Multidisciplinary tumor boards: A prospective study of the impact on patient management in a community-based Brazilian cancer center.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19261-e19261
Author(s):  
Marcos Costa ◽  
Carlos Henrique Teixeira ◽  
Renata Peixoto ◽  
Waldec Jorge ◽  
Felipe Ades ◽  
...  
Keyword(s):  
Patient Care ◽  
Patient Management ◽  
Ductal Carcinoma ◽  
Study Data ◽  
Medical Decision ◽  
Cancer Center ◽  
Nccn Guidelines ◽  
Tumor Boards ◽  
Medical Planning ◽  
The Impact

e19261 Background: MDTB have emerged as a valuable forum to address questions related to patient management. There is a general data lack of its overall benefit by attending physicians. However, few reports describe numerical impact on patient care of this tailor-made and shared model of medical decision. Methods: We describe, in this prospectively-collected study, data from a Cancer Center (HAOC) regarding multiple weekly, 1h-long discussions, as part of MDTB (GU, neuro-oncology GI, thorax, HN, breast, gyneco, melanoma/sarcoma and palliative care). Only newly-diagnosed or on-treatment challenging cancer cases were included. Attendees (onco, surgeons, RT, paths and radiologists) pooled their expertise to warrant quality and maximize resources. The primary endpoint was change in the medical planning. In our institution, further adherence to MDTB recommendations are left totally at physician discretion. Results: From Oct/17 to Feb/19, 413 cases were discussed (60% female), mean of 2.9 cases/MDTB, but GI (3.8), thorax (3.7) and breast (2.94) were above the median. Mean was 13.4 doctors/MDTB - more in breast (16.5), GI (15.8) and uro (15.1). Mean of oncologist/MDTB in general was 6.1, but 8.1 in GI, 7.8 thorax, breast 6.8 and 6.7 uro. Mean of surgeons/MDTB in general was 3.5, but 6.2 in breast, 5.8 uro and 5.5 GI. 100% of all had at least 1 oncologist and uro/GI/breast had at least 1 surgeon in 100% of them. In 50% (uro), 44% (neuro), 23.5% (breast), 6.4% (thorax) and 3.7% (GI) had at least 1 physician of 5 major areas. Oncologists engaged with more cases: 80.4% (thorax), 70.6% (uro), 59.6% (GI), 56.5% (HN). Prostate (38.2%), metastasis (neuro, 28.9%), colorectal (18.2%), lung adenoCA (43.5%), mouth (30.4%), ductal carcinoma (35.8%) were the more frequently discussed per system. In 25.7%, MDTB changed original medical planning. By site: GI (35,6%), thorax (24,7%), breast (22,6%), neuro (21,7%), uro (17,7%) and HN (17,4%). Oncologists were responsible more in thorax (73,9%) and less in breast (33%) and surgeons more in breast (50%) and less in GI (33%). Adherence to NCCN guidelines was total. Finally, but not measurable, a sizeable number of cases requires significant weekly time-effort. Conclusions: This study confirms MDTB leading role in cancer care, highlighting the importance of teamwork for more precise patient care. We point out that it led to substantial practice-changing in our institution, reinforcing its importance in a scenario which doctors are confronted with increasing complexities in patient management.

Documentation of goals of care (GOC) by medical oncologists is associated with improved oncology patient end-of-life (EOL) care outcomes.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 1507-1507
Author(s):  
Han Xiao ◽  
Michael Riley ◽  
Richard Donopria ◽  
Steven Martin ◽  
Judith Eve Nelson ◽  
...  
Keyword(s):  
Patient Care ◽  
Linear Regression Analysis ◽  
Cancer Center ◽  
Oncology Patient ◽  
Patient Goals ◽  
Medical Oncologists ◽  
Hospice Referral ◽  
Care Outcomes ◽  
Eol Care ◽  
The Impact

1507 Background: Documenting GOC is integral to patient care and quality performance but has been underutilized by oncologists due to many barriers. As oncologists play a key role in initiating GOC discussions, we implemented a clinical initiative to improve their GOC documentation and evaluated the impact of such documentation on patient care during the EOL (last 30 days of life). Methods: We launched the initiative among 270 medical oncologists in an academic cancer center in 4/2020. A newly formulated GOC note to ease documentation was embedded in oncology outpatient and inpatient notes. Oncologists completed components in the GOC note that applied to their communication about GOC with the patient: 1) cancer natural history, 2) patient goals, and 3) EOL discussion: patient resuscitation preferences and, when pertinent, receptivity to hospice referral. GOC notes were pulled to a centralized location in the electronic health record (EHR) that displays documents relevant to patients’ values, goals and preferences. A dashboard allowed continual monitoring of documentation performance. We evaluated the association between GOC notes and outcomes of patient care at EOL. We further analyzed the impact of EOL discussion on EOL care. Results: The GOC note completion rate steadily rose after implementation. GOC notes were present in EHR for 46% of 10,006 patients who were either seen in outpatient clinic or discharged from hospital during the 1st week of January 2021. Among 1790 patients who died between 7/1/20 and 12/31/20 and had either at least an outpatient visit or hospitalization during EOL, the median days from first GOC note and first EOL discussion to the patient’s death were 71 days and 24 days, respectively. Linear regression analysis demonstrated that patients who had GOC note 60 days before death spent less time as inpatient during EOL (0.4 day less/patient, from 8.1 to 7.7, P = 0.01). When EOL discussion was documented 30 days before death, patients also spent less time in the hospital (1.2 days less/patient, from 9.7 to 8.5, P < 0.001) and in the ICU (0.3 days less/patient, from 1.7 to 1.4 ICU days, P = 0.04), and were 4% less likely to receive chemotherapy (from 38% to 34%, P = 0.004) at EOL. During the same period, among 1,009 patients with hospital admission in the last 30 days of life, those with a prior documented EOL discussion had shorter inpatient stay (7.7 vs 13.1 days, P < 0.001) and were more likely to be discharged to hospice (34% vs 22%, P = 0.003). Conclusions: During the COVID-19 pandemic, we successfully implemented GOC documentation by medical oncologists that is easily visible by the full care team. Documentation of GOC including EOL discussion was associated with fewer days in the hospital and ICU, increased hospice referral, and lower likelihood of receiving chemotherapy during patients’ last 30 days of life.

Assessing the impact of a targeted educational initiative on colorectal cancer lymph node retrieval: A Fox Chase Cancer Center Partners' quality initiative

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 6524-6524
Author(s):  
B. Curley ◽  
M. A. O'Grady ◽  
S. Litwin ◽  
K. Stitzenberg ◽  
H. Armitage ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Colon Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Cancer Center ◽  
Community Hospitals ◽  
Educational Initiative ◽  
Tumor Boards ◽  
Nodal Yield ◽  
The Impact

6524 Background: The retrieval of ≥12 lymph nodes in a colorectal cancer surgical specimen is an established quality metric. The impact of targeted education to improve nodal yield at community hospitals has not been studied. We initiated an intensive educational program through the Fox Chase Cancer Center Partner (FCCCP) hospitals to improve nodal retrieval in colon cancer specimens. Methods: At 12 FCCCP community hospitals from 2004–05, educational initiatives were conducted by FCCC staff and included group presentations at hospital tumor boards, cancer and quality committees, and regional CME. Individual presentations to pathologists and surgeons were held. Tumor registry data were retrospectively collected from FCCCP from 2003 (pre-intervention) to 2006 (post-intervention) for patients undergoing curative colon cancer surgery. Data abstracted were age, sex, race, stage, surgical procedure, and total number of nodes examined. The primary end point was % surgical specimens with ≥12 lymph nodes. Obtaining at least 250 records per year would allow ≥90% power to detect a change from a baseline level of ∼40% to ≥50% after intervention. Results: Data from 4,208 patients from 12 FCCCP hospitals were collected. Overall characteristics: male/female (48%/52%), race (W 83%, AA 7%, other 10%), age (<50:6%, 50–70: 34%, >70:60%), node ± (39%/61%). The % of colon cancer operations with ≥12 nodes significantly increased over the four years of the study (Table, p<.00001). This difference persisted when pooling years before and after the intervention (2003–04 vs. 2005–06, p <0.0001). There was no difference in nodal yield between two pre-intervention years (2003 vs. 2004, p=0.1). No differences in other characteristics such as age, sex, race, or % lymph node positive were noted between years. Conclusions: A multi-intervention targeted educational initiative in a large community cancer network is feasible and associated with increased colon cancer nodal retrieval. [Table: see text] No significant financial relationships to disclose.

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.

Compliance with National Comprehensive Cancer Network guidelines for antiemesis in cisplatin regimens.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 280-280
Author(s):  
Terri P. Wolf ◽  
Dana Ann Little
Keyword(s):  
National Comprehensive Cancer Network ◽  
Medical Center ◽  
Academic Medical Center ◽  
Cancer Center ◽  
Adherence Rate ◽  
Cancer Centers ◽  
Nccn Guidelines ◽  
Guideline Compliance ◽  
Cancer Network ◽  
The Impact

280 Background: The members of a network of community cancer centers affiliated with an academic medical center report following National Comprehensive Cancer Network (NCCN) guidelines. To determine guideline compliance, cisplatin regimens were audited. Cisplatin was selected because of its wide use, high emetic potential, and the impact on QOL for patients with unmanaged nausea and vomiting.The community cancer centers affiliated with an academic medical center report following National Comprehensive Cancer Network (NCCN) guidelines for treatment plans. To determine guideline compliance rates, cisplatin regimens were audited. Cisplatin was selected because of its wide use, high emetic potential, and the impact on QOL for patients with unmanaged nausea and vomiting. Methods: Prior to a chart audit, medical oncologists were surveyed on their knowledge of NCCN antiemesis guidelines, frequency of prescribing based on guidelines, and reasons for not using guidelines. Auditors identified patient charts through billing records and reviewed cycle 1 day 1 orders of cisplatin regimens. Secondary data was collected on hydration orders and home medications for antiemesis. Results: Guideline adherence varied from 0% to 76% with overall adherence at 28%. Dexamethasone doses ranged from 2-20 mg (guideline 12 mg) as did serotonin antagonists (5HT3) ordered at higher IV doses of 24-32 mg (guideline 8-16 mg). Conclusions: Although cancer centers report following the guidelines, this study did not find consistent adherence. The cancer center with the highest adherence rate works closely with a pharmacist and has built order sets with the guidelines. One cancer center had wide variances among practitioners. The variances increase the potential for error. The cancer center with lowest adherence rate used 10 mg doses of dexamethasone because the drug is delivered in 10 mg vials. This study identified multiple systems issues impacting guideline compliance. Managing nausea and vomiting is important for patient QOL and to manage costs by decreasing hospitalizations, treatment delays, and nutritional deficits. Understanding prescribing habits relative to guidelines provides an opportunity to change practice and reduce variability.

scholarly journals Modern family: Texas critical care clinicians need to know about informal marriage

2020 ◽  
Vol 8 (34) ◽  
pp. 73-76
Author(s):  
Jamie Crist
Keyword(s):  
Critical Care ◽  
Patient Care ◽  
Interpersonal Relationships ◽  
Family Relationship ◽  
Improve Patient Care ◽  
Medical Decision ◽  
Modern Family ◽  
Surrogate Decision Makers ◽  
Surrogate Decision ◽  
The Impact

Critical care clinicians are legally and ethically obligated to identify the appropriate surrogate decision-makers for patients who lack capacity and cannot make medical decisions for themselves. When the identification of the appropriate surrogate is streamlined, patient care is improved due to an uninterrupted and consistent plan of care that adheres to patient preferences. However, the process of identifying this “appropriate” person can be complex, especially as interpersonal relationships have evolved over time. One such modern family relationship is informal marriage, a Texas-specific relationship formerly known as “common-law” marriage. Though crucially important, this relationship is can difficult to recognize and frequently misunderstood. Utilizing a case study that illustrates the impact the existence of an informal marriage has on medical decision-making, this paper seeks to demystify informal marriage by outlining what makes a relationship an informal marriage and provide tools to assist clinicians with identifying it.  In an age where non-traditional relationships are more common, Texas critical care clinicians should be familiar enough with informal marriage to recognize it in their patients in order to efficiently identify surrogates and therefore improve patient care.

Quality and value of subspecialty reinterpretation of outside thoracic CT scans of patients referred to a tertiary cancer center.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 265-265
Author(s):  
Brett W. Carter ◽  
Jeremy J. Erasmus ◽  
Mylene Truong ◽  
Reginald F. Munden ◽  
Jo-Anne O. Shepard ◽  
...  
Keyword(s):  
Poor Quality ◽  
Chest Ct ◽  
Ct Scans ◽  
Cancer Center ◽  
Management Change ◽  
Nccn Guidelines ◽  
Radiology Reports ◽  
The Impact ◽  
Tertiary Cancer Center

265 Background: At tertiary cancer centers, physicians frequently request reinterpretation of imaging studies performed at outside institutions. The purposes of this study were to determine the quality of outside computed tomography (CT) scans of the chest and compare the accuracy of accompanying radiology reports from outside institutions and our multidisciplinary cancer center. Methods: Two thoracic radiologists graded the quality of 59 outside chest CT scans and generated independent reports for 52 of the scans. A third thoracic radiologist scored the outside reports and reinterpretations for quality. Fisher’s exact tests were used to compare the frequency with which crucial items appeared in outside reports and reinterpretations. Next, two outside thoracic radiologists identified discrepancies between outside reports and reinterpretations (first radiologist) and determined whether the outside report or reinterpretation was more accurate in each case (second radiologist). Finally, the impact of discrepancies on management was evaluated, largely based on NCCN guidelines. Results: Of the 59 outside CT scans, 35 (59%) were of poor quality. Reinterpretations were more likely than outside reports to include information about lymph nodes, adrenal and liver metastasis, tumor nodules, and tumor texture. In 19 of 52 cases (37%), discrepancies were identified between outside reports and reinterpretations. In 17 of these cases, the reinterpretation was superior; in 2 cases, the reinterpretation and outside report were of equal quality. Among these 17 cases, reinterpretation allowed staging in nine cases that could not be staged with information from the outside reports; resulted in upstaging without management change in one case and upstaging with management change in four cases among the five cases with staging information present in both sets of reports; and revealed a significant omission (2 cases) or error (1 case) that changed management in three cases. In total, reinterpretation resulted in significant changes to 16 of 52 (31%) of CT scans. Conclusions: Subspecialty reinterpretation of chest CT scans can substantially improve clinical management.

Early versus late patient discussions in multidisciplinary tumor boards: Quality time for quality care.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e13539-e13539
Author(s):  
Sharif Ahmed ◽  
Greg Kubicek
Keyword(s):  
Patient Care ◽  
Median Time ◽  
Quality Care ◽  
Median Number ◽  
Quality Patient Care ◽  
Number Of Patients ◽  
Tumor Boards ◽  
Nurse Navigator ◽  
The Impact ◽  
Disease Specific

e13539 Background: Multi-disciplinary tumor boards (MTB) are a way to generate quality patient care by allowing different specialties to provide insight into patient care. While the vast majority of hospital systems have MTB there are several aspects of how to run the most efficient MTB. The aim of this study was to determine if there was a difference in patients presented early versus late in MTB. Methods: At our institution we have disease specific weekly MTB. Patients are added to MTB based on order they are received (physicians or APN will send patient name to the disease specific nurse navigator). We recorded the time devoted to each patient and the number of providers that gave a comment or suggestion per patient. The time and number of comments were compared for patients presented at the start of MTB versus towards the end of MTB. Unpaired T test was used to compare time and comments. Results: We analyzed a total of 25 MTBs which corresponded to 241 patients. The median number of patients discussed per MTB was 9 (range 5 to 16). The median time spent per patient was 5.21 minutes and the median number of providers providing comments was 3 (range 1 to 9) with an average of 3.2. When analyzed by the first 8 patients versus the remainder, the median time spent was 6.1 minutes on the first 1-8 patients and 3.4 for > 8 (P < 0.0001). The mean number of comments was 3.4 for the first 1-8 patients and 2.4 for > 8 (P < 0.0001). Conclusions: We found that patients discussed towards the end of weekly MTB had less amount of time per devoted per patient and less discussion (as measured by number of providers supplying comments and suggestions). While the impact on long-term patient care is unclear we feel that this data is important in helping to ensure productive MTB discussions and avoid any arbitrary factor for reduced multidisciplinary insight. MTB should be cognitive of this time and attention biases.

scholarly journals E-Mail Communication Practices and Preferences Among Patients and Providers in a Large Comprehensive Cancer Center

2016 ◽  
Vol 12 (7) ◽  
pp. 676-684 ◽  
Author(s):  
Natalie Cook ◽  
Manjula Maganti ◽  
Aditi Dobriyal ◽  
Michal Sheinis ◽  
Alice C. Wei ◽  
...  
Keyword(s):  
Health Care ◽  
Patient Care ◽  
Health Care Team ◽  
Care Team ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Cross Sectional ◽  
Factors Associated ◽  
The Impact ◽  
E Mail

Purpose: Little is known about how electronic mail (e-mail) is currently used in oncology practice to facilitate patient care. The objective of our study was to understand the current e-mail practices and preferences of patients and physicians in a large comprehensive cancer center. Methods: Separate cross-sectional surveys were administered to patients and physicians (staff physicians and clinical fellows) at the Princess Margaret Cancer Centre. Logistic regression was used to identify factors associated with current e-mail use. Record review was performed to assess the impact of e-mail communication on care. Results: The survey was completed by 833 patients. E-mail contact with a member of the health care team was reported by 41% of respondents. The team members contacted included administrative assistants (52%), nurses (45%), specialist physicians (36%), and family physicians (18%). Patient factors associated with a higher likelihood of e-mail contact with the health care team included younger age, higher education, higher income, enrollment in a clinical trial, and receipt of multiple treatments. Eighty percent of physicians (n = 63 of 79) reported previous contact with a patient via e-mail. Physician factors associated with a greater likelihood of e-mail contact with patients included older age, more senior clinical position, and higher patient volume. Nine hundred sixty-two patient records were reviewed, with e-mail correspondence documented in only 9% of cases. Conclusion: E-mail is commonly used for patient care but is poorly documented. The use of e-mail in this setting can be developed with appropriate guidance; however, there may be concerns about widening the gap between certain groups of patients.

Impact of Clinical Pharmacy Services on Patient Management in the Chemotherapy Infusion Clinics: A 5-Year Study at a Comprehensive Cancer Center

2021 ◽  
pp. 089719002110034
Author(s):  
Ola K. Mashni ◽  
Lama H. Nazer ◽  
Haya Z. Khalil ◽  
Maha I. Dalbah ◽  
Haitham W. Tuffaha ◽  
...  
Keyword(s):  
Clinical Pharmacy ◽  
Patient Management ◽  
Ambulatory Setting ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Pharmacy Services ◽  
Clinical Pharmacy Services ◽  
Clinical Pharmacists ◽  
Chemotherapy Infusion ◽  
The Impact

Background: Chemotherapy requires careful dosing and monitoring and is associated with numerous adverse events. There is limited data describing the impact of clinical pharmacists in the chemotherapy ambulatory setting. Objective: This study aimed to evaluate the impact of clinical pharmacy services on patient management in the adult chemotherapy infusion clinics. Methods: This was a 5-year retrospective study that utilized the pharmacy electronic documentation system to determine the type of interventions and adverse drug events (ADEs) reported by the clinical pharmacists in the chemotherapy infusion clinics. Interventions were described based on the type of intervention and medication involved. ADEs were evaluated based on the type of ADE, the suspected medication, and the required management. Results: During the study period, 3,279 interventions and 1,445 ADEs were reported. The most common interventions involved dose adjustments (51%), followed by addition (23%) or discontinuation (21%) of prescribed medications. Carboplatin (20%) and zoledronic acid (14%) were the most common medications that required pharmacist interventions. The most common types of ADEs were hematologic (22%) and infusion-related reactions (20%). Docetaxel was the most common medication associated with ADEs (20%). Among the reported ADEs, most required adding supportive care (44%), followed by adjusting chemotherapy doses (22%). Conclusion: Clinical pharmacy services at the chemotherapy infusion clinics play an important role in optimizing the chemotherapy regimens as well as identifying and managing ADEs. Future studies should be directed to measure the impact of these services on patient outcomes as well as, physicians and pharmacy operational workload and cost savings.

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