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Multidisciplinary care has become the preferred model of care for patients with amyotrophic lateral sclerosis (ALS). It is assumed that the sum of interventions associated with this approach has a positive effect on survival. The objective of the study was to evaluate the impact of a multidisciplinary care approach on the survival of patients with ALS. We performed a retrospective review of prospectively collected data in a tertiary referral center in Spain. Participants were patients with definite or probable ALS managed in a multidisciplinary care program. We compared demographic and survival data of patients with definite or probable ALS treated in a referral center without and with implementation of a multidisciplinary care program. We performed time-dependent multivariate survival analysis of the use of noninvasive mechanical ventilation (NIMV) and gastrostomy. We evaluated 398 consecutive patients, of whom 54 were treated by a general neurologist and 344 were treated in the multidisciplinary care clinic. Patients receiving multidisciplinary care were older (62 vs 58 years), tended to have bulbar onset disease (30% vs 17.7%), and were more likely to receive riluzole (88.7% vs 29.6%, <0.01), NIMV (48.8% vs 29.6%, >0.001), and nutrition via gastrostomy (32.3% vs 3.7%, <0.01). Kaplan-Meier analysis showed a 6-month increase in survival (log-rank, 16.03, <0.001). Application of the Andersen-Gill model showed that the variables associated with reduced mortality were reduced time to NIMV and gastrostomy and the duration of both, thus reflecting compliance. Multidisciplinary care increased the survival of ALS patients in our study population. Timely use of respiratory support and gastrostomy are fundamental aspects of this benefit.

This retrospective study compares a multidisciplinary clinic (MDC) to standard care for time to treatment of colorectal cancer. We queried our institutional ACS-NSQIP database for patients undergoing surgery for colorectal cancer from 2017 to 2020. Patients were stratified by initial clinic visit (MDC vs control). Primary endpoint was the time to start treatment (TST), either neoadjuvant therapy or surgery, from the date of diagnosis by colonoscopy. A total of 405 patients were evaluated (115 MDC, 290 Control). TST from diagnosis was not significantly shorter for the MDC cohort (MDC 30 days, Control 37 days; p = 0.07) even when stratified by type of initial treatment of neoadjuvant therapy (MDC 30, Control 34 days; p = 0.28) or surgery (MDC 32.5 days, Control 38 days; p = 0.35). Implementation of an MDC provides insignificant reduction in delay to start treatment for colorectal cancer patients as compared to standard care colorectal surgery clinics. Colorectal. •Rectal cancer treatment requires management by multidisciplinary teams (MDT).•The multidisciplinary clinic (MDC) model is thought to facilitate access to MDT.•Data comparing MDC to standard clinics in colorectal cancer is sparce.•We demonstrated insignificant reduction in time to start treatment for MDC.•Only benefit of MDC was seen in time to therapy for patients living further away.

Background The Ehlers-Danlos Syndromes (EDS) are a group of connective tissue disorders that are hereditary in nature and characterized by joint hypermobility and tissue fragility. The complex nature of this unique patient population requires multidisciplinary care, but appropriate centers for such care do not exist in large portions of the country. Need for more integrated services has been identified in Chicagoland, or Chicago and its suburbs. In order to explore and begin to address barriers to seeking appropriate care facing EDS patients in this region, we developed an online survey which we circulated through EDS social media groups for Chicagoland patients. Results Three hundred and nine unique respondents participated. We found that there exists a strong medical need for and interest in the development of a center in the region, and participants reported that, if made available to them, they would make extensive and regular use of such a facility. Conclusions We conclude that the establishment of a collaborative medical center specializing in the diagnosis and treatment of EDS, Hypermobility Spectrum Disorder, and related disorders in the Chicagoland area would greatly benefit patients by providing comprehensive care, alleviate the burden on overworked healthcare providers, and contribute to the sustainability of medical facilities.

Introduction Our analysis was designed to characterize the demographics and disparities between the diagnosis of pancreas cancer during emergency presentation (EP) and the outpatient setting (OP) and to see the impact of our institutions pancreatic multidisciplinary clinic (PMDC) on these disparities. Methods Institutional review board-approved retrospective review of our institutional cancer registry and PMDC databases identified patients diagnosed/treated for pancreatic ductal adenocarcinoma between 2014 and 2022. Chi-square tests were used for categorical variables, and one-way ANOVA with a Bonferroni correction was used for continuous variables. Statistical significance was set at p < 0.05. Results A total of 286 patients met inclusion criteria. Eighty-nine patients (31.1%) were underrepresented minorities (URM). Fifty-seven (64.0%) URMs presented during an EP versus 100 (50.8%) non-URMs ( p = 0.037). Forty-one (46.1%) URMs were reviewed at PMDC versus 71 (36.0%) non-URMs ( p = 0.10). No differences in clinical and pathologic stage between the cohorts ( p = 0.28) were present. URMs took 22 days longer on average to receive treatment (66.5 days vs. 44.8 days, p = 0.003) in the EP cohort and 18 days longer in OP cohort (58.0 days vs. 40.5 days, p < 0.001) compared with non-URMs. Pancreatic Multidisciplinary Clinic enrollment in EP cohort eliminated the difference in time to treatment between cohorts (48.3 days vs. 37.0 days; p = 0.151). Results Underrepresented minorities were more likely to be diagnosed via EP and showed delayed times to treatment compared with non-URM counterparts. Our PMDC alleviated some of these observed disparities. Future studies are required to elucidate the specific factors that resulted in these findings and to identify solutions.

Multidisciplinary cancer clinics deliver streamlined care and facilitate collaboration between specialties. We described patient volume and specialty service utilization, including surgery, of a multidisciplinary colorectal cancer clinic established at a tertiary care academic institution. We conducted a retrospective observational cohort study of adult patients with colorectal adenocarcinoma from 2012 to 2017. We performed a descriptive analysis of patient volume, percentage of rectal cancer patients, and the number of patients who saw and received surgery, chemotherapy, and radiation each year. Over 5 years, 1711 patients were served at the multidisciplinary clinic. Patient volume increased 37%, from n = 228 (annualized) to n = 312. The percentage of rectal cancer patients increased from 29% in 2013 to 42% in 2017. The highest rate of utilization was for surgery; 792 (46%) patients had surgery at the multidisciplinary clinic institution, and 510 (30%) received chemotherapy there. Out of 635 rectal cancer patients, 114 (18%) received radiation there. Over the five-year experience of a colorectal cancer-focused multidisciplinary clinic, overall patient volume increased by 37%. Over the study period, 63% of patients seen at the multidisciplinary clinic ultimately received at least one treatment modality at the clinic institution. Overall, the clinic’s establishment resulted in the increased referral of complex patients. •Establishing a multidisciplinary cancer clinic requires shared resources, oversight, and buy-in from the beginning from multiple specialties and professions.•Complex patient volume may increase over time after establishment of a multidisciplinary clinic for colorectal cancer.•Many patients seen at a multidisciplinary colorectal cancer clinic may undergo surgery at the clinic institution, representing a return on investment for surgeons.

Purpose To evaluate the feasibility of implementation of structured reporting in the setting of a high-volume pancreatic multidisciplinary clinic (PMDC) and to assess its value by comparing the accuracy of structured reports with expert imaging reviews. Methods A single institutional prospective cohort study was conducted during March 2022 to May 2024 to understand the feasibility of implementation of structured reporting (SR) for all patients who were seen in our weekly PMDC. Descriptive and regression analyses were performed to find an association between SR and difference in vascular involvement of the primary pancreatic tumor between the radiology report and expert radiologist review ( gold standard ) during PMDC. Results Among 466 patients seen in the PMDC, 426 (91.4%) had reports generated prior to PMDC. Of this, 294 reports met the inclusion criteria. The usage of SR increased from 58.3% in Mar 2022 to 87.8% in June 2024. Majority of the reports that used SR (n = 226, 76.9%), were performed for initial staging (n = 197, 67.0%) of PC. The median years of experience of reading radiologists that used non-SR was 14 (IQR: 8–27) years, while it was 9 (IQR − 9–15) years for those who used SR (p = 0.030). Of note, as compared to the radiology report, increased vascular involvement was noted in PMDC review 62.5% (20 out of 32) of the time with non-SRs, whereas increased vascular involvement during PMDC review was noted in only 36.6% (48 out of 132) of the time with SRs. On multivariable analysis, using SR lowered the odds of increase in vascular involvement during PMDC review by 0.29 times (95CIs 0.11–0.79; p = 0.015). Conclusion SR is feasible and superior to the free-text reporting with respect to the accuracy of peri-pancreatic vascular involvement. While its use cannot replace the PMDC radiology review, it can nonetheless be an indispensable tool in clinical management, particularly in a non-PMDC setting. Graphical abstract

Introduction: Given the complexity of managing unresectable hepatocellular carcinoma (HCC), few Italian centres have implemented integrated multidisciplinary clinics (MDTc), where hepatologists and oncologists jointly assess patients. This study aimed to evaluate whether this model improves survival outcomes in patients treated with atezolizumab and bevacizumab (A+B). Methods: In this multicentre retrospective study, 146 patients with cirrhosis and unresectable HCC treated with A+B were included. Based on the outpatient care model, centres were categorized into two groups: those with MDTc and those with standard oncology clinics, where hepatologists were consulted on demand. Primary outcomes were overall survival (OS) and progression-free survival (PFS); secondary outcomes included disease control rate (DCR) and objective response rate (ORR). An inverse probability weighting (IPW) analysis was performed to adjust for baseline imbalances between groups. Results: Seventy-seven (53%) patients were managed in MDTc settings, and 69 (47%) in oncology clinics. Median treatment duration was 6.0 months (IQR 2.0–11.0). Median OS did not significantly differ between groups [19.7 months (95% confidence intervals [CI]: 16.6–23.1) vs. 13.4 months (95% CI: 10.7–19.5); p = 0.07], whereas median PFS was significantly longer in the MDTc group (13.6 months [95% CI: 8.9–NA] vs. 7.7 months [95% CI: 4.9–13.0]; p = 0.02). While ORR was similar, DCR was higher in the MDTc group (70.1% vs. 60.3%; p = 0.05). Patients followed in MDTc remained on first-line therapy significantly longer (8 months [IQR 3–12] vs. 4 months [IQR 1–8]; p = 0.009). Although the overall treatment discontinuation rate did not differ between the two groups, liver-related events were more frequent and accounted for a greater proportion of discontinuations in oncology clinics (40.6% vs. 10.4%; p = 0.04). Furthermore, treatment duration was shorter in patients discontinuing A+B due to liver-related events than other causes (2.5 months [IQR 1.8–6.3] vs. 7.1 months [IQR 3.9–11.2]; p < 0.001). However, in the IPW analysis, the association between MDTc management and clinical outcomes was no longer significant. Conclusions: In patients with unresectable HCC treated with A+B, MDTc management did not significantly improved OS but was associated with better PFS and DCR. These benefits were likely driven by longer treatment duration and lower rates of liver-related decompensation, underscoring the value of integrated hepatologic-oncologic management in this complex population.

Background: We analysed the outcomes of 726 cases of primary head and neck cancer patients managed between 1996 and 2008, including those managed in the multidisciplinary clinic or team setting (MDT) and those managed outside of an MDT by individual disciplines (non-MDT) in the same institution. Methods: Data were collected from the Hospital Based Cancer Registry and a database within the Head and Neck Cancer Clinic. Univariable comparisons and multivariable analyses were performed using a logistic regression model. Survival by staging was analysed. Comparisons of management and outcomes were made between MDT and non-MDT patients. Results: 395 patients (54%) had been managed in the MDT vs 331 patients (46%) non-MDT. MDT patients were more likely to have advanced disease (likelihood ratio χ 2 =44.7, P <0.001). Stage IV MDT patients had significantly improved 5-year survival compared with non-MDT patients (hazard ratio=0.69, 95% CI=0.51–0.88, P =0.004) and more synchronous chemotherapy and radiotherapy ( P =0.004), and the non-MDT group had more radiotherapy as a single modality ( P =0.002). Conclusions: The improved survival of MDT-managed stage IV patients probably represents both the selection of multimodality treatment and chemotherapeutic advances that these patients received in a multidisciplinary team setting by head and neck cancer specialists as opposed to cancer generalists in a non-MDT setting.