Kaiser Permanente study quantifies impact of a virtual tumor board for rare cancer
By Sue Rochman
Drawing on the expertise of physicians representing multiple medical disciplines can lead to new treatment plans for adults and children with a rare type of cancer called sarcoma, a new Kaiser Permanente study showed.
The study, published in JCO Oncology Practice, found the Kaiser Permanente Northern California virtual multidisciplinary sarcoma case conference revised a physician’s treatment plan or created a treatment plan for about half of the 218 patients whose medical records were reviewed.
Minggui Pan, MD, PhD, adjunct investigator, Division of Research, and oncologist/hematologist, The Permanente Medical Group.
“This paper shows the impact of our virtual multidisciplinary sarcoma case conference is real, is not trivial, and improves the quality of care of our patients,” said the study’s lead author Minggui Pan, MD, PhD, an adjunct investigator with the Kaiser Permanente Northern California (KPNC) Division of Research and an oncologist/hematologist with The Permanente Medical Group.
Sarcoma is a rare type of cancer that begins in bone or soft tissue, such as cartilage, fat, muscle, blood vessels, or connective tissue. The American Cancer Society estimates that this year about 13,460 children and adults will be diagnosed with a soft tissue sarcoma and about 5,350 will die from the disease.
“These cancers are very challenging in terms of their treatment complexity,” said Pan, chief of the Department of Oncology and Hematology at Kaiser Permanente Santa Clara Medical Center and chair of the KPNC Soft Tissue and Bone Sarcoma Program. “It’s also challenging emotionally because patients often don’t do well on treatment and many are very young.”
Many cancer treatment guidelines recommend a patient’s treatment plan be reviewed by a multidisciplinary team, also known as a tumor board, especially if the patient has a rare cancer. During a multidisciplinary case conference, a team of specialists discuss which cancer treatments would be most beneficial for a specific patient and the order in which they should be given. The KPNC virtual multidisciplinary sarcoma case conference includes experts in surgical oncology, medical oncology, radiation oncology, musculoskeletal oncology, musculoskeletal radiology, nuclear medicine, pathology, and pediatric oncology.
For the study, Pan and his colleagues prospectively reviewed the multidisciplinary team’s treatment recommendations for 141 patients diagnosed with any type of soft tissue or bone sarcoma from July to October 2020. They also retrospectively reviewed treatment plans for 77 patients with metastatic or locally advanced high-grade soft tissue sarcoma referred in 2016 and 2017. Their analysis showed the team recommended a different treatment plan than the referring physician for 28% of the patients in the group studied prospectively and 20% of the patients in the group studied retrospectively. During both time periods, 28% of patients were referred without a treatment plan.
The study also showed that the multidisciplinary team was as likely to recommend a different treatment plan for a patient whether the referring physician was inside or outside the sarcoma group. “That was a very interesting finding,” said Pan. “We are experts and we meet every week and take care of a lot of patients, but when you brainstorm with other experts you develop new ideas and recommendations — and that’s important.”
Overall, the treatment plans were adhered to by 88% of the patients prospectively studied and 83% of the patients in the retrospective analysis. In the group of high-grade soft tissue sarcoma patients who were followed long enough to allow for survival assessment, the median overall survival of the patients the team provided treatment plans for was comparable to that seen in retrospective studies and clinical trials.
Pan established the virtual multidisciplinary case conference for sarcoma patients in 2013. Initially, the team met monthly. Over time, as more patients were referred by KPNC physicians as well as by physicians in Kaiser Permanente Mid-Atlantic, Northwest, Hawaii, and Southern California regions, the case volume grew. Now, the team meets weekly. The new research bolsters findings from a previous study Pan and his colleagues published in June 2020 that found referring physicians believed the team and its recommendations enhanced their confidence in treating sarcoma patients.
“The success of our program has been aided by the support we’ve received from Kaiser Permanente, which includes the creation of a dashboard platform that automatically sends us the records of all referred sarcoma patients,” said Pan. “We also wouldn’t be successful without the physicians we work with. It’s a team effort.”
The study was supported by Kaiser Permanente Northern California and the Jiayan Foundation.
Co-authors include Jeannette Yu, MD, Manpreet Sidhu, MD, Tiffany Seto, MD, and Andrew Fang, MD of The Permanente Medical Group.
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About the Kaiser Permanente Division of Research
The Kaiser Permanente Division of Research conducts, publishes and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and society at large. It seeks to understand the determinants of illness and well-being, and to improve the quality and cost-effectiveness of health care. Currently, DOR’s 600-plus staff is working on more than 450 epidemiological and health services research projects. For more information, visit divisionofresearch.kaiserpermanente.org or follow us @KPDOR.