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Review
. 2023 Nov;12(6):1310-1317.
doi: 10.21037/apm-23-357. Epub 2023 Oct 23.

Pivoting to telemedicine in a single-day multidisciplinary liver tumor clinic during COVID-19: the Texas Liver Tumor Center experience

Katherine S Crow  1 , Fred F Poordad  2 , Glenn A Halff  1 , Francisco G Cigarroa  1 , Eugenia Tsai  2 , Irma V Infante  1 , Sukeshi Patel Arora  3
Affiliations
Review

Pivoting to telemedicine in a single-day multidisciplinary liver tumor clinic during COVID-19: the Texas Liver Tumor Center experience

Katherine S Crow et al. Ann Palliat Med. 2023 Nov.

Abstract

Cancer guidelines recommend that all patients with hepatocellular carcinoma (HCC) have an evaluation by a multidisciplinary team to assess liver health, stage the cancer, and discuss treatment and palliative care options. Coronavirus disease 2019 (COVID-19) had a catastrophic impact on patients with cancer resulting in increased disease burden due to late diagnosis and treatment delays. Late diagnosis has highlighted the need for the early intervention of palliative care for patients with HCC. Conversion to telemedicine has been essential to caring for patients with all stages of cancer without added delays. Texas Liver Tumor Center (TLTC) offers patients with liver cancer at any stage a single-day multidisciplinary evaluation with tumor board review facilitating the early integration of treatment and palliative care services. National Comprehensive Cancer Network (NCCN) guidelines support increasing and improving access to palliative care. TLTC allows for the early integration of palliative care within a 1-day clinic model with an incorporated tumor board. This unique model of patient care decreases the burden of separate patient visits, may expedite the time from diagnosis to first treatment, facilitates the early intervention of palliative care specialists, and allows for optimal screening for clinical trials. In this review, we will provide an overview of the current multidisciplinary models of care for HCC and describe the successful pivot of TLTC from a fully in-person single-day multidisciplinary clinic with a multidisciplinary tumor board (MDTB) to a fully virtual experience, thereby maintaining access to this unique clinical model of patient care during the COVID-19 pandemic. The ability to pivot from in-person clinical visits to completely virtual visits increases patient access to care and enables more physicians to participate. Areas for future study include the impact on patient experience, clinical outcomes, and cost-effectiveness of this high-resource model.

Keywords: Telemedicine; coronavirus disease 2019 (COVID-19); hepatocellular carcinoma (HCC); multidisciplinary care; palliative care.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://apm.amegroups.com/article/view/10.21037/apm-23-357/coif). The series “Comprehensive Care for Patients with Hepatocellular Carcinoma: Insights from the 2022 San Antonio Liver Cancer Symposium” was commissioned by the editorial office without any funding or sponsorship. S.P.A. served as the unpaid Guest Editor of the series and serves as an unpaid editorial board member of Annals of Palliative Medicine from June 2022 to May 2024. S.P.A. is supported by the National Institutes of Health (No. CA054174) and she reports that she serves on the advisory board and receives personal fees from AstraZeneca, QED Therapeutics, and Seagen, and she also receives personal fees for speaker bureau from Exelixis, Bayer, and Bristol Meyers Squibb. The authors have no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
Virtual (i.e., Webex) versus in-person clinic visits by year at the TLTC. TLTC, Texas Liver Tumor Center.
See this image and copyright information in PMC

References

    1. Benson AB, D’Angelica MI, Abbott DE, et al. Hepatobiliary Cancers, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2021;19:541–65. - PubMed
    1. Gordan JD, Kennedy EB, Abou-Alfa GK, et al. Systemic Therapy for Advanced Hepatocellular Carcinoma: ASCO Guideline. J Clin Oncol 2020;38:4317–45. - PubMed
    1. Li D, Jia AY, Zorzi J, et al. Impact of the COVID-19 Pandemic on Liver Cancer Staging at a Multidisciplinary Liver Cancer Clinic. Ann Surg Open 2022;3:e207. - PMC - PubMed
    1. Zhang J, Mavros MN, Cosgrove D, et al. Impact of a single-day multidisciplinary clinic on the management of patients with liver tumours. Curr Oncol 2013;20:e123–31. - PMC - PubMed
    1. Jia AY, Popovic A, Mohan AA, et al. Development, Practice Patterns, and Early Clinical Outcomes of a Multidisciplinary Liver Cancer Clinic. Cancer Control 2021;28:10732748211009945. - PMC - PubMed