Establishment of a Regional Virtual Tumor Board Program to Improve the Process of Care for Patients With Hepatocellular Carcinoma
Establishment of a Regional Virtual Tumor Board Program to Improve the Process of Care for Patients With Hepatocellular Carcinoma
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DOI：
10.1200/jop.2014.000679
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发表时间：
2015-01-01
影响因子：
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通讯作者：
Anaya, Daniel A.
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文献类型：
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作者：
Salami, Aitua C.;Barden, Gala M.;Anaya, Daniel A.
目的：肝细胞癌的多学科评估(MDE)是目前的标准，通常通过肿瘤委员会(TB)论坛提供；该标准受到肿瘤学劳动力短缺和每个机构缺乏TB的限制。虚拟TBS(VTB)可能有助于克服这些限制。我们的研究目的是评估地区性VTB对肝癌患者MDE过程的影响。方法：进行了一项回顾性队列研究，包括从2009年到2013年从地区性机构转诊到三级癌症中心的肝癌患者。基线特征和结果基于转诊机制进行比较：VTB和专科会诊(非VTB)。主要成果是全面的MDE(所有必要的专家都出席并讨论了关键议题)。次要结果包括MDE的及时性和完成MDE的旅行负担。采用单因素和多变量Logistic回归分析VTB与综合MDE的关系。结果：共有116名患者进入研究，其中48人(41.4%)通过VTB进行评估。接受综合MDE的VTB患者比例较高(91.7%对64.7%；P=.001)；VTB独立地与较高的完成综合MDE的几率相关(优势比，6.0；95%CI，1.2至29.9；P=.02)。VTB患者完成MDE的时间明显更快(中位数，23天比39天；P=.001)，旅行负担更低(中位数，0比683英里；P=.001)。结论：VTB计划通过改善MDE过程的质量和及时性，同时避免了旅行需求带来的负担，积极地影响了肝癌患者的护理过程。未来的研究应侧重于在更大范围内实施VTB方案。
Purpose: Multidisciplinary evaluation (MDE) of hepatocellular cancer (HCC) is the current standard, often provided through a tumor board (TB) forum; this standard is limited by oncology workforce shortages and lack of a TB at every institution. Virtual TBs (VTBs) may help overcome these limitations. Our study aim was to assess the impact of a regional VTB on the MDE process for patients with HCC.Methods: A retrospective cohort study was conducted, including patients with HCC referred to a tertiary cancer center from regional facilities (2009 to 2013). Baseline characteristics and outcomes were compared based on the referral mechanism: VTB versus subspecialty consultation (non-VTB). The primary outcome was comprehensive MDE (all required specialists present and key topics discussed). Secondary outcomes included timeliness of MDE and travel burden to complete MDE. Univariable and multivariable logistic regressions were performed to examine the association of a VTB with comprehensive MDE.Results: A total of 116 patients were included in the study; 48 (41.4%) were evaluated through the VTB. A higher proportion of VTB patients received comprehensive MDE (91.7% v 64.7%; P = .001); the VTB was independently associated with higher odds of accomplishing comprehensive MDE (odds ratio, 6.0; 95% CI, 1.2 to 29.9; P = .02). VTB patients completed MDE significantly faster (median, 23 v 39 days; P = .001), with lower travel burden (median, 0 v 683 miles traveled; P = .001).Conclusion: This VTB program positively affected the process of care for patients with HCC by improving the quality and timeliness of the MDE process, while avoiding the burden arising from travel needs. Future studies should focus on implementation of VTB programs on a wider scale.