Impact of a Single-Day Multidisciplinary Clinic on the Management of Patients with Liver Tumours

Abstract

Purpose: 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.