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Evaluating the Impact of the Multidisciplinary Gastrointestinal Malignancy Clinic (MGMC) on the Delivery of Care at the Dallas VA Medical Center

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Background: Digestive system malignancies constitute 18% of all cancers in the US veteran population (VA Central Cancer Registry 2010 data). Managing these patients involves multiple treatment modalities. The Multidisciplinary Gastrointestinal Malignancy Clinic (MGMC) was established at the Dallas VAMC in 2016. Prior to the MGMC, patients presented to their primary care physicians, who once a malignancy was biopsy confirmed, consulted an oncologic specialist. Patients requiring multidisciplinary oncologic care had three or more appointments (medical, surgical, and radiation oncology) scheduled on separate days. However, since the MGMC was established, various oncologic specialists now evaluate the patients on a single clinic day and a definitive consensus therapy course is planned.

Methods: Patients seen in the MGMC were matched to patient controls (seen 2 years before the MGMC was established) by pathologic diagnosis and stage. The main endpoints were; time between initial oncologic consult and first definitive therapy; time from biopsy to completion of staging and first definitive therapy. The average times for each endpoint for these 2 groups was evaluated statistically using the student T test.

Results: 40 patient cases were selected from the group seen at the MGMC from July 2016 - June 2018 and matched with 40 controls. A statistically significant reduction in the average time between initial oncologic consult to the time of first definitive therapy was found in favor of patients seen in the MGMC (44.3 ±20.5 days vs 60.7 ±41.4 days). The average time from biopsy to first definitive therapy was not statistically significant different between patient groups. Average time from biopsy to completion of staging was significantly reduced in the MGMC group (31.4±33.1 days vs 53.2±40.5 days). Post-MGMC, fewer patients were referred to the CHOICE program and more patients completed treatment.

Conclusion: Establishment of the MGMC allowed cancer patients to meet with various oncology specialists in a single setting and for these providers to form an initial treatment plan, resulting in reduced time between initial consult and first definitive treatment. Staging was completed more efficiently. These results suggest that a multidisciplinary oncology clinic enhances delivery of care in patients with gastrointestinal malignancies.

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