Long-term assessment of efficacy with a novel Thoracic Survivorship Program for patients with lung cancer

Abstract Objective We developed a novel, nurse practitioner (NP)-run Thoracic Survivorship Program (TSP) to aid in long-term follow-up (f/u). NSCLC patients who were disease-free at least 1-year post-resection could be referred into TSP by their surgeon. Our objectives were to summarize f/u compliance and assess long-term outcomes betweenTSP enrollment and non-TSP. Methods Patients who underwent R0 resection for stages I-IIIA NSCLC between 2006-2016 were stratified by enrollment in TSP versus surgeon only f/u (non-TSP). F/u included 6-month chest CT scans for 2 years then annually. Lack of f/u compliance was defined by ≥2 consecutive delayed annual CT scans/visits ±90-days. Relationships between TSP and second primary NSCLC, extra thoracic cancers, and survival were quantified using multivariable Cox proportional hazards regression with time-varying covariate reflecting timing of enrollment. Results 1162/3940 (29.5%) were enrolled in TSP. Median time to enrollment was 2.3 years. 3279/3940 (83%) had complete CT scan data and 60/3279 (1.8%) had ≥2 delayed scans. 323/9082 (3.6%) non-TSP visits were non-compliant versus 132/4823 (2.7%) of TSP visits (p=0.009) 136/1146 TSP patients developed second primary NSCLC and 69/1123 extra thoracic cancer, while 322/2794 of non-TSP patients developed second primary NSCLC and 225/2817 extra thoracic cancer. In multivariable analyses, TSP enrollment was associated with improved disease-free survival (hazard ratio 0.57; 95% confidence interval 0.48-0.67; p Conclusion Our novel, NP-run TSP is associated with high patient compliance and outcomes not different from those seen with physician-based follow-up. These results have important implications for health care resource allocation and costs.