Department of Internal Medicine I, Focus On Hematology, Oncology and Stem Cell Transplantation, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstraße 53, 79106, Freiburg, Baden-Württemberg, Germany.
Clinical Trials Unit, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Ann Hematol. 2023 Mar;102(3):603-611. doi: 10.1007/s00277-022-05051-y. Epub 2022 Dec 5.
The established standard to ensure state-of-the-art cancer treatment is through multidisciplinary tumor boards (TBs), although resource- and time-intensive. In this validation study, the multiple myeloma (MM)-TB was reexamined, aiming to validate our previous (2012-2014) results, now using the TB data from March 2020 to February 2021. We assessed MM-TB protocols, physicians' documentation, patient, disease, remission status, progression-free survival (PFS), and overall survival (OS) as left-truncated survival times. Moreover, TB-adherence, level of evidence according to grade criteria, time requirements, study inclusion rates, and referral satisfaction were determined. Within a 1-year period, 312 discussed patients were documented in 439 TB protocols. Patient and disease characteristics were typical for comprehensive cancer centers. The percentages of patients discussed at initial diagnosis (ID), with disease recurrence or in need of interdisciplinary advice, were 39%, 28%, and 33%, respectively. Reasons for the MM-TB presentation were therapeutic challenges in 80% or staging/ID-defining questions in 20%. The numbers of presentations were mostly one in 73%, two in 20%, and three or more in 7%. The TB adherence rate was 93%. Reasons for non-adherence were related to patients' decisions or challenging inclusion criteria for clinical trials. Additionally, we demonstrate that with the initiation of TBs, that the number of interdisciplinarily discussed patients increased, that TB-questions involve advice on the best treatment, and that levels of compliance and evidence can be as high as ≥ 90%. Advantages of TBs are that they may also improve patients', referrers', and physicians' satisfaction, inclusion into clinical trials, and advance interdisciplinary projects, thereby encouraging cancer specialists to engage in them.
确保最先进的癌症治疗标准是通过多学科肿瘤委员会(TB),尽管资源和时间密集。在这项验证研究中,重新检查了多发性骨髓瘤(MM)-TB,旨在验证我们之前(2012-2014 年)的结果,现在使用 2020 年 3 月至 2021 年 2 月的 TB 数据。我们评估了 MM-TB 方案、医生的记录、患者、疾病、缓解状态、无进展生存期(PFS)和总生存期(OS)作为左截断生存时间。此外,还确定了 TB 依从性、根据等级标准的证据水平、时间要求、研究纳入率和转诊满意度。在 1 年内,有 312 名讨论过的患者在 439 个 TB 方案中被记录。患者和疾病特征是综合性癌症中心的典型特征。在初始诊断(ID)、疾病复发或需要跨学科建议时讨论的患者百分比分别为 39%、28%和 33%。MM-TB 呈现的原因是 80%的治疗挑战或 20%的分期/ID 定义问题。展示的次数大多为 73%的一次,20%的两次,7%的三次或更多。TB 依从率为 93%。不依从的原因与患者的决定或临床试验的纳入标准有关。此外,我们还证明,随着 TB 的启动,跨学科讨论的患者数量增加,TB 问题涉及最佳治疗建议,并且合规性和证据水平可以高达≥90%。TB 的优点是它们还可以提高患者、转介者和医生的满意度、纳入临床试验和推进跨学科项目,从而鼓励癌症专家参与其中。