In February, we held our fist multidisciplinary clinic for adult NF patients, which is now happening on a monthly basis. It is evident that this model of care provides significant benefits for patients who have active problems that require further evaluation and treatment, such as those who have tumors. During these multidisciplinary clinics, I am joined by Vanessa Eulo, MD, medical oncologist and Associate Professor of Medicine in the UAB Division of Hematology and Oncology, and Hari Jeyarajan, MD, Assistant Professor of Medicine in the UAB Department of Otolaryngology. Dr. Eulo evaluates patients with plexiform neurofibromas, some of whom may benefit from the drug selumetinib, as well as patients with MPNSTs (malignant peripheral nerve sheath tumors); Dr. Jeyarajan sees patients with head and neck temporal plexiform neurofibromas who may be candidates for surgical intervention.
Based on positive results from our inaugural clinics, we plan to offer this clinic model monthly to augment care that I and nurse practitioner Tammi Skelton, CRNP, provide during the regular adult NF clinic held each Thursday in The Kirklin Clinic. Most patients in the weekly adult NF clinic either come in for an initial evaluation and diagnosis or follow up with us once a year if they do not have active problems that require treatment. Previously, if we identified a patient with a tumor or other problem that requires evaluation by a surgeon or other specialist, we referred them to the relevant UAB clinic, which could often take weeks. For patients, this was often a frustrating cycle of waiting for an appointment and seeing specialists in multiple locations. However, the multidisciplinary clinic expedites care by allowing our team of specialists to confer about patients we have identified as requiring further evaluation and to implement a treatment plan; in many cases, patient evaluations that might have taken weeks to schedule were accomplished during the clinic. Our patients appreciate the streamlined care, and our specialists also benefit from the enhanced communication during the clinic and the opportunity to learn from one another. We are discussing the possibility of establishing a similar multidisciplinary clinic for pediatric patients who require additional evaluation and treatment. This month’s blog features perspectives on the adult NF multidisciplinary clinic from Dr. Jeyarajan and Dr. Eulo, including the benefits they have observed for both patients and providers.
How did you become involved in the multidisciplinary clinic?
Dr. Jeyarajan: Dr. Korf initially contacted me about a few patients with head and neck temporal plexiform neurofibromas to determine whether they might benefit from surgery. I was trained at a hospital in the UK that conducted a multidisciplinary clinic for complicated NF patients. The clinic, which featured medical oncologists, neurosurgeons, and geneticists, was tailored to patients who required multidisciplinary input. Together as a team, we formulated a treatment plan for these patients. Dr. Korf wanted to implement a similar multidisciplinary clinic model at UAB for adult NF patients.
Dr. Eulo: During my medical training in St. Louis, I gained a great deal of experience in evaluating NF patients with sarcomas, including those with MPNSTs. Dr. Korf felt that my participation in the clinic would provide a good opportunity to identify NF patients at higher risk of developing MPNSTs, which are extremely aggressive sarcomas that can develop from plexiform neurofibromas.
In what specific ways does the multidisciplinary clinic model benefit NF patients?
Dr. Jeyarajan: The unique thing about NF patients is that they have different problems that cross multiple organ systems and specialties. This can make it difficult to communicate with and counsel patients because they often must go to multiple waiting rooms and clinics.
When several specialists can get in the same room together, it greatly improves the quality of care and burden of care for patients who live much of their lives in the healthcare system. I believe the multidisciplinary clinic model allows us to offer patients with specific issues a higher standard of care.
Dr. Eulo: Particularly because many of our patients drive from a distance, it’s extremely helpful for them to accomplish as much as possible in one appointment. The multidisciplinary clinic gives specific patients that opportunity. Prior to seeing patients in the clinic, we review any prior imaging results. After seeing patients, we reconvene to review each patient’s case and discuss the treatment plan.
The clinic helps to identify and evaluate patients with plexiform neurofibromas, a type of tumor that has a higher risk of developing into an MPNST. Most plexiforms can be watched with regular imaging though some patients with plexiform neurofibromas may benefit from treatment with the drug selumetinib, which has received FDA approval for treatment of plexiform neurofibromas in pediatric NF patients. There is currently a clinical trial underway evaluating the efficacy of selumetinib in adults with plexiform neurofibromas. Some plexiforms can become large and painful and can also cause cosmetic concerns. One of the important things we do in the clinic is to determine whether patients might benefit from either surgery or medication.
In your view, what is the potential for the multidisciplinary clinic to further enhance patient care?
Dr. Jeyarajan: Hopefully, we can incorporate more specialties into the clinic so that patients can benefit from addressing multiple issues in one appointment. Also, because I believe we as providers learn from the other specialists, incorporating additional specialties provides greater opportunities for collaboration and learning.
Dr. Eulo: Some of the other specialties we hope to pull in include surgical oncology, plastics, and dermatology. The multidisciplinary clinic can become an important vehicle for ensuring that NF patients with active problems receive the most expedient evaluation and treatment possible.