Timing of multidisciplinary care and lung cancer survival.

502 Background: Optimal lung cancer care involves complex multidisciplinary interactions for diagnosis, staging, and treatment. We tested the association between timing of referral into a Multidisciplinary Thoracic Oncology Program (MTOP) and survival. Methods: Prospective observational study of an MTOP cohort enrolled from 2014 to 2024 in a community healthcare system, excluding patients with a history of lung cancer within 3 years. We compared patients enrolled before versus after: histologic diagnosis, radiologic staging (PET-CT, brain MRI, or bone scan), invasive staging (bronchoscopy with transbronchial needle aspiration, endobronchial ultrasound, thoracentesis, mediastinoscopy or biopsy of any extra-thoracic lesion), and treatment onset (chemotherapy, immunotherapy, oral targeted therapy, surgery, or radiation therapy). We evaluated the hazard of death with hazard ratios and 95% confidence intervals from Proportional Hazards models, using the cohort enrolled after each key care delivery step for reference. We adjusted for age, sex, race, insurance status, comorbidities, smoking status and histologic type. Results: In the cohort, 517 of 1,920 patients (27%) were referred into MTOP before histologic diagnosis; 463 of 1,602 (29%) before radiologic staging; 121 of 574 (21%) before invasive staging; and 1,370 of 1,644 (83%) before treatment (Table). Compared to patients enrolled after diagnosis, those enrolled before diagnosis had an adjusted hazard ratio (aHR) of 0.87 (0.75-1.01). The aHRs were 0.78 (0.66-0.92) for enrollment before radiologic staging, 0.86 (0.67 -1.11) for enrollment before invasive biopsy, and 1.05 (0.87 - 1.26) for enrollment before treatment onset. Conclusions: The survival benefit of multidisciplinary care was significantly associated with early engagement. Benefit was less evident with entry later in the lung cancer care-delivery continuum. Characteristics of MTOP patients according to timing of program entry across the continuum of lung cancer care delivery from initial diagnosis to treatment selection. Variable* Diagnosis N=1920 Radiologic staging N= 1602 Invasive staging N=574 Treatment N=1644 Pre 27 Post 73 Pre 29 Post 71 Pre 21 Post 79 Pre 83 Post 17% Median age (IQR), years 69 (13) 69 (13) 69 (12) 69 (13) 69 (13) 67 (13) 69 (13) 66 (14) Female 56 48 49 49 47 50 50 51 Race: White/ Black/ other 68/30/2 68/29/2 67/31/2 70/28/2 69/30/2 63/35/2 68/29/2 69/30/1 Medicare/Commercial/Medicaid/Uninsured 65/26/4/4 67/24/5/4 68/24/4/5 69/23/5/3 69/26/3/2 62/28/5/5 67/25/4/4 60/28/7/5 Comorbidity score 0/1/2 25/50/26 25/50/25 25/49/26 23/52/25 17/55/28 27/52/21 25/50/25 28/51/21 Active/former/never smoked 47/41/10 44/44/11 45/45/10 46/44/9 55/40/6 45/43/12 46/44/9 41/42/15 Histology: Adeno/sq/sclc 58/27/8 51/33/11 54/34/9 52/33/8 46/43/7 48/32/12 54/33/9 54/24/15 Clinical stage: I/II, III/IV 53/43