Fast track multidisciplinary approach for gastrointestinal tumours.

Abstract

102 Background: The incidence of gastrointestinal (GI) tract tumours in the Netherlands is rising. However, GI oncological medical care is still delayed and fragmented. There is a need for better and faster diagnostic work-up, faster start of treatment, but also for expert multidisciplinary deliberation. Therefore, the GIOCA, Gastro Intestinal Oncological Centre Amsterdam, started in 2009 as a one day fast track multidisciplinary outpatient clinic for patients with GI malignancies. The goal was an admission time (AT, time from referral to consultation) of < 1 week and a run through time (RTT, time from multidisciplinary meeting to start of treatment) of < 3 weeks. The aim of this study was first to evaluate the AT and RTT at GIOCA and secondly to evaluate the subjective impact of this novel strategy on patients burden and satisfaction. Methods: Patients were seen at GIOCA in the morning on a colorectal (CRC ), an oesophago/gastric (OES) or a hepatopancreaticobiliary (HPB) day. That same morning (additional) diagnostics were performed. At the multidisciplinary meeting afterwards, a final diagnosis and treatment plan was made, which was later communicated to the patient. The patient then met all involved specialists. AT and RTT were prospectively recorded for all GIOCA patients. For HPB malignancies, AT and RTT could be compared to historical controls from the preceding year. Patient impact and satisfaction was evaluated using a before/after cohort study design, with a written questionnaire prospectively administered to all GIOCA patients and compared to data obtained 3 months prior to GIOCA start. Results: Analyses of 2009 and 2010 showed the following results: The average AT for CRC, OES and HPB was 7.6, 9.5 and 9 days respectively. The average RTT for CRC, OES and HPB was 20.8, 24 and 25 days respectively. For HPB malignancies, this was 10.4 days (AT) and 59.8 days (RTT) in the year preceding GIOCA. Higher levels of patient satisfaction were obtained in GIOCA patients compared to controls. More than 90% of the patients interviewed would advice the GIOCA outpatient approach to other patients. Conclusions: Progress has been made in the AT and RTT in GI malignancies in GIOCA, but the goals were still not all reached. Patients were very satisfied with this novel approach.