Impact of GI Tumor Board on Patient Management and Adherence to Guidelines

Abstract

PurposeAs the burden of cancer on the population and the health care system continues to increase with more complicated treatment options, the need for multidisciplinary teams to be as efficient as possible becomes more vital. Our study aimed to evaluate the consistency of GI Tumor Board (GI TB) recommendations with international guidelines, the adherence of physicians involved in patient care to TB recommendations, and the impact on the management of patients.MethodsA prospective cohort study was conducted from January to June 2016 at our institution, which is a major tertiary hospital that provides comprehensive cancer care. All cases presented at the GI TB during this period were included. Data regarding adherence to National Comprehensive Cancer Network guidelines, adherence to TB recommendations, and changes made to the management of patients were collected weekly from the GI TB in a data collection form.ResultsOf the 104 patients included, 57 (55%) were males and the median age was 58 (16 to 85) years. Colorectal cancer was the most common diagnosis, in 65 patients (63%). Nearly one-half of cases (45%) were stage IV cancers. Starting new treatment was recommended for 72 patients (69%). Further investigations were requested for 15 patients (14%). For imaging, 24 recommendations (23%) were made. Adherence to National Comprehensive Cancer Network guidelines was observed in 97% of total recommendations. New findings were found in pathology (11%), radiology (13%), and staging (4%). Management plans were changed in 37 cases (36%). Over a 3-month period after presentation to the GI TB, most of the recommendations (87%) were performed.ConclusionA multidisciplinary tumor board enhances the adherence to guidelines and has an impact on patient management in approximately one-third of patients. Among physicians, adherence to recommendations of the TB was high.

Do Multidisciplinary Tumor Board Discussions Correlate With Increase in 5-Year Survival? A Meta-Analysis Study

“…[14] In a study on colorectal cancer MTB, discussed cases underwent complete staging studies and had treatment in keeping with established guidelines, increasing compliance from 83% to 98% (p , 0.0001). [25] Similar results were established from lung and esophageal cancer cases discussed in MTBs. [23,26] The frequency of preoperative magnetic resonance imaging scans increased in the MTB cohort and perioperative mortality decreased.…”

Survival Impact and Cost-Effectiveness of a Multidisciplinary Tumor Board for Breast Cancer in Mozambique, Sub-Saharan Africa

“…A study from Botswana showed a reduction in the time from biopsy to start of radiation therapy among patients with cervical cancer [34]. After the implementation of gastro-intestinal MTBs in Saudi Arabia and Ethiopia, adherence to evidence-based guidelines improved [35,36]. Unfortunately, these studies did not provide survival data.…”

<p>Benefits and Limitations of a Multidisciplinary Approach in Cancer Patient Management</p>

“…42 Similarly, both a cohort chart review and a prospective observational study respectively revealed change in management in 36% and 25% of gastrointestinal and pancreatic tumors after MTB discussion. 28,43 According to a study on colorectal cancer patients with stage IV disease, recommendations for preoperative chemotherapy have increased significantly in cases of oligometastatic disease (limited to one site) due to input from MTB discussion. Lowes et al observed that after MTB confrontation, physicians were considerably more prone to refer elderly patients (>70 years) for treatment.…”