“Ruolo dei Tumor Board virtuali nella gestione dei pazienti oncologici in Sicilia”

Introduction: Virtual Multidisciplinary Tumor Boards (VMTBs) facilitate multidisciplinary cancer care and could be essential to reinforce oncological networks especially in a vast geographical area like Sicily. Moreover, the Covid- 19 pandemic has altered the way of approaching the patient and virtual meetings helped to avoid interpersonal contact and, on the other side, to optimize the clinical information flows within the regional healthcare network. This pilot observational study assessed the feasibility and acceptance of using telemedicine to implement a cloud-based virtual tumor board program within Sicily. Patients and Methods: The VMTB program was implemented through a cloud- based platform (Navify, Roche; Basel, Switzerland). Feasibility, acceptability, and suitability were assessed via validated survey (1–5-point Likert scale), administered to 72 VMTB participants. The Secondary Endpoints included the preliminary data on VMTB meetings utilization and the effectiveness in providing access to quality and equitable cancer care including timely and appropriate multidisciplinary evaluation. Results: Overall, 365 patients were referred to the virtual conferences over an 18-month observation period. Nearly the 48% of cases came from general hospitals and tertiary centers, the 35% were referred from the comprehensive cancer centers and the 17% were referred from the teaching hospitals. Three cancer groups were formed: Prostate Cancer Group (PCG), Gynecological Cancer Group (GCG) and Lung Cancer Group (LCG). The majority of participants (96%) assumed, through the survey, that the VMTB could eliminate the geographical barriers and could improve the equity of care. Most of the prostate cancer patients had a stage III (45%) and IV (34%) of disease, while most Gynecological cancer patients and lung cancer patients had a stage III and IV of disease. The more discussed topics in the PCG, the GCG and the LCG were radiology findings followed by the medical treatment in the PCG and GCG, and the surgical treatment in the LCG. In the PCG, GCG and LCG respectively the 71%, 68% and 64% of the clinical cases discussed had no change in the diagnostic-therapeutic work-up after the virtual conferences. All the final recommendations electronically voted at the end of each meeting were controlled for adherence to the guidelines; the appropriateness of the VMTB assessment was of 98%. The majority of VMTB meetings (80%) were presented in a timely fashion; mean time from the consult request to the clinical case discussion was 7.3 business days. Conclusion: VMTB’s development is feasible and highly accepted by its participants. However, virtual conferences cannot necessarily replace traditional meetings because the VTBMs have still to overcome many barriers. Future studies should focus on widespread implementation and validating the effectiveness of this model.