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]

scholarly journals Physician and Practice Characteristics Influencing Tumor Board Attendance: Results From the Provider Survey of the Los Angeles Women's Health Study

2011 ◽  
Vol 7 (2) ◽  
pp. 103-110 ◽  
Author(s):  
Kevin S. Scher ◽  
Diana M. Tisnado ◽  
Danielle E. Rose ◽  
John Lloyd Adams ◽  
Clifford Y. Ko ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Los Angeles ◽  
Treatment Planning ◽  
Cancer Care ◽  
Tumor Board ◽  
Health Study ◽  
Practice Characteristics ◽  
Planning Approach ◽  
Provider Survey

Multidisciplinary approaches to cancer care have shown improvements in the quality of care. The tumor board treatment planning approach provides a structure for engaging providers in discussions of cancer cases that are designed to enhance the quality of care.

Implementing an innovation to improve coordination of care in breast cancer.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 52-52
Author(s):  
Nina A. Bickell ◽  
Rebeca Franco ◽  
Alexandra Moss ◽  
Zoe Lawrence ◽  
Ann Scheck McAlearney
Keyword(s):  
Breast Cancer ◽  
Quality Improvement ◽  
Communication Systems ◽  
Comparative Method ◽  
Specialty Care ◽  
Tumor Board ◽  
Coordination Of Care ◽  
Breast Cancer Patients ◽  
Web Based

52 Background: Underuse of adjuvant breast cancer treatments delivered by different specialists may be worsened by fragmented care and improved by effective coordination. To improve care coordination and adjuvant treatment delivery, we assessed the challenges to and feasibility of implementing a web-based Tracking and Feedback (T&F) innovation in hospitals serving predominantly minority breast cancer patients. Methods: We interviewed 67 key informants [Clinical (n = 39), Administrative (n = 14), Clerical (n = 11), Other (IT, Social Work) (n = 3)] from 8 inner-city hospitals to better understand how organizational characteristics might impact coordination of care and implementation of the T & F innovation. We used the constant comparative method of qualitative data analysis and standard techniques to code the data. Results: We found considerable variability across hospitals’ abilities to coordinate and track care. All sites have multi-disciplinary Tumor Board meetings and active Quality Improvement departments. Yet, in several sites, specialty care remains siloed, quality improvement efforts focus on inpatient care and communications systems across outpatient specialties are poor. All hospitals have electronic medical records but they are not integrated and are unable to track requested referrals. Many physicians rely on follow-up appointments to ascertain treatment receipt but sites vary in their ability to address “no-shows.” Several rely on staff to manually identify and follow up “no-shows,” but many of these staff are overwhelmed with ever increasing tasks and responsibilities. While quality was important, several interviewees felt they were bucking an inflexible system and devised ways to work around the obstacles. Perceived successful coordination factors included strong clinical leadership, designated accountabilities, and flexibility of staff. Conclusions: As care integration is encouraged by federal law, specialty care silos and rigid communication systems still pose barriers to change. Our results suggest that a web-based T&F innovation must be tailored to individual hospital characteristics, and flexible to permit modification of care processes at the organization level. Clinical trial information: NCT01544374.

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.

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.

Axillary management in early breast cancer: Surgeon attitudes in a population-based study.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 561-561
Author(s):  
Monica Morrow ◽  
Steven J. Katz ◽  
Reshma Jagsi
Keyword(s):  
Breast Cancer ◽  
Los Angeles ◽  
Educational Interventions ◽  
Breast Conserving Therapy ◽  
Population Based ◽  
Tumor Board ◽  
Breast Cancer Patients ◽  
Aggressive Surgical Approach ◽  
Pathology Reports ◽  
Practice Methods

561 Background: The ACOSOG Z0011 trial established the safety of omitting axillary dissection (ALND) for patients with 1‒2 sentinel node (SN) metastases having breast-conserving therapy (BCT) to reduce treatment-related morbidity. Little is known about surgeon uptake of this practice. Methods: Women with stage I and II breast cancer diagnosed between 7/13‒8/15 (n=3729) reported to the Los Angeles and Georgia SEER registries were surveyed about 2 months after diagnosis. All attending surgeons identified by the patients (n=489) were sent a questionnaire and 77% (n=377) responded. Pathology reports for SN positive patients are under review. Results: Mean surgeon age was 54 years, 25% were female, and median years in practice was 21. 49% and 63% endorsed ALND for Z0011 eligible patients with 1 or 2 SN macrometastases, respectively. Surgeons were classified as low (n=92), selective (n=178), or high (n=91) users of ALND based on responses to case scenarios with SN involvement ranging from isolated tumor cells in 1 SN (12% would do ALND) to macrometastasis in 3 SNs (92% would do ALND). 93% of high-use surgeons would perform ALND for any SN macrometastasis vs 40% of selective surgeons and 1% of low-use surgeons (p<.001). High-use surgeons were older, male, saw fewer breast cancer patients, and were less likely to discuss cases in tumor board (Table). High-ALND users were substantially less likely to endorse BCT margins of no ink on tumor (40%) than selective (63%) or low users (83%; p<.001). Conclusions: Wide variation exists in acceptance of Z011 results with one-quarter of surgeons endorsing routine ALND. Surgeons favoring ALND also endorse wider margins for BCT, suggesting an overall more aggressive surgical approach. Lower breast volume and lack of tumor board participation identify surgeons who should be targeted for educational interventions. [Table: see text]

scholarly journals The Structural Landscape of the Health Care System for Breast Cancer Care: Results from The Los Angeles Women’s Health Study

2009 ◽  
Vol 15 (1) ◽  
pp. 17-25 ◽  
Author(s):  
Diana M. Tisnado ◽  
Jennifer L. Malin ◽  
May L. Tao ◽  
Patricia Ganz ◽  
Danielle Rose-Ash ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Health Care ◽  
Los Angeles ◽  
Women’S Health ◽  
Women's Health ◽  
Health Care System ◽  
Cancer Care ◽  
Health Study ◽  
Breast Cancer Care ◽  
Care System

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.

scholarly journals Breast Cancer Experience of the Molecular Tumor Board at the University of California, San Diego Moores Cancer Center

2015 ◽  
Vol 11 (6) ◽  
pp. 442-449 ◽  
Author(s):  
Barbara A. Parker ◽  
Maria Schwaederlé ◽  
Michael D. Scur ◽  
Sarah G. Boles ◽  
Teresa Helsten ◽  
...  
Keyword(s):  
Breast Cancer ◽  
University Of California ◽  
Tumor Board ◽  
Cancer Center ◽  
Genomic Testing ◽  
Tumor Boards ◽  
Heavily Pretreated ◽  
Molecular Tumor Board ◽  
Cancer Experience ◽  
The University

Multidisciplinary molecular tumor boards may help optimize the management of patients with advanced, heavily pretreated breast cancer who have undergone genomic testing.

scholarly journals Continuity and coordination of care in highly selected chronic cancer patients treated with multiple repeat radiation therapy

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Sebastian M. Christ ◽  
Maiwand Ahmadsei ◽  
Annina Seiler ◽  
Eugenia Vlaskou Badra ◽  
Jonas Willmann ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Chronic Disease ◽  
Cancer Patients ◽  
Continuity Of Care ◽  
Radiation Oncology ◽  
Tumor Board ◽  
Study Patient ◽  
Coordination Of Care ◽  
Tumor Boards ◽  
Multiple Repeat

Abstract Introduction and background As cancer is developing into a chronic disease due to longer survival, continuity and coordination of oncological care are becoming more important for patients. As radiation oncology departments are an integral part of cancer care and as repeat irradiation becomes more commonplace, the relevance of continuity and coordination of care in operating procedures is increasing. This study aims to perform a single-institution analysis of cancer patients in which continuity and coordination of care matters most, namely the highly selected group with multiple repeat course radiotherapy throughout their chronic disease. Materials and methods All patients who received at least five courses of radiotherapy at the Department of Radiation Oncology at the University Hospital Zurich from 2011 to 2019 and who were alive at the time of the initiation of this project were included into this study. Patient and treatment characteristics were extracted from the hospital information and treatment planning systems. All patients completed two questionnaires on continuity of care, one of which was designed in-house and one of which was taken from the literature. Results Of the 33 patients identified at baseline, 20 (60.6%) participated in this study. A median of 6 years (range 3–13) elapsed between the first and the last visit at the cancer center. The median number of involved primary oncologists at the radiation oncology department was two (range 1–5). Fifty-seven percent of radiation therapy courses were preceded by a tumor board discussion. Both questionnaires showed high levels of experienced continuity of care. No statistically significant differences in experienced continuity of care between groups with more or less than two primary oncologists was found. Discussion and conclusion Patients treated with multiple repeat radiation therapy at our department over the past decade experienced high levels of continuity of care, yet further efforts should be undertaken to coordinate care among oncological disciplines in large cancer centers through better and increased use of interdisciplinary tumor boards.

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