scholarly journals 38. INNOVATIVE USE OF A CUSTOM MOBILE APPLICATION (APP) BY A BRAIN METASTASES PROGRAM FACILITATES MULTIDISCIPLINARY MANAGEMENT OF PATIENTS AND DECREASED LENGTH OF HOSPITAL STAY (LOS)

2020 ◽  
Vol 2 (Supplement_2) ◽  
pp. ii7-ii7
Author(s):  
Joseph Bovi ◽  
Jennifer Lindstedt ◽  
Fernando Santos-Pinheiro ◽  
Wade Mueller ◽  
Straza Michael ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Real Time ◽  
Treatment Algorithm ◽  
Length Of Hospital Stay ◽  
Multidisciplinary Care ◽  
Mobile App ◽  
Tumor Board ◽  
Patient Admissions ◽  
Tumor Boards ◽  
Current Pathway

Abstract INTRODUCTION Patients with Brain Metastases (BM) are complex, mandating multidisciplinary care. Our BM patients are discussed at in-person, weekly Brain Tumor Boards (BTB). However, BM patients diagnosed outside weekly BTBs wait several days for the next BTB, causing delays in generating multidisciplinary plans-of-care, prolonging LOS. We created a custom mobile app for our Brain Metastases Program to have a ‘Brain Metastases Virtual Tumor Board’ (BMVTB) discussion, in real-time, resulting in faster plans-of-care, decreasing LOS. METHODS The current pathway for navigating multidisciplinary discussions for patients with BM was examined by members of our Brain Metastases Program. We identified the need for all disciplines to participate in a BMVTB, outside of our in-person, weekly BTB. We developed a secure app that can be downloaded on any provider’s mobile device. The app includes a digital BM treatment algorithm for providers to understand comprehensive, data-driven, BM management. The app also gives our multidisciplinary Brain Metastases Program access to a BMVTB messenging tool to securely communicate and generate real-time consensus plans-of-care. Using a Vizient Clinical Database, we retrospectively calculated LOS index (observed LOS/expected LOS) for 184 BM patients over 21 months, creating a baseline. After launching our app and BMVTB workflow we prospectively evaluated LOS index in 45 BM patients over 6 months. RESULTS Over 21-months, 184 patients demonstrated baseline LOS index of 1.073. After launching our mobile app and BMVTB workflow, 45 patient admissions over 6-months demonstrated LOS index of 0.850. Using Levene’s test for equal variances, LOS variance with the app and BMVTB was lower than LOS variance at baseline (p = 0.049). This demonstrates a 38% reduction in LOS when the app and BMVTB generated real-time plans-of-care. CONCLUSION We demonstrated utility of a custom BM app coupled with a BMVTB to generate real-time plans-of-care for BM patients, reducing LOS.

scholarly journals Setting Up Telemedicine: Internet of Things to Support Rural Oncology Clinics in a Low- and Middle-Income Country—A Pilot Project in Kenya

2020 ◽  
Vol 6 (Supplement_1) ◽  
pp. 58-58
Author(s):  
Lamech Sigu ◽  
Fredrick Chite ◽  
Emma Achieng ◽  
Andrew Koech
Keyword(s):  
Internet Of Things ◽  
Real Time ◽  
Length Of Hospital Stay ◽  
Human Interaction ◽  
Sub Saharan Africa ◽  
Patient Treatment ◽  
The Internet ◽  
Tumor Boards ◽  
Iot Devices ◽  
Set Up

PURPOSE The Internet of Things (IoT) is a technology that involves all things connected to the Internet that share data over a network without requiring human-to-human interaction or human-to-computer interaction. Information collected from IoT devices can help physicians identify the best treatment process for patients and reach accurate and expected outcomes. METHODS The International Cancer Institute is partnering to set up remote oncology clinics in sub-Saharan Africa. Medical oncologists and expert teams from across the world connect with oncology clinics in other Kenyan counties—Kisumu, Meru, Makueni, Garissa, Kakamega, Bungoma, Siaya, and Vihiga counties. The furthest county is Garissa, approximately 651.1 km from Eldoret, and the nearest is Vihiga at 100.4 km from Eldoret. This study began July 2019, and as of November 30th, the team has hosted 21 sessions with an average of 11 participants attending a session led by a medical oncologist. RESULTS IoT devices have become a way by which a patient gets all the information he or she needs from a physician without going to the clinic. Patient monitoring can be done in real time, allowing access to real-time information with improved patient treatment outcomes and a decrease in cost. Through IoT-enabled devices, the International Cancer Institute has set up weekly virtual tumor boards during which cancer cases are presented and discussed by all participating counties. An online training module on cancer is also offered. Furthermore, remote monitoring of a patient’s health helps to reduce the length of hospital stay and prevents readmissions. CONCLUSION In our setting, which has a few oncologists, use of IoT and tumor boards has helped to improve patient decision support as well as training for general physicians.

Physician and practice characteristics influencing tumor board attendance: Results from the provider survey of the Los Angeles Women's Health Study

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e17501-e17501
Author(s):  
K. Scher ◽  
D. M. Tisnado ◽  
D. Rose-Ash ◽  
A. Rastegar ◽  
J. Adams ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Los Angeles ◽  
Multidisciplinary Care ◽  
Tumor Board ◽  
Health Study ◽  
Coordination Of Care ◽  
Volume Number ◽  
Practice Characteristics ◽  
Tumor Boards ◽  
Low Volume

e17501 Background: Coordination of care has grown in importance with the advent of new modalities of treatment requiring specialized expertise. In cancer care, multidisciplinary approaches have shown improvements in quality of care and patient satisfaction. Tumor boards provide a mechanism for improving coordination of care. We evaluated physician and practice characteristics that predict frequency of tumor board attendance. Methods: This cross-sectional study utilizes data obtained by surveying physicians of a population-based sample of women with incident breast cancer. Physicians were queried regarding tumor board attendance, specialty (medical oncologist [MO], radiation oncologist [RO], surgeon indicating that the hospital at which most breast cancer surgeries are performed has an American College of Surgeons accredited program [ACOSSg] and surgeon without such affiliation [non-ACOSSg]), physician characteristics (gender, race, teaching involvement, patient volume, number of offices, ownership interest), and practice setting (practice type, size, reimbursement). Univariate, bivariate, and multivariate analyses were performed for the dependent variable characterizing provider report of frequency of tumor board meeting attendance. Results: Most surveyed physicians (83%) report attending tumor board weekly (58%) or monthly (25%). Weekly participation was reported by 63%, 92%, 47%, and 32% of MOs, ROs, ACOSSgs, and non-ACOSSgs (p < 0.01). Specialty and higher patient volumes are significant predictors of more frequent attendance, after adjustment for practice size and type. In comparison to the most prevalent specialty category (low volume ACOSSgs), high volume MOs attend more (p = 0.01), and low volume non-ACOSSgs attend less frequently (p = 0.00). Conclusions: Tumor board attendance implies increased participation in multidisciplinary care, but specific subsets of providers are less frequent users. This not only has implications for choosing providers, but also for efforts to increase attendance. Tumor board agendas and formalized institution wide policies could be designed to further engage low frequency attendees as a means to promote multidisciplinary care and improve health outcomes. [Table: see text]

Utility of a multidisciplinary tumor board in the management of pancreatic diseases.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 319-319
Author(s):  
David G. Brauer ◽  
Matthew S. Strand ◽  
Dominic E. Sanford ◽  
Maria Majella Doyle ◽  
Faris Murad ◽  
...  
Keyword(s):  
Treatment Plan ◽  
Diagnostic Testing ◽  
Retrospective Chart Review ◽  
Multidisciplinary Care ◽  
Tumor Board ◽  
Cancer Center ◽  
Common Diagnosis ◽  
Tumor Boards ◽  
Cancer Network ◽  
The Impact

319 Background: Multidisciplinary Tumor Boards (MTBs) are a requirement for comprehensive cancer centers and are routinely used to coordinate multidisciplinary care in oncology. Despite their widespread use, the impact of MTBs is not well characterized. We studied the outcomes of all patients presented at our pancreas MTB, with the goal of evaluating our current practices and resource utilization. Methods: Data were prospectively collected for all patients presented at a weekly pancreas-specific MTB over the 12-month period at a single-institution NCI-designated cancer center. The conference is attended by surgical, medical, and radiation oncologists, interventional gastroenterologists, pathologists, and radiologists (diagnostic and interventional). Retrospective chart review was performed at the end of the 12-month period under an IRB-approved protocol. Results: A total of 470 patient presentations were made over a 12-month period. Average age at time of presentation was 61.5 years (range 17 – 89) with 51% males. 61.7% of cases were presented by surgical oncologists and 26% by medical oncologists. 174 cases were the result of new diagnoses or referrals. 78 patients were presented more than once (average of 2.3 times). Pancreatic adenocarcinoma was the most common diagnosis (37%), followed by uncharacterized pancreatic mass (16%), and pancreatic cyst (7%). The treatment plan proposed by the presenting clinician was known or could be evaluated prior to conference in 402 cases. Presentation of a case at MTB changed the plan of management 25% (n = 100) of the time, including MTB recommendation against a planned resection in 46 cases. When the initial plan changed as a result of MTB discussion, the most common new plan was to obtain further diagnostic testing such as biopsy and/or endoscopy (n = 24). Conclusions: MTBs are required and resource-intensive but offer the opportunity to discuss a wide array of pathologies and influence management decisions in a sizable proportion of cases. Additional investigations evaluating adherence rates to MTB decisions and to published guidelines (i.e. National Comprehensive Cancer Network) will further enhance the assessment and utility of MTBs.

Validation and implementation of a mobile app decision support system for quality assurance of tumor boards: Analyzing the concordance rates for testis cancer at a multidisciplinary tumor board of a tertiary referral center.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 399-399
Author(s):  
Yasemin Ural ◽  
Axel Heidenreich ◽  
Thomas Elter ◽  
Yasemin Yilmaz ◽  
David A. Pfister
Keyword(s):  
Decision Support ◽  
Decision Support System ◽  
Support System ◽  
Mobile App ◽  
Tumor Board ◽  
Daily Routine ◽  
Tertiary Referral ◽  
Term Survival ◽  
Line Therapy ◽  
Tumor Boards

399 Background: Guideline-compliance in the management of GCT is suboptimal concerning and it results in significantly impaired long-term survival. To facilitating guideline concordant decisions even in less experienced MTD, we developed an algorithm-driven and validated mobile App to provide evidence-based recommendations. This App contains latest guideline versions and it is continuously updated to include practice changing clinical trials. It is the purpose of this study to analyse treatment decision made by MTD compared to guideline recommended therapy. Methods: 302 patients with GCT and MTD decision were randomly selected from our database. Concordance rates of MTD recommendations were compared to query results of the digital APP “Easy Oncology” performed by 2 independent, blinded reviewers. Descriptive statistics and data analysis included IBM´s statistics software SPSS Version 25. Correlation analysis of cancer case characteristics was performed by Kendalls Tau, Gamma, Pearson and Spearman tests. Results: Median age was 35 (18-82) years. Clinical stages I, IIA-C, and III were identified in 32%, 37%, and 31%, resp. According to IGCCCG 56%, 18%, and 25% demonstrated good, intermediate, and poor prognosis, resp. 56% were non-seminomas and 44% were seminomas. 60%, 16%, and 7% of MTD decisions were related to 1st-line, 2nd, and 3rd line therapy and 18% dealt with follow up. Overall concordance rate was 99% (301/302). Concordance rates in CS I, IIA-C, and III were 100%, 98% and 99%, resp. Concordance rates with regard to 1st, 2nd and 3rd line therapy were 99% (135/136), 100%, and 88% (13/14). Conclusions: Our validated expert-created mobile decision support system demonstrates easy and reliable application in daily routine in an expert tertiary referral centre. The APP relies on guideline and trial based information and avoids MTD decisions by expert opinions. It might improve the MTD decision in less experienced MTDs which is currently evaluated in a prospective study.

scholarly journals Multidisciplinary Cancer Management of Colorectal Cancer in Tikur Anbessa Specialized Hospital, Ethiopia

2019 ◽  
pp. 1-7
Author(s):  
Biniyam Tefera Deressa ◽  
Nikola Cihoric ◽  
Ephrem Tefesse ◽  
Mathewos Assefa ◽  
Daniel Zemenfes
Keyword(s):  
Colorectal Cancer ◽  
Treatment Plan ◽  
Neoadjuvant Chemoradiotherapy ◽  
Multidisciplinary Care ◽  
Clinical Staging ◽  
Tumor Board ◽  
Colorectal Cancers ◽  
Cancer Management ◽  
Retrospective Assessment ◽  
Tumor Boards

PURPOSE Multidisciplinary cancer care is currently considered worldwide as standard for the management of patients with cancer. It improves patient diagnostic and staging accuracy and provides patients the benefit of having physicians of various specialties participating in their treatment plan. The purpose of this study was to describe the profile of patients discussed in the Tikur Anbessa Multidisciplinary Tumor Board (MTB) and the potential benefits brought by multidisciplinary care. METHODS The study involved the retrospective assessment of all patient cases presented to the Tikur Anbessa Hospital colorectal cancers MTB between March 2016 and November 2017. The data were collected from the MTB medical summary documents and were analyzed using SPSS version 20 (SPSS, Chicago, IL). RESULTS Of 147 patients with colorectal cancer, 96 (65%) were men. The median age at presentation was 46 years (range, 17-78 years). The predominant cancer was rectal (n = 101; 69%), followed by colon (n = 24; 16%). Of these, 68 (45%) and 22 (15%) had stage III and IV disease, respectively, on presentation to the MTB. The oncology department presented the majority of the patients for discussion. Most patients had undergone surgery before the MTB discussion but had no proper preoperative clinical staging information. The majority of patients with rectal cancer treated before the MTB discussion had undergone surgery upfront; however, most of the patients who were treatment naive before MTB received neoadjuvant chemoradiotherapy before surgery. CONCLUSION Decisions made by tumor boards are more likely to conform to evidence-based guidelines than are those made by individual clinicians. Therefore, early referral of patients to MTB before any treatment should be encouraged. Finally, other hospitals in Ethiopia should take a lesson from the Tikur Anbessa Hospital colorectal cancers MTB and adopt multidisciplinary cancer management.

Implementation of 11 system-wide, disease-specific, multidisciplinary tumor boards connecting 24 hospitals in an integrated health care system.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19152-e19152
Author(s):  
Brook Clayton ◽  
Craig Nielsen ◽  
Jane Jensen ◽  
Allison Tonkin ◽  
Paul Urie ◽  
...  
Keyword(s):  
Rural Communities ◽  
Healthcare System ◽  
Multidisciplinary Care ◽  
Clinical Decision ◽  
Tumor Board ◽  
High Quality ◽  
Specific Tumor ◽  
Tumor Boards ◽  
Oncology Providers ◽  
Disease Specific

e19152 Background: Cancer treatment is becoming more complex, necessitating subspecialty expertise and multidisciplinary approaches to treatment planning. Simultaneously, there is increasing demand to provide care as close to home as possible. While tumor boards have long been an institutional backbone to providing high-quality multidisciplinary care in tertiary facilities, connecting several hospitals and dozens of cancer specialists in a large integrated healthcare system is unique and potentially transformational for smaller facilities and communities. Methods: Using highly-secure, network firewall-protected Cisco Telepresence and WebEx capabilities, 11 disease specific tumor boards (Breast, GI, Sarcoma, GU, Thoracic, Head/Neck, Melanoma, Neuro, Heme, Hepatobiliary, Gyn) were organized across Intermountain Healthcare’s 24 geographically and medically diverse hospitals spanning over 500 miles. Meetings for each of these disease-specific tumor boards have been held at least every 1-2 weeks, at set times and days since July 2019. Cases are submitted to the appropriate tumor board by individual providers from anywhere in the system. Submitted cases are reviewed by a designated subspeciality leader. Cases are either added to the system-wide agenda, or at times, the clinical decision can be resolved immediately. Included cases’ records including pathology, radiology and pertinent medical history are obtained for display and discussion. After each tumor board, recommendations and conclusions are recorded by nurse navigators for future review and consultation. Results: From July 2019 to February 2020, 1,598 patient cases were discussed. Just as relevant, 293 unique oncology providers (surgeons, medical oncologists, radiation oncologists, genetic counselors, nurse navigators, and therapists) participated in tumor board discussions. These deliberations provided insight, experience and recommendations directly related to patient care. Conclusions: Our system-wide, disease-specific, multi-disciplinary tumor boards are useful in connecting oncology providers and subspecialists. This effort has led to better collaboration, coordination and delivery of high-quality cancer care to patients throughout a large healthcare system that includes thousands of patients and dozens of cancer providers in smaller/rural communities. In addition, provider engagement has improved. Work is ongoing to prospectively evaluate the effects on treatment decisions and clinical outcomes.

Quantifying the utility of a multidisciplinary neuro-oncology tumor board

2020 ◽  
pp. 1-6
Author(s):  
Adham M. Khalafallah ◽  
Adrian E. Jimenez ◽  
Carlos G. Romo ◽  
David Olayinka Kamson ◽  
Lawrence Kleinberg ◽  
...  
Keyword(s):  
Nervous System ◽  
Treatment Plan ◽  
Demographic Data ◽  
Image Interpretation ◽  
Multidisciplinary Care ◽  
Tumor Board ◽  
Eligibility Criteria ◽  
Tumor Boards ◽  
Treatment Plans ◽  
A Prospective Study

OBJECTIVEThere has been limited research on the efficacy of multidisciplinary tumor boards (MDTBs) in improving the treatment of patients with tumors affecting the nervous system. The objective of the present study was to quantify the utility of MDTBs in providing alternative diagnostic interpretations and treatment plans for this patient population.METHODSThe authors performed a prospective study of patients in 4 hospitals whose cases were discussed at MDTBs between July and November 2019. Patient demographic data, diagnoses, treatment plans, and eligibility for clinical trials were recorded, among other variables.RESULTSA total of 176 cases met eligibility criteria for study inclusion. The majority (53%) of patients were male, and the mean patient age was 52 years. The most frequent diagnosis was glioblastoma (32.4%). Among the evaluable cases, MDTBs led to 38 (21.6%) changes in image interpretation and 103 (58.2%) changes in patient management. Additionally, patients whose cases were discussed at MDTBs had significantly shorter referral times than patients whose cases were not discussed (p = 0.024).CONCLUSIONSMDTB discussions led to significant numbers of diagnostic and treatment plan changes as well as shortened referral times, highlighting the potential clinical impact of multidisciplinary care for patients with nervous system tumors.

scholarly journals NCOG-67. QUANTIFYING THE UTILITY OF A MULTIDISCIPLINARY NEURO-ONCOLOGY TUMOR BOARD

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii144-ii144
Author(s):  
Adham Khalafallah ◽  
Adrian Jimenez ◽  
Carlos Romo ◽  
David Kamson ◽  
Lawrence Kleinberg ◽  
...  
Keyword(s):  
Nervous System ◽  
Treatment Plan ◽  
Demographic Data ◽  
Image Interpretation ◽  
Multidisciplinary Care ◽  
Tumor Board ◽  
Eligibility Criteria ◽  
Tumor Boards ◽  
Treatment Plans ◽  
A Prospective Study

Abstract BACKGROUND There is limited research attempting to measure the efficacy of tumor boards (MDTBs) in the treatment of patients with tumors affecting the nervous system. OBJECTIVE The objective of the present study was to quantify the utility of a MDTB in providing alternative diagnostic interpretations and treatment plans for this patient population. METHODS A prospective study of patient cases discussed at four hospitals’ MDTBs between July and November 2019 was performed. Demographic data, diagnoses, treatment plans, and eligibility for clinical trials were recorded, among other variables. RESULTS A total of 176 patient cases met eligibility criteria. The majority of patients (53%) were male with a mean age of 52 years. The most frequent diagnosis was glioblastoma (32.4%). Among the evaluable cases, MDTBs led to 38 (21.6%) changes in image interpretation and 103 (58.2%) changes in patient management. Additionally, patients whose cases were discussed at MDTBs had significantly shorter referral times compared to patients whose cases were not discussed (p= 0.024). CONCLUSION MDTB discussions led to a significant number of diagnostic and treatment plan changes as well as shortened referral times, highlighting the potential clinical impact of multidisciplinary care for patients with nervous system tumors.

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