Impact of a Single-Day Multidisciplinary Clinic on the Management of Patients with Liver Tumours

Zhang, J.; Mavros, Michael N.; Cosgrove, David; Hirose, Kenzo; Herman, Joseph M.; Smallwood-Massey, S.; Kamel, Ihab R.; Gürakar, Ahmet; Anders, Robert A.; Cameron, Andrew M.; Geschwind, J.; Pawlik, Timothy M.

doi:10.3747/co.20.1297

Cited by 46 publications

(47 citation statements)

References 37 publications

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“…10,11 We also reported a 62 % increase in clinical trial accrual in our liver multidisciplinary clinic, as well as a near doubling in registration in the National Familial Pancreas Tumor Registry though implementation of the pancreas multidisciplinary clinic. 10,11 …”

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confidence: 75%

“…We reported that, in our own experience, treatment in either the pancreas or liver multi-disciplinary clinic led to treatment recommendations being modified in up to 25–40 % of patients. 10,11 Alterations in patient care included changes in imaging interpretation, revisions in diagnosis after re-review of outside pathology, or different treatment recommendations based on physician experience. 10,11 We also reported a 62 % increase in clinical trial accrual in our liver multidisciplinary clinic, as well as a near doubling in registration in the National Familial Pancreas Tumor Registry though implementation of the pancreas multidisciplinary clinic.…”

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confidence: 99%

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Multidisciplinary Clinic in the Management of Hepatocellular Carcinoma

et al. 2013

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confidence: 75%

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confidence: 99%

Multidisciplinary Clinic in the Management of Hepatocellular Carcinoma

et al. 2013

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“…The case for multidisciplinary care is even more pronounced for patients with HCC. 18 Treatment of HCC often includes possible surgical, intraarterial, and systemic options. As such, patients often benefit from being seen by various providers.…”

Section: Discussionmentioning

confidence: 99%

“…Within the last few years, the Johns Hopkins Liver Tumor Center established a single-day multidisciplinary clinic in response to this need of patients to be seen by a range of specialists. 18 The multidisciplinary liver clinic has had a significant impact on management of patients with liver tumors, resulting in alternations to imaging and pathology interpretation, diagnosis, and the management plan in a subset of patients. 18 …”

Section: Discussionmentioning

confidence: 99%

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Patterns of Consultation and Treatment of Patients with Hepatocellular Carcinoma Presenting to a Large Academic Medical Center in the US

Stacy

Hyder

Cosgrove

et al. 2013

Journal of Gastrointestinal Surgery

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Background Management of hepatocellular carcinoma (HCC) often involves many subspecialist providers, as well as a broad range of treatment options. This study sought to evaluate referral and treatment patterns among patients with HCC at a large academic medical center. Methods Data from our cancer registry between 2003–2011 were abstracted on 394 patients who were primarily diagnosed/treated for HCC at Johns Hopkins Hospital (JHH); data on patients who were diagnosed/treated with HCC elsewhere and who received secondary treatment at JHH (n=391) were also abstracted for comparison purposes. Results Among the main cohort, the most common specialties to be consulted were surgery (n=225, 57.1 %), gastroenterology (n=225, 57.1 %), and interventional radiologist (n=206, 52.3 %), while only 96 (24.4 %) were referred to medical oncology. Factors associated with surgical consultation included younger age (odds ratio (OR) 3.35, 95 % CI 1.62–6.92), tumor size <5 cm (OR 1.82, 1.09–3.02), and unilobar disease (OR 2.94, 1.31–6.59) (all P<0.05). Patients initially diagnosed/treated elsewhere had larger tumors (4 vs. 6 cm), bilateral disease (19.2 vs. 26.8 %), and were more likely to be seen by interventional radiology (all P<0.05) Conclusions Most patients were seen by surgeons, gastroenterologists, or interventional radiologists, with only a minority being seen by medical oncologists. Referral patterns depended on patient-level factors, as well as extent of disease.

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Patterns of Multidisciplinary Care of Head and Neck Squamous Cell Carcinoma in Medicare Patients

Hansen

Egleston

Leachman

et al. 2020

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Multidisciplinary care (MDC) yields proven benefits for patients with cancer, although it may be underused in the complex management of head and neck squamous cell carcinoma (HNSCC).OBJECTIVE To characterize the patterns of MDC in the treatment of HNSCC among elderly patients in the US. DESIGN, SETTING, AND PARTICIPANTSThis nationwide, population-based, retrospective cohort study used Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data from January 1, 1991, to December 31, 2011, to identify patients 66 years or older diagnosed with head and neck cancer and determine the dates of diagnosis, oncology consultations, treatment initiation, and speech therapy evaluation in addition to MDC completion. Multidisciplinary care was defined in a stage-dependent manner: localized disease necessitated consultations with radiation and surgical oncologists, and advanced-stage disease also included a medical oncology consultation, all before definitive treatment. Data were analyzed between December 2016 and September 2020. MAIN OUTCOMES AND MEASURESRates of MDC across all subsites of head and neck cancer as measured by the presence of an evaluation for each oncologist on the MDC team and its effect on treatment initiation. RESULTSThis cohort study assessed 28 293 patients with HNSCC (mean [SD] age, 75.1 [6.6] years; 67% male; 87% White) from the SEER-Medicare linked database. The HNSCC subsites included larynx (40%), oral cavity (30%), oropharynx (21%), hypopharynx (7%), and nasopharynx (2%). Overall, the practice of MDC significantly increased over time, from 24% in 1991 to 52% in 2011 (P < .001). For patients with localized (stage 0-II) tumors, 60% received care in the multidisciplinary setting, whereas 28% of those with advanced-stage disease did. A total of 18 181 patients (64%) were treated with initial definitive nonsurgical therapy across all stages. Regardless of stage and subsite, few patients (2%) underwent evaluation by a speech-language pathologist before definitive therapy. Multidisciplinary care prolonged the time to initiation of definitive treatment by 11 days for localized disease and 10 days for advanced disease.CONCLUSIONS AND RELEVANCE This cohort study found that most elderly patients with localized HNSCC received MDC, whereas few patients with advanced-stage disease received such care, although a significant proportion received adjuvant therapy. Multidisciplinary care may prolong time to initiation of definitive treatment with an uncertain impact. Consultation with a speech-language pathologist before definitive therapy was rare.

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Impact of a Single-Day Multidisciplinary Clinic on the Management of Patients with Liver Tumours

Cited by 46 publications

References 37 publications

Multidisciplinary Clinic in the Management of Hepatocellular Carcinoma

Multidisciplinary Clinic in the Management of Hepatocellular Carcinoma

Patterns of Consultation and Treatment of Patients with Hepatocellular Carcinoma Presenting to a Large Academic Medical Center in the US

Patterns of Multidisciplinary Care of Head and Neck Squamous Cell Carcinoma in Medicare Patients

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