Establishment of a Regional Virtual Tumor Board Program to Improve the Process of Care for Patients With Hepatocellular Carcinoma

Abstract

Purpose: Multidisciplinary evaluation (MDE) of hepatocellular cancer (HCC) is the current standard, often provided through a tumor board (TB) forum; this standard is limited by oncology workforce shortages and lack of a TB at every institution. Virtual TBs (VTBs) may help overcome these limitations. Our study aim was to assess the impact of a regional VTB on the MDE process for patients with HCC.Methods: A retrospective cohort study was conducted, including patients with HCC referred to a tertiary cancer center from regional facilities (2009 to 2013). Baseline characteristics and outcomes were compared based on the referral mechanism: VTB versus subspecialty consultation (non-VTB). The primary outcome was comprehensive MDE (all required specialists present and key topics discussed). Secondary outcomes included timeliness of MDE and travel burden to complete MDE. Univariable and multivariable logistic regressions were performed to examine the association of a VTB with comprehensive MDE.Results: A total of 116 patients were included in the study; 48 (41.4%) were evaluated through the VTB. A higher proportion of VTB patients received comprehensive MDE (91.7% v 64.7%; P ϭ .001); the VTB was independently associated with higher odds of accomplishing comprehensive MDE (odds ratio, 6.0; 95% CI, 1.2 to 29.9; P ϭ .02). VTB patients completed MDE significantly faster (median, 23 v 39 days; P Ͻ .001), with lower travel burden (median, 0 v 683 miles traveled; P Ͻ .001). Conclusion:This VTB program positively affected the process of care for patients with HCC by improving the quality and timeliness of the MDE process, while avoiding the burden arising from travel needs. Future studies should focus on implementation of VTB programs on a wider scale.

Telemedicine: An Evolving Field in Hepatology

“…In patients with hepatocellular carcinoma who are cared for at institutions without tumor board forums, virtual tumor boards can expedite the process of multidisciplinary evaluation. At the VA, patients enrolled in virtual tumor boards received high rates of comprehensive multidisciplinary evaluation within a shorter amount of time …”

“…At the VA, patients enrolled in virtual tumor boards received high rates of comprehensive multidisciplinary evaluation within a shorter amount of time. (6)…”

Treatment at high‐volume facilities and academic centers is independently associated with improved survival in patients with locally advanced head and neck cancer

“…Therefore, it is incumbent on the oncology community to find creative solutions to narrow the outcome gap between HVFs and lower-volume facilities, thereby ensuring high-quality care for all patients with head and neck cancer. 32,33 Real-time virtual contour and plan quality assurance by experienced head and neck experts, as is implemented by several cooperative groups for clinical trials, 34,35 could be adapted for ensuring radiation quality metrics in community cancer centers. 30 For example, teleoncology initiatives have been implemented successfully in segments of the United States and Europe to minimize outcome and treatment disparities across facilities for various cancers.…”

The State of Cancer Care in America, 2016: A Report by the American Society of Clinical Oncology

“…50 miles) were less likely to receive adjuvant chemotherapy in accordance with evidence-based guideline recommendations. 94 Virtual tools and improved care coordination can expand access to high-quality care for patients living far from major cancer centers. 93 Because cancer care is complex, requires frequent patient visits for treatment and monitoring, and involves providers from many disciplines, geographic access to care may be even more challenging for patients with cancer than for other rurally located patients.…”