scholarly journals Guideline Adherence and Implementation of Tumor Board Therapy Recommendations for Patients With Gastrointestinal Cancer

2022 ◽  
Author(s):  
Alina Krause ◽  
Gertraud Stocker ◽  
Ines Gockel ◽  
Daniel Seehofer ◽  
Albrecht Hoffmann ◽  
...  
Keyword(s):  
Guideline Adherence ◽  
Assessment Tool ◽  
Performance Status ◽  
Quality Criterion ◽  
Tumor Board ◽  
Treatment Recommendation ◽  
Guideline Recommendation ◽  
Cancer Center ◽  
Therapy Recommendations ◽  
Tumor Boards

Abstract Purpose: Although participation in multidisciplinary tumor boards (MTBs) is an obligatory quality criterion for certification, there is scarce evidence, whether MTB recommendations are consistent with consensus guidelines and whether they are followed in clinical practice. Reasons of guideline and tumor board deviations are poorly understood so far. Methods: MTBs recommendations from the weekly MTB for gastrointestinal cancers at the University Cancer Center Leipzig/Germany (UCCL) in 2020 were analyzed for their adherence to therapy recommendations as stated in National German guidelines and implementation within an observation period of 3 months. To assess adherence, an objective classification system was developed assigning a degree of guideline and tumor board adherence to each MTB case. For cases with deviations, underlying causes and influencing factors were investigated and categorized. Results: 76% of MTBs were fully adherent to guidelines, with 16% showing deviations, mainly due to study inclusions and patient comorbidities. Guideline adherence in 8% of case discussions could not be determined, especially because there was no underlying guideline recommendation for the specific topic. Full implementation of the MTBs treatment recommendation occurred in 64% of all cases, while 21% showed deviations with primarily reasons of comorbidities and differing patient wishes. Significantly lower guideline and tumor board adherences were demonstrated in patients with reduced performance status (ECOG-PS ≥ 2) and for palliative intended therapy (p=.002/.007). Conclusion: The assessment of guideline deviations and adherence to MTB decisions by a systematic and objective quality assessment tool could become a meaningful quality criterion for cancer centers in Germany.

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.

Quality assessment of tumor boards across an academic and community cancer network.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 122-122
Author(s):  
Daniel Aaron Roberts ◽  
Robert Stuver ◽  
Igor Schillevoort ◽  
Jessica A. Zerillo
Keyword(s):  
Quality Assessment ◽  
Response Rate ◽  
Gynecologic Oncology ◽  
The United States ◽  
Tumor Board ◽  
Cancer Center ◽  
Measurement Tool ◽  
Tumor Boards ◽  
Assessment Survey ◽  
Cancer Network

122 Background: Cancer tumor boards (TB), or multidisciplinary team meetings are standard of care in oncology care worldwide. Specific components are described by the American College of Surgeon's Commission on Cancer Program. Most data show consistent improvement in outcomes including a change in diagnostic findings, treatment, and possibly improved survival with TBs. Methods: We adapted a performance assessment tool based on a validated survey implemented in the United Kingdom. An initial survey aimed at assessing tumor board structure and design was sent to 21 TB leaders, and subsequently a tumor board quality assessment survey was sent to 175 participants throughout an academic and community network. The quality assessment survey required participants to identify an answer on a 5-point Likert scale in the categories of "very poor, poor, average, good, and very good". Results: TB leaders representing 16 of 21 (response rate 76%) TBs responded to the structure/design survey. Twelve TBs were from the academic center and included diseases such as Gynecologic Oncology, Cutaneous Oncology, Genitourinary Oncology, and Sarcoma, while four were from community sites. TB leaders indicated that 55% of TBs did not receive CME credit and 60% did not document their recommendations. One hundred eleven TB participants of 175 (response rate 63%) responded to the quality assessment survey. Participants identified the following strengths: 1) all relevant subspecialties present for meetings, 2) respectful teamwork and culture, and 3) operating on an organized agenda. Areas for improvement included: 1) inconsistent tumor board recommendation documentation and 2) post-meeting coordination of care. Results were reviewed with network and cancer center leadership as well as with the Cancer Committee. Conclusions: We assessed our own tumor boards across our cancer network by utilizing an adapted version of a validated TB performance measurement tool for the first time in the United States. Through this assessment we identified key areas for improvement including the need for obtaining CME credit for TB attendance, and developed a policy, process, and template for documenting TB recommendations in an easily accessible centralized location.

Performance of the patient reported CAPLET2.0 physical functioning assessment tool.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 194-194
Author(s):  
Alexandra McCartney ◽  
Julia Singer ◽  
Reenika Aggarwal ◽  
Katrina Hueniken ◽  
Raiza Commiting ◽  
...  
Keyword(s):  
Physical Function ◽  
Cancer Patients ◽  
Physical Functioning ◽  
Assessment Tool ◽  
Performance Status ◽  
Patient Reported Outcome ◽  
Cancer Center ◽  
Patient Reported ◽  
Hematological Cancers ◽  
Screening Questions

194 Background: CAPLET is a published patient reported outcome measure which assesses domains of physical function efficiently in cancer patients through a branching logic algorithm using a patient-reported outcome version of ECOG performance status and EQ5D-3L health utility score (PMID: 29982902; a total of 6 screening questions). We assessed the sensitivity and specificity of this tool after updating it with screening questions from the EQ5D-5L (CAPLET2.0) as opposed to the previously published EQ5D-3L screener (CAPLET). Methods: Eligible cancer patients across all outpatient clinics and disease sites (solid and liquid cancers) at the Princess Margaret Cancer Center completed a questionnaire on touch-screen technology containing the EQ5D-5L, patient-reported outcome (PRO)-ECOG performance scale, the gold standard WHODAS 2.0 (12 items) and HAQ-DI (20 items) physical functioning questionnaires, and a clinico-demographic survey. Results: Of 261 patients, 53% were female, 61% were Caucasian, and 71% had English as a first language. Disease sites included: 12% breast, 10% gastrointestinal, 12% genitourinary, 19% gynecological, 13% head and neck, 13% lung and 13% hematological cancers. The optimal branching logic cut-points were identified when PRO-ECOG, scored as 0-1 and individual EQ5D items scored with the best functioning category allowed specific WHODAS/HAQ-DI questions to be skipped. Against individual WHODAS-HAQ-DI items, CAPLET2.0 had sensitivities ranging from 83-100% (median 93%), and specificities of 50-82% (median 58%). Using CAPLET 2.0, 45% of patients could have skipped all but five questions measuring mental health and cognition which are always asked. Sensitivities, specificities and the proportion of questions that could have been skipped were all similar to the original CAPLET tool. Conclusions: CAPLET2.0, which uses the updated EQ5D-5L and PRO-ECOG as screening questions to assess physical function in cancer patients has comparable performance to the original CAPLET tool. CAPLET2.0 is therefore a viable alternative physical functioning screening tool for both routine and research use.

A virtual tumor board-driven synaptic knowledge network.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 89-89
Author(s):  
Laurence J. Heifetz ◽  
Ahrin B. Koppel ◽  
Elaine Melissa Kaime ◽  
Daphne Palmer ◽  
Thomas John Semrad ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Rural Areas ◽  
Cancer Care ◽  
Knowledge Network ◽  
Tumor Board ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Hospital District ◽  
Number Of Patients ◽  
Tumor Boards

89 Background: In 2006, Tahoe Forest Hospital District—a 25-bed hospital in Truckee, CA, a mountain resort community one hour from regional and two hours from academic cancer services—designed and implemented an oncology program utilizing effective telecommunications with a committed academic partner, the UC Davis Comprehensive Cancer Center in Sacramento. Methods: The UC Davis Cancer Care Network was established with four remote cancer programs, enabling participation in daily virtual tumor boards, clinical trial enrollment, and quality assurance assistance. (Richard J. Bold, et. al., Virtual tumor boards: community-university collaboration to improve quality of care. Community Oncol 10(11):310-315, November 2013.; Laurence J. Heifetz, MD, et. al., A Model for Rural Oncology. J Oncol Pract, 7:168-171, May 2011.). An increasing number of patients were observed to in-migrate to Truckee from even more remote rural areas in the mountains. In 2013, the now Gene Upshaw Memorial Tahoe Forest Cancer Center developed four remote telemedicine clinics to allow even more physically distant patients the capacity to be followed locally. Results: Since we opened the remote telemedicine clinics, our Sullivan-Luallin patient satisfaction scores have averaged 4.82/5.00 for “overall satisfaction with the practice” and 4.90/5.00 for “recommending your provider to others”; our in-migration rate of patients from outside our primary catchment area increased from 43% to 52%: and clinical trial accrual rate averaged 10%. Conclusions: Reducing cancer health disparities is an ASCO mission. (cover, ASCO Connection, July 2014; Laurence J. Heifetz, MD. Country Docs with City Technology Can Address Rural Cancer Care Disparities. Oncol, 29(9):641-644, September 2015.). We believe this synaptic knowledge network effectively addresses that mission for rural communities. This model can be scaled in many configurations to address the inherent degradation of quality care as a function of physical distance to an academic center that rural doctors and patients deal with on a daily basis. The key is to insist on a cultural shift – Do something smart at lunch every day. Attend a virtual tumor board.

scholarly journals Challenges and Experiences Extending the cBioPortal for Cancer Genomics to a Molecular Tumor Board Platform

2021 ◽  
Author(s):  
Niklas Reimer ◽  
Philipp Unberath ◽  
Hauke Busch ◽  
Melanie Börries ◽  
Patrick Metzger ◽  
...  
Keyword(s):  
Decision Making ◽  
Cancer Patients ◽  
Cancer Genomics ◽  
Tumor Board ◽  
Molecular Profile ◽  
Therapy Recommendations ◽  
Tumor Boards ◽  
Research Platform ◽  
Molecular Tumor Board ◽  
Aid Decision

In Molecular Tumor Boards (MTBs), therapy recommendations for cancer patients are discussed. To aid decision-making based on the patient’s molecular profile, the research platform cBioPortal was extended based on users’ requirements. Additionally, a comprehensive dockerized workflow was developed to support the deployment of cBioPortal and connected services. In this work, we present the challenges and experiences of nearly two years of implementing and deploying an MTB platform based on cBioPortal and compare those to findings of a previous study.

scholarly journals Targeting Lymph Node Retrieval and Assessment in Stage II Colon Cancer: A Quality Outcome Community-Based Cancer Center Study

2008 ◽  
Vol 4 (2) ◽  
pp. 55-58 ◽  
Author(s):  
Thomas Grote ◽  
Amy H. Hughes ◽  
Cathy C. Rimmer ◽  
Dale A. Less ◽  
Amy P. Abernethy ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Median Number ◽  
Stage Ii ◽  
Tumor Board ◽  
Cancer Center ◽  
Gastrointestinal Tumor ◽  
Tumor Boards ◽  
Stage Ii Colon Cancer

Purpose Adequate lymph node evaluation is required for the proper staging of colon cancer. The current recommended number of lymph nodes that should be retrieved and assessed is 12. Methods The multidisciplinary Gastrointestinal Tumor Board at the Derrick L. Davis Forsyth Regional Cancer Center reviewed and recommended that a minimum of 12 lymph nodes be examined in all cases of colon cancer to ensure proper staging. This recommendation occurred at the end of the first quarter of 2005. To ensure this new standard was being followed, an outcomes study looking at the number of lymph nodes evaluated in stage II colon cancer was initiated. All patients with stage II colon cancer diagnosed between 2004 and 2006 were reviewed. Results There was a statistically significant improvement in the number of stage II colon cancer patients with 12 or more lymph nodes evaluated. Before the Gastrointestinal Tumor Board's recommendation, 49% (40 out of 82 patients) had 12 or more lymph nodes sampled. The median number of lymph nodes evaluated was 11. After the Gastrointestinal Tumor Board's recommendation, 79% (70 out of 88 patients) had 12 or more lymph nodes sampled. The median number of lymph nodes was 16. Conclusion Multidisciplinary tumor boards can impact the quality of care of patients as demonstrated in this study. Although we do not yet have survival data on these patients, based on the previous literature referenced in this article, we would expect to see an improvement in survival rates in patients with 12 or more nodes retrieved and assessed.

scholarly journals A digital tumor board solution impacts case discussion time and postponement of cases in tumor boards

2021 ◽  
Vol 11 (3) ◽  
pp. 525-533
Author(s):  
Richard D. Hammer ◽  
Donna Fowler ◽  
Lincoln R. Sheets ◽  
Athanasios Siadimas ◽  
Chaohui Guo ◽  
...  
Keyword(s):  
Data Access ◽  
Tumor Board ◽  
Cancer Center ◽  
Case Discussion ◽  
Average Case ◽  
Tumor Boards ◽  
Nurse Navigator ◽  
Cancer Types ◽  
A Prospective Study ◽  
The Impact

AbstractMultidisciplinary tumor boards (TBs) is an integral part of cancer care. Emerging evidence shows that effective TB implementation is crucial. It remains largely unknown how digital solutions can assist effective TB conduction. This study aimed to evaluate the impact of a digital solution on case discussion during TB meetings in four cancer types: Breast, Gastrointestinal (GI), Ear, Nose & Throat (ENT), and Hematopathology. A prospective study was performed to evaluate case discussion time during TB meetings pre- and post-solution implementation, at an US academic healthcare cancer center. Data were recorded by a Nurse Navigator for each case during TB meetings. Case discussion times were recorded for 2312 patients, at a total of 286 TB meetings. Significant decreases were observed in the average case discussion time for the breast and GI TBs. We observed a trend for reduction in discussion time variance for all TBs, suggesting the potential of the digital solution to standardize case discussion via provision of uniform case presentation and data access. Postponement rate decreased from 23 to 10% for ENT TB. This study demonstrated that the digital solution enhanced effective TB implementation, with heterogeneity across cancer types.

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.

The impact of clinical decision making in a molecular tumor board at a tertiary care center.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 3128-3128
Author(s):  
Meena Sadaps ◽  
Kathryn Demski ◽  
Ying Ni ◽  
Vicky Konig ◽  
Brandie Leach ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Genetic Counselors ◽  
Tumor Board ◽  
Treatment Recommendation ◽  
Precision Oncology ◽  
Off Label ◽  
Tumor Boards ◽  
Molecular Tumor Board

3128 Background: Multidisciplinary molecular tumor boards were first established with the onset of precision oncology (PO), as many clinicians were unfamiliar with the interpretation and incorporation of the information into clinical practice. PO has since rapidly evolved and integrated itself into standard of care practices for most cancer patients, yet molecular tumor boards have not grown accordingly and in fact some have been discontinued. There remains a paucity of data in regards to the value and impact of molecular tumor board discussions themselves. We previously reported on our longitudinal experiences in PO ( Sadaps et al, 2018), focusing on the therapeutic impact of matched therapy. Here, we report on the utility of our molecular tumor board in clinical decision making. Methods: We conducted a retrospective review of patients seen at Cleveland Clinic with a solid tumor malignancy who had large panel, next-generation-sequencing (NGS) performed via any commercial platform from November 2019-January 2021. Cases were filtered through a local therapeutic algorithm and then reviewed individually. Initial review was performed by a core genomics committee comprised of 2 oncologists and 2 genetic counselors. Interesting and/or complex cases were flagged for discussion at our bimonthly molecular tumor board, which is regularly attended by medical oncologists, pathologists, genetic counselors, bioinformaticians, and patient care coordinators. Data analyzed included categorization of treatment recommendations and the percentage of cases for which initial recommendations were changed based on tumor board discussion. Results: Of 782 total cases, 575 (73.5%) had a clinically relevant genomics tumor board (GTB) recommendation as compared to 51.7% from our previously reported study. 16.7% of patients had on label recommendation(s) and 86.4% had off label/ clinical trial recommendation(s). 179 (22.9%) patients were recommended for genetic counseling (GC). During our bimonthly GTB, we discussed 173 (22.1%) of these cases. Of the discussed cases, the most common tumor types were hepatobiliary (18.5%), lower gastrointestinal (17.3%), and breast (16.2%). Topics of discussion at GTB included such things as pathologic/histologic/molecular testing, prioritization of available trials, appropriateness of an off label therapy, and need for a genetics consult. Discussion at GTB resulted in a change in treatment recommendation in 63 (36.4%) cases. Conclusions: Discussions from multidisciplinary molecular tumor board impacted treatment decisions for our patients. Referral to GC was also common and should be considered an integral part of somatic sequencing review. Molecular tumor boards remain a crucial platform for treatment guidance and clinical management, especially given the increase in “actionability” over the years due to newly discovered targets and targeted therapies in this rapidly evolving field.

Virtual Clinical and Precision Medicine Tumor Boards: A Cloud-based Platform-mediated Implementation of Multidisciplinary Reviews among Oncology Centers in the Covid-19 Era. (Preprint)

2020 ◽  
Author(s):  
Livio Blasi ◽  
Roberto Bordonaro ◽  
Vincenzo Serretta ◽  
Dario Piazza ◽  
Alberto Firenze ◽  
...  
Keyword(s):  
Decision Making ◽  
Health Professionals ◽  
Clinical Pathways ◽  
Prospective Trial ◽  
Banking System ◽  
Outcome Data ◽  
Tumor Board ◽  
Time Saving ◽  
Tumor Boards ◽  
Multidisciplinary Tumor Board

BACKGROUND Multidisciplinary tumor boards play a pivotal role in the patients -centered clinical management and in the decision-making process to provide best evidence -based, diagnostic and therapeutic care to cancer patients. Among the barriers to achieve an efficient multidisciplinary tumor board, lack of time and geographical distance play a major role. Therefore the elaboration of an efficient virtual multidisciplinary tumor board (VMTB) is a key-point to reach a successful oncology team and implement a network among health professionals and institutions. This need is stronger than ever in a Covid-19 pandemic scenario. OBJECTIVE This paper presents a research protocol for an observational study focused on exploring the structuring process and the implementation of a multi-institutional VMTB in Sicily. Other endpoints include analysis of cooperation between participants, adherence to guidelines, patients’ outcomes, and patients satisfaction METHODS This protocol encompasses a pragmatic, observational, multicenter, non-interventional, prospective trial. The study's programmed duration is five years, with a half-yearly analysis of the primary and secondary objectives' measurements. Oncology care health-professionals from various oncology subspecialties at oncology departments in multiple hospitals (academic and general hospitals as well as tertiary centers and community hospitals) are involved in a non-hierarchic fashion. VMTB employ an innovative, virtual, cloud-based platform to share anonymized medical data which are discussed via a videoconferencing system both satisfying security criteria and HIPAA compliance. RESULTS The protocol is part of a larger research project on communication and multidisciplinary collaboration in oncology units and departments spread in the Sicily region in Italy. Results of this study will particularly focus on the organization of VMTB involving oncology units present in different hospitals spread in the area and create a network to allow best patients care pathways and a hub and spoke relationship. Results will also include data concerning organization skills and pitfalls, barriers, efficiency, number and type con clinical cases, and customers’ satisfaction. CONCLUSIONS VMTB represents a unique opportunity to optimize patient’s management in a patient centered approach. An efficient virtualization and data banking system is potentially time-saving, a source for outcome data, and a detector of possible holes in the hull of clinical pathways. The observations and results from this VMTB study may hopefully useful to design nonclinical and organizational interventions that enhance multidisciplinary decision-making in oncology.

Sign in / Sign up

Export Citation Format

Share Document