M. Ju1, S. C. Wang1, S. Syed2, D. Agrawal2, M. R. Porembka1 1University Of Texas Southwestern Medical Center,Surgery,Dallas, TEXAS, USA 2University Of Texas Southwestern Medical Center,Internal Medicine,Dallas, TEXAS, USA
Introduction:
The initiation of treatment for gastric cancer is a complex process requiring multiple diagnostic tests, staging evaluations, and invasive procedures. Inefficiencies in coordinating these tasks delay treatment initiation. Streamlining care through the development of disease-based teams (DBT) may reduce such delays through practice integration.
Methods:
A retrospective review of sequential gastric cancer patients treated at Parkland Hospital (Dallas, TX) between 2013 and 2015 was performed. Patients were divided into two groups: those who received care prior to the creation of a DBT and standardized care pathways (n=50), and those who received care after these protocols were implemented (n=50). Patients who underwent urgent resection or elected to pursue hospice care were excluded. Time to treatment (TTT) from initial endoscopy to initiation of treatment (chemotherapy or surgery) was measured and compared. The number of diagnostic tests performed, use of diagnostic laparoscopy, and treatment variability were also evaluated.
Results:
The two groups were demographically similar in terms of age, sex, stage distribution, tumor location, and setting of initial presentation (outpatient vs. emergency room). Implementation of a DBT was associated with a decrease in TTT from 84.1 +/-12.3 days to 32.5 +/-15.2 days (p < 0.02). This decrease was primarily related to parallel performance of subspecialty evaluations, staging imaging studies, and procedures. The number of staging tests decreased (3.8 vs. 2.2; p<0.05). The use of diagnostic laparoscopy in patients with clinically advanced local disease increased (18% vs. 94%, p<0.05).
Conclusion:
Creation of a gastric cancer-specific DBT and uniform care pathways at a large safety net hospital expedited the initiation of treatment, reduced unnecessary tests, and improved consistency in patient management.