Thyroid Oncology Clinic Pulls Together Multidisciplinary Team

Zosia Chustecka

August 13, 2009

August 13, 2009 (Toronto, Ontario) — Because several different specialties are involved in the treatment of thyroid cancer, each with their own approach to treatment, patients can receive conflicting advice. To eliminate mixed messages and to coordinate care, the Thyroid Oncology Clinic was established in Halifax, Nova Scotia.

Previously, the advice that patients received "would depend on whose door they walked through," said Murali Rajaraman, MD, radiation oncologist at Capital Health in Halifax. He set up the clinic with 2 colleagues, endocrinologist Ali Imran, MD, and nuclear medicine specialist David Barnes, MD. Although they had been seeing the same patients, the patients were visiting each of them at different times. Now, they see they each patient together and coordinate the advice that the patient receives.

This "one-stop shopping" approach has been a great success with the patients, Dr. Rajaraman reported here at the World Congress on Thyroid Cancer 2009. Patients said they were receiving more consistent advice, and they also found it very reassuring to have a clinic to turn to with their questions, knowing that someone would get back to them within an hour or so.

Working as a team has enhanced all of our knowledge bases.

The clinic has also been a success with his colleagues. "Working as a team has enhanced all of our knowledge bases, and has resulted in better role definition," he told meeting attendees. "Each of us now has a better understanding of the role that we play in patient care."

"We have a similar movement in the United States," said Edmund Pribitkin, MD, head and neck surgeon from Thomas Jefferson University in Philadelphia, Pennsylvania, who moderated the session. "There are thyroid centers of excellence at several of the larger institutions," he told Medscape Oncology. "We have this at Jefferson, and there are others at MD Anderson [Cancer Center], Memorial Sloan-Kettering, and the Mayo Clinic."

The aim is the same: to coordinate care among the different disciplines and to allow the patient to see all of the team preferably on the same day, he explained. However, each of the specialists still works within his or her own department, so these are "virtual clinics," he said.

The difference in Nova Scotia is that the Thyroid Oncology Clinic is housed in 1 building. The obvious location was at Capital Health, which is the only site licensed in Nova Scotia for radioiodine radiotherapy.

The clinic was recently the recipient of the 2009 Excellence in Patient Care Award from Cancer Care Nova Scotia.

But there is still room for improvement, said Leslie McLean, clinical nurse specialist and project manager. An analysis of patient care before and after the clinic was set up showed that the time between surgery and follow-up consultation had increased, from 47 days to 76 days, she told the meeting. "We are now working to bridge this gap," she explained. But there was a decrease in the overall time from surgery to the completion of all postop consultations, from 651 days to 177 days. In addition, there was a reduction in the frequency of hospital visits, she reported.

Another Approach: An Internet Forum in the UK

Another approach to improving communication among the various disciplines involved in the care of thyroid cancer patients is being used in the United Kingdom. The Thyroid Cancer Forum was set up in July 2005 by Laura Moss, MD, consultant oncologist at the Velindre Cancer Center in Cardiff, Wales.

There are now 185 members, Dr. Moss told the meeting, and the specialties include oncology, surgery, endocrinology, nuclear medicine, pathology, and radiology. The forum, on a secure host because there is discussion of patient data, offers Web-based access to wider opinions for difficult cases, she explained. Members have said that these discussions with virtual colleagues have prompted them to change their management of a case, and many "value the peer support."

The forum also has abstracts from journals, and has carried out several surveys of national practices. There is also a national database for medullary and for anaplastic thyroid cancer. "We each see so few of these cases, it is difficult to assess outcomes," she noted.

Dr. Moss hopes to expand the forum internationally, and she encourages interested parties to get in touch by emailing contact@thyroid-cancer-forum-uk. org.

The researchers have disclosed no relevant financial relationships.

World Congress on Thyroid Cancer (WCTC) 2009: Abstracts 062 and 067. Presented August 8, 2009.

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