Outcomes and impact of multidisciplinary team care on immunologic and hemato-oncologic pediatric patients

Main Article Content

Alicia Domínguez Estirado
Gonzalo Solís García
Jorge Huerta Aragonés
Carmen Garrido Colino
Elena Seoane-Reula
Cristina Mata Fernández

Keywords

hematology, immunodeficiency, immunology, multidisciplinary, oncology, pediatric

Abstract

Introduction: Immunologic and hemato-oncologic disorders in the pediatric population represent an interrelated and complex group of conditions whose approach, diagnosis, and management could be difficult. Multidisciplinary teams have been proved beneficial in treating such complexities.


Methods: We conducted a retrospective observational study at a tertiary hospital in Madrid, Spain, which is a pediatric immunology and onco-hematology referral center. We included all patients of multidisciplinary outpatient consultation, comprising a working group of pediatric oncohematologists and immunologists, between April 2016 and December 2019. Epidemiologic, clinical, and laboratory data were collected. We analyzed these data and established a relationship between age and findings of final diagnosis as well as variance on diagnoses prior to their multidisciplinary assessment and number of visits to the consultation.


Results: In all, 93 children and adolescents were included in this study. Laboratory abnormalities were the most frequent reason for being referred to our unit (87.2%); 78% of children had a previously diagnosed comorbidity. Before starting follow-up in the multidisciplinary consultation, 14% of patients were diagnosed, and after the study by the multidisciplinary team, the final diagnosis was reached in 58.1% of patients. No correlation was discovered between final diagnosis and gender (P = 0.29), age (biserial correlation coefficient, r = 0.036, P = 0.70), and number of visits (P = 0.07).


Conclusion: A multidisciplinary approach to immunologic, hematologic, and oncologic pediatric diseases is feasible. It can be a powerful and useful tool for diagnosis and treatment, especially in complex pediatric patients.

Abstract 79 | PDF Downloads 45 HTML Downloads 12 XML Downloads 3

References

1. Cunningham-Rundles C. Hematologic complications of primary immune deficiencies. Blood Rev. 2002;16(1):61–4. 10.1054/blre.2001.0185

2. Social Care Institute for Excellence. Multidisciplinary teams [Internet]. Available from: https://www.scie.org.uk/integrated-care/research-practice/activities/multidisciplinary-teams. Accessed 17 Jan 2021.

3. Taylor C, Munro AJ, Glynne-Jones R, Griffith C, Trevatt P, Richards M, et al. Multidisciplinary team working in cancer: What is the evidence? BMJ. 2010;340:c951. 10.1136/bmj.c951

4. Pillay B, Wootten AC, Crowe H, et al. The impact of multi-disciplinary team meetings on patient assessment, management and outcomes in oncology settings: A systematic review of the literature. Cancer Treat Rev. 2016;42:56–72. 10.1016/j.ctrv.2015.11.007

5. McDonald K, Ledwidge M, Cahill J, Quigley P, Maurer B, Travers B, et al. Heart failure management multidisciplinary care has intrinsic benefit above the optimization of medical care. J Card Fail. 2002;8(3):142–8. 10.1054/jcaf.2002.124340

6. Chang JH, Vines E, Bertsch H, Fraker DL, Czerniecki BJ, Rosato EF, et al. The impact of a multidisciplinary breast cancer center on recommendations for patient management: The University of Pennsylvania experience. Cancer. 2001;91(7):1231–7. 10.1002/1097-0142(20010401)91:7<1231::aid-cncr1123>3.0.co;2-k

7. Greer HO, Frederick PJ, Falls NM, Tapley EB, Samples KL, Kimball KJ, et al. Impact of a weekly multidisciplinary tumor board conference on the management of women with gynecologic malignancies. Int J Gynecol Cancer 2010;20(8):1321–5. 10.1111/IGC.0b013e3181f5871e

8. Van Cleave J, Gortmaker SL, Perrin JM. Dynamics of obesity and chronic health conditions among children and youth. JAMA. 2010;303(7):623–30. 10.1001/jama.2010.104

9. Cohen E, Berry JG, Camacho X, Anderson G, Wodchis W, Guttmann A. Patterns and costs of health care use of children with medical complexity. Pediatrics. 2012;130(6):e1463–70. 10.1542/peds.2012-0175

10. Hall DE. The care of children with medically complex chronic disease. J Pediatr. 2011;159(2):178–80. 10.1016/j.jpeds.2011.03.031

11. Ajarmeh S, Er L, Brin G, Djurdjev O, Dionne JM. The effect of a multidisciplinary care clinic on the outcomes in pediatric chronic kidney disease. Pediatr Nephrol. 2012;27(10):1921–7. 10.1007/s00467-012-2209-6

12. Wren AA, Ross AC, D’Souza G, Almgren C, Feinstein A, Marshall A, et al. Multidisciplinary pain management for pediatric patients with acute and chronic pain: A foundational treatment approach when prescribing opioids. Children (Basel). 2019;6(2):33. 10.3390/children6020033

13. Rove KO, Edney JC, Brockel MA. Enhanced recovery after surgery in children: Promising, evidence-based multidisciplinary care. Paediatr Anaesth. 2018;28(6):482–92. 10.1111/pan.13380

14. Murphy S. Pediatric neurocritical care. Neurotherapeutics. 2012;9(1):3–16. 10.1007/s13311-011-0093-6

15. Dalesio NM, Diaz-Rodriguez N, Koka R, Kudchadkar S, Mark LJ, Cover R, et al. Development of a multidisciplinary pediatric airway program: An institutional experience. Hosp Pediatr. 2019;9(6):468–75. 10.1542/hpeds.2018-0226

16. Alisi A, Feldstein AE, Villani A, Raponi M, Nobili V. Pediatric nonalcoholic fatty liver disease: A multidisciplinary approach. Nat Rev Gastroenterol Hepatol. 2012;9(3):152-61. 10.1038/nrgastro.2011.273

17. Hauck F, Gennery AR, Seidel MG. The Relationship between cancer predisposition and primary immunodeficiency. Front Immunol. 2019;10:1781. 10.3389/fimmu.2019.01781

18. Uriol Rivera MG, Cabello Pelegrin S. Impact of a multidisciplinary team for the management of thrombotic microangiopathy. PloS One. 2018;13(11):e0206558. 10.1371/journal.pone.0206558

19. Maffeis M, Notarangelo LD, Schumacher RF, Soncini E, Soresina A, Lanfranchi A, et al. Primary immunodeficiencies and oncological risk: The experience of the children’s hospital of Brescia. Front Pediatr. 2019;7:232. 10.3389/fped.2019.00232