Development of multi-institutional nation-wide tumor board system for testicular cancer in Japan.

Abstract

562 Background: The standard treatments have been established for metastatic germ cell tumors and the cure rates are quite improving. Cumulative experience by centralization is required for expertise in all aspects of care but it is quite difficult due to its rarity and the present medical situations in Japan. To resolve this problem, we established the nation-wide internet tumor board system for testicular cancer from 2012. Methods: To start with, 28 members from 14 institutions were registered in the internet mailing list (ML) for this tumor board, then the members who wanted to join this system were added to this ML. The tumor board was operated in semi-closed system and with no consultant fee. The member can present the case by e-mail at any time when he encounters the difficult case. Then the other members replied and commented their opinions or experiences against his questions by e-mail. All members could read his case-presentation and comments of consultants in e-mail. In this study, we summarized the initial 5-year experience and the discussed contents and the usage status were analyzed to assess the quality of this internet nation-wide reference system. Results: The number of members and discussed cases increased gradually. At the present, this ML consists with 179 members from 79 institutions all over Japan. We discussed 100 testicular cancer cases during 5 years. Discussed cases were categorized into 10 categories. 44% of the cases discussed in the ML were poor prognostic cases or extragonadal cases. In 63 cases, the consultants were replied within 24 hours when the case was presented in ML, and some comments were replied within at 5 days in all cases. The median number of comments was 6, and active discussions with 10 or more comments were performed in 26 cases (26%). Conclusions: The nation-wide internet tumor board system for testicular tumor was growing in Japan and useful to decide treatment strategy for difficult cases. It might be helpful for members in low volume centers to gain cumulative experience.