Process outcome measures of patients with head/neck, thoracic, and gynecologic malignancies in the MDC clinic.

Abstract

61 Background: Queen’s Medical Center (QMC) was selected as one of 14 sites nationwide to participate in the expansion of the National Cancer Institute’s Community Cancer Centers program in 2010. In 2011, QMC implemented Multidisciplinary Clinics (MDC) to make the treatment of patients with head and neck (H&N), thyroid, thoracic, and GYN malignancies more efficient and seamless. The purpose of this study was to examine the following process outcomes: timeliness of care, adherence to MDC treatment plans and national guidelines, and utilization of ancillary services in H&N, thyroid, thoracic, and GYN MDC. Methods: Retrospective, chart review of patients with H&N, thyroid, thoracic, and GYN malignancies who were seen at the MDC from Jan 2012 to Dec 2012 was conducted. Variables collected were patient demographics, initial date of referral to the MDC, date of first cancer treatment, clinical variables (e.g. cancer diagnosis, co-morbidities, social habits [smoking, drinking, drug use]), and hospital process variables (e.g. reasons for delay in treatment, adherence to national guidelines, and use of ancillary services [e.g. navigation, dietary, survivorship, social work, chaplain, genetic counseling]). Results: 222 charts were reviewed (H&N = 69, Thyroid = 54, Thoracic = 48, Gyn = 51). Ethnic minorities represented over 50% of the sample. For all cancers combined, average time to referral to first treatment was 32 days. Post-hoc analysis showed that patients seen in GYN MDC (mean = 17.5 + 12.3 days) had significantly fewer days from referral to first cancer treatment compared to patients seen in the H&N MDC (mean = 41.3 + 25.6 days), F = 4.3, p = 0.003. For all sites combined, there was 99.5% adherence to the MDC recommended treatment plans, and 100% adherence to NCCN guidelines in the treatment received. Most patients with GYN malignancy (96.1%) were referred to one or more ancillary services followed by H&N (88.4%), thoracic (85.4%), and thyroid (46.3%). Conclusions: Study provided baseline process outcomes for MDC of disease sites which are often less studied in literature. MDC nurse coordinator played a critical role in ensuring efficient and quality patient care. Results can serve as basis for further quality improvement.