A multidisciplinary team care approach improves outcomes in high-risk pediatric neuroblastoma patients

// Hsiu-Hao Chang 1 , Yen-Lin Liu 1, 2 , Meng-Yao Lu 1 , Shiann-Tarng Jou 1 , Yung-Li Yang 1, 3 Dong-Tsamn Lin 1, 3 , Kai-Hsin Lin 1 , Kai-Yuan Tzen 4 , Ruoh-Fang Yen 4 , Ching-Chu Lu 4 , Chia-Ju Liu 4 , Steven Shinn-Forng Peng 5 , Yung-Ming Jeng 6 , Shiu-Feng Huang 7 , Hsinyu Lee 8, 9 , Hsueh-Fen Juan 8, 10 , Min-Chuan Huang 11 , Yung-Feng Liao 12 , Ya-Ling Lee 13, 14 , Wen-Ming Hsu 15 1 Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan 2 Department of Pediatrics, Taipei Medical University Hospital, Taipei, Taiwan 3 Department of Laboratory Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan 4 Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan 5 Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan 6 Department of Pathology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan 7 Division of Molecular and Genomic Medicine, National Health Research Institutes, Miaoli County, Taiwan 8 Department of Life Science, National Taiwan University, Taipei, Taiwan 9 Institutes of Zoology, National Taiwan University, Taipei, Taiwan 10 Institutes of Molecular and Cellular Biology, National Taiwan University, Taipei, Taiwan 11 Graduate Institute of Anatomy and Cell Biology, National Taiwan University College of Medicine, Taipei, Taiwan 12 Institute of Cellular and Organismic Biology, Academia Sinica, Taipei, Taiwan 13 Department of Nursing, National Taiwan University College of Medicine, Taipei, Taiwan 14 Department of Nursing, Central Taiwan University of Science and Technology, Taichung, Taiwan 15 Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan Correspondence to: Ya-Ling Lee, email: yallee@ntu.edu.tw Wen-Ming Hsu, email: billwmhsu@gmail.com 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.