scholarly journals Development of a virtual multidisciplinary lung cancer tumor board in a community setting.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 325-325
Author(s):  
Marvaretta Miesha Stevenson ◽  
Tonia Irwin ◽  
Terry Lowry ◽  
Maleka Zafreen Ahmed ◽  
Thomas L. Walden ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Treatment Guidelines ◽  
Treatment Plan ◽  
Community Setting ◽  
Multidisciplinary Care ◽  
Tumor Board ◽  
Definitive Treatment ◽  
Cancer Center ◽  
Web Conferencing ◽  
Virtual Conference

325 Background: Creating an effective platform for multidisciplinary tumor conferences can be challenging in the rural community setting. The Duke Oncology Network, which is affiliated with hospitals in rural locations throughout North Carolina, created an internet-based platform for a multidisciplinary conference to enhance the care of lung cancer patients in the community. This conference incorporates providers from different physical locations within the community and affiliated providers from a university-based cancer center two hours away. An electronic approach connects providers through space and time vocally and visually. Methods: Development of the virtual conference began in February 2009. Biweekly conferences were set up using the Adobe Connect web conferencing platform. This provides a secure website and phone line to ensure patient confidentiality. Case information is de-identified and incorporated into a slideshow uploaded to the platform. Multiple disciplines are invited to participate, including radiology, radiation oncology, thoracic surgery, pathology, pulmonology, and medical oncology. Participants only need telephone access and internet connection to participate. Results: The first virtual tumor board occurred December 14, 2009. Patient histories and physicals are presented, and the web conferencing platform allows radiologic and histologic images to be reviewed. Treatment plans for patients are discussed, allowing providers to coordinate care among the different subspecialties. Patients are identified that need referral to the affiliated university-based cancer center for specialized services. Pertinent treatment guidelines and journal articles are reviewed. In 2011, there were 9-10 participants per session, with 2-3 cases presented, on average. Conclusions: The use of a web conferencing platform allows subspecialty providers throughout the community and hours away to participate in discussing lung cancer patient cases. This platform increases convenience for providers, eliminating travel time to a central location. Coordination of care for patients requiring multidisciplinary care is facilitated, shortening evaluation time prior to definitive treatment plan.

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 Development of a Virtual Multidisciplinary Lung Cancer Tumor Board in a Community Setting

2013 ◽  
Vol 9 (3) ◽  
pp. e77-e80 ◽  
Author(s):  
Marvaretta M. Stevenson ◽  
Tonia Irwin ◽  
Terry Lowry ◽  
Maleka Z. Ahmed ◽  
Thomas L. Walden ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Patient ◽  
Lung Cancer Patient ◽  
Community Setting ◽  
Tumor Board ◽  
Web Conferencing ◽  
Central Location ◽  
Cancer Tumor

The use of a Web conferencing platform allows subspecialty providers throughout the community and hours away to discuss lung cancer patient cases and increases convenience for providers by eliminating travel to a central location.

scholarly journals Collaborative Pediatric Bone Tumor Program to Improve Access to Specialized Care: An Initiative by the Lebanese Children’s Oncology Group

2017 ◽  
Vol 3 (1) ◽  
pp. 23-30 ◽  
Author(s):  
Raya Saab ◽  
Zeina Merabi ◽  
Miguel R. Abboud ◽  
Samar Muwakkit ◽  
Peter Noun ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Local Control ◽  
Bone Tumor ◽  
Bone Tumors ◽  
Treatment Plan ◽  
Multidisciplinary Care ◽  
Tumor Board ◽  
Cancer Center ◽  
Financial Barriers ◽  
Complex Needs

Background Children with malignant bone tumors have average 5-year survival rates of 60% to 70% with current multimodality therapy. Local control modalities aimed at preserving function greatly influence the quality of life of long-term survivors. In developing countries, the limited availability of multidisciplinary care and limited expertise in specialized surgery and pediatric radiation therapy, as well as financial cost, all form barriers to achieving optimal outcomes in this population. Methods We describe the establishment of a collaborative pediatric bone tumor program among a group of pediatric oncologists in Lebanon and Syria. This program provides access to specialized local control at a tertiary children’s cancer center to pediatric patients with newly diagnosed bone tumors at participating sites. Central review of pathology, staging, and treatment planning is performed in a multidisciplinary tumor board setting. Patients receive chemotherapy at their respective centers on a unified treatment plan. Surgery and/or radiation therapy are performed centrally by specialized staff at the children’s cancer center. Cost barriers were resolved through a program development initiative led by St Jude Children’s Research Hospital. Once program feasibility was achieved, the Children’s Cancer Center of Lebanon Foundation, via fundraising efforts, provided continuation of program-directed funding. Results Findings over a 3-year period showed the feasibility of this project, with timely local control and protocol adherence at eight collaborating centers. We report success in providing standard-of-care multidisciplinary therapy to this patient population with complex needs and financially challenging surgical procedures. Conclusion This initiative can serve as a model, noting that facilitating access to specialized multidisciplinary care, resolution of financial barriers, and close administrative coordination all greatly contributed to the success of the program.

Development of a patient-oriented navigation model for lung cancer patients.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18033-e18033
Author(s):  
Christine Holmberg ◽  
Kathrin Gödde ◽  
Hella Fuegemann ◽  
Jacqueline Mueller-Nordhorn ◽  
Nina Rieckmann ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Data Analysis ◽  
Cancer Patients ◽  
Secondary Data ◽  
Secondary Data Analysis ◽  
Tumor Board ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Optimal Care ◽  
Lung Cancer Patients

e18033 Background: Patient navigation is seen to support and enable patient-oriented, optimal care both in palliative and in screening settings. However, the evidence remains inconclusive on what patient groups are best targeted by navigation and what may be improved by such a care model. Lung cancer patients are at particular risk for sub-optimal care because they face complex care trajectories due to severe and rapid disease progression and accompanying comorbidity. Methods: To develop a navigation model for lung cancer, we conducted a mixed-methods study to investigate who may be at risk of receiving sub-optimal care in the German health care setting. To capture the patient perspective a longitudinal qualitative component was included with patients (N = 20) assessed at three dtime points. In addition, a secondary data analysis of cancer registry data of a comprehensive cancer center was conducted and a repository of patient support offers gathered. Results of the study components were integrated to develop a patient-oriented navigation model. Results: Secondary data analysis showed that medical care functioned according to tumor board recommendations. Patient data revealed institutional barriers that conflict with individual needs and preferences. A lack of contact persons, information provision as well as bureaucratic difficulties were identified. Patients without a social network seem particularly in need for support. Identification of regional support offers shows that there are resources available to meet some of these needs. However, knowledge on such offers was not common among patients and caregivers. Navigators should provide practical support, give advice on social care issues and refer to existing support offers. Conclusions: Social networks crucial. Patients lack knowledge to use available resources. Navigation needs to be implemented within existing care structures to reach patients.

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.

Understanding practices and gaps in multidisciplinary hepatocellular carcinoma (HCC) care within the community oncology setting.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 390-390
Author(s):  
Lorna Lucas ◽  
Philip Agop Philip ◽  
Marianne Gandee ◽  
Amanda Kramar
Keyword(s):  
Clinical Trials ◽  
Community Care ◽  
Care Delivery ◽  
Delayed Diagnosis ◽  
Multidisciplinary Care ◽  
Tumor Board ◽  
Cancer Center ◽  
Multidisciplinary Teams ◽  
Nccn Guidelines ◽  
Psychosocial Services

390 Background: HCC incidence continues to rise and presents a myriad of complex challenges involving multi disciplines to screen, diagnose, and provide personalized therapy. Recent advances in diagnostics and therapies necessitate a well-coordinated multidisciplinary approach in managing HCC patients, signaling a need to understand care within community care. The study aimed to understand how multidisciplinary cancer programs were structured to manage HCC care and to identify challenges and practices for management of HCC, a cancer less commonly seen in community care settings. Methods: The Association of Community Cancer Centers (ACCC) developed a survey to identify factors associated with delivery and coordination of care for HCC patients. The survey deployed electronically in July 2018 to multidisciplinary providers, representing 17 oncology professions. Of responses (n = 31), 69% identified their care setting as a “non-teaching community hospital, freestanding cancer center, private practice or other.” Results: 61% of respondents indicated their cancer programs do not have specialized hepatobiliary multidisciplinary team. Among those who have hepatobiliary multidisciplinary teams the composition and degree of specialization varied. 85% of respondents that do not have a specialized hepatobiliary team indicated that HCC patients are managed in consultation with a general tumor board. 52% indicated their program discussed participation in clinical trials with all HCC patients, and 55% of cancer programs conducted HCC clinical trials. 52% indicated their program had a formal pathway that outlines adherence to the NCCN guidelines for HCC management, 5% were in the process of developing and 43% were not in the process of developing such a pathway. Of respondents that reported barriers their program faces (n = 13) 31% indicated lack of psychosocial services, lack of screening and no/limited access to clinical trials. 23% responded delayed treatment and 15% responded delayed diagnosis as challenges. Conclusions: Review of multidisciplinary care delivery for HCC patients revealed unique protocols and challenges within primarily community-based settings.

Effect of a multidisciplinary cancer conference for thoracic malignancies on patient care management.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 112-112
Author(s):  
Henner M. Schmidt ◽  
John M. Roberts ◽  
Artur M. Bodnar ◽  
Steven H. Kirtland ◽  
Sonia H. Kunz ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Decision Making ◽  
Esophageal Cancer ◽  
Cancer Patients ◽  
Treatment Plan ◽  
Treatment Decision ◽  
Primary Treatment ◽  
Prior Treatment ◽  
Tumor Board ◽  
Treatment Decision Making

112 Background: Treatment of thoracic cancers frequently involve multiple subspecialties thus treatment decisions are typically best facilitated in multidisciplinary tumor boards (MTB). This approach should facilitate and improve treatment decision making, standardize staging and therapeutic decisions and improve outcomes. In this study we analyze the evolution in staging and treatment decision making associated with presentation at MTB. Methods: Retrospective review of all patients with lung or esophageal cancer presented at our weekly MTB from June 1, 2010 to September 30, 2012. All providers submitting patients to tumor board recorded their current treatment plan prior to presentation. The physician’s plan was then compared to the tumor board’s final recommendation. Changes made were graded according to degree of magnitude as minor, moderate or major change. Minor changes included changes in diagnostic imaging. Moderate changes involved modifications in the type of invasive staging or biopsy procedures. Major changes were defined as changes to final therapeutic plans such as surgery, chemotherapy, or radiation therapy. Results: 435 patients with esophageal or lung cancer were discussed in the MTB. 86 patients having no prior treatment plan available were excluded. In the remaining 347 patients there were 163 patients with esophageal cancer (47%) and 184 patients with lung cancer (53%). In the esophageal cancer patients a change to the physician’s prior treatment plan was recommended in 33 cases (21%). For lung cancer patients a change in the treatment plan was recommended in 50 cases (27%). Overall a recommendation for change in treatment occurred in 83 cases (24 %). Changes were major 13%, moderate 6% and minor 5%. Follow-up in 249 patients confirmed that MTB recommendations were followed in 97% of cases. Conclusions: MTB recommendations frequently differs from the physician’s primary treatment plan. MTB reviews have previously been documented to improve patient’s outcome. The study demonstrates that in one quarter of patients MTB recommendation will be different from the primary treatment plan. Complex cancer patients should be considered for presentation at MTB whenever feasible.

Impact of multidisciplinary discussion on therapeutic decision in cancer patients: a prospective observational study.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18243-e18243
Author(s):  
Carla Pires Amaro ◽  
Larissa Gomes ◽  
Daniel Almeida ◽  
Kelly Reiner ◽  
Gustavo Fernandes Godoy Almeida ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Decision Making ◽  
Cancer Patients ◽  
Rate Of Change ◽  
Tumor Board ◽  
Cancer Center ◽  
Final Decision ◽  
Main Theme ◽  
Number Of Patients ◽  
The Impact

e18243 Background: Continued and rapid evolution of diagnosis and staging methods along with the development of new treatments has changed decision-making process of cancer patient into a more complex task. We evaluated the impact of multidisciplinary tumor board meetings (MTM) in the final decision of cancer patients approach in comparison to the initial decision based on clinical oncologist’s individual choice. Methods: Between April 2016 and January 2017, data were collected prospectively during the MTM held daily at the Antônio Ermírio de Moraes Cancer Center, Sao Paulo, Brazil. Data were gathered by filling out a questionnaire. The therapeutic plan initialy proposed by the physician was compared to the proposal offered by the multidisciplinary team. We evaluated data from breast, gastrointestinal (GI) and lung cancer MTM. Results: We evaluated 100 questionnaires: 39% GI tumors, 34% lung cancer, 27% breast cancer. The main theme for discussion was selection of systemic therapy (65%). The rate of change in therapy choice was 24.6%. The recommendation suggested by the MTM surgeons and radio-oncologists showed disagreement with the one initially proposed in 21 cases. The majority of discordant cases was related to the choice of therapeutic method (57%) with 42% changes in the chemotherapy protocol. Eight patients were submitted to genetic test and mutations search. Only two cases were recommended for clinical trial enrollment. Conclusions: The rate of therapy plan change after MTM is in accordance with international studies. The largest volume of discussions on systemic therapies reflects the large number of new therapies as well as new treatment strategies. This research highlights the potential of multidisciplinary discussions in changing decision-making in cancer cases, allowing a more comprehensive care with the patient. In addition, a MTM allows the access of more patients to new medications made available through clinical trials and protocols. The small number of patients referred to a clinical study reflects the lack of clinical protocols available in Brazil, a problem that needs to be acknowledged and become a priority for Brazilian medical societies and regulatory agencies.

scholarly journals Posttransplant Lymphoproliferative Disorder Presenting as Testicular Lymphoma in a Kidney Transplant Recipient: A Case Report and Review of the Literature

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Steve Omoruyi Obanor ◽  
Michelle Gruttadauria ◽  
Kayla Applebaum ◽  
Mohammad Eskandari ◽  
Michelle Lieberman Lubetzky ◽  
...  
Keyword(s):  
Lymphoproliferative Disorder ◽  
Treatment Guidelines ◽  
Treatment Plan ◽  
Kidney Transplant Recipient ◽  
B Cell Lymphoma ◽  
Definitive Treatment ◽  
Intrathecal Methotrexate ◽  
Posttransplant Lymphoproliferative Disorder ◽  
Testicular Lymphoma ◽  
One Year

Posttransplant lymphoproliferative disorder (PTLD) is a malignancy caused by the immunosuppression that occurs after transplantation. It is primarily a nodal lesion but frequently it involves extranodal masses. Treatment is usually by reducing immunosuppressive therapy. Testicular lymphoma as PTLD is notably rare in documented literature and there is limited evidence of definitive treatment guidelines. This manuscript describes a patient who developed diffuse large B-cell lymphoma of his right testis one year following kidney transplantation. A diagnosis of PTLD was made and treatment with rituximab, locoregional radiotherapy, and intrathecal methotrexate in addition to the standard reduction of immunosuppression resulted in complete remission until now. We submit this case along with literature review of similar cases in the past and a review of specific peculiarities of our case with emphasis on our treatment plan to further the understanding of this diversiform disease.

scholarly journals Quality indicators and excellence requirements for a multidisciplinary lung cancer tumor board by the Spanish Lung Cancer Group

2021 ◽  
Author(s):  
M. Guirado ◽  
A. Sanchez-Hernandez ◽  
L. Pijuan ◽  
C. Teixido ◽  
A. Gómez-Caamaño ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Quality Indicators ◽  
Optimal Strategies ◽  
Multidisciplinary Care ◽  
Tumor Board ◽  
Multidisciplinary Teams ◽  
Key Factors ◽  
Optimal Care ◽  
Cancer Group ◽  
Cancer Tumor

AbstractMultidisciplinary care is needed to decide the best therapeutic approach and to provide optimal care to patients with lung cancer (LC). Multidisciplinary teams (MDTs) are optimal strategies for the management of patients with LC and have been associated with better outcomes, such as an increase in quality of life and survival. The Spanish Lung Cancer Group has promoted this review about the current situation of the existing national LC-MDTs, which also offers a set of excellence requirements and quality indicators to achieve the best care in any patient with LC. Time and sufficient resources; leadership; administrative and institutional support; and recording of activity are key factors for the success of LC-MDTs. A set of excellence requirements in terms of staff, resources and organization of the LC-MDT have been proposed. At last, a list of quality indicators has been agreed to achieve and measure the performance of current LC-MDTs.

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