Adherence to Tumor Board Recommendations in the Treatment of Patients with Hepatocellular Carcinoma
Yueming Cao,1 Catherine Mezzacappa,1,2 Ariel Jaffe,1,2 Mario Strazzabosco,1,2 Tamar H Taddei1,2 1Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA; 2Department of Internal Medicine Digestive Disease Section, Yale School of Medicine, New Haven, CT, USACorrespondence: Tamar...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Dove Medical Press
2023-05-01
|
| Series: | Journal of Multidisciplinary Healthcare |
| Subjects: | |
| Online Access: | https://www.dovepress.com/adherence-to-tumor-board-recommendations-in-the-treatment-of-patients--peer-reviewed-fulltext-article-JMDH |
| _version_ | 1797813978999554048 |
|---|---|
| author | Cao Y Mezzacappa C Jaffe A Strazzabosco M Taddei TH |
| author_facet | Cao Y Mezzacappa C Jaffe A Strazzabosco M Taddei TH |
| author_sort | Cao Y |
| collection | DOAJ |
| description | Yueming Cao,1 Catherine Mezzacappa,1,2 Ariel Jaffe,1,2 Mario Strazzabosco,1,2 Tamar H Taddei1,2 1Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA; 2Department of Internal Medicine Digestive Disease Section, Yale School of Medicine, New Haven, CT, USACorrespondence: Tamar H Taddei, Department of Internal Medicine, Yale School of Medicine, PO Box 208019, New Haven, CT, 06520-8019, USA, Tel +1 203-785-7312, Fax +1 203-785-7273, Email tamar.taddei@yale.eduBackground: Hepatocellular carcinoma (HCC) is a heterogeneous disease that typically arises in the setting of chronic liver disease, making treatment selection complex. Multidisciplinary liver tumor boards (MDLTB) have been shown to improve outcomes in patients with HCC. However, in many cases, patients evaluated by MDLTBs ultimately do not receive the board’s recommended treatment.Purpose: This study aims to assess adherence to MDLTB recommendations for the treatment of HCC, the reasons for non-adherence, and the survival of Barcelona Clinic Liver Cancer (BCLC) Stage A patients treated with curative treatment compared to palliative locoregional therapy.Patients and Methods: A single-site, retrospective cohort study was conducted of all patients with treatment-naïve HCC who were evaluated by an MDLTB at a tertiary care center in Connecticut between 2013 and 2016, of which 225 patients met inclusion criteria. Investigators conducted a chart review and recorded adherence to the MDLTB’s recommendations, and in cases of discordance, evaluated and recorded the underlying cause; investigators assessed MDLTB recommendations’ compliance with BCLC guidelines. Survival data was accrued through February 1st of 2022 and analyzed via Kaplan–Meier analysis and multivariate Cox regression.Results: Treatment adherent to MDLTB recommendations occurred in 85.3% of patients (n=192). The majority of non-adherence occurred in the management of BCLC Stage A disease. In cases where adherence was possible but the recommendation was not followed, most discrepancies were whether to treat with curative or palliative intent (20/24), with almost all discrepancies occurring in patients (19/20) with BCLC Stage A disease. For patients with Stage A unifocal HCC, those who received curative therapy lived significantly longer than patients who received palliative locoregional therapy (5.55 years vs 4.26 years, p=0.037).Conclusion: Most forms of non-adherence to MDLTB recommendations were unavoidable; however, treatment discordance in the management of patients with BCLC Stage A unifocal disease may present an opportunity for clinically significant quality improvement.Keywords: compliance, multidisciplinary liver tumor board, HCC, treatment guidelines |
| first_indexed | 2024-03-13T08:00:44Z |
| format | Article |
| id | doaj.art-055bac662090480a822da55b700ddea5 |
| institution | Directory Open Access Journal |
| issn | 1178-2390 |
| language | English |
| last_indexed | 2024-03-13T08:00:44Z |
| publishDate | 2023-05-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Journal of Multidisciplinary Healthcare |
| spelling | doaj.art-055bac662090480a822da55b700ddea52023-06-01T16:35:14ZengDove Medical PressJournal of Multidisciplinary Healthcare1178-23902023-05-01Volume 161531154084103Adherence to Tumor Board Recommendations in the Treatment of Patients with Hepatocellular CarcinomaCao YMezzacappa CJaffe AStrazzabosco MTaddei THYueming Cao,1 Catherine Mezzacappa,1,2 Ariel Jaffe,1,2 Mario Strazzabosco,1,2 Tamar H Taddei1,2 1Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA; 2Department of Internal Medicine Digestive Disease Section, Yale School of Medicine, New Haven, CT, USACorrespondence: Tamar H Taddei, Department of Internal Medicine, Yale School of Medicine, PO Box 208019, New Haven, CT, 06520-8019, USA, Tel +1 203-785-7312, Fax +1 203-785-7273, Email tamar.taddei@yale.eduBackground: Hepatocellular carcinoma (HCC) is a heterogeneous disease that typically arises in the setting of chronic liver disease, making treatment selection complex. Multidisciplinary liver tumor boards (MDLTB) have been shown to improve outcomes in patients with HCC. However, in many cases, patients evaluated by MDLTBs ultimately do not receive the board’s recommended treatment.Purpose: This study aims to assess adherence to MDLTB recommendations for the treatment of HCC, the reasons for non-adherence, and the survival of Barcelona Clinic Liver Cancer (BCLC) Stage A patients treated with curative treatment compared to palliative locoregional therapy.Patients and Methods: A single-site, retrospective cohort study was conducted of all patients with treatment-naïve HCC who were evaluated by an MDLTB at a tertiary care center in Connecticut between 2013 and 2016, of which 225 patients met inclusion criteria. Investigators conducted a chart review and recorded adherence to the MDLTB’s recommendations, and in cases of discordance, evaluated and recorded the underlying cause; investigators assessed MDLTB recommendations’ compliance with BCLC guidelines. Survival data was accrued through February 1st of 2022 and analyzed via Kaplan–Meier analysis and multivariate Cox regression.Results: Treatment adherent to MDLTB recommendations occurred in 85.3% of patients (n=192). The majority of non-adherence occurred in the management of BCLC Stage A disease. In cases where adherence was possible but the recommendation was not followed, most discrepancies were whether to treat with curative or palliative intent (20/24), with almost all discrepancies occurring in patients (19/20) with BCLC Stage A disease. For patients with Stage A unifocal HCC, those who received curative therapy lived significantly longer than patients who received palliative locoregional therapy (5.55 years vs 4.26 years, p=0.037).Conclusion: Most forms of non-adherence to MDLTB recommendations were unavoidable; however, treatment discordance in the management of patients with BCLC Stage A unifocal disease may present an opportunity for clinically significant quality improvement.Keywords: compliance, multidisciplinary liver tumor board, HCC, treatment guidelineshttps://www.dovepress.com/adherence-to-tumor-board-recommendations-in-the-treatment-of-patients--peer-reviewed-fulltext-article-JMDHcompliancemultidisciplinary liver tumor boardhcctreatment guidelines |
| spellingShingle | Cao Y Mezzacappa C Jaffe A Strazzabosco M Taddei TH Adherence to Tumor Board Recommendations in the Treatment of Patients with Hepatocellular Carcinoma Journal of Multidisciplinary Healthcare compliance multidisciplinary liver tumor board hcc treatment guidelines |
| title | Adherence to Tumor Board Recommendations in the Treatment of Patients with Hepatocellular Carcinoma |
| title_full | Adherence to Tumor Board Recommendations in the Treatment of Patients with Hepatocellular Carcinoma |
| title_fullStr | Adherence to Tumor Board Recommendations in the Treatment of Patients with Hepatocellular Carcinoma |
| title_full_unstemmed | Adherence to Tumor Board Recommendations in the Treatment of Patients with Hepatocellular Carcinoma |
| title_short | Adherence to Tumor Board Recommendations in the Treatment of Patients with Hepatocellular Carcinoma |
| title_sort | adherence to tumor board recommendations in the treatment of patients with hepatocellular carcinoma |
| topic | compliance multidisciplinary liver tumor board hcc treatment guidelines |
| url | https://www.dovepress.com/adherence-to-tumor-board-recommendations-in-the-treatment-of-patients--peer-reviewed-fulltext-article-JMDH |
| work_keys_str_mv | AT caoy adherencetotumorboardrecommendationsinthetreatmentofpatientswithhepatocellularcarcinoma AT mezzacappac adherencetotumorboardrecommendationsinthetreatmentofpatientswithhepatocellularcarcinoma AT jaffea adherencetotumorboardrecommendationsinthetreatmentofpatientswithhepatocellularcarcinoma AT strazzaboscom adherencetotumorboardrecommendationsinthetreatmentofpatientswithhepatocellularcarcinoma AT taddeith adherencetotumorboardrecommendationsinthetreatmentofpatientswithhepatocellularcarcinoma |