Abstract
Simple SummaryIn this perspective piece we will summarize our path to implement local, regional and integrated service network tumor boards and our use of technology to facilitate this process and provide guidance for other institutions outside of Veterans Affairs system to implement this unique model. We offer a road map to establish regional multidisciplinary liver tumor boards.In this perspective piece, we summarize the development and implementation of multidisciplinary liver tumor boards across the Veterans Affairs health care system dating back to 2010. Referral to multidisciplinary tumor boards (MDLTB) has been demonstrated to decrease the number of unnecessary invasive procedures, reduce health care costs and maximize patient outcomes. Although the VA is the largest single care provider in the US, there is significant heterogeneity in healthcare delivery. We have shown that receiving care at VA centers with MDLTB is associated with higher odds of receiving active therapy and a 13% reduction in mortality. Access to expert hepatology care appears to be one of the critical benefits of MDLTB resulting in 30% reduction in mortality. Integrated health care systems such as the VA have the unique capability of implementing virtual tumor boards that can easily overcome geographic barriers and standardize care across multiple facilities regardless of their access to hepatology or other disciplines. Significant barriers remain requiring implementation plans. This document serves as a roadmap to establish multidisciplinary tumor boards, including standardization of imaging reports, identifying stake holders who need to be present at tumor board, institution buy-in, and specifics for local, regional and integrated service network tumor boards.
Highlights
Hepatocellular carcinoma (HCC) accounts for 85% of primary liver cancers with the majority of the remainder resulting from bile duct or mixed tumors
In another study comparing patients with HCC managed by a multidisciplinary tumor board (MDTB) to those who were not, it was demonstrated that patients managed by MDTB were more likely to present with cancer at earlier stages and with lower serum alpha-fetoprotein (AFP)
The Veterans Health Administration (VHA) oversees the largest integrated healthcare system in the United States, including 170 Veterans Administration (VA) medical centers (VAMCs) and 1074 outpatient sites caring for varying complexity of diseases and serving 6 million enrolled Veterans each year
Summary
In another study comparing patients with HCC managed by a multidisciplinary tumor board (MDTB) to those who were not, it was demonstrated that patients managed by MDTB were more likely to present with cancer at earlier stages and with lower serum alpha-fetoprotein (AFP). A multidisciplinary approach is imperative to guide the management plan with consideration of severity of underlying liver disease, performance status, tumor stage, and presence of metastatic disease. Multiple providers such as hepatologists and gastroenterologists, interventional and diagnostic radiologists, surgical oncologists and transplant surgeons, medical oncologists, radiation oncologists, pathologists, and primary care and palliative care providers should be involved in the care of patients with HCC. We discuss our experience with development and implementation of multi-site, virtual MDTBs that provide recommendations for patients with HCC in geographically diverse medical facilities within the VA healthcare system
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