Review by a Multidisciplinary Team (MDT) has been shown to lead to increased rates of surgical resection, radiotherapy, chemotherapy and timeliness of care. Most recently, the Victorian lung cancer patterns of care study have found that MDT review is an independent predictor of lung cancer survival.

2. Predictors of Lung Cancer multidisciplinary
review and the impact on survival for HNELHD
residents treated in the public sector
Cancer Innovations Conference
Date: Thursday, 15 October, 2015
Location: Aerial Function Centre
Address: Building 10, Level 7/235 Jones Street, Sydney, New South Wales 2007, Australia
Dr Elizabeth Tracey
Research Fellow University of Newcastle
Consultant Epidemiologist
HNE Cancer Network Directorate
The Lodge
John Hunter Hospital Campus

3. Acknowledgments
• Professor Anthony Proietto – review and discussion
• Dr Sanjiv Gupta – Chair of the HNELHD Lung MDT
• Denise Kaminski – MDT survey extraction
• Peter Troke and staff of the Clinical Cancer Registry- extraction of ClinCR data, data
quality and death checking
– Jodie Pride
– Gina O’Hearn
– Lisa Shaw
Feedback from the
• Cancer Clinical Network Leadership Committee,
• Lung MDT
• Respiratory Meeting

4. Outline
• Background
• Method
• Results
• Summary
• Implications and Recommendations

5. Background
• Lung cancer is a poor survival cancer that usually presents at a late stage1,2 but if detected
early and staged appropriately surgical resection alone or with adjuvant chemotherapy is
currently the recommended treatment.
• The primary reason for a Multidisciplinary Team (MDT) review
– is to ensure that all appropriate diagnostic test and treatment options have been
considered; 3
– for the development of standardised patient protocols; as well as
– a forum for the continuing education of the clinical staff.
1. Walters S, Maringe C, Butler J, Brierley JD, Rachet B, Coleman MP. Comparability of stage data in cancer registries in six countries: lessons from the
International Cancer Benchmarking Partnership. Int J Cancer 2013; 132(3): 676-85.
2. Walters S, Maringe C, Coleman MP, et al. Lung cancer survival and stage at diagnosis in Australia, Canada, Denmark, Norway, Sweden and the UK: a
population-based study, 2004-2007. Thorax 2013.
3. Multidisciplinary cancer conferences: A systematic review and development of practice standards. 2007; 43(6): 1002–10.

6. Background (continued)
• Review by an MDT has been shown to lead to increased rates of surgical
resection, radiotherapy, chemotherapy and timeliness of care.4,5 Most recently,
the Victorian lung cancer patterns of care study have found that MDT review is an
independent predictor of lung cancer survival. 6
• Cancer Australia 2012 Guidelines recommend that all patients suspected of lung cancer
be referred to a lung cancer MDT. 7
• Previous patterns of care studies have compared lung cancer survival and treatment
patterns in South Western Sydney and Northern Sydney Area Health with the Hunter New
England Local Health District (HNELHD) region and reported that Hunter New England
residents had significantly poorer lung cancer survival and proportionally less surgical and
chemotherapy treatment than the other regions.8
4.Coory M, Gkolia P, Yang IA, Bowman RV, Fong KM. Systematic review of multidisciplinary teams in the management of lung cancer. Lung Cancer 2008; 60(1): 14-21.
5.Boxer MM, Vinod SK, Shafiq J, Duggan KJ. Do multidisciplinary team meetings make a difference in the management of lung cancer? Cancer 2011; 117(22): 5112-20.
6.Mitchell PL, Thursfield VJ, Ball DL, et al. Lung cancer in Victoria: are we making progress? Med J Aust 2013; 199(10): 674-9.
7.Cancer Australia. Investigating symptoms of lung cancer: a guide for GPs. 2012. http://canceraustralia.gov.au/publications-and-resources/cancer-australia-publications/investigating-
symptoms-lung-cancer-guide-gps (accessed 30th July 2014).
10.Vinod S, Hui A, Esmaili N, Hensley M, Barton M. Comparison of patterns of care in lung cancer in three area health services in New South Wales, Australia. Intern Med J 2004; 34(12): 677-
83

7. Aims
1. To examine predictors of lung cancer MDT review in the HNELHD Public
sector patients after adjusting for patient, tumour, treatment and system
factors
2. To determine whether MDT is independent predictor of survival
3. To review the quality and usefulness of data collected at the MDT review

8. Method
• Data linkage study:
– Hunter New England residents diagnosed with lung cancer between January 1st 2009
and June 30th 2013 identified HNE Clinical Cancer Registry
– MDT patient - lung cancer patients treated at some time in the public sector
• A protocol was developed and ethical approval was obtained from the Hunter New England
Ethics Committee (LNR/15/HNE/10).
• Exclusions: Private patients reviewed by the MDT that had not also been treated in the
public sector and patients who were treated outside the LHD were excluded to ensure
consistent numerator and denominator information.

9. Statistical Analyses
• SAS 9.4 was used for data cleaning and linkage. STATA12.115 was used for the statistical analysis.
Descriptive statistics using chi square and multinomial Logistic regression analysis (no MDT
participation (referent category) relative to MDT participation.
• We described all cause survival from lung cancer and its predictors using Kaplan–Meier curves and
univariable and multivariable Cox proportional hazards regression models. Patients without a date
if death ( N=564) were checked to see if they had died up to December 31st 2014 by the Clinical
Cancer Registry staff looking up the NSW death register. Patients who had died after that date
were censored.

10. Results
Clinical Cancer Registry 2009-2013
8679 records for people with lung cancer
and mesothelioma.
Tamworth – 18 Rural and 22 Calvary Mater
Lung MDT
Of the 2,167 individuals with lung cancer 411
matched the clinical cancer their MDT
attendance. 1788 did not attend an MDT
95 people reviewed in an MDT but were not
in the Clinical Cancer Registry –
Exclusions
Exclude 461 records with mesothelioma.
This leaves 8,218 records of lung cancer for
2,167 individuals with the number of
episodes per person ranging from 2-22
MDT reviewed 2009-2013
644 records 558 once,72 twice,12 three
times, 2 four times

11. Descriptive characteristics – key points
• 20% of total HNELHD lung cancer patients are reviewed annually at an MDT
• On average 450 lung cancer patients a year are registered in the ClinCR. Given that there
are 500 recorded cases of lung cancer annually in HNELHD (based on CCR data) it would
appear most lung cancer patients have some access with the public health system.
Although according to the Cancer Institute only 37% of patients receive their lung cancer
surgery in HNELHD. This was confirmed using FLOWINFO which showed that most
respiratory surgery was conducted in the private sector
• There were a similar proportion of patients reviewed and not reviewed by age, sex,
indigenous status, laterality, histological grade.
• More patients with localised and regional stage and less distant stage reviewed at the
MDT.
• More squamous and adenocarcinoma reviewed at the MDT.

12. Descriptive characteristics – key points
• 43.4% patients treated at Calvary Mater (61.8% of all MDT patients were treated at
Calvary Mater)
• Approximately 6% had surgery (11.2% if attending an MDT).
• 29% chemotherapy, (41% MDT)
• 44.7% radiotherapy (72% MDT)
• 54% not referred to palliative care (62% MDT)
• 35.5% seen by a specialist nurse relative (57% MDT)
• If referred to an MDT are reviewed 70% of patients are reviewed within a month of their
diagnosis
• 29% of patients do not have treatment (16.8% if attending an MDT)
• For patients who do undergo treatment most (92%) have their treatment within 6 months
of their date of diagnosis.

13. Predictors of MDT review – multivariate model
Total MDT
2187 411
Age at diagnosis n n % OR LCI UCI
15-49 70 14 3.4 1
50-59 276 67 16 1.34 0.66 2.73
60-69 645 148 36 1.28 0.65 2.52
70-79 740 137 33 1.09 0.55 2.16
80+ 455 45 11 0.66 0.31 1.39 P=0.0319
TNM stage
stage 1 303 74 18 1
Stage II 136 55 13 2.26 1.37 3.75
Stage III 415 129 31 1.09 0.71 1.69
Stage IV 1,100 133 32 0.42 0.27 0.66
Not Applicable 56 9 2.2 0.37 0.15 0.90
Unknown 97 4 1 0.23 0.07 0.70
Unstaged 73 5 1.2 0.57 0.19 1.69 <.0001
Best basis of diagnosis
Other 537 54 13 1
Cytology 1,145 265 65 1.55 1.06 2.26
Histology 504 92 22 1.39 0.91 2.12 P=0.077
Hospital of treatment
Other 121 5 1.2 1
Armidale and New England 96 1 0.2 0.11 0.01 1.02
Belmont Hospital 70 4 1.0 1.05 0.26 4.33
Calvery Mater Hospital 950 254 61.8 3.28 1.27 8.50
Cessnock District Hospital 34 3 0.7 1.55 0.32 7.55
John Hunter Hospital 451 113 27.5 3.51 1.33 9.32
Maitland Hospital 62 4 1.0 1.74 0.41 7.45
Manning River Base Hospital 154 17 4.1 2.43 0.82 7.15
Total MDT
2187 411
n n % OR LCI UCI
Moree Hospital 19 1 0.2 1.28 0.13 13.21
Muswellbrook Hospital 18 2 0.5 2.40 0.36 16.20
Singleton Hospital 13 3 0.7 6.63 1.09 40.49
Tamworth base hospital 199 4 1.0 0.15 0.04 0.61 p<.0001
Surgery
No surgery 1,502 278 67.6 1
Biopsy 576 101 24.6 1.52 0.96 2.40
Pneumonectomies 4 2 0.5 0.84 0.38 1.87
Lobectomy 48 12 2.9 1.62 0.22 11.97
Wedge resection 85 32 7.8 1.67 0.91 3.06 P=0.2605
Chemotherapy
No Chemotherapy 1,100 148 36 1
Chemotherapy consultation 447 95 23 1.35 0.96 1.90
Chemotherapy 639 168 41 1.11 0.79 1.57 P=0.2145
Radiotherapy
No radiotherapy 1162 107 26.0 1
Radiotherapy consultation 47 8 1.9 2.25 0.86 5.93
Radiotherapy 978 296 72.0 2.98 2.16 4.13 p<.0001
Referred to palliative care
Not referred 1,173 254 62 1
Referred 1,013 157 38 0.65 0.49 0.87 P=0.0032
Referral to psychosocial care
No stated 1,157 140 34 1
Other 254 35 9 1.31 0.83 2.05
Specialist nurse 775 236 57 2.61 1.94 3.51 <.0001

14. Kaplan Meier – unadjusted survival from lung cancer by MDT review

15. Kaplan Meier – unadjusted lung cancer survival by MDT review by
TNM Stage

16. Kaplan Meier – unadjusted survival from lung cancer by MDT review
stratified for patients with Stage III lung cancer

17. Kaplan Meier – unadjusted survival from lung cancer by MDT review
stratified for patients with Stage IV lung cancer

18. Final Multivariate survival model
MDT review Total N Died %Died HR LCI UCI P-value
No MDT review 1,775 1,562 83.2 1
MDT review 411 315 16.8 0.79 0.70 0.91 p<0.0001
Sex
Male 1,318 1,178 62.8 1
Female 868 699 37.2 0.83 0.75 0.91 p<0.0001
Age group
15-49 70 56 3.0 1
50-59 276 218 11.6 1.06 0.79 1.43
60-69 645 542 28.9 1.15 0.87 1.52
70-79 740 641 34.2 1.18 0.89 1.56
80+ 455 420 22.4 1.23 0.92 1.64 p=0.4314
Aboriginal status
Non-Aboriginal or Torres Strait 71 63 3.4 1
Abtsi 7 6 0.3 1.30 1.00 1.68
Not stated unknown 2,108 1,808 96.3 0.93 0.41 2.10 p=0.1401
TNM Stage at diagnosis
I 303 172 9.2 1
II 139 105 5.6 1.86 1.46 2.39
III 418 353 18.8 2.39 1.96 2.90
IV 1,100 1,044 55.6 4.49 3.75 5.37
Not Applicable 73 67 3.6 3.15 2.22 4.48
Unknown 56 53 2.8 1.70 1.30 2.24
Unstaged 97 83 4.4 2.94 2.19 3.94 p<0.0001
Histological subtype
Carcinoma NOS 422 364 19.4 1
Adenocarcinoma 799 651 34.7 0.80 0.70 0.90
Large-cell carcinoma 246 224 11.9 1.02 0.84 1.23
Small-cell carcinoma 168 144 7.7 1.00 0.83 1.20
Squamous cell carcinoma 551 494 26.3 1.09 0.94 1.26 p<0.0001
Surgery Total N Died %Died HR LCI UCI P-value
Biopsy 547 490 23.3 1
Lobectomy 48 14 0.75 0.36 0.20 0.63
Wedge resection 85 38 2.02 0.52 0.36 0.76
Pneumonectomies 5 1 0.05 0.17 0.02 1.23
No surgery 1,502 1,335 73.9 1.02 0.86 1.22 p=0.0002
Chemotherapy
No chemotherapy 1,100 955 50.9 1
Chemo consultation 447 377 20.1 0.72 0.64 0.82
Chemotherapy 639 545 29.0 0.52 0.46 0.59 p<0.0001
Radiotherapy
No radiotherapy 1162 979 52.2 1
Radio consult 47 44 2.3 0.97 0.71 1.32
Radiotherapy 978 855 45.6 0.85 0.76 0.96 P=0.0216
Palliative care
Not referred 1,173 892 47.5 1.00
Referred 1,013 985 52.5 1.35 1.22 1.48 p<0.0001
Hospital of treatment
John Hunter Hospital 451 332 17.7 1.00
Armidale Hospital 96 84 4.5 1.13 0.87 1.46
Belmont Hospital 70 68 3.6 1.43 1.10 1.88
Calvary Mater Hospital 950 828 44.1 1.10 0.96 1.27
Cessnock District Hospital 34 33 1.8 1.26 0.88 1.82
Maitland Hospital 62 60 3.2 1.42 1.07 1.88
Manning River Base Hospital 154 144 7.7 1.20 0.97 1.47
Moree Hospital 19 15 0.8 0.60 0.35 1.02
Muswellbrook 18 17 0.9 1.25 0.76 2.05
Singleton 13 12 0.6 1.55 0.87 2.78
Tamworth base hospital 199 173 9.2 1.27 1.04 1.54
Other 121 112 6.0 1.27 1.01 1.59 P=0.0245

19. Final Multivariate survival model stratified by TNM stage
Stage I and II Stage III Stage IV Unknown Stage
MDT review HR 95% CI Hazard
95% Hazard Ratio
Confidence Hazard
95% Hazard
Ratio
Confidence Hazard
95% Hazard Ratio
Confidence
No_MDT review 1 1 1 1
MDT review 1.11 0.84 1.48p=0.4561 0.59 0.45 0.77P<0.0001 0.80 0.66 0.97 p=0.0244 0.63 0.34 1.15p=0.1309
Sex
Male 1 1 1 1
Female 0.82 0.64 1.050=0.1128 0.87 0.69 1.09p=0.2137 0.87 0.76 0.98 p=0.0272 0.56 0.41 0.76p=0.0002
Age group
15-49 1 1 1 1
50-59 0.70 0.24 2.03 0.83 0.32 2.14 1.04 0.73 1.48 1.45 0.52 4.04
60-69 1.41 0.55 3.60 0.71 0.29 1.77 1.11 0.80 1.55 1.55 0.61 3.96
70-79 1.62 0.64 4.11 0.69 0.28 1.73 1.11 0.80 1.54 1.38 0.54 3.56
80+ 1.95 0.75 5.05p=0.032 0.66 0.26 1.67p=0.8032 1.07 0.76 1.52 p=0.9406 2.06 0.80 5.33p=0.3042
Histological subtype
Carcinoma NOS 1 1 1 1
Adenocarcinoma 0.66 0.48 0.92 0.90 0.66 1.24 0.77 0.65 0.90 1.15 0.76 1.76
Large-cell carcinoma 0.83 0.49 1.42 0.93 0.61 1.41 1.13 0.88 1.45 1.36 0.64 2.90
Small-cell carcinoma 1.07 0.45 2.58 1.35 0.88 2.07 0.89 0.71 1.12 1.56 1.03 2.38
Squamous cell
carcinoma 1.34 0.98 1.85p=0.001 1.06 0.77 1.45p=0.4144 0.96 0.78 1.17 p=0.0018 1.95 1.14 3.33p=0.001
Surgery
No surgery 1 1 1 1
Biopsy 1.04 0.58 1.85 0.86 0.60 1.23 1.04 0.83 1.32 0.96 0.55 1.66p=0.0989
Wedge_resection 0.45 0.29 0.68 1.63 0.50 5.30 1.22 0.58 2.59
Lobectomy 0.36 0.19 0.68 0.26 0.04 1.90p=0.365 0.53 0.07 3.77 p=0.8467
Pneumanectomy 0.14 0.02 1.01p<.0001
Chemotherapy
No chemotherapy 1 1 1 1
Chemo consult 0.71 0.53 0.95 0.60 0.45 0.80 0.77 0.65 0.90 0.80 0.52 1.24
Chemotherapy 0.78 0.54 1.12p=0.0537 0.39 0.30 0.51p<.0001 0.52 0.45 0.61 p <.0001 0.82 0.50 1.35p=0.5109
Radiotherapy
No radiotherapy 1 1 1 1
Radio consult 0.99 0.49 2.00 0.99 0.52 1.86 0.93 0.61 1.43 1.44 0.34 6.18
Radiotherapy 0.86 0.65 1.13p=0.5378 0.71 0.56 0.90p=0.019 0.82 0.72 0.94 p=0.0128 0.71 0.44 1.15p=0.3094
Palliative care
Not referred 1 1 1 1
Referred 2.21 1.70 2.87p<.0001 1.19 1.05 1.35 p=0.001 1.45 1.16 1.82 p=0.0007 1.06 0.79 1.41p=0.7142

20. Adjusted survival curves – overall and stage specific
Overall
TNM stage I and II
TNM stage III
TNM stage IV

21. Discussion
• Coory4 in a systematic review between 1984 and 2007 identified 16 studies only one was a
randomised control trial (n=88). Only two of the 16 studies reported an improvement in
survival.
Forrest 9 Chemotherapy increased (7-23%); Palliative care decreased (58-44%) and the
proportion of patients formally staged increased. An improvement in median survival
from 3.4 to 6.6 months for inoperable (stage III and stage IV patients) – no effect of age,
sex or deprivation and a stage shift toward more advanced disease.
The second study10 showed an improvement in one year survival for patients aged 70
years and older from 18% to 23%.
4.Coory M, Gkolia P, Yang IA, Bowman RV, Fong KM. Systematic review of multidisciplinary teams in the management of lung cancer. Lung Cancer 2008; 60(1): 14-21.
9.Forrest L, McMillan D, McArdle C, Dunlop D. An evaluation of the impact of a multidisciplinary team, in a single centre, on treatment and survival in patients with inoperable non-small-cell lung
cancer. British journal of cancer 2005; 93(9): 977-8.
10. Price A, Kerr G, Gregor A, Ironside J, Little F. The impact of multidisciplinary teams and site specialisation on the use of radiotherapy in elderly people with non-small cell lung cancer
(NSCLC). Radiother Oncol 2002; 64(Suppl 1): 80.

22. Discussion (continued)
• In South Western Sydney Boxer et al5 examined 988 lung cancer patients
of which 504 were reviewed at the lung MDT. This study found that for
patients with significantly better performance status, the MDT group had
significantly more radiotherapy and chemotherapy regardless of stage but
it was found not to be an independent predictor of survival.
• More recently, St Vincent’s undertook a retrospective audit of 1,022 lung
cancer patients11 between January 2006 and December 2012. Of these
29% were reviewed at the MDT. Similar to this study a unadjusted survival
benefit was shown for stage IV patients at 1 and 2 years post diagnosis
and for stage 1 patients at five years.
5. Boxer MM, Vinod SK, Shafiq J, Duggan KJ. Do multidisciplinary team meetings make a difference in the management of lung cancer? Cancer 2011; 117(22): 5112-20.
11. Bewes T, Zhang L, Djavdkhani Y, Nguyen T, Shaw T, Rankin N, Stone E. An evaluation of a multidisciplinary approach in the management of lung cancer (abstract)

23. .
Aim 1– Predictors of lung cancer MDT review in HNELHD residents
Higher odds of MDT review
• If stage 2
• If cytologically or histologically verified
• Four times more likely if treated at Calvary Mater or John Hunter.
• If undergoing radiotherapy treatment
• If seen by a specialist nurse
Lower odds of MDT review
• If referred to Palliative Care
• If the person dies within a month of diagnosis or
• If they are stages 3 and 4 or unknown or unstaged

24. Aim 2 MDT review and whether it is an independent predictor of survival
• There is an unadjusted median survival of 17 months (95% CI 13-21) for HNELHD
residents who undergo an MDT review. Compared to six months (95%CI 6-7
months).
• MDT review was an independent predictor of survival with a 21% lower hazard of
death (HR 0.79 95% CI 0.20-0.90). After adjustment for sex, age, aboriginal status,
TNM stage, histological subtype, surgery, chemotherapy, radiotherapy, palliative
care and hospital of treatment.

25. Aim 2 MDT review and whether it is an independent predictor of survival
stratified by TNM stage
No MDT review MDT review
Median survival Months 95% CI Months 95% CI Log rank
Stage I and II 25 (21-31) 32 (25-35) p=.6578
Stage III 8 (7-10) 23 (16-30) p<.0001
Stage IV 4 (3-4) 7 (5-8) p=0.0003
Unknown 7 (5-9) 13 (9-36) p=0.0594
Unadjusted Fully adjusted *
HR LCI UCI P value HR LCI UCI P value
No MDT review 1 1
MDT review Stage I and II 0.94 (0.73-1.22) p=0.6424 1.11 (0.84-1.48) p=0.4561
MDT review Stage III 0.45 (0.35-0.57) p<.0001 0.59 (0.45-0.77) p<0.0001
MDT review Stage IV 0.72 (0.60-0.87) p=0.0007 0.80 (0.66-0.97) p=0.0244
MDT review Unknown 0.62 (0.37-1.04) p=0.0717 0.63 (0.34-1.15) p=0.1309
* adjusted for sex, age at diagnosis, histology, surgery, chemotherapy, radiotherapy, palliative care

26. Aim 3 – descriptive overview of the 411 MDT patients
• 32% stage 1 and 2 63 % stage 3 or 4
• 47% no weight loss
• 47% had no performance status recorded
• 43% had no local complications
• 47% had tobacco consumption as the main comorbidity
• 42% had a treatment intent of palliative
• 80% are Medicare eligible

27. Implications and Recommendations
1. Present at the Lung MDT and review and discuss the usefulness of
the data items
– It is not clear to me based on the terms of reference for the Lung MDT what the
criteria are used for referral – who determines whether some patients are referred
and others are not?
– Given that there is an independent survival advantage to an MDT review how do
we increase the proportion attending from 20% of lung cancer patients?
– Is it possible to prioritise patients with a confirmed lung cancer to increase the
proportion of primary lung cancer patients who have an MDT review?
– Investigate why there is a low proportion of patients having surgery with localised
stage (stage 1 and stage 2)?

28. Implications and Recommendations
– There are a large number of treatment categories are these necessary? Ideally it
should be possible to compare actual with expected treatment but this requires
grouping of treatment categories.
– Why is the proportion missing for seemingly important data items like ECOG score
high?
– Should smoking be included as a comorbidity or should it be a separate category?
• Why are the number of pack years collected?
– Comorbidity categories need to be reviewed to determine why there are four
columns?
– There is a reduced likelihood of review by an MDT if patients are referred to
palliative care yet there is a large proportion of patients reviewed that are palliative
instead of curative is this appropriate?
– Discuss how reporting of the findings of the Lung Cancer MDT can be improved to
assist decision making and monitoring of patients.

29. Next steps
1. Obtain ECOG and comorbidity scores for stage III patients
• Allocate ECOG–two medical oncologist will review doctors letters to allocate the score where
it is not recorded.
• The Charlson comorbidity index will be allocated on the basis of Admissions (IPM)
• Sensitivity analysis - rerun the model for stage III patients to determine whether the reduction
in the hazard due to MDT review remains or is explained by a favourable ECOG or
comorbidity profile.
2. Describe the referral pathways to diagnosis and treatment in HNELD residents
Hunter Cancer Research Alliance Funding has been obtained to extend to current linkage to include Lung
Clinic and Emergency Department data to determine whether these referral pathways affect the likelihood of
MDT review.

30. Predictors of Lung Cancer multidisciplinary
review and the impact on survival for HNELHD
residents treated in the public sector
Cancer Innovations Conference
Date: Thursday, 15 October, 2015
Location: Aerial Function Centre
Address: Building 10, Level 7/235 Jones Street,
Sydney, New South Wales 2007, Australia
Dr Elizabeth Tracey
Research Fellow ,University of Newcastle
Consultant Epidemiologist
HNE Cancer Network Directorate
The Lodge
John Hunter Hospital Campus

31. MDT data – descriptive overview
Total
Age at diagnosis n %
Total 411 100.0
15-49 14 3.4
50-59 67 16.3
60-69 148 36.0
70-79 137 33.3
80+ 45 10.9
TNM Stage
I 74 18.0
II 57 13.9
III 129 31.4
IV 133 32.4
Unstaged 5 1.2
Not Applicable 9 2.2
Unknown 4 1.0
Weight Loss
5% 60 14.6
6-10% 37 9.0
>10% 22 5.4
No weight loss 192 46.7
Unknown 79 19.2
Total 390 94.9
Performance status
Fully active 56 13.6
No strenuous but ambulatory 104 25.3
Ambulatory but cannot work 48 11.7
Limited self care 10 2.4
Not stated 193 47.0
Time from diagnosis to MDT
Prior to diagnosis 12 2.9
At diagnosis or within a month 290 70.6
Two_six_months post diagnosis 91 22.1
Seven to twelve months post diagnosis 8 1.9
Greater than 12 months 10 2.4
Complications
Bronchial obstruction 50 12.2
Compression of the superior vena cava 3 0.7
Infection (would include pneumonia aspergillosis) 9 2.2
Lung collapse (segmental lobular or lung) 4 1.0
Mediastinal invasion 16 3.9
Nerve damage(eg brachial plexus spinal cord recurrent laryngeal
nerve damage)
9
2.2
No local complications 179
43.6
Other 15 3.6
Pleural effusion 6 1.5
Unknown 120 29.2
Comorbidity
Cardiovascular co-morbidity 31 7.5
Diabetes mellitus 21 5.1
Neoplastic co-morbidity 19 4.6
None 49 11.9
Renal insufficency 9 2.2
Respiratory co-morbidity 24 5.8
Tobacco consumption 195 47.4
Unknown 39 9.5
none 24 5.8
Treatment intent
Curative 126 30.7
Palliative 173 42.1
Pending 53 12.9
Unknown 59 14.4

32. Summary of actual and recommended treatment
Summary or recommended treatment
Cancer surgery determined by procedure codes
Pneumanectomy 2 0.5
Lobectomy 6 1.5
Wedge resection 24 5.8
Biopsy 101 24.6
No_surgery 278 67.6
Chemotherapy 411
No chemotherapy 148 36.0
Chemotherapy 168 40.9
Chemo_consult 95 23.1
Radiotherapy 411
No_radiotherapy 295 71.8
Radiotherapy 47 11.4
Radio_consultation 69 16.8
Referal to palliative care
Referred 157 38.2
not_referred 254 61.8
Psycho social referral
Not_stated 140 34.1
Other 35 8.5
Specialist_nurse 236 57.4
Recorded treatment 0.0
Radiotherapy 70 17.0
Sequential radiotherapy 3 0.7
Adjuvant radiotherapy 1 0.2
Chemotherapy 66 16.1
Chemotherapy , radiotherapy 61 14.8
Concurrent chemotherapy followed by radiotherapy 43 10.5
Sequential chemotherapy followed by radiotherapy 1 0.2
Adjuvant chemotherapy 9 2.2
Neo-adjuvant chemotherapy 3 0.7
Neurosurgery 1 0.2
Orthopaedic surgery 1 0.2
Pneumonectomy 2 0.5
Bronchoscopy 4 1.0
VATS 3 0.7
Mediastinoscopy 4 1.0
Lobectomy 6 1.5
Wedge resection 24 5.8
Palliative care 5 1.2
Assessment 11 2.7
Follow-up survey 4 1.0
Not for treatment 3 0.7
Treat when symptoms 2 0.5
Unknown - not recorded 84 20.4
Financial class
Medicare Eligible 246 59.9
Medicare card holder - nursing home 78 19.0
Not Recorded 1 0.2
Public Non Chargeable 18 4.4
Veterans Affairs 2 0.5
Total 346 84.2
Months from diagnosis to MDT
Prior_diag 12 2.9
one_month 290 70.6
Two_six_months 91 22.1
seven_12_months 8 1.9
more_than_12 10 2.4
Time from diagnosis to death 0.0
one_month 21 5.1
Two_six_months 76 18.5
seven_12_months 69 16.8
more_than_12 94 22.9
Alive 151 36.7
Total 411 100.0

33. Patients that did not link - reasons
Other cancer sites 51
Blank in ClinCR 13
Mesothelioma 9
Coded since CLINCR close off 7
Not cancer 5
MDT only 3
Not in clinCr 3
Private 2
No admission in HIE 1
No treatment recorded 1
95