Effect of Multidisciplinary Board on The Diagnosis and Treatment of Endocrine Diseases

Abstract

Objective: We aimed to evaluate the outcomes of our multidisciplinary endocrine board (MEB) which is established for more specific treatment management of the patients with endocrine gland diseases.

Material and Methods: The MEB is established at 2012 in our institution. Prior to this date, the setup of board was a general tumor board (GTB) in which mostly malignant cases were discussed. The records of GTB rounds from January 2009 to September 2012, the records of MEB rounds from September 2012 to December 2014 and the endocrine surgery cases performed at our department since 2009 were retrospectively analyzed and compared.

Results: A total of 1012 patients were included the study. In GTB period, 336 patients, in MEB period, 599 patients underwent surgery for endocrine diseases. Only 94 of these patients who underwent surgery were discussed at GTB, dispite that, 582 cases were discussed at MEB (p<0.001). Benign, suspicious or malignant thyroid gland diseases (n=396) were most commonly discussed (68%) at MEB. The total number of surgery for endocrine cases, thyroid, parathyroid and adrenal gland diseases were increased after the establishment of the MEB (p=0.06, p=0.13, p=0.04 and p=0.09, respectively) when compared with GTB. Also the number of surgery for thyroid cancer and the requirement of prophylactic and therapeutic neck dissection were increased (p=0.10 and p=0.03, respectively).

Conclusion: In a field as complex as endocrine diseases, a special board should increase the quantity of more sophisticated cases, as well as the quality and effectiveness of disease management rather than a GTB.

Keywords

• Endocrine system diseases,Interdisciplinary communication,Specialty boards

Multidisipliner Kurulun Endokrin Hastalıkların Tanı Ve Tedavisine Etkisi

Abstract

Amaç: Endokrin bez hastalığı olan hastalara daha spesifik tedavi yönetimi sağlanabilmesi amacı ile kurulmuş olan multidisipliner endokrin kurulumuza (MEK) ait sonuçlarımızı paylaşmayı amaçladık.

Gereç ve Yöntem: Kurumumuzda MEK 2012 yılında kurulmuştur. Bu tarihten önce, konseyin şekli genel tümör kurulu (GTK) olup, daha çok habis olgular tartışılmakta idi. Ocak 2009 -Eylül 2012 yıllarına ait GTK, Ekim 2012 – Aralık 2014 yıllarına ait MEK kayıtları ve kliniğimizde 2009 yılından beri ameliyat edilen endokrin cerrahi olgularına ait tıbbi kayıtlar retrospektif olarak değerlendirildi ve karşılaştırıldı.

Bulgular: Toplam 1012 hasta çalışmaya dahil edildi. GTK döneminde 336 hasta, MEK döneminde 599 hasta endokrin hastalıklar nedeniyle ameliyat edildi. Ameliyat edilen hastalardan 94’ü GTK’unda tartışılırken, 582’si MEK’unda tartışıldı (p<0,001). MEK’de çoğunlukla selim, şüpheli veya malign tiroid bezi hastalıkları (n=396) tartışıldı (%68). Tüm endokrin olgular, tiroid, paratroid ve adrenal gland hastalıkları için ameliyat sayıları MEK’unun kurulmasından sonra arttı (p=0,06; p=0.13; p=0,04 ve p=0,09, sırasıyla). Aynı zamanda, tiroid kanseri ameliyatı sayısı ve profilaktik veya terapötik boyun diseksiyonu gereksinimi de arttı (p=0,10 ve p=0,03, sırasıyla).

Sonuç: Endokrin hastalıklar gibi kompleks bir alanda, GTK’una kıyasla özel bir kurul daha sofistike olguların sayısını, aynı zamanda hastalık yönetiminin kalite ve verimini arttırabilir.

Keywords

• Endokrin sistem hastalıkları,disiplinler arası iletişim,özel kurullar

References

1. 1. Wright FC, De Vito C, Langer B, Hunter. Multidisciplinary cancer conferences: a systematic review and development of practice standards. Eur J Cancer 2007;43(6):1002-10.
2. 2. Nguyen NP, Vos P, Lee H, Borok TL, Karlsson U, Martinez T et al. Impact of tumor board recommendations on treatment outcome for locally advanced head and neck cancer. Oncology 2008;75(3-4):186-91.
3. 3. Santoso JT, Schwertner B, Coleman RL, Hannigan EV. Tumor board in gynecologic oncology. Int J Gynecol Cancer 2004;14(2):206-9.
4. 4. Keating NL, Landrum MB, Lamont EB, Bozeman SR, Shulman LN, McNeil BJ. Tumor boards and the quality of cancer care. J Natl Cancer Inst 2013;105(2):113-21.
5. 5. Güler SA, Cantürk NZ. Multidisciplinary breast cancer teams and proposed standards. Ulus Cerrahi Derg 2014;31(1):39-41.
6. 6. Carty SE, Doherty GM, Inabnet WB 3rd, Pasieka JL, Randolph GW, Shaha AR et al; American Thyroid Association statement on the essential elements of interdisciplinary communication of perioperative information for patients undergoing thyroid cancer surgery. Thyroid 2012;22(4):395-9.
7. 7. Wheless SA, McKinney KA, Zanation AM. A prospective study of the clinical impact of a multidisciplinary head and neck tumor board. Otolaryngol Head Neck Surg 2010;143(5):650-4.
8. 8. van Hagen P, Spaander MC, van der Gaast A, van Rij CM, Tilanus HW, van Lanschot JJ, et al. Rotterdam Oesophageal Tumour Study Group. Impact of a multidisciplinary tumour board meeting for upper-GI malignancies on clinical decision making: a prospective cohort study. Int J Clin Oncol 2013;18(2):214-9.

9. 9. Dural AC, Akarsu C, Unsal MG, Büyükaşık S, Çelik MF, Soyluk Selçukbiricik Ö, et al. Multidisciplinary management of surgery for thyroid diseases: Analysis of five years with the experience of Bakirkoy Dr. Sadi Konuk Education and Research Hospital. Endokrinolojide Diyalog 2015;12(1):1-8.
10. 10. Berman HL. The tumor board: is it worth saving? Mil Med 1975;140(8):529-31.
11. 11. Fennell ML, Das IP, Clauser S, Petrelli N, Salner A. The organization of multidisciplinary care teams: modeling internal and external influences on cancer care quality. J Natl Cancer Inst Monogr 2010;40:72-80.
12. 12. Fleming ID. Multidisciplinary treatment planning. Tumor boards. Cancer 1989;64(1 Suppl):279-81.
13. 13. Snelgrove RC, Subendran J, Jhaveri K, Thipphavong S, Cummings B, Brierley J, et al. Effect of multidisciplinary cancer conference on treatment plan for patients with primary rectal cancer. Dis Colon Rectum 2015;58(7):653-8.
14. 14. Traynor BJ, Alexander M, Corr B, Frost E, Hardiman O. Effect of a multidisciplinary amyotrophic lateral sclerosis (ALS) clinic on ALS survival: a population based study, 1996–2000. J Neurol Neurosurg Psychiatry 2003;74(9):1258-61.