Ontario oncologists’ perspective on addressing potential barriers in the management of patients with neuroendocrine tumors.

Fingrut, W., Yelamanchili, R., Thawer A., Chan D., Wyld, D., Singh S., Lo, D. Ontario oncologists’ perspective on addressing potential barriers in the management of patients with neuroendocrine tumors.

Background: Management of neuroendocrine tumors (NETs) is complex and requires a multidisciplinary approach. Our team recently surveyed medical oncologists and identified their perspective on potential barriers to management of NET patients. The goal of the current project was to better understand these barriers and to identify oncologists’ perspectives on potential solutions.

Methods: We hosted a meeting on 29/03/2018 with 17 medical oncologists from across Ontario, predominantly from the GTA. The meeting focus was: “Understanding the barriers in creating a shared-care model for the management NET patients”. Meeting minutes were transcribed, and qualitative approaches were used to identify key themes.

Results: Participants shared multiple potential barriers in management of their NET patients, related to four themes: education, access, communication, and coordination. Multiple solutions for each potential barrier were proposed. On the theme of education, participants requested NET management algorithms designed by specialist physicians to simplify and standardize care. They also requested updates on clinical trials, and teaching on treatment choices at time of disease progression. With respect to access barriers, participants proposed development of virtual tools including remote tumour boards, and highlighted the need for improved access to radiology tests (including 68Ga PET scans) and to expert pathology, surgery, and endocrinology expertise. Regarding communication, participants proposed development of a patient journey tool, and supported assigning an oncologist at each centre to be a key NET contact person. Participants also requested distribution of a NET newsletter. Relating to coordination, participants identified the need for a separate focused multidisciplinary case conference to support timely treatment planning. Participants also proposed the creation of a nurse-navigator position to coordinate patient care in the region.

Conclusions: These results suggest multiple potential avenues for addressing barriers in the management of NET patients. They inform the development of resources and approaches to improve the care of NET patients.