the operation of a multidisciplinary thoracic oncology clinic (MTOC) with a period after it closed (non-MTOC), during which only a weekly multidisciplinary conference was held.
  
  
  METHODS
  Patients were identified from a tumor registry. Manual chart reviews were performed on all patients. Outcome measures included time from initial presentation to diagnosis (TTD) and time from diagnosis to treatment initiation (TTT).
  
  
  RESULTS
  Three hundred forty-five patients (244 in MTOC, 101 in non-MTOC) diagnosed with lung cancer between 1999 and 2003 were included in the study. Baseline characteristics were similar between the two groups. Median TTD was 48 days (95% confidence interval [CI]: 37-61) and 47 days (95% CI: 39-55) in the MTOC (n = 164) and non-MTOC cohorts (n = 89), respectively (p = 0.09). Median TTT was 22 days (95% CI: 20-27) and 23 days (95% CI: 20-34) in the MTOC (n = 165) and non-MTOC cohorts (n = 89), respectively (p = 0.71). There was no difference in overall survival.
  
  
  CONCLUSIONS
  Retrospective comparison of sequential cohorts failed to reveal benefit in the timeliness of care measures during the time period of MTOC operation. Potential confounders include the absence of a surgeon in the MTOC setting, an ongoing weekly multidisciplinary conference in the non-MTOC cohort, and existing infrastructures based on previous MTOC experiences and past provider experience. Confirmation of these findings in other health care settings is warranted, preferably in a prospective fashion.
authors.affiliation: Department of Medicine, Durham Veterans Affairs Medical Center and Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Richard F
authors.initials: RF
authors.lastname: Riedel
authors.forename: Xiaofei
authors.initials: X
authors.lastname: Wang
authors.forename: Meg
authors.initials: M
authors.lastname: McCormack
authors.forename: Eric
authors.initials: E
authors.lastname: Toloza
authors.forename: Gustavo S
authors.initials: GS
authors.lastname: Montana
authors.forename: Gilbert
authors.initials: G
authors.lastname: Schreiber
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Kelley
mesh_terms: D000368:Aged; D002173:Cancer Care Facilities / Q000458:organization & administration; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D006787:Hospitals, Veterans; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D008297:Male; D008511:Medicine; D017063:Outcome Assessment, Health Care; D010044:Outpatient Clinics, Hospital / Q000458:organization & administration; D013038:Specialization; D015996:Survival Rate; D013997:Time Factors