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Evaluating the Impact of a Single-Day Multidisciplinary Clinic on the Management of Pancreatic Cancer

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the impact of a multidisciplinary clinic on the clinical care recommendations of patients with pancreatic cancer compared with the recommendations the patients received prior to review by the multidisciplinary tumor board.

Methods

The records of 203 consecutive patients referred to the Johns Hopkins pancreatic multidisciplinary clinic were prospectively collected from November 2006 to October 2007. Cross-sectional imaging, pathology, and medical history were evaluated by a panel of medical/radiation oncologists, surgical oncologists, pathologists, diagnostic radiologists, and geneticists. Alterations in treatment recommendations between the outside institution and the multidisciplinary clinic were recorded and compared.

Results

On presentation, the outside computed tomography (CT) report described locally advanced/unresectable disease (34.9%), metastatic disease (17.7%), and locally advanced disease with metastasis (1.1%). On review of submitted imaging and imaging performed at Hopkins, 38 out of 203 (18.7%) patients had a change in the status of their clinical stage. Review of the histological slides by dedicated pancreatic pathologists resulted in changes in the interpretation for 7 of 203 patients (3.4%). Overall, 48 out of 203 (23.6%) patients had a change in their recommended management based on clinical review of their case by the multidisciplinary tumor board. Enrollment into the National Familial Pancreas Tumor Registry increased from 52 out of 106 (49.2%) patients in 2005 to 158 out of 203 (77.8%) with initiation of the multidisciplinary clinic.

Conclusion

The single-day pancreatic multidisciplinary clinic provided a comprehensive and coordinated evaluation of patients that led to changes in therapeutic recommendations in close to one-quarter of patients.

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References

  1. Back MF, Ang EL, Ng WH, et al. Improvements in quality of care resulting from a formal multidisciplinary tumour clinic in the management of high-grade glioma. Ann Acad Med Singapore 2007;36:347–51

    PubMed  Google Scholar 

  2. Gabel M, Hilton NE, Nathanson SD. Multidisciplinary breast cancer clinics. Do they work? Cancer 1997;79:2380–4

    Article  PubMed  CAS  Google Scholar 

  3. Petty JK, Vetto JT. Beyond doughnuts: tumor board recommendations influence patient care. J Cancer Educ 2002;17:97–100

    PubMed  Google Scholar 

  4. Nyquist JG, Radecki SE, Gates JD, et al. An educational intervention to improve hospital tumor conferences. J Cancer Educ 1995;10:71–7

    PubMed  CAS  Google Scholar 

  5. Radecki SE, Nyquist JG, Gates JD, et al. Educational characteristics of tumor conferences in teaching and non-teaching hospitals. J Cancer Educ 1995;9:204–16

    PubMed  CAS  Google Scholar 

  6. Wright FC, De Vito C, Langer B, et al. Multidisciplinary cancer conferences: a systematic review and development of practice standards. Eur J Cancer 2007;43:1002–10

    Article  PubMed  CAS  Google Scholar 

  7. Newman EA, Guest AB, Helvie MA, et al. Changes in surgical management resulting from case review at a breast cancer multidisciplinary tumor board. Cancer 2006;107:2346–51

    Article  PubMed  Google Scholar 

  8. Chang JH, Vines E, Bertsch H, et al. The impact of a multidisciplinary breast cancer center on recommendations for patient management: the University of Pennsylvania experience. Cancer 2001;91:1231–7

    Article  PubMed  CAS  Google Scholar 

  9. Ujiki MB, Talamonti MS. Guidelines for the surgical management of pancreatic adenocarcinoma. Semin Oncol 2007;34:311–20

    Article  PubMed  Google Scholar 

  10. Varadhachary GR, Tamm EP, Abbruzzese JL, et al. Borderline resectable pancreatic cancer: definitions, management, and role of preoperative therapy. Ann Surg Oncol 2006;13:1035–46

    Article  PubMed  Google Scholar 

  11. Crane CH, Varadhachary G, Wolff RA, et al. The argument for pre-operative chemoradiation for localized, radiographically resectable pancreatic cancer. Best Pract Res Clin Gastroenterol 2006;20:365–82

    Article  PubMed  Google Scholar 

  12. Varadhachary GR, Tamm EP, Crane C, et al. Borderline resectable pancreatic cancer. Curr Treat Options Gastroenterol 2005;8:377–84

    Article  PubMed  Google Scholar 

  13. Novick SL, Fishman EK. Three-dimensional CT angiography of pancreatic carcinoma: role in staging extent of disease. Am J Roentgenol 1998;170:139–43

    CAS  Google Scholar 

  14. House MG, Yeo CJ, Cameron JL, et al. Predicting resectability of periampullary cancer with three-dimensional computed tomography. J Gastrointest Surg 2004;8:280–8

    Article  PubMed  Google Scholar 

  15. Klein AP, Brune KA, Petersen GM, et al. Prospective risk of pancreatic cancer in familial pancreatic cancer kindreds. Cancer Res 2004;64:2634–8

    Article  PubMed  CAS  Google Scholar 

  16. Tseng JF, Raut CP, Lee JE, et al. Pancreaticoduodenectomy with vascular resection: margin status and survival duration. J Gastrointest Surg 2004;8:935–49; discussion 949–50

    Article  PubMed  Google Scholar 

  17. Poon RT, Fan ST, Lo CM, et al. Pancreaticoduodenectomy with en bloc portal vein resection for pancreatic carcinoma with suspected portal vein involvement. World J Surg 2004;28:602–8

    Article  PubMed  Google Scholar 

  18. Harrison LE, Klimstra DS, Brennan MF. Isolated portal vein involvement in pancreatic adenocarcinoma. A contraindication for resection? Ann Surg 1996;224:342–7; discussion 347–9

    Article  PubMed  CAS  Google Scholar 

  19. Bluemke DA, Cameron JL, Hruban RH, et al. Potentially resectable pancreatic adenocarcinoma: spiral CT assessment with surgical and pathologic correlation. Radiology 1995;197:381–5

    PubMed  CAS  Google Scholar 

  20. Fishman EK, Horton KM. Imaging pancreatic cancer: the role of multidetector CT with three-dimensional CT angiography. Pancreatology 2001;1:610–24

    Article  PubMed  CAS  Google Scholar 

  21. Schima W, Ba-Ssalamah A, Kolblinger C, et al. Pancreatic adenocarcinoma. Eur Radiol 2007;17:638–49

    Article  PubMed  Google Scholar 

  22. Bartolozzi C, Donati F, Cioni D, et al. Detection of colorectal liver metastases: a prospective multicenter trial comparing unenhanced MRI, MnDPDP-enhanced MRI, and spiral CT. Eur Radiol 2004;14:14–20

    Article  PubMed  Google Scholar 

  23. Balci NC, Semelka RC. Radiologic diagnosis and staging of pancreatic ductal adenocarcinoma. Eur J Radiol 2001;38:105–12

    Article  PubMed  CAS  Google Scholar 

  24. Weg N, Scheer MR, Gabor MP. Liver lesions: improved detection with dual-detector-array CT and routine 2.5-mm thin collimation. Radiology 1998;209:417–26

    PubMed  CAS  Google Scholar 

  25. Kopka L, Grabbe E. Biphasic liver diagnosis with multiplanar-detector spiral CT. Radiologe 1999;39:971–8

    Article  PubMed  CAS  Google Scholar 

  26. Kopp AF, Heuschmid M, Claussen CD. Multidetector helical CT of the liver for tumor detection and characterization. Eur Radiol 2002;12:745–752

    Article  PubMed  Google Scholar 

  27. Graf O, Boland GW, Warshaw AL, et al. Arterial versus portal venous helical CT for revealing pancreatic adenocarcinoma: conspicuity of tumor and critical vascular anatomy. Am J Roentgenol 1997;169:119–23

    CAS  Google Scholar 

  28. McCarthy MJ, Evans J, Sagar G, et al. Prediction of resectability of pancreatic malignancy by computed tomography. Br J Surg 1998;85:320–5

    Article  PubMed  CAS  Google Scholar 

  29. Fishman EK, Wyatt SH, Ney DR, et al. Spiral CT of the pancreas with multiplanar display. Am J Roentgenol 1992;159:1209–15

    CAS  Google Scholar 

  30. Nakagohri T, Kinoshita T, Konishi M, et al. Survival benefits of portal vein resection for pancreatic cancer. Am J Surg 2003;186:149–53

    Article  PubMed  Google Scholar 

  31. Weitz J, Kienle P, Schmidt J, et al. Portal vein resection for advanced pancreatic head cancer. J Am Coll Surg 2007;204:712–6

    Article  PubMed  Google Scholar 

  32. Metz DC. Diagnosis and treatment of pancreatic neuroendocrine tumors. Semin Gastrointest Dis 1995;6:67–78

    PubMed  CAS  Google Scholar 

  33. Norton JA. Neuroendocrine tumors of the pancreas and duodenum. Curr Probl Surg 1994;31:77–156

    Article  PubMed  CAS  Google Scholar 

  34. Teh SH, Deveney C, Sheppard BC. Aggressive pancreatic resection for primary pancreatic neuroendocrine tumor: is it justifiable? Am J Surg 2007;193:610–3; discussion 613

    Article  PubMed  Google Scholar 

  35. Norton JA, Kivlen M, Li M, et al. Morbidity and mortality of aggressive resection in patients with advanced neuroendocrine tumors. Arch Surg 2003;138:859–66

    Article  PubMed  Google Scholar 

  36. Kronz JD, Westra WH, Epstein JI. Mandatory second opinion surgical pathology at a large referral hospital. Cancer 1999;86:2426–35

    Article  PubMed  CAS  Google Scholar 

  37. Tomaszewski JE, LiVolsi VA. Mandatory second opinion of pathologic slides: is it necessary? Cancer 1999;86:2198–200

    Article  PubMed  CAS  Google Scholar 

  38. Murthy VH, Krumholz HM, Gross CP. Participation in cancer clinical trials: race-, sex-, and age-based disparities. JAMA 2004;291:2720–6

    Article  PubMed  CAS  Google Scholar 

  39. Ford BM, Evans JS, Stoffel EM, et al. Factors associated with enrollment in cancer genetics research. Cancer Epidemiol Biomarkers Prev 2006;15:1355–9

    Article  PubMed  Google Scholar 

  40. Townsley CA, Selby R, Siu LL. Systematic review of barriers to the recruitment of older patients with cancer onto clinical trials. J Clin Oncol 2005;23:3112–24

    Article  PubMed  Google Scholar 

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Acknowledgements

Support: Dr. Pawlik is supported by Grant Number 1KL2RR025006-01 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. The contents of the publication are solely the responsibility of the authors and do not necessarily represent the official view of NCRR or NIH.

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Authors and Affiliations

  1. Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Baltimore, MD, USA

    Timothy M. Pawlik MD, MPH, Christopher L. Wolfgang MD, PhD, Kurt Campbell MD & Richard D. Schulick MD

  2. Department of Oncology, The Sol Goldman Pancreatic Cancer Research Center, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Baltimore, MD, USA

    Daniel Laheru MD

  3. Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Baltimore, MD, USA

    Ralph H. Hruban MD & Syed Ali MD

  4. Department of Radiation Oncology & Molecular Radiation Sciences, The Sol Goldman Pancreatic Cancer Research Center, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Baltimore, MD, USA

    JoAnn Coleman CRNP & Joseph M. Herman MD, MSc

  5. Department of Radiology, The Sol Goldman Pancreatic Cancer Research Center, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Baltimore, MD, USA

    Elliot K. Fishman MD

  6. Department of Radiation Oncology & Molecular Radiation Sciences, Multidisciplinary Pancreatic Cancer Clinic, 401 North Broadway/Suite 1440, Baltimore, MD, 21231-2410, USA

    Joseph M. Herman MD, MSc

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  1. Timothy M. Pawlik MD, MPH
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  2. Daniel Laheru MD
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  3. Ralph H. Hruban MD
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  7. Syed Ali MD
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  10. Joseph M. Herman MD, MSc
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the Johns Hopkins Multidisciplinary Pancreas Clinic Team

Corresponding author

Correspondence to Joseph M. Herman MD, MSc.

Additional information

Presented at the American Pancreatic Association’s Annual Meeting, Chicago, Illinois, November 1, 2007.

The Johns Hopkins Multidisciplinary Pancreas Clinic Team: Ranh Voong, BA, Marian Raben, PA, Barish Edil, MD, Fariba Asrari, MD, Cathy Stanfield, PA, Karen Horton, MD, Marty A. Makary, MD, MPH, Ross Donehower, MD, Luis A. Diaz, Jr., MD.

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Pawlik, T.M., Laheru, D., Hruban, R.H. et al. Evaluating the Impact of a Single-Day Multidisciplinary Clinic on the Management of Pancreatic Cancer. Ann Surg Oncol 15, 2081–2088 (2008). https://doi.org/10.1245/s10434-008-9929-7

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  • DOI: https://doi.org/10.1245/s10434-008-9929-7

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