BI17 A novel multidisciplinary clinic for the management of cutaneous T-cell lymphoma

Abstract

Mycosis fungoides cutaneous T-cell lymphoma (MF-CTCL) is a rare condition that can present diagnostic difficulty and challenging management as no standard pathway exists. Patients require haematology and dermatology involvement to ensure optimal management, and the British Association of Dermatologists guidelines suggest regional supranetwork skin MDT for the majority of patients. However, this distances patients and local clinicians from the decision-making process. We propose a multidisciplinary model that includes local dermatology and haematology teams with the assistance of a regional expert to evaluate all of a region’s patients with MF-CTCL to ensure appropriate staging and management. On review of our cohort of patients with MF-CTCL, there were 42 patients with only 50% staged. We proposed a day-long multidisciplinary clinic model that enabled all patients with MF-CTCL to attend the dermatology department to receive a teaching session by trained nurses, a 30-minute consultation with a dermatology consultant with direct access to a specialist haematology consultant and a regional cutaneous lymphoma specialist, and access to on-the-day blood tests and diagnostic biopsies if needed. Twenty-six patients attended the clinic; 22 were confirmed to have MF-CTCL, 21 of whom were appropriately staged on the day. Ninety-five per cent of patients said they felt ‘extremely involved and informed’ about their management and treatment decisions after the clinic (vs. 19% preclinic). Ninety-five per cent would recommend the clinic to a family or friend, and 90% would attend a similar clinic in the future. From a clinician perspective, the survey responses showed high value in having repeated exposure to patients with CTCL, understanding the management options for MF-CTCL, face-to-face discussions with the multidisciplinary team (MDT) and longer clinic appointments. In conclusion, we offer this MDT clinic model as an efficient means for delivering patient-centred management and care, continuing education to local referring clinicians and ensuring close working relationships between dermatology and haematology. We propose running this clinic annually to ensure that all patients with MF-CTCL have appropriate investigation, staging and management pathways. The success of the clinic has led the department to adopt this model in other areas such as inflammatory conditions.