Assessing current diagnostic, staging, and treatment practices in community and academic centers for individuals with stage IB–IIIA non-small cell lung cancer

Introduction

Each year in the United States (US), more than 226,000 individuals are diagnosed with lung cancer, a disease associated with 125,000 deaths annually (1-3). Although the number of individuals diagnosed with lung cancer is decreasing in the US and many new therapies have been approved over the past 10 years, the aggregate overall 5-year survival remains low at only 18% (1,4-6). Most individuals surviving 5 years or more after diagnosis undergo curative-intent surgical resection. The 5-year survival for individuals with surgically resected, early-stage non-small cell lung cancer (NSCLC) is around 50% (1).

Across the US, the quality of care received by patients with lung cancer varies and not everyone has access to cutting edge therapeutic approaches (7-9). Inaccurate clinical or pathologic staging can lead to suboptimal treatment delivery (10,11). Even when staging is correct, evidence-based guidelines are not always followed. Variation in quality of care issues can impact long-term outcomes. Many of these quality gaps can be improved when care is managed by a well-functioning multidisciplinary team (12,13).

The recent availability of biomarker-driven therapy for individuals with early-stage lung cancer who have undergone surgery may improve outcomes (4-6). Therefore, identification of epidermal growth factor receptor (EGFR)- and anaplastic lymphoma kinase (ALK) mutation-positive patients as well as those patients eligible for immunotherapy is important to inform adjuvant treatment decisions. Biomarker-driven therapies for late-stage NSCLC have been available for more than 10 years, but biomarker testing is still not universal in such patients due to gaps in the quality of care delivered (14,15). Recently, similar gaps have been seen in the management of early-stage lung cancer.

Gaps in the quality of diagnostic evaluation, care coordination, and biomarker testing persistently hinder optimal evidence-based treatment and outcomes for individuals with lung cancer. Although such quality deficits exist, they are not well understood in the community cancer setting. To better understand current practices in lung cancer care in the US, the Association of Cancer Care Centers (ACCC) surveyed individuals who provide care for patients with lung cancer in community and academic centers across the US. We present this article in accordance with the SURGE reporting checklist (available at https://tlcr.amegroups.com/article/view/10.21037/tlcr-2025-111/rc).

Methods

In 2022, ACCC conducted a survey of cancer care providers and administrators who work in NSCLC to assess current patterns in the diagnosis and treatment of patients with early-stage (IB–IIIA) disease. The survey was developed and piloted by an expert steering committee that included medical oncologists, thoracic surgeons, epidemiologists, pulmonologists, and advanced practice lung cancer specialists. The survey was designed to collect self-reported information about each respondent and their cancer program (e.g., processes for diagnosis, treatment planning, and care delivery) for individuals with early-stage lung cancer. The survey included 46 questions; its estimated time for completion was 15–30 minutes. Question style included those that asked respondents to select one, select all that apply, select numbers within a range, or add percentages up to 100%. In results reporting we note when the option was to select all that apply and when a range was selected. Questions involving turn-around-time collected estimated average time in integer values (unit weeks).

The survey was distributed as an official communication from ACCC to ACCC members and their associated networks by email, by QR-coded flyers at scientific meetings, and by the steering committee within their networks. It was open from February 2022 to March 2022 and was administered in Qualtrics XM via an anonymous link and follow-up with multi-modal reminders. Respondents had the option of providing an email address and the name of the institution in which they practice. Respondents who opted in were entered into a drawing for a $50 gift card. The project was conducted with oversight from the WIRB-Copernicus Group (WCG) institutional review board with a waiver of informed consent.

Statistical analysis

Stratified results were summarized as frequencies and percentages or mean ± standard deviation. Associations were evaluated using the Wilcoxon-Mann-Whitney test and the χ² test or, if the cell counts were small, the Fisher’s exact test. The respondent was the unit of analysis, and responses were considered independent. No aggregate scoring of the questions was done, each question was analyzed individually and all responses are reported. Because this was an exploratory design aimed at quality improvement, no reliability or validity studies were conducted. Additionally, a broad, multi-modal distribution strategy was implemented to attain the largest number of responses, focusing on provider level responses rather than institution-level, which did not allow for sample size estimation, response rate estimation, or comparisons between respondents and non-respondents to assess representativeness. Data were analyzed with SAS version 9.4 (SAS Institute Inc) and R version 4.3.2 (R Foundation). P values less than 0.05 were considered statistically significant.

Results

ACCC received 124 evaluable survey responses from individuals in 33 states. One respondent who did not provide direct patient care for individuals with lung cancer was automatically directed out of the survey after the first question and deemed unevaluable. The remaining 123 respondents were from institutions that were urban (74, 60%), suburban (28, 23%), and rural (21, 17%). Further, the 123 respondents practiced in community cancer programs (65, 53%), academic-National Cancer Institute (NCI)-designated cancer programs (45, 37%), and private practice (11, 9%) with 2 not reported. The range of lung cancer case volumes for each responding practitioner by disease stage (IB, IIA/IIB, IIIA) varied by site; most respondents treat 11–30 or >50 patients per year in each stage group (stage IB, stage IIA/IIB, stage IIIA, Tables 1,2).

Current practices related to process of preoperative care

Respondents were asked a series of questions about the process of preoperative care for their patients with NSCLC. Initial tissue biopsy was typically performed by interventional radiologists (29% of cases), interventional pulmonologists (22%), general pulmonologists (11%), thoracic surgeons (16%), or another provider (3%). Invasive mediastinal staging in patients with stage IIA–IIIA disease was typically done before surgery according to 49% of respondents and during surgery according to 17%; on the other hand, invasive mediastinal staging was typically not performed according to 18% of respondents. According to 114 respondents, the barriers that most frequently had an impact on optimal staging and diagnosis included scheduling [84 respondents (73%)], cost [58 respondents (51%)], tissue quantity [52 respondents (46%)], limited access to tests or procedures [48 respondents (42%)], and missed appointments [41 respondents (36%)] (Figure 1).

Figure 1 Factors impacting staging and diagnosis.

When barriers were separated by academic or nonacademic institutions (40 vs. 74 institutions, respectively), there was some or a significant impact on scheduling (80% vs. 69%), cost (53% vs. 50%), tissue quantity (40% vs. 49%), limited access to tests or procedures (43% vs. 42%), and missed appointments (50% vs. 28%). The proportion of patients who accessed nurse navigators at each site was reported as: <15%, 16–30%, 31–50%, 51–75%, >75%. For institutions in which nurse navigation was involved in ≥50% or ˂50% of early-stage lung cancer cases (33 vs. 42 institutions, respectively), there was some or a significant impact on scheduling (76% vs. 73%), cost (50% vs. 45%), tissue quantity (45% vs. 42%), limited access to tests or procedures (43% vs. 39%), and missed appointments (33% vs. 30%).

Regarding timeliness of care, respondents estimated that the mean time from abnormal imaging to first diagnostic procedure was 2.8±1.4 weeks, to complete staging was 3.9±1.7 weeks, and to receipt of first treatment (i.e., surgery, chemotherapy, or radiation) was 5.1±1.9 weeks. In findings from academic vs. nonacademic institutions, respectively, the mean time from abnormal imaging to first diagnostic procedure was 2.5±0.8 vs. 3.0±1.7 weeks (P=0.26), to complete staging was 3.6±1.3 vs. 4.1±1.9 weeks (P=0.42), and to receipt of first treatment (surgery, chemotherapy, or radiation) was 4.8±1.8 vs. 5.2±2.0 weeks (P=0.43).

Respondents were asked about their use of clinical pathways (institutional protocols or algorithms) when treating patients with early-stage NSCLC. Of 80 respondents who answered this question, 60% replied that they used clinical pathways when treating patients with stage IB disease, 61% indicated that they did for those having stage IIA or IIB disease, and 65% said that they did for patients with stage IIIA disease.

The survey also evaluated processes around determining whether surgical resection could be offered. When asked whether their cancer practice had specific protocols that defined candidacy for surgical resection for NSCLC, 50 respondents did not answer. Of the 30 respondents who answered, 33% reported that their institutions had such protocols, 50% reported that they did not, and 17% were unsure about protocols in place. When asked which criteria would determine that NSCLC was unresectable, selecting all that apply the most common answers were contralateral mediastinal nodal metastases (27%); bulky, multi-station, ipsilateral, mediastinal nodal metastases (26%); mediastinal nodal metastases confirmed by biopsy (21%); computed tomography (CT) or positron emission tomography (PET)/CT evidence of mediastinal nodal metastases (10%); low-volume, multistation, ipsilateral nodal metastases (9%); and low-volume single nodal station ipsilateral nodal metastases (2%).

Multidisciplinary care

Regarding multidisciplinary tumor board use, 40% of respondents’ institutions included lung cancer within a general cancer tumor board, 65% had a thoracic-specific tumor board, and 19% had a dedicated molecular tumor board; those in institutions having multiple formats selected all that applied. Overall, 117 of 124 respondents (94%) had at least 1 of the 3 tumor board options above in place. Meetings of tumor boards to discuss individuals with lung cancer occurred weekly according to 57% of respondents, 2 to 3 times per month according to 22% of respondents, and monthly according to 11% of respondents. Adjuvant treatment recommendations for patients with lung cancer were determined by the multidisciplinary tumor board in 24% of institutions, by the medical oncologist in 68% of institutions, and by the surgeon’s recommendation to the medical oncologist in 8% of institutions.

Biomarker testing

Issues around the process of care for biomarker testing and biomarker-driven therapy were evaluated. Findings revealed that 66% of respondents had biomarker protocols in place for patients with resected NSCLC, 21% did not, and 12% were unsure (Figure 2). When tissue-based biomarker testing was ordered, 32% report they usually order next-generation sequencing (NGS) that tested for more than 50 genes, 44% multiplex panel testing for fewer than 50 genes, 27% EGFR testing only, and 11% were unsure (checking all that apply). When asked where tissue-based testing was most frequently conducted, 10% of respondents reported that an in-house pathology laboratory performed the tests, 42% sent specimens to a third-party laboratory for testing, and 39% used a mix of in-house and third-party laboratories. Selecting all answers that applied, respondents reported biomarker testing for patients with resected NSCLC typically was ordered by medical oncologists (76%), surgeons (29%), pathologists (28%), pulmonologists (17%), and advanced practice providers (10%). Liquid biopsy was used less frequently; specifically, the survey found that for all patients with resected NSCLC, 14% ordered liquid biopsy, 9% never ordered liquid biopsy, and 33% only ordered this diagnostic when tissue testing was not performed. Medical oncologists ordered liquid biopsy tests 65% of the time, whereas even when checking all that apply, respondents report less than 10% of each other specialists ordered liquid biopsy tests. Finally, 62% of respondents reported that their institutions typically ordered programmed death ligand 1 (PD-L1) testing for individuals with resected NSCLC.

Figure 2 (A) Percentage of sites with a standard biomarker testing protocol for patients with resected non-small cell lung cancer. (B) Most common reasons why biomarker testing was not performed in eligible patients. NSCLC, non-small cell lung cancer.

Biomarker testing associations

These provider-level data suggest biomarker testing protocols for resected NSCLC were more frequently used when any multidisciplinary tumor board was involved than when they were not (69% vs. 17% respectively; P=0.007); their use did not differ by rural versus urban location (P=0.29) and by type of practice: community programs (65%), academic/NCI designated programs (78%), or private practice (45%) (P=0.12). NGS testing may be more often when any multidisciplinary tumor board was used than when one was not used but was not statistically significant (32% vs. 13%; P=0.15), did not differ by rural-urban institutions (P=0.64), and was not significantly different among community programs (32%), academic/NCI-designated programs (29%), or private practice (13%, P=0.55).

Patient support

Overall, 83% of respondents believed that their cancer practice had adequate staff and resources to help patients navigating the health system. However, only 45% typically assigned a nurse navigator to individuals with early-stage NSCLC. In-depth patient education before treatment for early-stage NSCLC was most often done by a physician (31%), nurse (23%), advanced practice provider (18%), or navigator (16%). Referrals to palliative care services for early-stage NSCLC were made sometimes or often in 48% of sites, whereas referrals were made rarely or never in 51% of sites.

Psychosocial distress screening was performed very frequently and throughout the course of medical treatment in 34% of practices. Additionally, 39% of respondents reported that this screening occurred occasionally throughout the course of medical treatment, 8% were not sure, and 4% never performed psychosocial distress screening. Regarding financial hardship, 24% reported that patients stated missing treatments due to financial hardship sometimes or often, whereas 62% reported that this rarely or never happened. A tobacco cessation program was frequently offered, but shame and stigma related to tobacco use was not frequently discussed (Figure 3).

Figure 3 (A) Frequency of evidence-based tobacco cessation treatments used by patients with early-stage non-small cell lung cancer who are currently using tobacco. (B) Frequency that stigma or shame are discussed with patients with early-stage non-small cell lung cancer who are currently using tobacco.

Barriers to optimal care

Each respondent was asked to report up to three barriers to optimal care for early-stage lung cancer at their cancer center. The largest barriers to optimal care included scheduling of procedures and surgery (23%), patient refusal (19%), communication breakdowns between the patient and members of the cancer care team (17%), inadequate staffing (15%), and limited access to subspecialties (14%, Figure 4). In 40 academic vs. 74 nonacademic institutions, scheduling of procedures and surgery (24% vs. 38%, respectively), patient refusal (20% vs. 29%), communication breakdowns (27% vs. 23%), inadequate staffing (33% vs. 13%), and limited access to subspecialties (7% vs. 28%) were reported as barriers. In 42 institutions that involved nurse navigation for at least half of early-stage lung cancer cases compared with 33 institutions that did not, barriers included scheduling of procedures and surgery (64% vs. 48%, respectively), patient refusal (39% vs. 45%), communication breakdowns (30% vs. 48%), inadequate staffing (30% vs. 36%), and limited access to subspecialties (48% vs. 21%).

Figure 4 Greatest barriers to providing optimal care for your patients with early-stage non-small cell lung cancer.

Discussion

The assessment of current practices in the care of patients with early-stage lung cancer covered 33 states and included representation from varied practice types and cancer program types. Patterns in preoperative assessments differed somewhat, and there were differences in multidisciplinary care patterns. Biomarker testing practices also varied, but most sites had standard protocols for biomarker testing in early-stage lung cancer. Availability of different elements of supportive care was not standardized across sites; from the providers’ perspective, however, patients were adequately supported. Additionally, several barriers to optimal care that centered around process and capacity were identified, which may impede patients from receiving guideline-concordant therapy.

Adequate staging and biomarker testing before treatment begins is becoming increasingly important as therapeutic options expand for individuals with stage IB-IIIA lung cancer. Recent improvements in neoadjuvant therapy options and the promise of more targetable biomarkers being identified before this survey was performed have intensified this need (4-6,15). Without adequate testing, eligible patients may not receive cutting-edge therapy. The majority of programs perform mediastinal staging for stage IIA–IIIA disease, but less than 50% of the staging was performed preoperatively, perhaps a missed opportunity to deliver neoadjuvant therapy. Most barriers to optimal staging that were identified focused around timing, cost, and access. These were experienced both in academic and non-academic care settings; potentially impeding optimal treatment delivery.

Biomarker testing in individuals with resected NSCLC varies across institutions, providing opportunities for quality improvement projects to increase standardization. More than half of respondents reported having testing protocols in place, but the type of testing varied. The factor that was most associated with a biomarker testing protocol was the use of multidisciplinary tumor boards. Multidisciplinary team-based care improves the thoroughness of care, but it is not well implemented in many care settings across the United States (13,16,17). Recent National Comprehensive Cancer Network (NCCN) biomarker testing guidelines recommend testing for ALK rearrangement, EGFR mutation, and PD-L1 sensitivity in patients with early-stage lung cancer (18). Understanding biomarker status early, a key step in a process that is often suboptimally implemented, is now necessary to provide guideline-concordant care of this disease (15,19).

Multidisciplinary care coordination is important; when implemented properly, it improves equitable delivery of guideline concordant care (20,21). Recommended best practice includes weekly tumor-specific meetings, participation by members of key disciplines, and prospective treatment planning (20,21). More than half (65%) of respondents reported having a lung cancer-specific tumor board. However, 43% of tumor boards did not meet on a weekly basis. Lung tumor boards were near universal at NCI-designated cancer centers (91%), yet their use in the community-care setting varied (50% overall), and more barriers may have contributed to the physicians’ ability to participate regularly. ACCC investigators also found that limited access to subspecialties was a barrier in non-academic institutions. However, academic institutions reported struggling with inadequate staffing to meet the needs of individuals with lung cancer. A multidisciplinary approach within the context of a program’s capabilities provides the optimal patient evaluation (21).

Most survey respondents believed that patients had adequate support when navigating the system (83%), but nurse navigators were involved less than half of the time. These are provider perspectives that may differ from the patient perspective. Navigators are key members of the multidisciplinary team who facilitate timely follow-up, biomarker testing, and coordination of care (13,22,23). Missed appointments and patient refusal were barriers to optimal care in some situations. Nurse navigators provide an opportunity to address patient needs that create such barriers (22,23). A greater emphasis on providing nurse navigation services for all patients with early-stage lung cancer is warranted.

Surgical resection provides the best probability of long-term survival for most individuals with early-stage lung cancer (1). Determination of candidates for surgical resection is an increasingly complex question that mandates surgical input and multidisciplinary discussion (24-27). Many programs do not have a specific protocol to define surgical resection candidacy, which is often a complex, multifaceted decision. Objective criteria determining cases that are not able to be surgically resected are complicated and highly patient specific, except for contralateral nodal disease (26,27). However, more rigorously standardized criteria are a potential opportunity to improve care.

The ACCC investigators conducted this survey as part of a larger quality improvement initiative. This initiative used multimodal methodology including provider surveys, retrospective data collection from sites, quality improvement workshops at participating sites, and prospective data collection of quality improvement metrics during site projects. Results from the first phase that addressed care quality in late-stage NSCLC were reported previously. In phase 2 testing, 4 quality improvement projects informed by this survey and site baseline assessments will be conducted.

Limitation

This survey has limitations, including the use of a convenience sample via email distribution that may have caused the results to be skewed toward the perspective of those who are more likely to respond. The self-report nature of the questions also could have led to some misclassification if respondents did not recall information correctly and chose not to verify. Also received were some responses from the same institutions (124 total responses from 92 total institutions or locations), which then may be overrepresented in institution-specific results. However, the survey was designed to assess provider-level experience which can vary within sites. Additionally, we did not assess the patient’s perspective in the survey. Given that the self-selecting individuals who responded to the survey could be more likely to pay attention to issues of quality, we hypothesize that there could be even more variation in care than we found. Population-level analyses on quality metrics are warranted to evaluate the potential issues identified in this descriptive study.

Conclusions

In this broad sample of oncology practices across the US, several strengths and barriers to optimal care for individuals with early-stage NSCLC were identified. Improved care coordination and standardized staging and diagnosis practices could optimize care in this dynamic treatment landscape.

Acknowledgments

The authors would like to thank all the respondents who participated, the ACCC steering committee for this project, and AstraZeneca for funding this effort.

Footnote

Reporting Checklist: The authors have completed the SURGE reporting checklist. Available at https://tlcr.amegroups.com/article/view/10.21037/tlcr-2025-111/rc

Data Sharing Statement: Available at https://tlcr.amegroups.com/article/view/10.21037/tlcr-2025-111/dss

Peer Review File: Available at https://tlcr.amegroups.com/article/view/10.21037/tlcr-2025-111/prf

Funding: This work was supported by AstraZeneca.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tlcr.amegroups.com/article/view/10.21037/tlcr-2025-111/coif). M.P.S. serves as an unpaid editorial board member of Translational Lung Cancer Research from September 2025 to August 2027. All authors report that this work was supported by AstraZeneca. The authors have no other conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The project was conducted with oversight from the WIRB-Copernicus Group (WCG) institutional review board with a waiver of informed consent.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

1. Siegel RL, Kratzer TB, Giaquinto AN, et al. Cancer statistics, 2025. CA Cancer J Clin 2025;75:10-45. [Crossref] [PubMed]
2. Jemal A, Schafer EJ, Sung H, et al. The Burden of Lung Cancer in Women Compared With Men in the US. JAMA Oncol 2023;9:1727-8. [Crossref] [PubMed]
3. Gray JE, Salomonsen RJ, Diaz Perez I, et al. Real-World Clinical Characteristics, Treatment Patterns, and Clinical Outcomes in US Patients with Stage I-III Resected NSCLC Without Known EGFR Mutations: The RESECT Study. Drugs Real World Outcomes 2025;12:175-88. [Crossref] [PubMed]
4. Wu YL, Tsuboi M, He J, et al. Osimertinib in Resected EGFR-Mutated Non-Small-Cell Lung Cancer. N Engl J Med 2020;383:1711-23. [Crossref] [PubMed]
5. Tsuboi M, Herbst RS, John T, et al. Overall Survival with Osimertinib in Resected EGFR-Mutated NSCLC. N Engl J Med 2023;389:137-47. [Crossref] [PubMed]
6. Felip E, Altorki N, Zhou C, et al. Adjuvant atezolizumab after adjuvant chemotherapy in resected stage IB-IIIA non-small-cell lung cancer (IMpower010): a randomised, multicentre, open-label, phase 3 trial. Lancet 2021;398:1344-57. [Crossref] [PubMed]
7. Muslim Z, Razi SS, Poulikidis K, et al. Treatment quality and outcomes vary with hospital burden of uninsured and Medicaid patients with cancer in early non-small cell lung cancer. JTCVS Open 2022;11:272-85. [Crossref] [PubMed]
8. Yusuf D, Walton RN, Hurry M, et al. Population-based Treatment Patterns and Outcomes for Stage III Non-Small Cell Lung Cancer Patients: A Real-world Evidence Study. Am J Clin Oncol 2020;43:615-20. [Crossref] [PubMed]
9. Odell DD, Feinglass J, Engelhardt K, et al. Evaluation of adherence to the Commission on Cancer lung cancer quality measures. J Thorac Cardiovasc Surg 2019;157:1219-35. [Crossref] [PubMed]
10. Farjah F, Flum DR, Ramsey SD, et al. Multi-modality mediastinal staging for lung cancer among medicare beneficiaries. J Thorac Oncol 2009;4:355-63. [Crossref] [PubMed]
11. Smeltzer MP, Faris NR, Ray MA, et al. Association of Pathologic Nodal Staging Quality With Survival Among Patients With Non-Small Cell Lung Cancer After Resection With Curative Intent. JAMA Oncol 2018;4:80-7. [Crossref] [PubMed]
12. Stone E, Rankin N, Kerr S, et al. Does presentation at multidisciplinary team meetings improve lung cancer survival? Findings from a consecutive cohort study. Lung Cancer 2018;124:199-204.
13. Smeltzer MP, Ray MA, Faris NR, et al. Prospective Comparative Effectiveness Trial of Multidisciplinary Lung Cancer Care Within a Community-Based Health Care System. JCO Oncol Pract 2023;19:e15-24. [Crossref] [PubMed]
14. Smeltzer MP, Wynes MW, Lantuejoul S, et al. The International Association for the Study of Lung Cancer Global Survey on Molecular Testing in Lung Cancer. J Thorac Oncol 2020;15:1434-48. [Crossref] [PubMed]
15. Aggarwal C, Bubendorf L, Cooper WA, et al. Molecular testing in stage I-III non-small cell lung cancer: Approaches and challenges. Lung Cancer 2021;162:42-53. [Crossref] [PubMed]
16. Osarogiagbon RU. Chapter 11. Achieving better quality of lung cancer care. In: Tanoue LT, Detterbeck F, editors. Lung Cancer: Evidence-Based Evaluation and Management. Amsterdam: Elsevier; 2021.
17. Freeman RK, Van Woerkom JM, Vyverberg A, et al. The effect of a multidisciplinary thoracic malignancy conference on the treatment of patients with lung cancer. Eur J Cardiothorac Surg 2010;38:1-5. [Crossref] [PubMed]
18. Ettinger DS, Wood DE, Aisner DL, et al. NCCN Guidelines insights: non-small cell lung cancer, version 2.2023. J Natl Compr Canc Netw 2023;21:340-50. [Crossref] [PubMed]
19. To KKW, Fong W, Cho WCS. Immunotherapy in Treating EGFR-Mutant Lung Cancer: Current Challenges and New Strategies. Front Oncol 2021;11:635007. [Crossref] [PubMed]
20. Prabhu Das I, Baker M, Altice C, et al. Outcomes of multidisciplinary treatment planning in US cancer care settings. Cancer 2018;124:3656-67. [Crossref] [PubMed]
21. Oyer RA, Smeltzer MP, Kramar A, et al. Equity-Driven Approaches to Optimizing Cancer Care Coordination and Reducing Care Delivery Disparities in Underserved Patient Populations in the United States. JCO Oncol Pract 2021;17:215-8. [Crossref] [PubMed]
22. Tan NQP, Lowenstein LM, Douglas EE, et al. The TELEhealth Shared decision-making COaching and navigation in Primary carE (TELESCOPE) intervention: a study protocol for delivering shared decision-making for lung cancer screening by patient navigators. BMC Prim Care 2024;25:373. [Crossref] [PubMed]
23. Peckham J, Mott-Coles S. Interprofessional Lung Cancer Tumor Board: The Role of the Oncology Nurse Navigator in Improving Adherence to National Guidelines and Streamlining Patient Care. Clin J Oncol Nurs 2018;22:656-62. [Crossref] [PubMed]
24. Expert Consensus Panel. The American Association for Thoracic Surgery (AATS) 2023 Expert Consensus Document: Staging and multidisciplinary management of patients with early-stage non-small cell lung cancer. J Thorac Cardiovasc Surg 2023;166:637-54.
25. Zhao Y, Wang W, Liang H, et al. The Optimal Treatment for Stage IIIA-N2 Non-Small Cell Lung Cancer: A Network Meta-Analysis. Ann Thorac Surg 2019;107:1866-75. [Crossref] [PubMed]
26. Rodriguez-Quintero JH, Elbahrawy MM, Montal AM, et al. Minimally invasive surgery for clinical T4 non-small cell lung cancer: national trends and outcomes. Eur J Cardiothorac Surg 2024;65:e109-15. [Crossref] [PubMed]
27. Carter L, Apte V, Shukla A, et al. Stage 3 N2 Lung Cancer: A Multidisciplinary Therapeutic Conundrum. Curr Oncol Rep 2024;26:65-79. [Crossref] [PubMed]