{"id":4676,"date":"2016-08-03T00:00:00","date_gmt":"2016-08-03T06:00:00","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/2016\/08\/03\/study-confirms-uchs-team-approach-a-winner-for-gi-cancer-patients\/"},"modified":"2024-02-22T06:35:05","modified_gmt":"2024-02-22T13:35:05","slug":"study-confirms-uchs-team-approach-a-winner-for-gi-cancer-patients","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/study-confirms-uchs-team-approach-a-winner-for-gi-cancer-patients\/","title":{"rendered":"Study confirms: UCH\u2019s team approach a winner for GI cancer patients"},"content":{"rendered":"<div style=\"margin-top: 0px; margin-bottom: 0px;\" class=\"sharethis-inline-share-buttons\" ><\/div><h5><\/h5>\n<p>The one- and two-day initial visits that have become a hallmark of University of Colorado Hospital\u2019s gastrointestinal cancer care are as good for diagnostic accuracy and appropriate treatment as they are for patient convenience and speed of service.<\/p>\n<figure style=\"width: 300px\" class=\"wp-caption alignleft\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/1970\/01\/28144655\/EXT_08-04-16_GI-MDC-team.webp\" alt=\"GI-MDC-team\" width=\"300\" height=\"200\" \/><figcaption class=\"wp-caption-text\">From left, Cancer Center multidisciplinary GI clinic coordinators (left to right) Megan Boniface, Cheryl Meguid, Amanda Young and Whitney Herter. These advanced practice providers offer consistent points of contact for incoming gastrointestinal cancer patients at UCH as well as the medical acumen to get cancer care off to a strong start, and quickly.<\/figcaption><\/figure>\n<p>That\u2019s according to a University of Colorado School of Medicine team that considered 1,747 patients involved in four GI multidisciplinary clinics (MDCs) from late 2012 through December 2015. They found MDCs changed the diagnoses of referred patients 27 percent of the time and altered patients\u2019 recommended treatments 28 percent of the time.<\/p>\n<p>The numbers jibe with previous studies that sought to quantify the effects of having diverse experts gather to decide on the course of a patient\u2019s care, says <a href=\"https:\/\/www.cudoctors.com\/Find_A_Doctor\/Profile\/21144\" target=\"_blank\" rel=\"noopener noreferrer\">Cheryl Meguid, DNP<\/a>, the director of Multidisciplinary Program Development at CU and a nurse practitioner who has helped to lead the University of Colorado Cancer Center\u2019s Multidisciplinary Pancreas and Biliary Clinic since it <a href=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2017\/02\/28144654\/pancreatic20cancer20clinic.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">launched<\/a> in October 2012.<\/p>\n<p>\u201cWe knew it was significant and enough to make an impact,\u201d said Meguid, the lead author of the new study published in the <em>Annals of Surgical Oncology<\/em>.<\/p>\n<p><strong>Big changes<\/strong><\/p>\n<p>The authors, from the CU departments of Surgery, Radiation Oncology and Medical Oncology, represented four GI MDCs: pancreas and biliary; <a href=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2017\/02\/28144654\/gi20multidisciplinary20clinic.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">esophageal and gastric<\/a>, launched in August 2013; liver and neuroendocrine, launched in April 2014; and colorectal, launched in February 2015. All but the esophageal and gastric MDC distill into a single day patients\u2019 initial assessments, labs, scans, meetings with dietitians and social workers, consensus expert diagnoses and face-to-face meetings with the physicians who will lead their care. The esophageal and gastric MDC takes two days to allow time for an endoscopic evaluation the day before the multidisciplinary review.<\/p>\n<p>The pancreas and biliary clinic has had the biggest impact, the data show, with 38 percent of patients leaving with a different diagnosis and 35 percent with a different treatment recommendation than they arrived with. The changes are also significant for the other clinics:<\/p>\n<ul>\n<li>Patients with liver and neuroendocrine tumors saw their diagnoses change 22 percent of the time and their treatment recommendations change 27 percent of the time.<\/li>\n<li>Patients with esophageal and gastric cancers had their diagnoses changed 13 percent of the time and treatment recommendations 20 percent of the time.<\/li>\n<li>Patients with colorectal cancer had their diagnoses changed 16 percent of the time and treatment recommendations 13 percent of the time.<\/li>\n<\/ul>\n<p>Those figures don\u2019t count the more than 6 percent of cases in which the MDC\u2019s experts found problems unrelated to the cancer diagnosis. Such \u201cincidental findings\u201d included adrenal nodules, breast nodules, enlarged prostates, colorectal thickening, pulmonary emboli and benign cysts.<\/p>\n<p><strong>Spared the knife<\/strong><\/p>\n<p>Why did diagnoses changed more often with pancreatic and biliary cancer patients than with those with, say, colorectal cancer? It boils down to the challenges associated with the cancers themselves and the expertise demanded in their care, Meguid says.<\/p>\n<p>For example, few institutions perform the necessary multidetector CT scan, which determines whether a pancreatic tumor involves the blood vessels. Such involvement means a tumor deemed to be operable may not be \u2013 or it may be necessary to do chemotherapy and\/or radiation therapy to shrink the tumor before doing surgery. In addition, few outside institutions include chest CT scans in the initial pancreatic cancer workup, despite 10 percent of pancreatic cancers metastasizing to the lungs only.\u00a0 This may move a patient\u2019s cancer stage to stage 4, at which point surgery isn\u2019t a good option.<\/p>\n<p>As a result, nearly 54 percent of the changes in diagnoses among pancreatic and biliary cancer patients involved reclassifying referring providers\u2019 assessments from resectable (removable via surgery) to borderline\/locally advanced; another 43 percent of diagnoses were changed to metastatic. Only about 3 percent of the time did a referring provider\u2019s diagnosis that a pancreatic cancer was inoperable end up being overturned in the MDC.<\/p>\n<p>In short, in addition to crafting better care pathways, the MDC spares patients surgeries that would have failed to remove all the cancer, Meguid and colleagues found.<\/p>\n<p><strong>One or 20<\/strong><\/p>\n<p><a href=\"https:\/\/www.cudoctors.com\/Find_A_Doctor\/Profile\/20652\" target=\"_blank\" rel=\"noopener noreferrer\">Richard Schulick, MD, MBA<\/a>, chairman of CU\u2019s Department of Surgery and a specialist in complex GI cancer procedures, championed the MDC approach at UCH and coauthored the paper. He says the new data further underscore the value MDCs provide to patients.<\/p>\n<p>\u201cThink about it \u2013 do you want one doctor deciding what the plan of attack should be, or do you want 20 experts?\u201d Schulick said. \u201cInstead of one doc focusing on surgery, one on radiation oncology, and one on chemo, you want them all arguing and debating what pathway should be the right one.\u201d<\/p>\n<p>The centerpiece of a GI multidisciplinary clinic is a noon meeting involving as many as 40 or 50 physicians, nurses, medical residents and others. It brings together medical oncologists, radiation oncologists, and cancer surgeons as well as gastroenterologists, pathologists and radiologists; in the case of liver cancer patients, transplant surgeons and interventional radiologists are also there. In addition to the four GI MDCs covered in the new study, there are also three other cancer MDCs devoted to <a href=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2017\/02\/28144654\/breast20cancer20tumor20board.pdf\">breast cancer<\/a>, thoracic oncology and sarcomas.<\/p>\n<p><strong>Serious prep<\/strong><\/p>\n<p>The work starts long before noon. The MDCs each have a dedicated advanced care practitioner (either a nurse practitioner or a physician assistant) who serves as a patient\u2019s primary point of contact. Typically, patients go from referral to MDC within a week. By the time the patient arrives in the morning, the MDC coordinator has assembled a clinical history, established a patient\u2019s probable care pathway, and set a schedule.<\/p>\n<p>Patients start with radiology and labs, a health assessment and physical. There are meetings with support services, free within the UCH cancer center, such as dieticians and social workers, and then a lunch break, during which, in a Cancer Center conference room, the assembled specialist physicians consider cases and establish plans of care. Patients then meet with the appropriate physicians (if surgery is the first step, a surgical oncologist; if chemotherapy, a medical oncologist, as examples). Patients leave the cancer center knowing exactly where their care is headed.<\/p>\n<p>\u201cMy single best healthcare experience EVER,\u201d wrote one patient.\u00a0\u201cHaving been in the healthcare world for more than 20 years, I sometimes get a bit jaded. An experience like today\u2019s restores my belief that true personalized medicine does exist.\u201d<\/p>\n<p>Compare that to the old approach \u2013 still too often the status quo \u2013 in which patients must schedule separate appointments over a period of weeks with a succession of cancer specialists who may or may not be communicating. At an academic medical center such as UCH, where up to 18 percent of cancer patients come from out of state, it led to uncertainty compounded by inconvenience.<\/p>\n<p>Such MDCs remain the exception, Schulick said, because few hospitals have the requisite depth of expertise.<\/p>\n<p>\u201cEven top-notch academic medical centers can\u2019t all do this,\u201d Schulick said. \u201cIt takes being top-notch, but it also takes the willpower and the discipline to say, \u2018This is important, it\u2019s a priority, and it\u2019s the right thing for the patient.\u2019\u201d<\/p>\n<hr \/>\n<p>The authors of the Annals of Surgical Oncology paper<em>, The Multidisciplinary Approach to GI Cancer Results in Change of Diagnosis and Management of Patients. Multidisciplinary Care Impacts Diagnosis and Management of Patients,<\/em> include:<\/p>\n<p>Cheryl Meguid, DNP, ACNP<br \/>\nRichard Schulick, MD, MBA, FACS<br \/>\nTracey Schefter, MD<br \/>\nChristopher Lieu, MD<br \/>\nMegan Boniface, PA-C<br \/>\nNicole Williams, AGNP<br \/>\nJon Vogel, MD, FACS<br \/>\nCsaba Gajdos, MD, FACS<br \/>\nMartin McCarter, MD, FACS<br \/>\nBarish Edil, MD, FACS<\/p>\n","protected":false},"excerpt":{"rendered":"<p>The one- and two-day initial visits that have become a hallmark of University of Colorado Hospital\u2019s gastrointestinal cancer care are as good for diagnostic accuracy and appropriate treatment as they are for patient convenience and speed of service. That\u2019s according to a University of Colorado School of Medicine team that considered 1,747 patients involved in [&hellip;]<\/p>\n","protected":false},"author":23,"featured_media":3046,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[5],"tags":[28,49,181],"class_list":["post-4676","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-innovative-care","tag-cancer-care-oncology","tag-cancer-treatment","tag-gastroenterology"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.7 (Yoast SEO v27.7) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Study confirms: UCH\u2019s team approach a winner for GI cancer patients - UCHealth Today<\/title>\n<meta name=\"description\" content=\"The one- and two-day initial visits that have become a hallmark of University of Colorado Hospital\u2019s gastrointestinal cancer care are as good for diagnostic accuracy and appropriate treatment as they are for patient convenience and speed of service. 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