Multidisciplinary virtual management of pulmonary nodules

• Published in: Pulmonology 2024-05, Vol.30 (3), p.239-246
• Main Authors: Polanco, D., González, J., Gracia-Lavedan, E., Pinilla, L., Plana, R., Molina, M., Pardina, M., Barbé, F.
• Format: Article
• Language: English
• Subjects: Aged; Female; Guideline Adherence - statistics & numerical data; Humans; Lung cancer; Lung Neoplasms - therapy; Lung nodule; Male; Middle Aged; Multidisciplinary care; Multiple Pulmonary Nodules - therapy; Patient Care Team - organization & administration; Pulmonary Disease, Chronic Obstructive - therapy; Pulmonary nodules; Referral and Consultation; Remote care; Solitary Pulmonary Nodule - therapy; Telemedicine - methods; Virtual care
• ISSN: 2531-0437; 2531-0437
• DOI: 10.1016/j.pulmoe.2021.12.003

Multidisciplinary nodule clinics provide high-quality care and favor adherence to guidelines. Virtual care has shown savings benefits along with patient satisfaction. Our aim is to describe the first year of operation of a multidisciplinary virtual lung nodule clinic, the population evaluated and issued decisions. Secondarily, among discharged patients, we aimed to analyze their follow-up prior to the existence of our consultation, evaluating its adherence to guidelines. Observational study including all patients evaluated at the Virtual Lung Nodule Clinic (VLNC) (March 2018- March 2019). Clinical and radiological data were recorded. Recommendations, based on 2017 Fleischner Society guidelines, were categorized into follow-up, discharge or referral to lung cancer consultation. Discharged patients were classified according to adherence to guidelines of their previous management, into adequate, prolonged and non-indicated follow-up. A total of 365 patients (58.9% men; median age 64.0 years) were included. Sixty-four percent had smoking history and 23% had chronic obstructive pulmonary disease (COPD). Most nodules were solid (87.4%) and multiple (57.5%). The median diameter was 6.00 mm. 43.8% of patients were discharged following first VLNC evaluation. Among them, 27.5% had received appropriate follow-up, but 66.9% had received poor management. Patients with prolonged follow-up (33.1%) were older (67.0 vs 60.5 years) and had larger nodules (6.00 mm vs 5.00). Non-indicated follow-up patients (33.8%) were more non-smokers (77.8% vs 31.8%) and presented smaller nodules (4.00 vs 5.00 mm). During its first year of operation, the VLNC has evaluated a population with a relevant risk profile for lung cancer development, management of which should be cautious and adhere to guidelines. After the first VLNC assessment, approximately one-half of this population was discharged. It was noticeable that previous follow-up of discharged patients was found poorly adherent to guidelines, with a marked tendency to overmanagement.