Multidisciplinary Teams Improve Gastric Cancer Treatment Efficiency at a Large Safety Net Hospital

  • Michelle Ju
  • Sam C. Wang
  • Samira Syed
  • Deepak Agrawal
  • Matthew R. PorembkaEmail author
Health Services Research and Global Oncology



Gastric cancer treatment initiation is a complex process. Inefficiencies in care coordination can lead to significant delays, which are often more prominent at safety net hospitals. Multidisciplinary teams (MDTs) have been proposed as an effective solution.


A retrospective review of sequential gastric cancer patients receiving treatment at Parkland Hospital (Dallas, TX) between 2013 and 2015 was performed before (n = 50) and after (n = 50) creation of a MDT and standardized care pathways. Patients undergoing urgent resection were excluded. Time to treatment (TTT) from initial endoscopy to initiation of chemotherapy was evaluated. The number of diagnostic tests performed and treatment variability also were compared.


Groups were similar in terms of age, sex, stage distribution, tumor location, and type of presentation (outpatient vs. emergency room). Post-intervention, TTT decreased from 84.1 ± 12.3 to 32.5 ± 15.2 days (p < 0.02). This decrease was primarily related to parallel performance of subspecialty evaluations, staging studies, and procedures. MDT review reduced the number of unnecessary staging tests performed, leading to a decrease in the average number of studies from 3.8 per patient to 2.2 (p < 0.05). Use of diagnostic laparoscopy in patients with clinically locally advanced disease increased from 18 to 94% (p < 0.05).


Creation of a gastric cancer MDT and uniform care pathways at a large safety net hospital expedited initiation of treatment, reduced unnecessary tests, and promoted consistent patient management.



None of the authors have conflicts of interest to disclose. SCW is a Disease Oriented Clinical Scholar at UTSW. MRP is a Dedman Family Scholar in Clinical Care at UTSW.


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Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Michelle Ju
    • 1
  • Sam C. Wang
    • 1
  • Samira Syed
    • 2
  • Deepak Agrawal
    • 3
  • Matthew R. Porembka
    • 1
    Email author
  1. 1.Division of Surgical Oncology, Department of SurgeryParkland Health and Hospital System, University of Texas Southwestern Medical CenterDallasUSA
  2. 2.Division of Hematology/Oncology, Department of Internal MedicineParkland Health and Hospital System, University of Texas Southwestern Medical CenterDallasUSA
  3. 3.Division of Digestive and Liver Disease, Department of Internal MedicineParkland Health and Hospital System, University of Texas Southwestern Medical CenterDallasUSA

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