title: Utility of a multidisciplinary tumor board in the management of pancreatic and upper gastrointestinal diseases: an observational study.
abstract: Multidisciplinary tumor boards (MDTBs) are frequently employed in cancer centers but their value has been debated. We reviewed the decision-making process and resource utilization of our MDTB to assess its utility in the management of pancreatic and upper gastrointestinal tract conditions.
  
  
  
  A prospectively-collected database was reviewed over a 12-month period. The primary outcome was change in management plan as a result of case discussion. Secondary outcomes included resources required to hold MDTB, survival, and adherence to treatment guidelines.
  
  
  
  Four hundred seventy cases were reviewed. MDTB resulted in a change in the proposed plan of management in 101 of 402 evaluable cases (25.1%). New plans favored obtaining additional diagnostic workup. No recorded variables were associated with a change in plan. For newly-diagnosed cases of pancreatic ductal adenocarcinoma (n = 33), survival time was not impacted by MDTB (p = .154) and adherence to National Comprehensive Cancer Network guidelines was 100%. The estimated cost of physician time per case reviewed was $190.
  
  
  
  Our MDTB influences treatment decisions in a sizeable number of cases with excellent adherence to national guidelines. However, this requires significant time expenditure and may not impact outcomes. Regular assessments of the effectiveness of MDTBs should be undertaken.
authors.affiliation: Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center at Washington University School of Medicine, Saint Louis, MO, USA.
authors.forename: David G
authors.initials: DG
authors.lastname: Brauer
authors.affiliation: Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center at Washington University School of Medicine, Saint Louis, MO, USA.
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Strand
authors.affiliation: Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center at Washington University School of Medicine, Saint Louis, MO, USA.
authors.forename: Dominic E
authors.initials: DE
authors.lastname: Sanford
authors.affiliation: Department of Medicine, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center at Washington University School of Medicine, Saint Louis, MO, USA.
authors.forename: Vladimir M
authors.initials: VM
authors.lastname: Kushnir
authors.affiliation: Department of Medicine, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center at Washington University School of Medicine, Saint Louis, MO, USA.
authors.forename: Kian-Huat
authors.initials: KH
authors.lastname: Lim
authors.affiliation: Department of Medicine, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center at Washington University School of Medicine, Saint Louis, MO, USA.
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Mullady
authors.affiliation: Department of Medicine, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center at Washington University School of Medicine, Saint Louis, MO, USA.
authors.forename: Benjamin R
authors.initials: BR
authors.lastname: Tan
authors.affiliation: Department of Medicine, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center at Washington University School of Medicine, Saint Louis, MO, USA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Wang-Gillam
authors.affiliation: Department of Medicine, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center at Washington University School of Medicine, Saint Louis, MO, USA.
authors.forename: Ashley E
authors.initials: AE
authors.lastname: Morton
authors.affiliation: Department of Pathology and Immunology, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center at Washington University School of Medicine, Saint Louis, MO, USA.
authors.forename: Marianna B
authors.initials: MB
authors.lastname: Ruzinova
authors.affiliation: Department of Radiation Oncology, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center at Washington University School of Medicine, Saint Louis, MO, USA.
authors.forename: Parag J
authors.initials: PJ
authors.lastname: Parikh
authors.affiliation: Mallinckrodt Institute of Radiology, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center at Washington University School of Medicine, Saint Louis, MO, USA.
authors.forename: Vamsi R
authors.initials: VR
authors.lastname: Narra
authors.affiliation: Mallinckrodt Institute of Radiology, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center at Washington University School of Medicine, Saint Louis, MO, USA.
authors.forename: Kathryn J
authors.initials: KJ
authors.lastname: Fowler
authors.affiliation: Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center at Washington University School of Medicine, Saint Louis, MO, USA.
authors.forename: Majella B
authors.initials: MB
authors.lastname: Doyle
authors.affiliation: Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center at Washington University School of Medicine, Saint Louis, MO, USA.
authors.forename: William C
authors.initials: WC
authors.lastname: Chapman
authors.affiliation: Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center at Washington University School of Medicine, Saint Louis, MO, USA.
authors.forename: Steven S
authors.initials: SS
authors.lastname: Strasberg
authors.affiliation: Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center at Washington University School of Medicine, Saint Louis, MO, USA.
authors.forename: William G
authors.initials: WG
authors.lastname: Hawkins
authors.affiliation: Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center at Washington University School of Medicine, Saint Louis, MO, USA. Electronic address: fieldsr@wudosis.wustl.edu.
authors.forename: Ryan C
authors.initials: RC
authors.lastname: Fields
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000191:economics / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D000066491:Clinical Decision-Making; D016208:Databases, Factual; D019033:Delivery of Health Care, Integrated / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000191:economics / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D019983:Guideline Adherence; D017048:Health Care Costs; D006295:Health Resources / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000191:economics / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D010348:Patient Care Team / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D016896:Treatment Outcome; D055815:Young Adult