title: Improvements in quality of care resulting from a formal multidisciplinary tumour clinic in the management of high-grade glioma.
abstract: BACKGROUND
  There is increasing belief that a formal protocol-based multidisciplinary care model should be adopted as an optimal care model in oncology. However, there is minimal outcome evidence to demonstrate an improvement in patient care. The aim of this study was to compare clinical quality outcomes between patients with high-grade glioma managed at one hospital using a formal neuro-oncology multidisciplinary tumour clinic (MTC) and a second hospital with a traditional on-call referral pattern (non-MTC).
  
  
  METHODS
  Patients with high-grade glioma managed radically with radiation therapy at 2 Singapore hospitals from May 2002 to May 2006 were entered into a prospective database. Patients were grouped into management via MTC or non-MTC. Four clinical quality indicators were chosen retrospectively to assess the variation in practice: a) Use of computed tomography (CT) or magnetic resonance (MR) imaging post-resection (POI) for assessment of residual disease; b) Commencement of radiation therapy (RT) within 28 days of surgery; c) Adjuvant chemotherapy use for glioblastoma multiforme (CTGBM) and d) Median survival.
  
  
  RESULTS
  Sixty-seven patients were managed radically, with 47 by MTC and by 20 by non-MTC. MTC patients were more likely to have POI (P = 0.042), and CTGBM (P = 0.025). Although the RT start time was similar for the whole cohort (60% versus 45%: P = 0.296); for GBM patients, the RT start was earlier (63% vs 33% P = 0.024). The median survival for the MTC group was 18.7 months versus 11.9 months for the non-MTC group (P = 0.11).
  
  
  CONCLUSIONS
  Clinical quality outcomes were significantly improved in patients with high-grade glioma managed in this neuro-oncology MTC.
authors.affiliation: The Cancer Institute, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433. mback@nsccahs.health.nsw.gov.au
authors.forename: Michael F
authors.initials: MF
authors.lastname: Back
authors.forename: Emily L L
authors.initials: EL
authors.lastname: Ang
authors.forename: Wai-Hoe
authors.initials: WH
authors.lastname: Ng
authors.forename: Siew-Ju
authors.initials: SJ
authors.lastname: See
authors.forename: C C Tchoyoson
authors.initials: CC
authors.lastname: Lim
authors.forename: Lee-Lee
authors.initials: LL
authors.lastname: Tay
authors.forename: Tseng-Tsai
authors.initials: TT
authors.lastname: Yeo
mesh_terms: D002173:Cancer Care Facilities; D005260:Female; D005910:Glioma / Q000145:classification / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D016019:Survival Analysis