Establishment of a Regional Virtual Tumor Board Program to Improve the Process of Care for Patients With Hepatocellular Carcinoma

Abstract

Purpose: Multidisciplinary evaluation (MDE) of hepatocellular cancer (HCC) is the current standard, often provided through a tumor board (TB) forum; this standard is limited by oncology workforce shortages and lack of a TB at every institution. Virtual TBs (VTBs) may help overcome these limitations. Our study aim was to assess the impact of a regional VTB on the MDE process for patients with HCC.

Methods: A retrospective cohort study was conducted, including patients with HCC referred to a tertiary cancer center from regional facilities (2009 to 2013). Baseline characteristics and outcomes were compared based on the referral mechanism: VTB versus subspecialty consultation (non-VTB). The primary outcome was comprehensive MDE (all required specialists present and key topics discussed). Secondary outcomes included timeliness of MDE and travel burden to complete MDE. Univariable and multivariable logistic regressions were performed to examine the association of a VTB with comprehensive MDE.

Results: A total of 116 patients were included in the study; 48 (41.4%) were evaluated through the VTB. A higher proportion of VTB patients received comprehensive MDE (91.7% v 64.7%; P = .001); the VTB was independently associated with higher odds of accomplishing comprehensive MDE (odds ratio, 6.0; 95% CI, 1.2 to 29.9; P = .02). VTB patients completed MDE significantly faster (median, 23 v 39 days; P < .001), with lower travel burden (median, 0 v 683 miles traveled; P < .001).

Conclusion: This VTB program positively affected the process of care for patients with HCC by improving the quality and timeliness of the MDE process, while avoiding the burden arising from travel needs. Future studies should focus on implementation of VTB programs on a wider scale.

Figure 1.

Logistic regression models evaluating association between virtual tumor boards (VTBs) and comprehensive multidisciplinary evaluation (N = 116).

Figure A1.

Study flowchart delineating trajectory of patients referred to Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC; referral center) for hepatocellular carcinoma (HCC) evaluation (N = 116) by referral mechanism (consult type) and corresponding outcome. MDE, multidisciplinary evaluation; TB, tumor board; VTB, virtual tumor board. (*) P < .001 for comparisons of outcomes. (†) Quality of MDE; guideline-driven MDE, defined as MDE by team that at minimum was composed of following clinical specialties: radiology, hepatology, surgical oncology, interventional radiology, medical oncology, and transplantation before initiation of treatment.