Leveraging Evidence-based Oncology Pathways to Inform Multidisciplinary Tumor Board Decisions in Melanoma

J Clin Pathways. 2021;7(9):28.

AdventHealth Cancer Institute is one of the largest cancer care providers in Florida, delivering comprehensive oncology services ranging from disease prediction and prevention to state-of-the-art detection, treatment, and research. AdventHealth’s team of over 200 medical oncologists, radiation oncologists, surgeons, and other specialists provide patients with a multidisciplinary approach to cancer diagnosis and treatment. This approach is particularly important as AdventHealth treats more patients newly diagnosed with cancer than any other health care system in Central Florida.

Melanoma treatment options have undergone a revolution, starting with the Food and Drug Administration’s approval of ipilimumab for the treatment of metastatic melanoma in 2011.¹ Over the past decade, this trend of continually changing treatment options for melanoma has continued. As a result, the care delivery model for melanoma has also advanced significantly. With most melanomas treated in the community setting, staying abreast of changing practice patterns can be very challenging.  

Over that same period, we recognized a need to shift our treatment approach for melanoma. No longer could a tertiary health system simply wait for referrals of patients with melanoma and systemic disease. We identified a need to engage with our community providers in offering an end-to-end service for patients with melanoma and ensure seamless referrals to specialists. A Cutaneous Oncology Consortium (COC) was created, composed of Central Florida physician members representing all specialties who share expertise in the care of patients with malignant melanoma. The mission of the COC is to improve the outcomes of patients with melanoma in Central Florida. 

Following the establishment of the COC in February 2020, the backbone of this initiative has been a dedicated Multidisciplinary Melanoma Tumor Board (MMTB) beginning in January 2021. The MMTB offers a second opinion review on pathology, prospective treatment plans, clinical trial screening, and navigation support for patients. With participation from across Central Florida, the MMTB group meets and discusses, on average, seven patients.

AdventHealth implemented oncology pathways in 2018, choosing to adopt Elsevier’s ClinicalPath (formerly Via Oncology) solution. These evidence-based pathways are developed by experienced disease committees, composed of leading oncologists nationally. At each committee meeting, the latest evidence is discussed and evaluated based on a hierarchy of efficacy, toxicity, and cost. Given the depth of discussion, these committee meetings are highly educational for all multidisciplinary participants.

We use the knowledge gained from these committee meetings and ClinicalPath’s multidisciplinary pathways to guide us in making evidence-based decisions during our MMTB meetings. For example, we recently discussed a patient with cutaneous squamous cell carcinoma, with locally advanced unresectable disease. Because we do not see these types of presentations often, we consulted the pathways, which indicated that treatment with neoadjuvant cemiplimab was supported by the literature.  

Being able to access these trusted pathways during tumor board discussions has been particularly helpful to our team. With the large volume of data discussed during the MMTB, this guidance allows us to make evidence-based, multidisciplinary decisions for our patients. In the future, we intend to further enhance the infrastructure needed for a seamless referral process for patients with melanoma. These efforts support us in achieving the mission of the COC: improving outcomes for patients with melanoma in Central Florida. 

Reference 

FDA approves new treatment for a type of late-stage skin cancer. News release. PRNewswire. March 25, 2011. Accessed November 2, 2021. https://www.prnewswire.com/news-releases/fda-approves-new-treatment-for-a-type-of-late-stage-skin-cancer-118656794.html

Disclaimer

This article is sponsored by Elsevier. The opinions and statements of the clinicians are specific to the respective authors and not necessarily those of Elsevier, Journal of Clinical Pathways, or HMP Global.