title: Impact of a single-day multidisciplinary clinic on the management of patients with liver tumours.
abstract: OBJECTIVE
  Multidisciplinary cancer clinics may improve patient care. We examined how a single-day multidisciplinary liver clinic (mdlc) affected care recommendations for patients compared with the recommendations provided before presentation to the mdlc.
  
  
  METHODS
  We analyzed the demographic and clinicopathologic data of 343 patients assessed in the Johns Hopkins Liver Tumor Center from 2009 to 2012, comparing imaging and pathology interpretation, diagnosis, and management plan between the outside provider (osp) and the mdlc.
  
  
  RESULTS
  Most patients were white (n = 259, 76%); median age was 60 years; and 146 were women (43%). Outside providers referred 182 patients (53%); the rest were self-referred. Patients travelled median of 83.4 miles (interquartile range: 42.7-247 miles). Most had already undergone imaging (n = 338, 99%) and biopsy (n = 194, 57%) at the osp, and a formal management plan had been formulated for about half (n = 168, 49%). Alterations in the interpretation of imaging occurred for 49 patients (18%) and of biopsy for 14 patients (10%). Referral to the mdlc resulted in a change of diagnosis in 26 patients (8%), of management plan in 70 patients (42%), and of tumour resectability in 7 patients (5%). Roughly half the patients (n = 174, 51%) returned for a follow-up, and 154 of the returnees (89%) received treatment, primarily intraarterial therapy (n = 88, 57%), systemic chemotherapy (n = 60, 39%), or liver resection (n = 32, 21%). Enrollment in a clinical trial was proposed to 34 patients (10%), and 21 of the 34 (62%) were accrued.
  
  
  CONCLUSIONS
  Patient assessment by our multidisciplinary liver clinic had a significant impact on management, resulting in alterations to imaging and pathology interpretation, diagnosis, and management plan. The mdlc is an effective and convenient means of delivering expert opinion about the diagnosis and management of liver tumours.
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, U.S.A.
authors.forename: J
authors.initials: J
authors.lastname: Zhang
authors.forename: M N
authors.initials: MN
authors.lastname: Mavros
authors.forename: D
authors.initials: D
authors.lastname: Cosgrove
authors.forename: K
authors.initials: K
authors.lastname: Hirose
authors.forename: J M
authors.initials: JM
authors.lastname: Herman
authors.forename: S
authors.initials: S
authors.lastname: Smallwood-Massey
authors.forename: I
authors.initials: I
authors.lastname: Kamel
authors.forename: A
authors.initials: A
authors.lastname: Gurakar
authors.forename: R
authors.initials: R
authors.lastname: Anders
authors.forename: A
authors.initials: A
authors.lastname: Cameron
authors.forename: J F H
authors.initials: JF
authors.lastname: Geschwind
authors.forename: T M
authors.initials: TM
authors.lastname: Pawlik
keywords: Multidisciplinary care; interventional radiology; liver tumours; single-day clinic; surgical oncology
references.citation: J Clin Oncol. 2010 Jan 20;28(3):481-6
references.pmid: 20008627
references.citation: Am J Surg Pathol. 2002 Aug;26(8):978-88
references.pmid: 12170084
references.citation: Arch Pathol Lab Med. 1986 Nov;110(11):1035-40
references.pmid: 2430547
references.citation: Ann Surg Oncol. 2008 Aug;15(8):2081-8
references.pmid: 18461404
references.citation: Liver Transpl. 2004 Feb;10(2 Suppl 1):S3-8
references.pmid: 14762831
references.citation: Cancer. 2006 Nov 15;107(10):2346-51
references.pmid: 16998942
references.citation: J Clin Oncol. 2011 Oct 20;29(30):3960-7
references.pmid: 21911714
references.citation: J Cancer Educ. 2002 Summer;17(2):97-100
references.pmid: 12092861
references.citation: J Oncol Pract. 2010 Nov;6(6):e27-30
references.pmid: 21358947
references.citation: Ann Surg Oncol. 2011 Dec;18(13):3657-65
references.pmid: 21681380
references.citation: Eur J Surg Oncol. 1998 Dec;24(6):492-5
references.pmid: 9870722
references.citation: Cancer. 2009 Aug 25;117(4):237-46
references.pmid: 19551848
references.citation: Cancer. 1997 Jun 15;79(12):2380-4
references.pmid: 9191526
references.citation: Radiology. 2012 Jul;264(1):285-94
references.pmid: 22627601
references.citation: JBR-BTR. 2009 Jul-Aug;92(4):195-201
references.pmid: 19803097
references.citation: Oncol Nurs Forum. 1999 Nov-Dec;26(10):1673-80
references.pmid: 10573684
references.citation: J Urol. 2012 Jan;187(1):103-8
references.pmid: 22088334
references.citation: J Oncol Pract. 2010 Nov;6(6):292-4
references.pmid: 21358958
references.citation: Laryngoscope. 2011 Oct;121(10):2131-5
references.pmid: 21826674
references.citation: J Gastrointest Surg. 2011 Nov;15(11):2089-97
references.pmid: 21725699
references.citation: J Am Acad Dermatol. 1998 May;38(5 Pt 1):742-51
references.pmid: 9591819
references.citation: Lancet Oncol. 2009 Feb;10(2):98-9
references.pmid: 19185826
references.citation: J Oncol Pract. 2010 Nov;6(6):288-92
references.pmid: 21358957
references.citation: BJU Int. 2012 Oct;110(7):998-1003
references.pmid: 22404874
references.citation: Cancer Imaging. 2007 Oct 01;7 Spec No A:S1-14
references.pmid: 17921080
references.citation: Br J Cancer. 1994 Aug;70(2):363-70
references.pmid: 8054286
references.citation: Ann Surg Oncol. 2012 Sep;19(9):2897-907
references.pmid: 22476754
references.citation: Ann Surg. 2010 Jul;252(1):142-8
references.pmid: 20531007
references.citation: Am J Clin Pathol. 2006 Sep;126(3):337-340
references.pmid: 16880147
references.citation: J Oncol Pract. 2010 Nov;6(6):e5-e10
references.pmid: 21358951
references.citation: Curr Oncol. 2007 Feb;14(1):9-12
references.pmid: 17576458
references.citation: Int J Breast Cancer. 2011;2011:831605
references.pmid: 22295234
references.citation: J Oncol Pract. 2010 Nov;6(6):e21-6
references.pmid: 21358946
references.citation: Int J Gynecol Cancer. 2004 Mar-Apr;14(2):206-9
references.pmid: 15086716
references.citation: Arch Dermatol. 2002 May;138(5):617-21
references.pmid: 12020222
references.citation: Cancer. 2001 Apr 1;91(7):1231-7
references.pmid: 11283921
references.citation: Am J Clin Oncol. 2013 Apr;36(2):121-5
references.pmid: 22307214
references.citation: Diagn Cytopathol. 2002 Jan;26(1):45-8
references.pmid: 11782087
references.citation: Br J Cancer. 2011 Apr 12;104(8):1246-8
references.pmid: 21448166
references.citation: Curr Probl Diagn Radiol. 2004 Nov-Dec;33(6):239-53
references.pmid: 15549050