Development of a Retrospective  and Prospective Multidisciplinary  Pancreas Database

Joseph Herman, MD, MSc

Barbara Biedrzycki, PhD, CRNP

Amol

Narang, MD

Radiation and Medical Oncology

The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins

Why is Multidisciplinary Care  Important?

Multi‐D Care Benefits

• Less confusion for patients/families

• Improved communication between staff

• Inter‐disciplinary teaching• “One stop shop”• Improved outcomes

• Less errors?• Cost effective?

Rational for Pancreatic MDC

• Pancreatic cancer is highly lethal

• Time is of the essence

• Correct staging is necessary for correct therapy

• Optimal care for pancreatic cancer involves numerous 

specialties 

• “Standard Care”

my not be best care for any given individual

– Tailored therapies• Relatively rare so that, in general, no one community 

physician is an expert on pancreatic cancer

• Diagnosis can often be paralyzing and overwhelming

Standard Scenario PCA DiagnosisJa

undi

ce

Med

ical

Onc

olog

ist

PP

CT

Sur

geon

Rad

iatio

n O

ncol

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Bor

derli

ne R

esec

tabl

e??

Liver

Met

Ther

apy

Sta

rts1 week 1 week 1 week 2 weeks 1 week

6 weeks!!

PMDC Scenario Ja

undi

ce

Surgeon

1 week Days

PM

DC

Medical Oncology

PPCT/Expert Review

Radiation Oncology

Pathology Review

Clinical Trial Assessment

Pain MedicineNutrition

Consensus on Optimal Treatment

Pancreatic MDC Website

• 7‐9 AM: Necessary imaging and lab  studies obtained

• 9‐10 AM: Patients given overview of  support services (10‐15 min briefings  by nutrition, nursing, social work and  National Familial Pancreas Tumor 

Registry)

• 10‐12 PM: Patients seen by fellows,  residents, NPs and PAs

for a complete 

history and physical exam 

• 12:30‐2 PM: Multi‐D team meets

Pancreatic MDC: Patient Schedule

Pancreatic MDC: Case Review

Review ImagesCT/PET/MRI/

EUS

Discuss Caseand reach

consensus

ReviewPathology

See patients anddiscuss options

Present Casesusing outline

Enroll in trials/studies

Dictate note and cc toreferring physicians

Patients and Methods

• Pancreatic Multidisciplinary Clinic • 203 pts (November 2006 – October 2007)

• Data Collection• Patient demographics • Clinicopathologic factors• Outside vs. MDC findings / recommendations

Geographic Distribution of Referrals

International: 4

Results: Initial Cross‐Sectional Imaging

N = 174

Resectable 46

Locally advanced / unresectable 35

Metastasis 18

Locally advanced / unresectable + metastasis

1

Initial Assessment Percent of Patients (%)

MDC Review: Cross‐Sectional ImagingChange in Clinical Stage

38 out of 174 (22%)

Resectable

Locally advanced/ Unresectable

N = 3

No Metastasis

Metastatic

Disease

N = 26

Locally advanced/ Unresectable

Resectable

N = 5

Suspicious Mass

No Lesion

N = 4

MDC Review: Pathology

Change in Diagnosis

7 out of 203 (3%)

• Neuroendocrine tumor (n=2)

• Breast metastasis (n=1)

• Gastrointestinal stromal tumor (n=1)

• Gallbladder cancer (n=1)

• Benign inflammatory process (n=1)

• Serous cystadenoma (n=1)

Conclusions

Pancreatic MDC is an efficient means to assess patients with presumed pancreatic cancer

MDC format facilitates consensus recommendations and less confusion regarding the therapeutic plan

A single day MDC may help to improve patient education, permit greater interaction with support staff (e.g. social work, nutrition, etc.) and decrease patient anxiety

Pancreatic MDC provides an important expert opinion for many patients that may lead to dramatic changes in their care

PMDC Coordination

• Identify appropriate patients• Educate on different levels• Optimize treatment options

• Follow‐up for outcomes

• Enhance patient satisfaction

Original Data Management System

Microsoft Excel Spreadsheet

•Simple

•Weekly log

•Track numbers

Excel Variables

• Demographics

• Diagnosis

• Imaging

• Disciplines 

Original Data Management System

Microsoft Excel Spreadsheet

•Validity•0 or 1•Versionitis•Integrity

Better Data Management  System Needed

PMDC and Technology

•Patients•Clinicians•Researchers•Administrators

Work to date

• Database design based on relevant clinical  and research needs of multidisciplinary team

– Temporal organization• Preclinic, clinic, post‐clinic

– Information type• Pathology, radiology, recommendations, treatment, 

etc.

• Construction of prospective and retrospective  databases with attention to data compatibility

Barriers in Database Construction

• Compatibility between multiple databases to  ensure appropriate analysis

• Data abstraction• Real‐time modification and testing of forms

Barriers of Combining  Retrospective and Prospective data

• Recall bias• Error of data entry with retrospective data: 

the prospective data is reviewed again at the  pancreatic mdc

consensus conference

• Ability to link both datasets for analysis• Need to get updated data for retrospective 

patients

• Integration with biomarker data

Other Challenges

• Working with data programmers to develop  forms that are complete, concise, but efficient 

and realistic for clinicians to enter data

• IRB approval for both research and clinical use• Ability to export data for clinical notes• Knowing “when to say when”, collect what 

you really need

Acknowledgements

• JHU: Dan Ford, Diana Gumas, Dorothy  Damron, Susan Booker

• Harris Corporation: Raju

Prasannappa, Seth  Puckett, Christian Hertel