A Collaborative Multidisciplinary Approach May Lead to Enhanced Clinical Outcomes and Quality of Care for Patients with Diffuse TGCT

Tenosynovial giant cell tumor (TGCT) is a rare tumor of joint synovium which causes significant pain and limitations to daily living. Historically, management has been surgical excision but recently, a new agent was approved by the Food and Drug Administration (FDA) in August 2019 for use in patients who are not surgical candidates. Little information exists on the outcomes of patients treated with drug or surgery and drug in combination. A look at best practices, and then a rapid dissemination of those findings across specialties is urgently needed. 

The collaborators include John Abraham, MD, an orthopedic oncology surgeon, Gerhard Maale, MD, an orthopedic surgeon, and R. Lor Randall, MD, an orthopedic surgeon. Dr. Abraham is affiliated with the Jefferson Musculoskeletal Oncology Center at the Kimmel Cancer Center, the Rothman Orthopedic Institute, and the Dana Farber Cancer Center, one of the leading sarcoma centers globally. Dr. Maale is the founder of the Dallas Ft. Worth Sarcoma Group. Dr. Randall is affiliated with the UC Davis Comprehensive Cancer Center.  Having a range of expertise from along the patient journey provides a unique perspective and aid in connecting both surgical and oncology communities to the findings. The challenge of the multi-site, multi-PI, coalition-based project required an agile and responsive approach to understand and improve what we didn't know.

Educational Strategy:

The project was initiated in the Fall of 2021 with a Virtual Consortium Summit meeting with each PI and their respective member institutions for each location (Dallas, TX, Sacramento, CA, and Philadelphia, PA) via Zoom. It leveraged PDSA, or Plan-Do-Study-Act. PDSA is an iterative, four-stage problem-solving model used for improving a process or carrying out change.  

By bringing together a consortium of members, the project will include different perspectives and ideas on combination approaches and maintenance, but also had a pragmatic rationale--institutions from varying geographic areas would help answer questions of regionality regarding the real-world application of the findings. The consortium met and developed an Aims Statement to guide the project. 

The first action was a baseline data analysis of combined and de-identified patient cohort records from each institution. These data were distilled into case reviews to identify best practices across institutions. An examination of the data as determined by the parameters to assess changes or improvements as described in the Aim Statement.

The consortium then coalesced the results and implications and through Medical Impact Ventures, shared them with the participating sites and then with the sarcoma community-at-large through a unique “outcomes microsite” and in posters and abstracts as foundational to changing how providers approach TGCT. Assessment tools are used to measure the impact of the project on perceptions and practices.

Patient-Level Outcome(s) Measured:

In all three high-volume centers, a multidisciplinary tumor board approach to all patients was utilized. Utilizing this approach, a highly favorable response in the patient series was seen, with moderate to high rates of MRI response, histologic response, and symptomatic response. Based on the assessment of the results of our three centers, the PI’s concluded that this collaborative multispecialty approach is necessary and optimal for management of this tumor. It is likely that some of these patients may have become better surgical candidates after medical treatment, and therefore continued multidisciplinary input is needed throughout the treatment course, not just at the initiation of treatment. 

Based on these findings, video-based education was disseminated among Consortium institutions and beyond; and the impact of this education on perceptions and practices, along with ongoing educational needs, will be measured and reported in a final report and in future studies. 

This first-in-kind “research to education” project breaks new ground in leveraging real-world evidence (RWE) in real-time to develop, deploy and measure educational programming.