National Gaps in Appendiceal Cancer Care and Implementation of a Regional Virtual Multidisciplinary Care Conference

BACKGROUND: Appendiceal cancers (AC) are rare, heterogenous tumors with unique diagnostic and management challenges requiring highly specialized multidisciplinary management. Access to multidisciplinary care varies widely, particularly across community and rural settings. Further, at the time of this study, limited evidence-based guidelines existed for the management of AC, presenting a challenge for gastrointestinal (GI) oncologists. METHODS: We conducted a two-part study. First, we established and evaluated the impact of a regional virtual AC-dedicated multidisciplinary care conference (MCC) at a high-volume tertiary care center. Second, we performed a national cross-sectional survey of GI oncologists to assess perceived gaps in knowledge, confidence, and standardization of care for AC. RESULTS: The regional AC-dedicated MCC reviewed 614 unique cases between May 2020 and June 2022 with multidisciplinary participation across medical oncology, surgical oncology, pathology, and radiology. Among MCC participants, 88.5% reported improved knowledge, 94% reported perceived improved quality of care, and 100% reported increased confidence in managing AC. Most participants reported that MCC discussions influenced treatment decisions in ≥ 30% of cases. A total of 114 gastrointestinal oncologists completed the national survey. Most practiced in academic centers (86.1%) and reported low clinical exposure to AC, with 72.0% managing fewer than 10 cases annually. Only 17.5% believed sufficient evidence exists to guide systemic therapy, and two-thirds reported that AC treatment is not or only somewhat standardized. Confidence in managing AC was moderate in most respondents (44.7%), with only 37.7% reporting high confidence. Educational resources were rated as fair or poor by 83.5% of respondents. CONCLUSIONS: Significant national gaps remain in evidence, standardization, provider confidence, and educational resources for AC management. In parallel, implementation of a regional virtual AC-dedicated MCC was feasible and was associated with participant-reported improvements in knowledge, confidence, and perceived quality of care. This model may offer valuable expert guidance, improve clinician education and confidence, and facilitate decision-making in the management of a rare disease for which high-quality evidence remains limited.