The Multidisciplinary Approach to GI Cancer Results in Change of Diagnosis and Management of Patients. Multidisciplinary Care Impacts Diagnosis and Management of Patients

Background: The multidisciplinary approach to GI cancer is becoming more widespread as a result of multimodality therapy. At the University of Colorado Hospital (UCH), we utilize a formal multidisciplinary approach through specialized clinics across a variety of settings, including pancreas and biliary cancer, esophageal and gastric cancer, liver cancer and neuroendocrine tumors (NET), and colorectal cancer. Patients with these suspected diagnoses are seen in a multidisciplinary clinic. We evaluated whether implementation of disease-specific multidisciplinary programs resulted in a change in diagnosis and/or change in management for these patients. Methods: Data from 1747 patients were prospectively collected from inception of each multidisciplinary program through December 31, 2015. Change in diagnosis was defined as a change in radiographic or endoscopic findings that resulted in a change in cancer stage or clinical diagnosis and/or a change in pathologic diagnosis. Reports of incidental findings unrelated to primary diagnosis on radiographic evaluation were also assessed, but not included in overall change in diagnosis findings. We further evaluated if patients had a change in the management of their disease compared with outside recommendations. Results: Of 1747 patients evaluated, change occurred in 38 % (pancreas and biliary), 13 % (esophageal and gastric); 22 % (liver and NET), and 16 % (colorectal). Change in management for each multidisciplinary program occurred in 35 % (pancreas and biliary), 20 % (esophageal and gastric), 27 % (liver and NET), and 13 % (colorectal). Conclusions: The use of a multidisciplinary clinic to manage GI cancer has a substantial impact in change in diagnosis and/or management in more than one-third of patients evaluated.