Research Papers:
A multidisciplinary team care approach improves outcomes in high-risk pediatric neuroblastoma patients
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Abstract
Hsiu-Hao Chang1, Yen-Lin Liu1,2, Meng-Yao Lu1, Shiann-Tarng Jou1, Yung-Li Yang1,3 Dong-Tsamn Lin1,3, Kai-Hsin Lin1, Kai-Yuan Tzen4, Ruoh-Fang Yen4, Ching-Chu Lu4, Chia-Ju Liu4, Steven Shinn-Forng Peng5, Yung-Ming Jeng6, Shiu-Feng Huang7, Hsinyu Lee8,9, Hsueh-Fen Juan8,10, Min-Chuan Huang11, Yung-Feng Liao12, Ya-Ling Lee13,14, Wen-Ming Hsu15
1Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
2Department of Pediatrics, Taipei Medical University Hospital, Taipei, Taiwan
3Department of Laboratory Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
4Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
5Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
6Department of Pathology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
7Division of Molecular and Genomic Medicine, National Health Research Institutes, Miaoli County, Taiwan
8Department of Life Science, National Taiwan University, Taipei, Taiwan
9Institutes of Zoology, National Taiwan University, Taipei, Taiwan
10Institutes of Molecular and Cellular Biology, National Taiwan University, Taipei, Taiwan
11Graduate Institute of Anatomy and Cell Biology, National Taiwan University College of Medicine, Taipei, Taiwan
12Institute of Cellular and Organismic Biology, Academia Sinica, Taipei, Taiwan
13Department of Nursing, National Taiwan University College of Medicine, Taipei, Taiwan
14Department of Nursing, Central Taiwan University of Science and Technology, Taichung, Taiwan
15Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
Correspondence to:
Ya-Ling Lee, email: [email protected]
Wen-Ming Hsu, email: [email protected]
Keywords: chemotherapy, high-risk, multidisciplinary team care, neuroblastoma, outcomes
Received: June 30, 2016 Accepted: December 01, 2016 Published: December 10, 2016
ABSTRACT
We assessed the impact of a multidisciplinary team care program on treatment outcomes in neuroblastoma patients. Newly diagnosed neuroblastoma patients received treatment under the Taiwan Pediatric Oncology Group (TPOG) N2002 protocol at the National Taiwan University Hospital beginning in 2002. A multidisciplinary team care approach that included nurse-led case management for patients treated under this protocol began in January 2010. Fifty-eight neuroblastoma patients, including 29 treated between 2002 and 2009 (Group 1) and 29 treated between 2010 and 2014 (Group 2), were enrolled in the study. The 5-year overall survival (OS) and event-free survival (EFS) rates for all 58 patients were 59% and 54.7%, respectively. Group 2 patients, who were treated after implementation of the multidisciplinary team care program, had better 3-year EFS (P = 0.046), but not OS (P = 0.16), rates than Group 1 patients. In a multivariate analysis, implementation of the multidisciplinary team approach was the only significant independent prognostic factor for neuroblastoma patients. In further subgroup analyses, the multidisciplinary team approach improved EFS, but not OS, in patients with stage 4 disease, those in the high-risk group, and those with non-MYCN amplified tumors. These data indicate a multidisciplinary team care approach improved survival outcomes in high-risk neuroblastoma patients. However, further investigation will be required to evaluate the long-term effects of this approach over longer follow-up periods.
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