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Preliminary experience with a new institutional tumor board dedicated to patients with neuroendocrine neoplasms
Nikolaos A Trikalinos1,2, Chet Hammill3, Jingxia Liu4
1Department of Medicine, Division of Oncology, Washington University Medical School Campus, 660 South Euclid Avenue, Box 8069, St. Louis, MO, 63110, USA. ntrikalinos@wustl.edu.
Purpose:
To determine the decision patterns of a neuroendocrine neoplasm (NEN) tumor board (TB) and the factors behind those.
Methods:
We retrospectively reviewed all NEN-TB recommendations from 07/2018 to 12/2021 and recorded patient characteristics, TB outcomes and associations between them.
Results:
A total of 652 patient entries were identified. Median age of participants was 61 years and an equal number of men and women were presented. Most patients (33.4%) had tumors originating in the small bowel with 16.8% of high grade and 25.9% of pancreatic origin. Imaging was reviewed 97.2% of the time, with most frequently reviewed modalities being PET (55.3%) and CT (44.3%). Imaging review determined that there was no disease progression 20.8% of the time and significant treatment changes were recommended in 36.1% of patients. Major pathology amendments occurred in 3.7% of cases and a clinical trial was identified in 2.6%. There was no association between patient or disease presentation with the tumor board outcomes. There was a slight decrease in number of patients discussed per session, from 10.0 to 8.2 (p < 0.001) when the TB transitioned to a virtual format during the COVID-19 pandemic but all other factors remained unchanged.
Conclusion:
NEN-TB relies heavily on image review, can impact significant treatment changes in patients with rare tumors like NENs, and was not affected by the switch to a virtual format. Finally, none of the examined factors were predictive of the tumor board recommendations.
Insights
Neuroendocrine Neoplasm (NEN) tumor boards heavily use imaging to guide treatment decisions. Factors like patient or disease presentation did not predict NEN tumor board outcomes.
Area of Science:
- Oncology
- Medical Imaging
- Tumor Board Management
Background:
- Neuroendocrine neoplasms (NENs) are rare tumors requiring specialized multidisciplinary care.
- Tumor boards (TBs) are crucial for NEN management, integrating diverse expertise.
- Understanding NEN tumor board (TB) decision-making is essential for optimizing patient care.
Purpose of the Study:
- To analyze the decision patterns of neuroendocrine neoplasm tumor boards (NEN-TBs).
- To identify factors influencing NEN-TB recommendations.
- To evaluate the impact of imaging and virtual transition on NEN-TB outcomes.
Main Methods:
- Retrospective review of 652 NEN-TB recommendations from July 2018 to December 2021.
- Analysis of patient characteristics, tumor origin, grade, and imaging modalities (PET, CT).
- Assessment of treatment changes, pathology amendments, and clinical trial identification.
Main Results:
- Imaging review (PET, CT) was central to NEN-TB decisions (97.2%).
- Significant treatment changes were recommended for 36.1% of patients.
- No association found between patient/disease factors and TB outcomes.
- Transition to virtual format during COVID-19 slightly reduced case discussion per session but did not alter outcomes.
Conclusions:
- NEN-TBs significantly influence treatment for rare NENs, primarily through image review.
- The virtual transition did not negatively impact NEN-TB decision-making.
- No patient or disease characteristics predicted NEN-TB recommendations, highlighting the complexity of NEN management.
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