A multidisciplinary team care approach improves outcomes in high-risk pediatric neuroblastoma patients.

Hsiu-Hao Chang,Yung-Feng Liao,Shiann-Tarng Jou,Hsinyu Lee,Steven Shinn-Forng Peng,Wen-Ming Hsu,Kai-Yuan Tzen,Ya-Ling Lee,Ching‐Chu Lu ,Ruoh‐Fang Yen ,Yen‐Lin Liu ,Meng‐Yao Lu ,Yung‐Li Yang ,Hsueh‐Fen Juan ,Chia‐Ju Liu ,Dong‐Tsamn Lin ,Shiu‐Feng Huang ,Ming Chih Huang ,Kai‐Hsin Lin ,Yung‐Ming Jeng

doi:10.18632/oncotarget.13874

Abstract

We assessed the impact of a multidisciplinary team care program on treatment outcomes in neuroblastoma patients. Newly diagnosed neuroblastoma patients received treatment under the Taiwan Pediatric Oncology Group (TPOG) N2002 protocol at the National Taiwan University Hospital beginning in 2002. A multidisciplinary team care approach that included nurse-led case management for patients treated under this protocol began in January 2010. Fifty-eight neuroblastoma patients, including 29 treated between 2002 and 2009 (Group 1) and 29 treated between 2010 and 2014 (Group 2), were enrolled in the study. The 5-year overall survival (OS) and event-free survival (EFS) rates for all 58 patients were 59% and 54.7%, respectively. Group 2 patients, who were treated after implementation of the multidisciplinary team care program, had better 3-year EFS (P = 0.046), but not OS (P = 0.16), rates than Group 1 patients. In a multivariate analysis, implementation of the multidisciplinary team approach was the only significant independent prognostic factor for neuroblastoma patients. In further subgroup analyses, the multidisciplinary team approach improved EFS, but not OS, in patients with stage 4 disease, those in the high-risk group, and those with non-MYCN amplified tumors. These data indicate a multidisciplinary team care approach improved survival outcomes in high-risk neuroblastoma patients. However, further investigation will be required to evaluate the long-term effects of this approach over longer follow-up periods.

Highlights

Neuroblastoma is a childhood tumor that is derived from neural crest sympathoadrenal lineage progenitor cells
In a Canadian review of 30 studies relating to multidisciplinary team care for many types of cancer, Croke et al [13] found that multidisciplinary care usually resulted in changes in diagnosis and management decisions, there was scant evidence regarding effects on cancer patient survival
In an Australian study, the use of multimodal therapies was associated with the management of Stage IV head and neck cancer patients by a multidisciplinary care team, and it seemed likely that this was the cause of the improved survival observed in these patients

Summary

Introduction

Neuroblastoma is a childhood tumor that is derived from neural crest sympathoadrenal lineage progenitor cells. It can develop anywhere in the sympathetic nervous system, but occurs most often in the adrenal gland [1]. Neuroblastoma is the most common extra-cranial solid tumor in children and the most frequently diagnosed malignancy in infants. It is exceedingly rare in adults; more than 96% of neuroblastoma patients are diagnosed when they are less than 10 years old [2]. Despite recent improvements in treatment, the prognosis remains extremely poor for metastatic neuroblastoma patients who are diagnosed at less than 18 months of age

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