Multidisciplinary Clinics for Colorectal Cancer Care Reduces Treatment Time

Kozak, Vanessa Nascimento; Khorana, Alok A.; Amarnath, Sudha; Glass, Katherine; Kalady, Matthew F.

doi:10.1016/j.clcc.2017.03.020

Cited by 31 publications

(26 citation statements)

References 20 publications

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“…In the context of findings of potential harm, we believe it is incumbent upon insurers and health systems to simplify access and reduce operational barriers to initiating treatment. Recent initiatives have shown that TTI can be substantially reduced by multidisciplinary approaches and cost-neutral interventions and such efforts need to be adopted more broadly and with a greater sense of urgency [27, 28].…”

Section: Discussionmentioning

confidence: 99%

Time to initial cancer treatment in the United States and association with survival over time: An observational study

et al. 2019

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Background Delays in time to treatment initiation (TTI) for new cancer diagnoses cause patient distress and may adversely affect outcomes. We investigated trends in TTI for common solid tumors treated with curative intent, determinants of increased TTI and association with overall survival. Methods and findings We utilized prospective data from the National Cancer Database for newly diagnosed United States patients with early-stage breast, prostate, lung, colorectal, renal and pancreas cancers from 2004–13. TTI was defined as days from diagnosis to first treatment (surgery, systemic or radiation therapy). Negative binomial regression and Cox proportional hazard models were used for analysis. The study population of 3,672,561 patients included breast (N = 1,368,024), prostate (N = 944,246), colorectal (N = 662,094), non-small cell lung (N = 363,863), renal (N = 262,915) and pancreas (N = 71,419) cancers. Median TTI increased from 21 to 29 days (P<0.001). Aside from year of diagnosis, determinants of increased TTI included care at academic center, race, education, prior history of cancer, transfer of facility, comorbidities and age. Increased TTI was associated with worsened survival for stages I and II breast, lung, renal and pancreas cancers, and stage I colorectal cancers, with hazard ratios ranging from 1.005 (95% confidence intervals [CI] 1.002–1.008) to 1.030 (95% CI 1.025–1.035) per week of increased TTI. Conclusions TTI has lengthened significantly and is associated with absolute increased risk of mortality ranging from 1.2–3.2% per week in curative settings such as early-stage breast, lung, renal and pancreas cancers. Studies of interventions to ease navigation and reduce barriers are warranted to diminish potential harm to patients.

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Section: Discussionmentioning

confidence: 99%

Time to initial cancer treatment in the United States and association with survival over time: An observational study

et al. 2019

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“…Evidence has shown that the MDC model is associated with improved efficiency and completeness of care for many chronic diseases. 21–23 Indeed, the current data demonstrated that the pDD was significantly shorter in patients with axial SpA who were managed by the MDC compared with the propensity score matched historical controls (1 versus 13 months, P = 0.026), after adjustments for possible confounders such as sex, education level, history of smoking, HLA-B27 status and SpA/AS criteria.…”

Section: Discussionmentioning

confidence: 61%

A multidisciplinary clinic approach to improve physician-related diagnostic delay for patients with axial spondyloarthritis: a retrospective study

Chen

et al. 2019

J Int Med Res

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Objective To assess the diagnostic delay (DD) and physician-related DD (pDD) in patients with axial spondyloarthritis (SpA) and the potential benefits of a multidisciplinary clinic (MDC) approach. Methods A retrospective study was undertaken among patients with axial SpA, which aimed to analyse DD, pDD and their risk factors. The influence of pDD on disease outcomes was examined. The pDDs among consecutive SpA patients in an MDC cohort were compared with propensity score matched historical controls (1:1). Results A total of 208 patients with axial SpA formed the historical control group and 49 patients with axial SpA formed the MDC cohort after introduction of the MDC. The median DD and pDD in the historical controls were 25.5 and 10.0 months, respectively. A cut-off of pDD > 4 months was associated with more active disease and functional impairment. An initial visit to a non-rheumatologist was the most significant risk factor for pDD. Following MDC introduction, the median pDD decreased from 13 months to 1 month after adjustments were made for confounders such as sex, education level, history of smoking, human leukocyte antigen-B27 status and SpA/ankylosing spondylitis classification criteria. Conclusion The MDC was a promising approach that resulted in a reduced pDD among patients with axial SpA.

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“…This is consistent with previous research that has demonstrated improved timeliness of care from multidisciplinary clinics in cancer care. Existing literature, however, largely relates to multidisciplinary clinics of physicians, and timeliness of care refers to decreasing the interval from diagnosis or first consultation, to commencement of treatment [29][30][31]. In our clinic, patients perceived the care received as high quality and able to facilitate positive lifestyle changes.…”

Section: Discussionmentioning

confidence: 99%

Implementation of a Multidisciplinary Allied Health Optimisation Clinic for Cancer Patients with Complex Needs

Ray

Beaumont

Loeliger

et al. 2020

JCM

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This study examined the feasibility of implementing a multidisciplinary allied health model of care (MOC) for cancer patients with complex needs. The MOC in this retrospective study provided up to eight weeks of nutritional counselling, exercise prescription, fatigue management and psychological support. Implementation outcomes (acceptability, adoption, fidelity and appropriateness) were evaluated using nine patient interviews, and operational data and medical records of 185 patients referred between August 2017 and December 2018. Adoption, including intention to try and uptake, were acceptable: 88% of referred patients agreed to screening and 71% of eligible patients agreed to clinic participation. Fidelity was mixed, secondary to inpatient admissions and disease progression interrupting patient participation. Clinician compliance with outcome assessment was variable at program commencement (dietetic, 95%; physiotherapy, 91%; occupational therapy, 33%; quality of life, 23%) and low at program completion (dietetic, 32%; physiotherapy, 13%; occupational therapy, 10%; quality of life, 11%) mainly due to non-attendance. Patient interviews revealed high satisfaction and perceived appropriateness. Adoption of the optimisation clinic was acceptable. Interview responses suggest patients feel the clinic is both acceptable and appropriate. This indicates a multidisciplinary model is an important aspect of comprehensive, timely and effective care. However, fidelity was low, secondary to the complexities of the patient cohort.

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Multidisciplinary Clinics for Colorectal Cancer Care Reduces Treatment Time

Cited by 31 publications

References 20 publications

Time to initial cancer treatment in the United States and association with survival over time: An observational study

Time to initial cancer treatment in the United States and association with survival over time: An observational study

A multidisciplinary clinic approach to improve physician-related diagnostic delay for patients with axial spondyloarthritis: a retrospective study

Implementation of a Multidisciplinary Allied Health Optimisation Clinic for Cancer Patients with Complex Needs

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