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虚拟多学科肉瘤病例讨论会对大型综合医疗系统中治疗方案及生存情况的影响

Impact of a Virtual Multidisciplinary Sarcoma Case Conference on Treatment Plan and Survival in a Large Integrated Healthcare System.

作者信息

Pan Minggui, Yu Jeanette, Sidhu Manpreet, Seto Tiffany, Fang Andrew

机构信息

Department of Oncology and Hematology, Kaiser Permanente, Santa Clara, CA.

Division of Research, Kaiser Permanente, Oakland, CA.

出版信息

JCO Oncol Pract. 2021 Nov;17(11):e1711-e1718. doi: 10.1200/OP.20.01078. Epub 2021 Apr 14.

DOI:10.1200/OP.20.01078
PMID:33852341
Abstract

PURPOSE

Quantifying the impact of a multidisciplinary cancer case conference on patient outcome and care quality remains challenging.

PATIENTS AND METHODS

We prospectively investigated the impact of our virtual multidisciplinary sarcoma case conference (VMSCC) on treatment plan in patients presented to the VMSCC from July to October 2020 (prospective cohort) and retrospectively in patients with metastatic or locally advanced high-grade soft-tissue sarcoma (STS) reviewed in the VMSCC in 2016 and 2017 (high-grade STS cohort). We also investigated the factors related to the nonadherence to the VMSCC-recommended plan in both cohorts.

RESULTS

In both cohorts, approximately 28% of the patients were referred to the VMSCC for review without a treatment plan. In significantly more cases, referring physicians outside of the sarcoma group did not have a plan formulated before the VMSCC review compared with the referring physicians within the sarcoma group. In 28.2% (prospective cohort) and 19.5% (high-grade STS cohort) of the patients, VMSCC recommended a different plan. The adherence to the VMSCC-recommended plan was 87.9% and 83.1%, respectively. The causes of the nonadherence were primarily due to disease progression or patient's decision against recommended therapy. The median overall survival for the high-grade STS cohort was 26 months.

CONCLUSION

VMSCC affected the treatment plan in approximately 50% of the patients in both cohorts. The median overall survival of the patients with high-grade STS reviewed by the VMSCC in our cohort is comparable with the literature.

摘要

目的

量化多学科癌症病例讨论会对患者预后和护理质量的影响仍然具有挑战性。

患者与方法

我们前瞻性地研究了虚拟多学科肉瘤病例讨论会(VMSCC)对2020年7月至10月参加VMSCC的患者治疗计划的影响(前瞻性队列),并回顾性地研究了2016年和2017年在VMSCC中接受审查的转移性或局部晚期高级别软组织肉瘤(STS)患者(高级别STS队列)。我们还研究了两个队列中与未遵守VMSCC推荐计划相关的因素。

结果

在两个队列中,约28%的患者在没有治疗计划的情况下被转诊至VMSCC进行审查。与肉瘤组内的转诊医生相比,肉瘤组外的转诊医生在VMSCC审查前制定计划的情况明显更少。在28.2%(前瞻性队列)和19.5%(高级别STS队列)的患者中,VMSCC推荐了不同的计划。对VMSCC推荐计划的依从率分别为87.9%和83.1%。不依从的原因主要是疾病进展或患者决定不接受推荐治疗。高级别STS队列的中位总生存期为26个月。

结论

VMSCC在两个队列中约50%的患者中影响了治疗计划。我们队列中由VMSCC审查的高级别STS患者的中位总生存期与文献报道相当。

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