骨転移キャンサーボードの実態調査

Patterns of multidisciplinary conferences for patients with bone metastases

骨転移診療には放射線治療医，画像診断医，整形外科医，リハビリテーション医，腫瘍内科医，腫瘍外科医，緩和ケア医，看護師，理学療法士，ソーシャルワーカーなど多診療科，多職種が関与する。質の高い骨転移診療を行うためには，骨転移に特化したキャンサーボードを通じて問題点を共有し治療方針を協議することが重要とされている^1）2）。一方で神戸大学の酒井らが2016年にがん診療拠点病院を中心に行ったアンケート調査では，骨転移キャンサーボードを行っている施設はわずか13％であった^3）。骨転移キャンサーボードの普及・啓発は日本における骨転移診療の質の向上に非常に重要な役割を果たすと考えられる。

Multidisciplinary approach is crucial for the management of patients with bone metastases. However, multidisciplinary cancer board（MDCB）specific for bone metastases are available only in limited institutions. In addition, how to conduct MDCB for bone metastases is largely varied according to each institution. As a reference for institutions who might start MDCB for bone metastases in the near future, we performed the survey how it was conducted in 9 institutions. In addition to physicians, nurses regularly participated in 6 institutions, while physical therapists and pharmacists participated in 5 and 4 institutions, respectively. Radiation oncologists and orthopedic surgeons regularly participated in all 9 institutions, while palliative oncologists, rehabilitation physicians, diagnostic radiologists participated in 6, 6, 4 institutions, respectively. Attending physicians regularly participated in only 2 institutions. How to pick-up patients to discuss largely varied according to institutions. Some institutions emphasized that it was important that diagnostic radiologist contributed on patients’ pick-up. Proportions of the discussion points were 15-70％ for treatments, 10-30％ for diagnosis, and 0-35％ for rehabilitation. Large variations were shown in the way to conduct MDCB for bone metastases. Each institution should find the best way according to the current status.