Determinants and outcomes of adherence to recommendations from a multidisciplinary tumour conference for hepatocellular carcinoma

Gashin, Laurie; Tapper, Elliot B.; Babalola, Atinuke; Lai, Kuan Chi; Miksad, Rebecca A.; Malik, Rabiya; Cohen, Eric

doi:10.1111/hpb.12280

Cited by 22 publications

(15 citation statements)

References 19 publications

(18 reference statements)

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“…Our data is in line with previous studies which showed improved survival by MDT management [18–24]. The strength of this data is the relatively large sample size that enabled us to create exactly matched cohort.…”

Section: Discussionsupporting

confidence: 89%

“…However, MDT with participation by experts from multiple academic disciplines requires additional medical resources and time per patient, which leads to significant healthcare burden and high cost [17]. Several previous studies suggested that MDT management for HCC may improve survival [18–24], yet is limited by analyzing small number of patients [18–22], comparing patients who were treated in different time period [18,19,22], including those only received MDT management [20,21,23,24], or including those who received curative treatment only [20]. Recently, Serper et al, reported that MDT management was associated with reduced mortality, by analyzing 3,988 patients who received care through the Veterans Administration in involving 128 centers in U.S. [25].…”

Section: Introductionmentioning

confidence: 99%

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Multidisciplinary approach is associated with improved survival of hepatocellular carcinoma patients

et al. 2019

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BackgroundGiven the complexity of managing hepatocellular carcinoma (HCC), a multidisciplinary approach (MDT) is recommended to optimize management of HCC patients. However, evidence suggesting that MDT improves patient outcome is limited.MethodsWe performed a retrospective cohort study of all patients newly-diagnosed with HCC between 2005 and 2013 (n = 6,619). The overall survival (OS) rates between the patients who were and were not managed via MDT were compared in the entire cohort (n = 6,619), and in the exactly matched cohort (n = 1,396).ResultsIn the entire cohort, the 5-year survival rate was significantly higher in the patients who were managed via MDT compared to that of the patients who were not (71.2% vs. 49.4%, P < 0.001), with an adjusted hazard ratio (HR) of 0.47 (95% confidence interval [CI]; 0.41–0.53). In the exactly matched cohort, the 5-year survival rate was higher in patients who were managed via MDT (71.4% vs. 58.7%, P < 0.001; HR [95% CI] = 0.67 [0.56–0.80]). The survival benefit of MDT management was observed in most pre-defined subgroups, and was especially significant in patients with poor liver function (ALBI grade 2 or 3), intermediate or advanced tumor stage (BCLC stage B or C), or high alphafetoprotein levels (≥200 ng/ml).ConclusionMDT management was associated with improved overall survival in HCC patients, indicating that MDT management can be a valuable option to improve outcome of HCC patients. This warrants prospective evaluations.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Multidisciplinary approach is associated with improved survival of hepatocellular carcinoma patients

et al. 2019

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“…The promissory tenor of genomic testing is reflected in our findings that treating physicians perceived the clinical utility of genomic testing to be significant for few patients but low for most patients, which was further evidenced through the low uptake of MGTB recommendations related to genomic testing by patients whose cases were reviewed. While these findings are consistent with previous research on follow up on tumor board recommendations [15, 19, 20], our study cannot explain the specific factors that contributed to uptake of MGTB recommendations by physicians and patients.…”

Section: Discussionsupporting

confidence: 88%

“…Research suggests that multidisciplinary cancer care teams can improve patients’ therapy planning, pain control, and medication adherence, though findings supporting their effectiveness in impacting patient survival and the costs of care are limited [16–18]. This may be due in part to discordance between recommendations and patient values and lack of follow up on tumor board recommendations [19, 20]. Nevertheless, studies suggest that multidisciplinary tumor boards and the use of standardized templates in tumor board conferences can improve oncology patient outcomes based on proxy measures such as the adherence to standards of care and national guidelines for treatment [21, 22].…”

Section: Introductionmentioning

confidence: 99%

“A rising tide lifts all boats”: establishing a multidisciplinary genomic tumor board for breast cancer patients with advanced disease

et al. 2016

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Background: Research suggests that multidisciplinary genomic tumor boards (MGTB) can inform cancer patient care, though little is known about factors influencing how MGTBs interpret genomic test results, make recommendations, and perceive the utility of this approach. This study's objective was to observe, describe, and assess the establishment of the Breast Multidisciplinary Genomic Tumor Board, the first MGTB focused on interpreting genomic test results for breast cancer patients with advanced disease. Methods: We conducted a qualitative case study involving participant observation at monthly MGTB meetings from October 2013 through November 2014 and interviews with 12 MGTB members. We analyzed social dynamics and interactions within the MGTB regarding interpretation of genomic findings and participants' views on effectiveness of the MGTB in using genomics to inform patient care. Results: Twenty-two physicians, physician-scientists, basic scientists, bioethicists, and allied care professionals comprised the MGTB. The MGTB reviewed FoundationOne™ results for 40 metastatic breast cancer patients. Based on findings, the board mostly recommended referring patients to clinical trials (34) and medical genetics (15), and Food and Drug Administration-approved (FDA) breast cancer therapies (13). Though multidisciplinary, recommendations were driven by medical oncologists. Interviewees described providing more precise care recommendations and professional development as advantages and the limited actionability of genomic test results as a challenge for the MGTB. Conclusions: Findings suggest both feasibility and desirability of pooling professional expertise in genomically-guided breast cancer care and challenges to institutionalizing a Breast MGTB, specifically in promoting interdisciplinary contributions and managing limited actionability of genomic test results for patients with advanced disease.

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“…It is important to note that the correct functioning of the MDT meeting relies on the proper union between the scientific evidence and the local experience in the diagnosis and cure of a given hepatobiliary disease. A MDT well balanced among specialties represented, and authoritative in all its specialists, provides better patient management resulting in better short-and long-term outcomes (56)(57)(58)(59).…”

Section: Minimum Hospital Requirements In Hepatobiliary Surgerymentioning

confidence: 99%

Effects of volume on outcome in hepatobiliary surgery: a review with guidelines proposal

Franchi

Donadon

Torzilli

2020

GHM

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The positive relationship between volume and outcome in hepatobiliary surgery has been demonstrated for many years. As for other complex surgical procedures, both improved short-and long-term outcomes have been associated with a higher volume of procedures. However, whether the centralization of complex hepatobiliary procedures makes full sense because it should be associated with higher quality of care, as reported in the literature, precise criteria on what to centralize, where to centralize, and who should be entitled to perform complex procedures are still missing. Indeed, despite the generalized consensus on centralization in hepatobiliary surgery, this topic remains very complex because many determinants are involved in such a centralization process, of which some of them cannot be easily controlled. In the context of different health systems worldwide, such as national health systems and private insurance, there are different stakeholders that demand different needs: politicians, patients, surgeons, institutions and medical associations do not always have the same needs. Starting from a review of the literature on centralization in hepatobiliary surgery, we will propose some guidelines that, while not data-driven due to low evidence in the literature, will be based on good clinical practice.

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Determinants and outcomes of adherence to recommendations from a multidisciplinary tumour conference for hepatocellular carcinoma

Abstract: There are patient-related as well as physician-related reasons for non-adherence to recommendations. Non-adherence affects clinical outcomes and can be avoided in selected cases.

Cited by 22 publications

References 19 publications

Multidisciplinary approach is associated with improved survival of hepatocellular carcinoma patients

Multidisciplinary approach is associated with improved survival of hepatocellular carcinoma patients

“A rising tide lifts all boats”: establishing a multidisciplinary genomic tumor board for breast cancer patients with advanced disease

Effects of volume on outcome in hepatobiliary surgery: a review with guidelines proposal

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