Multidisciplinary Tumor Conference Research Articles

Treatment confidence and patient participation in multidisciplinary tumor conferences: A structural equation modeling approach.

Multidisciplinary tumor conference (MTC) is a key instrument in multidisciplinary cancer care. In recent years, if and how patient participation in MTC can contribute to a more patient-centered care have been scientifically discussed. This study aimed to identify determinants of treatment confidence in the context of patient participation in MTC. Therefore, the association among health literacy-sensitive communication, trust in health-care providers (HCP), and treatment confidence is examined. This study used data from the multicenter, observational study "PINTU" on patient participation in MTC. Data were collected from November 2018 to February 2020. Validated scales for treatment confidence, health literacy-sensitive communication, and trust in providers were included in the structural equation modeling (SEM) analysis. A total of 95 patients participated in MTC. The sample compromised n = 80 completed datasets. The SEM fit measures indicated good fit of the proposed model. The analysis showed a positive association between health literacy-sensitive communication and treatment confidence when adding the mediating effect of trust in providers. Patient-centered communication during MTC in combination with a trustful relationship between participating patients and health-care providers is positively associated with treatment confidence. The results indicated the relevance of a trustful doctor-patient communication and relationship. Trainings for physicians targeting patient-centered communication could be a promising approach to strengthen patient participation.

Is patient participation in multidisciplinary tumor conferences associated with their fear of progression?

Previous studies found that some breast cancer patients in Germany are invited to participate in a multidisciplinary tumor conference (MTC) during the discussion of their own case. MTCs are regular meetings of a treatment team in which the diagnosis and treatment plan of cancer patients are discussed. Psychological consequences concerning the patients' participation in an MTC have not been examined yet. This study examines the association between patients' participation in MTC and patients' fear of progression (FoP). This analysis is part of a larger project named "Patient participation in multidisciplinary tumor conferences in Breast Cancer Care" (PINTU) which is a multicenter observational mixed-methods study. The study was conducted in six breast and gynecological cancer centers in North Rhine-Westphalia, Germany. Data were collected from 2018 to 2020 by patient survey at three time points. Patients with (n=81) and without (n=120) MTC participation were compared. FoP was measured with a 12-item short form of the FoP Questionnaire (FoP-Q-SF) at all three measurement time points. Data analysis included descriptive statistics, a one-way repeated variance analysis (ANOVA), and a one-way repeated ANCOVA using the propensity score as a covariate. Data of n=201 patients were included in the analysis. In general, FoP scores decreased in both groups from T0 to T2 (F=36.539, p<0.001, η2 =0.155). Non-participating patients did not differ with regard to their FoP from patients who participated in an MTC before and after participation. The results of AN(C)OVA revealed no significant effects concerning the influence of patient participation in an MTC on FoP (F=0.014, p=0.907, η2 = <0.001 and (F=0.013, p=0.909, η2 = <0.001). Since the FoP is not influenced by participation, the findings do not support recommendations for or against patient participation in an MTC. Further research should focus on the question of which patient groups might benefit from participation in an MTC with regard to which outcome variables.

The impact of COVID-19 on head and neck cancer diagnosis and disease extent.

BackgroundDue to COVID‐19, diagnostic delays and a surge of advanced head and neck cancer (HNC) is anticipated. We hereby evaluate patient and tumor characteristics before and during the early COVID‐19 period.MethodsRetrospective review of patients with HNC presented at a multidisciplinary tumor conference from May 14, 2020 to June 18, 2020 was performed and compared to a similar 6‐week period a year before. Demographics, time to diagnosis, and tumor characteristics were analyzed.ResultsThere was a 25% reduction in newly diagnosed malignancies. Groups were similar in baseline characteristics, duration of symptoms, and time to diagnosis. However, median primary tumor size was significantly larger (p = 0.042) and T stage more advanced for mucosal subsites (p = 0.025) in the COVID‐19 group.ConclusionOur findings suggest increased tumor burden in patients with HNC presenting during the pandemic, despite a similar time to diagnosis. This may become more pronounced as the pandemic duration is extended.

Evaluation of internal mammary lymph node biopsy during microsurgical breast reconstruction: An analysis of 230 consecutive patients.

Clinical significance of internal mammary (IM) lymph node biopsy during microvascular free flap breast reconstruction remains controversial. Some microsurgeons may choose to biopsy an IM lymph node during routine IM vessel dissection. The authors reviewed the results of IM lymph node biopsy during autologous breast reconstruction. A retrospective chart review of patients who underwent autologous breast reconstruction during a seven-year period (January 2010 to January 2017) was performed. Patient demographic data, disease staging, flap details, pathology reports, and adjuvant treatment were evaluated. A total of 230 patients with a mean age of 52.1 (SD 9.3) underwent IM lymph node biopsy (n=297). Single IM lymph node was removed in 169 patients, 2 nodes were removed in 56 patients, 3 nodes in 4 patients, and 4 nodes in a single patient. Histopathologic analysis demonstrated presence of IM lymph node metastasis in 16 patients (7.0%). Thirteen patients were found to have metastatic IM lymph nodes in the setting of immediate reconstruction. Three patients were found to have metastatic IM lymph nodes in the setting of delayed. Five out of 16 patients (31.3%) had negative axillary sentinel lymph node biopsy and IM lymph nodes were the only site of nodal metastases. All five of these patients were upstaged accordingly and received adjuvant therapy based on the discussion at the multidisciplinary breast tumor conference. Opportunistic internal mammary lymph node sampling during autologous breast reconstruction can be performed with minimal morbidity and has significant impact on the disease staging and adjuvant treatment.

Evaluation of the Metastatic Spine Disease Multidisciplinary Working Group Algorithms as Part of a Multidisciplinary Spine Tumor Conference.

Study Design:Retrospective cohort study.Objective:The Metastatic Spine Disease Multidisciplinary Working Group Algorithms are evidence and expert opinion–based strategies for utilizing radiation therapy, interventional radiology procedures, and surgery to treat 5 types of spine metastases: asymptomatic spinal metastases, uncomplicated spinal metastases, stable vertebral compression fractures (VCF), unstable VCF, and metastatic epidural spinal cord compression (MESCC). Evaluation of this set of algorithms in a clinical setting is lacking. The authors aimed to identify rate of treatment adherence to the Working Group Algorithms and, subsequently, update these algorithms based on actual patient management decisions made at a single-institution, multidisciplinary, spine tumor conference.Methods:Patients with metastatic spine disease from primary non-hematologic malignancies discussed at an institutional spine tumor conference from 2013 to 2016 were evaluated. Rates of Working Group Algorithms adherence were calculated for each type of metastasis. Based on the reasons for algorithm nonadherence, and patient outcomes in such cases, updated Working Group Algorithms recommendations were proposed.Results:In total, 154 eligible patients with 171 spine metastases were evaluated. Rates of algorithm adherence were as follows: asymptomatic (67%), uncomplicated (73%), stable VCF (20%), unstable VCF (32%), and MESCC (41%). The most common deviation from the Working Group Algorithms was surgery for MESCC despite poor prognostic factors, but this treatment strategy was supported based on median survival surpassing 6 months in these patients.Conclusions:Adherence to the Working Group Algorithm was lowest for MESCC and VCF patients, but many nonadherent treatments were supported by patient survival outcomes. We proposed updates to the Working Group Algorithm based on these findings.

Induction Therapy in Localized Pancreatic Cancer.

Pancreatic cancer (PDAC) with localized stage includes resectable (RPC), borderline resectable (BRPC), or locally advanced unresectable (LAPC). Standard of care for RPC is adjuvant chemotherapy. There are no prospective randomized trials for best treatment of BRPC and LAPC. We evaluate the impact of induction chemotherapy on localized PDAC. Charts of PDAC patients treated at Emory University between 2009 and 2016 were reviewed. The primary end point was overall survival (OS). A total of 409 localized PDACs were identified. Resectability was prospectively determined at a multidisciplinary tumor conference. Median age was 67 years (range, 30-92 years), 49% were male, 66% were white, 171 had RPC, 131 had BRPC, and 107 had LAPC. Median OSs for RPC, BRPC, and LAPC were 19.5, 16.1, and 12.7 months, respectively. Type of chemotherapy and age were predictors of OS. Induction chemotherapy was used in 106 with BRPC (81%) and 74 with RPC (56.5%); patients with BRPC who received combination chemotherapy and resection had a median OS of 31.5 compared with 19.5 months in patients with RPC (P = 0.0049). Patients with LAPC had a median OS of 12.7 months. In patients with BRPC who undergo resection after induction treatment, the OS was significantly better than in patients with RPC. Neoadjuvant treatment should be considered for all localized PDACs.

How do breast cancer patients experience multidisciplinary tumor conferences? – A description from the patient perspective

ObjectivesAim of this study was to investigate the experiences of breast cancer patients who participated in multidisciplinary tumor conferences (MTCs). Study designData from two consecutive years of an annual postal survey of patients with primary breast cancer were combined. Data was collected between February and July 2015 (response rate 72%) and 2016 (response rate 73%) from N = 8893 patients (ICD-10 C50) after hospital discharge from 86 breast cancer center hospitals in North Rhine-Westphalia, Germany. The study used a mixed-methods design. Standardized quantitative survey questions were analyzed descriptively and an open-ended question was analyzed using qualitative content analysis. ResultsAround 9% of the patients were invited to participate in a multidisciplinary tumor conference (MTC) and 49% of the invited patients reported actual participation in a MTC. Approximately 87% of those patients did not regret their participation in the MTC. The qualitative analysis from the open-ended question indicated that MTC participation was perceived by patients as being both supportive and informative (n = 109 expressions). However, some patients reported difficult experiences and emotional reactions during and after participation (n = 37 expressions). Altogether, the patients' perception was divided into positive and negative, cognitive and emotional experiences following participation in a MTC. ConclusionThe perception of the MTCs varies between the participating patients. Further research on advantages and disadvantages for patients and particularly on the feasibility from the provider's perspective is necessary.

Effect of multidisciplinary tumor conference on clinical management of rectal cancer.

749 Background: Presentation of rectal cancer cases at a multidisciplinary tumor conference (MTC) is a required standard for the newly formed National Accreditation Program for Rectal Cancer. However, its impact on clinical decision-making remains incompletely defined. Our aim was to determine the frequency and manner in which MTC changed the management of patients with rectal cancer at a tertiary academic center. Methods: All rectal cancer cases presented at the weekly Colorectal Cancer MTC between July 2015 and June 2016 at a single institution were prospectively included. Patient demographics and clinical information were recorded. The presenting physician completed a uniform written questionnaire outlining their plan before and after the MTC discussion, and any changes in management as a result of the discussion. Imaging and pathology were reviewed for each case at MTC and consistency with prior interpretation was recorded. Results: 234 unique initial rectal cancer cases were included. Survey responses were obtained for 212 cases (90.6%). The mean patient age was 58.3 years. 37 patients (15.8%) presented with Stage IV disease and 20 (9.4%) had locally recurrent cancer. There was a documented change in plan as a result of the MTC discussion in 70 of 212 (33%) cases surveyed, including 22 cases (10.4%) in which the presenting physician had a “definitive plan” prior to the MTC. Changes in management included a change in therapy or change in therapy sequence in 45 cases (64%), and recommendation of further evaluation in 26 cases (37%). Change in management following MTC did not vary by surgeon experience: it occurred in 31.4%, 37.2% and 29.8% of cases presented by surgeons with &lt; 10, 10-20, and ≥ 20 years of experience respectively (Chi-square p= 0.71). The imaging or pathology review at MTC resulted in a different interpretation than previously reported in 23% and 12% of cases, respectively. Conclusions: MTC changes clinical management for a significant portion of rectal cancer patients at a tertiary care center, independent of the presenting surgeons’ years of clinical experience. Our results highlight the utility of multidisciplinary rectal cancer care and support the MTC standard for the National Accreditation Program for Rectal Cancer.

Bilateral Sinonasal Lymphoma in the Absence of a Solitary Lesion: Case Report and Review of the Literature

Objective: Primary sinus lymphoma is rare, accounting for about 0.2 to 5% of extra nodal lymphomas. Lymphomas are the second most common malignancy in the head and neck after squamous cell carcinoma. Methods: Case report Results: We present the case of a 50-year-old African American female with an atypical presentation of sinonasal lymphoma. She had chronic nasal congestion and sinusitis for one-year duration. Computed tomography was significant for scattered mucosal thickening bilaterally in all paranasal sinuses; however, no discrete mass lesion was identified. She underwent functional endoscopic sinus surgery, and pathology was positive for diffuse large B-cell lymphoma. The multidisciplinary tumor conference recommended R-CHOP with intrathecal therapy. She deferred further treatment and was symptom-free without evidence of recurrent disease at 10 months post-surgery. Conclusion: This case of bilateral sinonasal lymphoma with no mass lesion serves as a reminder to maintain a high index of suspicion for non-typical sinus pathology that may masquerade as chronic sinusitis.

Retroperitoneal tumors

Retroperitoneal tumors are rare malignancies. The retroperitoneum can host awide spectrum of pathologies including primary or metastatic lesions. Treatment of retroperitoneal tumors is often associated with several challenges because of their relative late presentation and anatomic location. Because of various pathologies, adetailed case history, laboratory investigation and ultrasound should be performed. Radiologic examinations remain amajor component in the diagnosis. In addition to computed tomography, magnetic resonance imaging and positron emission tomography are used. Although radiologic findings are often unspecific, there are often typical findings such as dissemination, margins, vascularization and tumor texture which contribute to the differential diagnosis even before making a definitive diagnosis. Due to the complexity of primary retroperitoneal tumors, which require different treatments depending on the final diagnosis, the treatment approach should be determined in a multidisciplinary tumor conference prior to histological confirmation and initiation of treatment. To ensure the best potential curative treatment modality for retroperitoneal tumors, treatment is best performed in high-volume centers by amultidisciplinary team.

Diagnosis of bone metastasis from thyroid carcinoma: a multidisciplinary approach

Sarcomas are rare tumors originating from soft tissue or bone. Diagnosis and treatment of sarcomas should be performed at specialized sarcoma centers, where patients are evaluated at a multidisciplinary tumor conference. We present a case where sarcoma was suspected from magnetic resonance imaging (MRI), but histology revealed a metastasis from thyroid carcinoma, although the patient had no previous history of thyroid malignancy and resection of the thyroid gland was without malignancy. Ultrasound-guided biopsy was possible due to cortical destruction and the multidisciplinary approach with re-evaluation of previous pathology and a thorough patient history enabled a final diagnosis.

Tu1032 Multidisciplinary HCC Tumor Conference Is Poor At Adhering to Own Treatment Recommendations

Tu1032 Multidisciplinary HCC Tumor Conference Is Poor At Adhering to Own Treatment Recommendations

A Population-Based Study on the Implementation of Treatment Recommendations for Chemotherapy in Early Breast Cancer

BackgroundThere is considerable heterogeneity in the use of chemotherapy for patients with early breast cancer (BC), despite international recommendations issued from the National Comprehensive Cancer Network (NCCN), National Institutes of Health (NIH), and the St. Gallen biannual conference. This population-based study assessed the patterns of chemotherapy use in early BC. Patients and MethodsThe study included all or representative samples of patients with stage I-III BC from 7 Swiss cancer registries between 2003 and 2005. Factors modifying chemotherapy use were determined by logistic regression, considering patients receiving chemotherapy as cases (n = 1535) and the others as controls (n = 2004). ResultsNodal involvement was by far the strongest predictor for the use of chemotherapy (adjusted odds ratio [OR], 9.7; 95% confidence interval [CI], 7.2-13.0). Tumor biological characteristics such as histologic differentiation (OR, 4.4; 95% CI, 3.2-6.2), estrogen receptor (ER) status (OR, 3.8; 95% CI, 2.6-5.5), human epidermal growth factor receptor 2 (HER2) status (OR, 1.9; 95% CI, 1.3-2.7), and patient age (OR, 4.6; 95% CI, 3.5-6.2) were less important predictors for chemotherapy use. Socioeconomic and provider-related factors, such as patient education, affluence, insurance, breast surgeon's annual caseload, and case presentation at a multidisciplinary tumor conference did not predict the use of chemotherapy, with the exception of the health care provider's participation in clinical research (OR, 2.1; 95% CI, 1.6-2.8). The patient's region of residence did not predict the use of chemotherapy, but it was associated with the specific type of chemotherapy used. ConclusionNodal status, rather than surrogate markers for tumor biological features, was the predominant factor for choosing chemotherapy in patients with early BC in this large population study. Improvements should be made to increase the weight of tumor biological features in choosing chemotherapy in early BC.

The Multidisciplinary Tumor Conference in Gynecologic Oncology-Does It Alter Management?

To assess the role of the multidisciplinary tumor conference in patient management in a tertiary gynecologic oncology service. Data were analyzed from the records of all patients presented at the gynecologic oncology tumor conferences at Auckland City Hospital from August 1, 2005, to August 1, 2006. Patient information including referral source, cancer site, stage, whether surgery had been performed before the tumor conference and if so where and by whom, and benign versus malignant was extracted from the records. The radiological and pathological findings and diagnosis for each patient both before and after each tumor conference were compared. A discrepancy was defined as a change in tumor site, histological type, grade, or stage that resulted from findings discussed at the conferences. Diagnostic discrepancies that resulted in a change in patient management were classified as major discrepancies. Discrepancies that did not affect patient management were classified as minor discrepancies. A total of 509 cases were discussed during the study period. Forty-six discrepancies (9%) were noted, with 30 major (5.9%) and 16 minor (3.1%) discrepancies. The most common changes to patient management that resulted from the tumor conferences were the addition of chemotherapy and surgery. This study demonstrates that gynecologic oncology tumor conferences alter the diagnosis in a significant number of cases and therefore affect patient management.

Frameless Cyberknife radiosurgery for metastatic and primary brain tumors

11527 Background: Cyberknife delivers image-guided stereotactic radiation to intracranial and extracranial skull base tumors without a frame. This frameless feature makes Cyberknife a completely non-invasive procedure and allows non-surgical neuro-oncology personnel to treat patients with tumors in the neuraxis. Methods: Patients with intracranial tumors were selected from our Brain Tumor Clinic if they were not surgical candidates or had residual tumors after neurosurgery. The decision for Cyberknife radiosurgery was made after careful review of all available treatment options in our multidisciplinary brain tumor conference based on patients’ history and neurologic findings, neuroimaging data, and pathology. All patients signed informed consent prior to fusion head MRI and CT scanning. They were pre-medicated with 4 mg of dexamethasone and 500 mg of levetiracetam twice daily. All dose plans were calculated based on CT images acquired from 1.25-mm slices with an inverse planning technique. Dynamic tracking software monitored patient movements and adjusted the robotic arm accordingly, compensating for patient motion up to 10 mm in translation and 5 degree in rotation. Results: Nine subjects with 15 treatment targets, including 4 meningiomas, 1 high-grade glioma, 1 plasmacytoma, and 3 melanomas, were treated with single-fraction or 5 fractions of Cyberknife radiosurgery. No acute toxicity was seen during or within 24 hours of treatment. One subject developed subacute onset of cerebral edema 2 weeks after the procedure but his symptoms were quickly reversed with dexamethasone. Conclusions: Cyberknife radiosurgery is a well-tolerated procedure for intracranial and extracranial tumors in the skull base. Neuro-oncologist, with the appropriate training, could perform Cyberknife radiation planning with radiation oncologists and physicists. No significant financial relationships to disclose.

Teaching surgical oncology to medical students.

A recent review of the curriculum at University of Kansas Medical Center-Kansas City revealed several deficiencies in oncology teaching in the medical school curriculum. Analysis of the surgery core course final examination showed a weaker response by students to surgical oncology items than nononcologic questions. A multidisciplinary cancer course and tumor conference were then added to the surgery core curriculum. Analysis of student performance since this addition reveals that the multimodal course improved the successful response rate to surgical oncology questions on the final examination. This effect has been sustained through nine consecutive student group rotations. These results suggest that surgical oncology teaching can be effectively improved by a multidisciplinary effort.