Role of the multidisciplinary team in breast cancer management: results from a large international survey involving 39 countries

The effect of 1-day multidisciplinary clinic on breast cancer treatment

PURPOSE

A delay in breast cancer treatment is associated with inferior survival outcomes; however, no clear guidelines exist defining the appropriate time frame from diagnosis to definitive treatment of breast cancer. A multidisciplinary approach for breast cancer treatment can minimize the time from diagnosis to first treatment. We hypothesized single-day multidisciplinary clinic (MDC) may accelerate the time to first treatment on complex breast cancer cases at our institution.

METHODS

We identified patients who were treated at Johns Hopkins for stage II or III breast cancer, who were at least 18 years of age, and were seen in a new single-day MDC with coordination between two or three specialties or by specialists from varying disciplines on different days (IDC). Patients who initiated treatment between May 2015 (initiation of MDC clinic) and December 2017 were included in our study.

RESULTS

A total of 296 patient records were reviewed independently. The mean (SD) patient age was 55 (13) years. The median time to first neoadjuvant chemotherapy (NACT) was significantly reduced for patients seen in the MDC (12.7 days), compared to those seen at the IDC (24.4 days, logrank p < 0.001). The median time to definitive surgery was similar between groups (31 and 32 days for the MDC and IDC cohorts, respectively).

CONCLUSIONS

A single-day MDC visit is associated with a reduced time from diagnosis to NACT. Further studies are needed to determine if a shorter interval can improve the management and the outcome of complex breast cancer cases.

Compliance with multidisciplinary team recommendations and disease outcomes in early breast cancer patients: An analysis of 4501 consecutive patients

Background

Multidisciplinary team (MDT) discussions are widely held to facilitate the diagnosis and treatment of breast cancer, but patient compliance with the MDT recommendations and the impact of compliance on disease outcome are uncertain.

Methods

We conducted a retrospective review of data from a prospective database of breast cancer patients treated at Shanghai Ruijin Hospital between April 2013 and August 2018. MDT discussions were held for all patients before they started adjuvant therapy. The patients were classified into compliant and non-compliant groups according to whether they received the MDT-recommended regimens. We also analyzed which clinicopathological factors were associated with compliance and prognosis.

Results

Of 4501 breast cancer patients, 3681 (81.8%) and 820 (18.2%) were included in the compliant and non-compliant groups, respectively. Age >70 years (P < 0.001), invasive ductal carcinoma (P < 0.001), and histological grade III (P = 0.011) were independently associated with higher risk of non-compliance, whereas Ki-67 labeling index ≥14% and history of benign breast disease were independently associated with compliance. Disease-free survival (hazard ratio [HR] 1.813, 95% confidence interval [CI] 1.367–2.405, P < 0.001) and overall survival (HR 2.478, 95% CI 1.431–4.291, P < 0.001) were worse in the non-compliant group.

Conclusions

Several clinicopathological factors were associated with non-compliance with MDT recommendations for early breast cancer patients. Non-compliance was associated with worse disease outcome.

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A large consecutive breast cancer cohort with MDT-based treatment recommendation.

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Factors identified associated with non-compliance with MDT recommendations.

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A significantly better survival in patients compliant with MDT recommendation.

The requirements of a specialist breast centre

This article is an update of the requirements of a specialist breast centre, produced by EUSOMA and endorsed by ECCO as part of Essential Requirements for Quality Cancer Care (ERQCC) programme, and ESMO. To meet aspirations for comprehensive cancer control, healthcare organisations must consider the requirements in this article, paying particular attention to multidisciplinarity and patient-centred pathways from diagnosis, to treatment, to survivorship.

Aberrant methylation of WD-repeat protein 41 contributes to tumour progression in triple-negative breast cancer

WD-repeat proteins are implicated in a variety of biological functions, most recently in oncogenesis. However, the underlying function of WD-repeat protein 41 (WDR41) in tumorigenesis remains elusive. The present study was aimed to explore the role of WDR41 in breast cancer. Combined with Western blotting and immunohistochemistry, the results showed that WDR41 was expressed at low levels in breast cancer, especially in triple-negative breast cancer (TNBC). Using methylation-specific PCR (MSP), we observed that WDR41 presented hypermethylation in MDA-MB-231 cells. Methylation inhibitor 5-aza-2'-deoxycytidine (5-aza-dC) management increased the expression of WDR41 in MDA-MB-231 cells, but not in MCF-10A (normal mammary epithelial cells) or oestrogen receptor-positive MCF-7 breast cancer cells. WDR41-down-regulation promoted, while WDR41-up-regulation inhibited the tumour characteristics of TNBC cells including cell viability, cell cycle and migration. Further, WDR41-up-regulation dramatically suppressed tumour growth in vivo. Mechanistically, WDR41 protein ablation activated, while WDR41-up-regulation repressed the AKT/GSK-3β pathway and the subsequent nuclear activation of β-catenin in MDA-MB-231 cells, and 5-aza-dC treatment enhanced this effect. After treatment with the AKT inhibitor MK-2206, WDR41-down-regulation-mediated activation of the GSK-3β/β-catenin signalling was robustly abolished. Collectively, methylated WDR41 in MDA-MB-231 cells promotes tumorigenesis through positively regulating the AKT/GSK-3β/β-catenin pathway, thus providing an important foundation for treating TNBC.

How Ineffective Interprofessional Collaboration Affects Delivery of Breast Reconstruction to Breast Cancer Patients: A Qualitative Study

BACKGROUND

Despite the benefits of breast reconstruction (BR), health care professionals do not consistently integrate it as an option in the treatment of breast cancer patients. Interprofessional collaboration (IPC) amongst professionals may facilitate the elaboration of comprehensive oncological treatment plans. As the application of IPC in the delivery of BR has not yet been studied, we undertook a qualitative study to explore the perceptions of physicians and administrators on IPC in breast cancer care and how these impact BR delivery.

METHODS

Interviews were conducted with 30 participants (22 physicians and 8 administrators). Physician interviews focused on their personal beliefs and values regarding BR, while administrator interviews explored their institutional treatment regimens as well as the availability of a BR program. Our thematic analysis was informed by the Canadian Interprofessional Health Collaborative (CIHC) competency framework.

RESULTS

IPC challenges were thought by participants to affect the delivery of BR. At the physician level, a lack of role clarity as well as the absence of an explicitly established leader negatively influence collaboration in BR delivery. In addition, varying views on the usefulness of BR and on the role of plastic surgeons in breast oncological teams discourage positive collaboration, rendering the delivery of BR more difficult.

CONCLUSIONS

The delivery of BR is overall impaired due to a lack of effective IPC. IPC could be improved through clarifying physician roles, establishing clear leadership, and aligning viewpoints on quality oncological care in collaborative teams; ultimately, this may promote equitable BR delivery for breast cancer patients.

Nurses' perception and experiences towards medical device-related pressure injuries: A qualitative study

AIMS AND OBJECTIVES

This study aims to explore nurses' perceptions and experiences regarding pressure injuries caused by medical devices and to understand the perceived challenges and barriers nurses face in preventing medical device-related pressure injuries.

BACKGROUND

Nurses have a responsibility to prevent pressure injuries and play a major role in their prevention. As there has been a lack of research on medical device-related pressure injuries, not much is known about nurses' perceptions and experiences. This therefore hinders the establishment of effective and efficient interventions in nurses' education and in the practical environment.

DESIGN

A descriptive qualitative design was adopted, and the COREQ checklist was employed to report on the current study.

METHODS

The study was conducted at an acute care hospital in Singapore. Purposive sampling was used, and a total of 21 enrolled and registered nurses who had recent experiences with medical device-related pressure injuries were recruited between August and December 2018. Face-to-face interviews were conducted using a semi-structured interview guide. A thematic analysis was performed to analyse the qualitative data.

RESULTS

Five themes emerged regarding pressure injuries: (1) preventable yet unavoidable, (2) everyone's responsibility, (3) harmonising theory with practice reality, (4) pre-existing conditions may limit injury prevention and management; and (5) nurses expressed a need for experiential training.

CONCLUSIONS

The study's findings could be used to develop improvements in nursing practice and policy at acute care hospitals, as well as to improve awareness of medical device-related pressure injuries among healthcare professionals. Moreover, the findings can also inform future research studies to develop effective evidence-based practices and improve patient outcomes.

RELEVANCE TO THE CLINICAL PRACTICE

This study reveals the unique challenges and dilemmas that nurses face and will help to inform healthcare institutions and management in developing programmes and improving protocols to reduce the incidence rate of pressure injuries caused by medical device.

Progress in the application of organoids to breast cancer research

Breast cancer is the most common cancer diagnosed in women. Breast cancer research is currently based mainly on animal models and traditional cell culture. However, the inherent species gap between humans and animals, as well as differences in organization between organs and cells, limits research advances. The breast cancer organoid can reproduce many of the key features of human breast cancer, thereby providing a new platform for investigating the mechanisms underlying the development, progression, metastasis and drug resistance of breast cancer. The application of organoid technology can also promote drug discovery and the design of individualized treatment strategies. Here, we discuss the latest advances in the use of organoid technology for breast cancer research.

Teaching cross-cultural design thinking for healthcare

OBJECTIVES

Artificial intelligence (AI) is poised to transform breast cancer care. However, most scientists, engineers, and clinicians are not prepared to contribute to the AI revolution in healthcare. In this paper, we describe our experiences teaching a new undergraduate course for American students that aims to prepare the next generation for cross-cultural designthinking, which we believe is crucial for AI to achieve its full potential in breast cancer care.

MATERIALS AND METHODS

The key course activities are planning, conducting, and interpreting interviews of healthcare professionals from both Portugal and the United States. Since the course is offered as a short-term faculty-led study abroad program in Portugal, students are able to explore the impact of culture on healthcare delivery and the design of healthcare technologies.

RESULTS

The learning assessments demonstrated student growth in several areas pertinent for future development of AI for breast cancer care. With respect to understanding breast cancer care, prior to taking this course, most students had underestimated the impact of cancer and its treatment on women's quality of life and most were unaware of the importance of multidisciplinary care teams. Regarding AI in medicine, students became more mindful of data privacy issues and the need to consider the effect of AI on healthcare professionals.

CONCLUSION

This course illustrates the potential benefits for AI in medicine of introducing future scientists, engineers, and clinicians to cross cultural design-thinking early in their educational experiences.

Characterizing communication patterns among members of the clinical care team to deliver breast cancer treatment

OBJECTIVE

Research to date focused on quantifying team collaboration has relied on identifying shared patients but does not incorporate the major role of communication patterns. The goal of this study was to describe the patterns and volume of communication among care team members involved in treating breast cancer patients.

MATERIALS AND METHODS

We analyzed 4 years of communications data from the electronic health record between care team members at Vanderbilt University Medical Center (VUMC). Our cohort of patients diagnosed with breast cancer was identified using the VUMC tumor registry. We classified each care team member participating in electronic messaging by their institutional role and classified physicians by specialty. To identify collaborative patterns, we modeled the data as a social network.

RESULTS

Our cohort of 1181 patients was the subject of 322 424 messages sent in 104 210 unique communication threads by 5620 employees. On average, each patient was the subject of 88.2 message threads involving 106.4 employees. Each employee, on average, sent 72.9 messages and was connected to 24.6 collaborators. Nurses and physicians were involved in 98% and 44% of all message threads, respectively.

DISCUSSION AND CONCLUSION

Our results suggest that many providers in our study may experience a high volume of messaging work. By using data routinely generated through interaction with the electronic health record, we can begin to evaluate how to iteratively implement and assess initiatives to improve the efficiency of care coordination and reduce unnecessary messaging work across all care team roles.

Practice patterns of multidisciplinary team meetings in Korean cancer care and patient satisfaction with this approach

BACKGROUND/AIMS

The multidisciplinary team (MDT) approach is a cornerstone of clinical oncology. This study investigated the current state of MDT care, including patient satisfaction, in Korea.

METHODS

We obtained the annual number of cancer patients who have received MDT care since 2014 from the registry of the Health Insurance Review and Assessment Service (HIRA). In addition, patients who received MDT care from August 2014 to May 2017 at four university hospitals were further characterized, and patient satisfaction was measured prospectively using a patient-reported questionnaire.

RESULTS

The total number of patients who received MDT care increased from 2014 to 2016 (2,113 to 9,998 patients, respectively) in the HIRA Cohort. The type of cancer that most often required MDT was breast cancer (23.8%), followed by colorectal cancer (19.1%). In the Representative Cohort (n = 1,032), MDT was requested by the surgeon more than half the time (55.7%). The main focus of MDT was decision making for further treatment planning (99.0%). The number of doctors participating in the MDT was usually five (70.0%). After initiating an MDT approach, the treatment plan changed for 17.4% of patients. Among these patients, 359 completed a prospective satisfaction survey regarding their MDT care. The overall satisfaction with the MDT approach was very high, with an average score of 9.6 out of 10 points.

CONCLUSION

The application of MDT care is a rapidly growing trend in clinical oncology, and shows high patient satisfaction. Further research is needed to determine which types of cancer patients could benefit most from MDT, and to enable MDT care to operate more efficiently so that it may expand successfully throughout Korea.

Healthcare professionals' perceptions of the pre-requisites and realisation of interprofessional collaboration in cancer care

OBJECTIVE

The purpose of this study is to describe the pre-requisites and realisation of interprofessional collaboration as perceived by healthcare professionals working in the cancer care setting and to produce knowledge to support the development of collaborative practices.

METHODS

This study employed a descriptive survey design. The data were collected in one Finnish cancer centre between May and October 2018 from nurses, physicians and other healthcare professionals using an electronic survey (n = 350). The survey focused on the pre-requisites of interprofessional collaboration (appreciation and competence) and its realisation in cancer care. The data were analysed using descriptive and interferential statistics.

RESULTS

The pre-requisites of interprofessional collaboration were perceived as good and the collaboration was well realised in the cancer centre. The perceptions of pre-requisites and realisation were associated with each other. Male respondents, physicians and professionals belonging to interprofessional teams had more positive perceptions of the pre-requisites and realisation of interprofessional collaboration than others.

CONCLUSION

The findings indicate that the pre-requisites of interprofessional collaboration and its realisation seem to be well implemented in the cancer care setting. However, the ongoing evaluation of interprofessional collaboration requires further attention from healthcare administration and professionals to support the systematic development of collaborative practices.

Multidisciplinary meetings at the emergency department: A conversation-analytic study of decision-making

Multidisciplinary meetings (MDMs) have become an established part of many medical disciplines. Much research has been done to investigate the conditions under which they work best. This research, however, has been mostly retrospective and has had little consideration for the actual workings of MDMs. The aim of this study was to determine how Multidisciplinary Teams (MDTs) come to a shared decision and thus how they organize MDMs moment by moment. For this purpose we recorded twenty MDMs at the Department of Emergency Medicine (ED) of the Radboud University Medical Center in The Netherlands between November 2017 and June 2018. These meetings, contrary to those discussed in the literature, were scheduled ad-hoc as patients were seen at the ED and were conducted by small MDTs of between three and six participants, always involving a surgeon, a geriatrician, and an emergency physician. Using Conversation Analysis we found that despite the ad hoc nature of these meetings, teams collaboratively developed a structure that was grounded in everyday medical practice and reached a decision in on average slightly over 10 min. First they do a case presentation in which they share the patient's medical history and results of the physical examination and any medical tests. They subsequently agree on a differential diagnosis, and then develop a work plan. Finally, the decision is often formulated to invite confirmation and make it an interactionally shared decision. The benefit of having an MDM was evidenced by discussion of patients' frailty in particular: it was sometimes omitted during the case presentation, but then consistently requested by the geriatrician. And as we show, it was occasionally invoked as a definitive argument for deciding between surgical or conservative treatment. Our analysis suggests that MDMs can have added value in other disciplines where it is feasible to schedule meetings ad hoc.

What is multidisciplinary cancer care like in practice? a protocol for a mixed-method study to characterise ambulatory oncology services in the Australian public sector

INTRODUCTION

An understanding of the real-world provision of oncology outpatient services can help maintain service quality in the face of escalating demand and tight budgets, by informing the design of interventions that improve the effectiveness or efficiency of provision. The aims of this study are threefold. First, to develop an understanding of cancer services in outpatient clinics by characterising the organisation and practice of multidisciplinary care (MDC). Second, to explore the key areas of: (a) clinical decision-making and (b) engagement with patients' supportive needs. Third, to identify barriers to, and facilitators of, the delivery of quality care in these settings.

METHODS AND ANALYSIS

A suite of mixed-methods studies will be implemented at six hospitals providing cancer outpatient clinics, with a staged roll-out. In Stage One, we will examine policies, use unstructured observations and undertake interviews with key health professionals to characterise the organisation and delivery of MDC. In Stage Two, observations of practice will continue, to deepen our understanding, and to inform two focused studies. The first will explore decision-making practices and the second will examine how staff engage with patients' needs; both studies involve interviews, to complement observation. As part of the study of supportive care, we will examine the implications of an introduction of patient-reported measures (PRMs) into care, adding surveys to interviews before and after PRMs roll-out. Data analysis will account for site-specific and cross-site issues using an adapted Qualitative Rapid Appraisal, Rigorous Analysis approach. Quantitative data from clinician surveys will be statistically analysed and triangulated with the related qualitative study findings.

ETHICS AND DISSEMINATION

Ethical approval was granted by South Eastern Sydney Local Health District Human Research Ethics Committee (no. 18/207). Findings will be shared with participating hospitals and widely disseminated through publications and presentations.

Crumbs protein homolog 3 (CRB3) expression is associated with oestrogen and progesterone receptor positivity in breast cancer

The crumbs protein homolog 3 (CRB3) regulates the tight junction to help maintain epithelial polarity. Altered CRB3 expression was associated with carcinogenesis of epithelial cells. This study detected CRB3 expression in 192 cases of breast cancer tissues and in the Molecular Taxonomy of Breast Cancer International Consortium (Metabric) and The Cancer Genome Atlas (TCGA) datasets for association with triple negative breast cancer (TNBC) phenotypes. The in vitro experiments confirm the ex vivo data. The data showed that levels of both CRB3 mRNA and protein were associated with TNBC phenotypes, ie, 41.1% (39/95) of ER+ breast cancer was CRB3-positive, whereas 26.9% (25/93) ER- tumour was CRB3-positive (P = 0.046). Moreover, 47.6% (30/63) of PR+ breast cancer was CRB3-positive vs 28.4% (33/116) PR- tumours positive for CRB3 (P = 0.013). In addition, 40.1% (27/66) of ER+/PR+ tumour was CRB3-positive, but only 22.4% (19/85) of TNBC showed CRB3 expression (P = 0.048). Indeed, levels of CRB3 mRNA were higher in non-TNBC than TNBC in both Metabric (P = 3.682e-10) and TCGA datasets (P = 2.501e-07). The in vitro data showed that CRB3 expression was higher in luminal (MCF7 and T47D) than in HER2 (MDA-MB-453 and SK-BR-3) and basal (MDA-MB-231 and BT-549) breast cancer cell lines. More interestingly, ERα regulated expression of CRB3 protein in MCF7 and BT-549 cells and ERα expression was associated with CRB3 expression in breast cancer tissues specimens. This study demonstrated that ERα could be a novel regulator for CRB3 expression in breast cancer.

Educational Value of Surgical Multidisciplinary Team Meetings for Learning Non-Technical Skills - A Pilot Survey of Trainees From Two UK Deaneries

OBJECTIVE

This prospective survey study aimed to identify trainee surgeons' views on the educational potential of multi-disciplinary team (MDT) meetings for learning non-technical skills and relevant issues around using MDT meetings as an educational instrument.

DESIGN

An online survey questionnaire containing eight closed and three open-ended questions; was developed based on established educational theories. Responses were anonymous.

SETTING

This survey study was designed as professional project for masters in medical education degree at Warwick University. The study received ethical approval from the Biomedical Science Research and Ethics Committee of Warwick University.

PARTICIPANTS

Trainee surgeons and non-trainee junior surgical doctors within two regions (Health Education Kent Surrey and Sussex, Health Education Wessex) in the UK were invited through an email to take the survey with the help of regional heads of surgery and coordinators.

RESULTS

Twenty eight (28) out of 420 invitees completed the survey. High internal consistency was observed for questionnaire (Cronbach's α = 0.924). 71.42% (20/28) respondents attended MDT at least once a week. 75.9% of participants indicated the importance of attendance to MDT meetings with any level of involvement; passive attendance considered the least important (5/28, 17.9%, p=0.005). Trainees felt included in the team by attendance to MDT meetings (Median score 5, p=0.027). MDT meetings were considered important for learning all domains of non-technical skills for surgeons taxonomy (cumulative mean score 2.4, p=001). Respondents considered MDT as a valuable tool for learning non-technical skills for surgeons on Miller's pyramid for learning (Cumulative mean 5.6, p=0.025). Free text answers indicated agreement to the learning opportunity provided by MDT meetings. Consistent suggestions of increasing trainee participation were obtained.

CONCLUSION

Results indicate consistently positive views from trainees about the educational value of MDT meeting in general and for non-technical skills. Trainee participation, in the form of case-preparation, presentation, and discussion are recommended by respondents.

Improving the effectiveness of cancer multidisciplinary team meetings: analysis of a national survey of MDT members' opinions about streamlining patient discussions

Background

Cancer is diagnosed and managed by multidisciplinary teams (MDTs) in the UK and worldwide, these teams meet regularly in MDT meetings (MDMs) to discuss individual patient treatment options. Rising cancer incidence and increasing case complexity have increased pressure on MDMs. Streamlining discussions has been suggested as a way to enhance efficiency and to ensure high-quality discussion of complex cases.

Methods

Secondary analysis of quantitative and qualitative data from a national survey of 1220 MDT members regarding their views about streamlining MDM discussions.

Results

The majority of participants agreed that streamlining discussions may be beneficial although variable interpretations of ‘streamlining’ were apparent. Agreement levels varied significantly by tumour type and occupational group. The main reason for opposing streamlining were concerns about the possible impact on the quality and safety of patient care. Participants suggested a range of alternative approaches for improving efficiency in MDMs in addition to the use of treatment protocols and pre-MDT meetings.

Conclusions

This work complements previous analyses in supporting the development of tumour-specific guidance for streamlining MDM discussions considering a range of approaches. The information provided about the variation in opinions between MDT for different tumour types will inform the development of these guidelines. The evidence for variation in opinions between those in different occupational groups and the reasons underlying these opinions will facilitate their implementation. The impact of any changes in MDM practices on the quality and safety of patient care requires evaluation.

Integrated traditional Chinese and Western medicine in hepatocellular carcinoma treatment

As the branches of oncology become more and more detailed, its deficiencies gradually appear in clinical work in recent years. With the development of modern medicine, individualized treatment of hepatocellular carcinoma (HCC) has already been more emphasized in clinical work. This article reviews the diagnosis and treatment of HCC, which can be regarded as an organic systemic disease, based on a concept of integrated medicine. It is suggested that simply eliminating cancer lesions does not mean curing HCC. In clinical practice, it is necessary to use integrative thoughts such as basic study combined with clinical practice, medicine with pharmacy, traditional Chinese medicine with Western medicine, local with whole, etc, so as to find new integrative methods for diagnosis and treatment of HCC.

Patterns of care for stage III non-small cell lung cancer in Australia

Stage III non-small cell lung cancer (NSCLC) makes up a third of all NSCLC cases and is potentially curable. Despite this 5-year survival rates remain between 15% and 20% with chemoradiation treatment alone given with curative intent. With the recent exciting breakthroughs in immunotherapy use (durvalumab) for stage III NSCLC, further improvements in patient survival can be expected. Most patients with stage III NSCLC present initially to their general practitioner (GP). The recommended time from GP referral to first specialist appointment is less than 14 days with treatment initiated within 42 days. Our review found that there is a shortfall in meeting these recommendations, however a number of initiatives have been established in Australia to improve timely and accurate diagnosis and treatment patterns. The lung cancer multidisciplinary team (MDT) is critical to consistency of evidence-based diagnosis and treatment and can improve patient survival. We aimed to review current patterns of care and clinical practice recommendations for stage III NSCLC across Australia and identify opportunities to improve practice in referral, diagnosis and treatment pathways.

Taking the pulse of multidisciplinary cancer conferences for breast cancer care in Canada: A stocktake of current practice

AIM

International guidelines highlight the importance of implementation supports and quality monitoring of multidisciplinary care for breast cancer. In Canada, Ontario has standards for formal multidisciplinary cancer conferences (MCCs), but other provinces/territories do not. This study aimed to stocktake MCCs for breast cancer in Canadian sites participating in the RUBY cohort study (Reducing the Burden of Breast Cancer in Young Women) to better understand variations in multidisciplinary care across Canada and to add to the international literature.

METHODS

A cross-sectional survey was conducted with surgeons and surgical oncologists representing 34 clinical centres participating in RUBY. Questions were grouped according to: type of multidisciplinary care, implementation, function, practice, participation and presentation, operation, and demographics, and included a mix of Likert-based, tick box and open-ended questions.

RESULTS

Twenty-two responses (65%) were received. 91% of respondents reported that formal MCCs are part of regular practice. However, variation exists in the supports in place for ongoing implementation of MCCs, the understanding of the functions of MCCs, and the patients presented for discussion. Results also suggest less formalized processes for MCC in provinces without practice standards.

CONCLUSIONS

Response differences between Ontario and elsewhere suggest that standards for MCC and supports for their implementation make a positive difference in their operation. However, ongoing operational challenges and issues with attendance exist for all sites and suggest that along with development of practice standards, incentives for participation and further education on benefits and function of MCC may support uptake of MCCs in clinical practice.

Optimise not compromise: The importance of a multidisciplinary breast cancer patient pathway in the era of oncoplastic and reconstructive surgery

Modern breast cancer care is a complex multidisciplinary undertaking in which the integrated function of multiple constituent parts is critical, and where changes to one therapeutic component may profoundly influence the delivery and outcomes of another. Oncoplastic and reconstructive breast surgery has evolved in the era of longer survival rates for women with breast cancer and aims to enhance oncological and cosmetic outcomes. However, concurrently there has been an expansion in the indications for post-mastectomy radiation therapy (Abdulkarim et al., 2011; Early Breast Cancer Trialists' Collaborative Group (EBCTCG), 2014; Poortmans et al., 2015; Wang et al., 2011), the recognition of several biologically distinct breast cancer subtypes (Perou et al., 2000; Sørlie et al., 2001, 2003; Cheang et al., 2008, 2009; Sotiriou et al., 2003; Millar et al., 2011; Blows et al., 2010; Schnitt, 2010; Haque et al., 2012; Dai et al., 2015) and the development of recommendations for prophylactic surgery for high-risk women, including BRCA-mutation carriers (James et al., 2006; Domchek et al., 2010). Primary systemic therapy is increasingly utilised yet has varying efficacy depending on tumour biology (Cortazar et al., 2014). In this paper we review the evidence which informs the multidisciplinary team opinion in the era of oncoplastic and reconstructive breast surgery. We aim to describe an optimal multidisciplinary approach which balances competing risks of multimodal therapies to optimise oncological and cosmetic outcomes.

Understanding indications and defining guidelines for breast magnetic resonance imaging

Magnetic resonance imaging (MRI) of the breast is the most sensitive imaging modality for detecting cancer. With improved scan resolution and correctly applied clinical indications, the specificity of breast MRI has markedly improved in recent years. Current literature indicates an overall sensitivity for breast MRI of 98% - 100% and specificity of 88%. By comparison, the sensitivity and specificity for mammography is in the region of 71% and 98%, respectively. In particular, the very high negative predictive value (NPV) of breast MRI, which approaches 100%, is hugely useful in establishing absence of disease. Furthermore, the ability to accurately delineate viable cancer by way of combining both morphological and functional (contrast enhancement) capabilities means that MRI is the best tool we have in terms of local cancer staging and identifying residual or recurrent disease. The high NPV also means that breast MRI is uniquely capable of ruling out cancer or high-grade ductal carcinoma in situ in appropriate circumstances. I hope that the following guidelines that are based on those of the American College of Radiology and the European Society of Breast Imaging in addition to multiple review articles will provide some assistance to radiologists in terms of the correct indications for breast MRI. There are few formal guidelines in South Africa for the usage of breast MRI. In fact, there is a general paucity of guidelines in the international radiology world. The role of breast MRI in high-risk screening and identification of the primary in occult breast cancer is universally accepted. Thereafter, there is little consensus. By using some general guidelines, and bringing MRI into the discussion of multidisciplinary breast cancer management, good clinical practice and consistent decision-making can be established.

Anti-breast-Cancer Activity Exerted by β-Sitosterol-d-glucoside from Sweet Potato via Upregulation of MicroRNA-10a and via the PI3K-Akt Signaling Pathway

Breast cancer (BC) is a prominent source of cancer mortality in women throughout the world. β-Sitosterol-d-glucoside (β-SDG), a newly isolated phytosterol from sweet potato, possibly displays potent anticancer activity. However, the probable anticancer mechanisms involved are still unclear. This study sought to study how β-SDG from sweet potato affects two BC cell lines (MCF7 and MDA-MB-231) and nude mice bearing MCF7-induced tumors. In addition, we assessed how β-SDG affects tumor suppressor miR-10a and PI3K-Akt signaling in BC cells. Cell viability and proliferation were determined via MTT and colony-formation assays, and apoptosis was quantified by Hoechst staining and flow cytometry. In addition, miR-10a expression and apoptosis-related protein levels were measured. Our study indicated that β-SDG exhibited cytotoxic activities on MCF7 and MDA-MB-231 cells via inducing apoptosis and activating caspase proteases in these cells. Furthermore, the experimental results in nude mice bearing MCF7-induced tumors demonstrated that oral β-SDG administration at medium (60 mg/kg) or high (120 mg/kg) doses was sufficient to substantially impair the growth of tumors and to decrease the levels of CEA, CA125, and CA153 by 64.71, 74.64, and 85.32%, respectively, relative to those of the controls ( P < 0.01). β-SDG was further found to regulate the expression of PI3K, p-Akt, Bcl-2-family members, and other factors involved in the PI3K-Akt-mediated mitochondrial signaling pathway via the tumor suppressor miR-10a. These findings indicated that β-SDG suppresses tumor growth by upregulating miR-10a expression and inactivating the PI3K-Akt signaling pathway. Furthermore, β-SDG could be developed as a potential therapeutic agent against MCF7-cell-related BC.

Molecular mechanism of activated T cells in breast cancer

Introduction

This study aimed to explore the effect of activated T cells on breast cancer (BC) cells and provide a theoretical basis for the interaction mechanism studies between BC and immune cells.

Methods

The microarray dataset GSE73527 was downloaded from the Gene Expression Omnibus database. The common differentially expressed mRNAs (co-DEMs) and the common differentially expressed long non-coding RNAs (co-DElncRNAs) were identified between MDA-MB-231 cells and MCF7 activated human T cells, respectively. The RNA–miRNA–lncRNA (ceRNA) network was constructed. Furthermore, the Kyoto encyclopedia of genes and genomes pathway and the gene ontology function analyses were performed on co-DEMs. The protein–protein interaction networks and modules were investigated.

Results

A total of 639 co-DEMs (such as interleukin-6 [IL6] and signal transducer and activator of transcription 1 [STAT1]) were detected in this study. Defense response to other organisms and herpes simplex infection were the most outstanding function and pathway assembled with co-DEMs, respectively. One protein–protein interaction network and three modules were further constructed. A total of 88 mRNA–miRNA–lncRNA relationships such as BTN3A1-has-mir-20-b-5p-HCP5 were explored in the ceRNA network.

Conclusion

Activated T cells may play a crucial role in the defense response to other organism functions and herpes simplex infection pathways by upregulating IL6 and STAT1, which further affected the progression of BC. The BTN3A1-has-miR-20b-5p-HCP5 relationship may be the potential interaction mechanism between BC and immune cells.

Experiences of hospital-based multidisciplinary team meetings in oncology: An interview study among participating general practitioners

Background: Cancer care has become complex, requiring healthcare professionals to collaborate to provide high-quality care. Multidisciplinary oncological team (MDT) meetings in the hospital have been implemented to coordinate individual cancer patients’ care. General practitioners (GPs) are invited to join, but their participation is minimal.

Objectives: Aim of this study is to explore participating GPs’ perceptions of their current role and to understand their preferences towards effective role execution during MDT meetings.

Methods: In May to June 2014, semi-structured interviews (n = 16) were conducted involving GPs with MDT experience in Belgium. The analysis was done according to qualitative content analysis principles.

Results: Attendance of an MDT meeting is perceived as part of the GP’s work, especially for complex patient care situations. Interprofessional collaborative relationships and the GP’s perceived benefit to the MDT meeting discussions are important motivators to participate. Enhanced continuity of information flow and optimized organizational time management were practical aspects triggering the GP’s intention to participate. GPs valued the communication with the patient before and after the meeting as an integral part of the MDT dynamics.

Conclusion: GPs perceive attendance of the MDT meeting as an integral part of their job. Suggestions are made to enhance the efficiency of the meetings.

Up-regulation of ceRNA TINCR by SP1 contributes to tumorigenesis in breast cancer

Background

Assembling evidences suggested that aberrant expression of tissue differentiation-inducing non-protein coding RNA (TINCR) intimately associated with variety of human cancer. However, the expression pattern and involvement of TINCR in breast cancer has not been fully investigated. Here we set out to analyze expression of TINCR in breast cancer and elucidate its mechanistic involvement in tumor incidence and progression.

Methods

The expression of TINCR was determined by q-PCR. SP1 binding sites were analyzed by ChIP-qPCR. The relative transcription activity was measured with luciferase reporter assay. Cell viability was measured with CCK-8 method. Clonogenic capacity was evaluated by soft agar assay. Cell apoptosis was analyzed by Annexin V/7-AAD staining. The migration and invasion were determined by trans-well assay and wound healing. The tumor growth in vivo was evaluated in xenograft mice model. Protein expression was quantified by immunoblotting.

Results

TINCR was aberrantly up-regulated by SP1, which in turn stimulated cell proliferation, anchorage-independent growth and suppressed cell apoptosis in breast cancer. TINCR silencing significantly suppressed migration and invasion in vitro and xenograft tumor growth in vivo. Mechanistically, TINCR modulated KLF4 expression via competing with miR-7, which consequently contributed to its oncogenic potential. MiR-7 inhibition severely compromised TINCR silencing-elicited tumor repressive effects.

Conclusion

Our data uncovered a crucial role of TINCR-miR-7-KLF4 axis in human breast cancer.

Electronic supplementary material

The online version of this article (10.1186/s12885-018-4255-3) contains supplementary material, which is available to authorized users.

Superior anti-tumor efficacy of diisopropylamine dichloroacetate compared with dichloroacetate in a subcutaneous transplantation breast tumor model

Dichloroacetate (DCA), an inhibitor of pyruvate dehydrogenase kinase, has anti-tumor properties in various carcinoma models. Diisopropylamine dichloroacetate (DADA), an over-the-counter drug for chronic liver disease, is a derivative of DCA. To date, few studies have evaluated the anticancer potential of DADA in breast cancer. In this study, MDA-MB-231 cells, a breast adenocarcinoma cell line, were used in in vitro and in vivo experiments to evaluate the anti-tumor efficacy of DADA and DCA. The half maximal inhibitory concentration (IC50) of DADA (7.1 ± 1.1 mmol/L) against MDA-MB-231 cells was significantly lower than that of DCA (15.6 ± 2.0 mmol/L); 100 mg/kg (0.0004 mol/kg) DADA was better than 100 mg/kg (0.0008 mol/kg) DCA at suppressing the growth of subcutaneous transplantation breast tumor at the same dose after 24 days intervention. Histological examination showed that both DCA and DADA interventions led to necrosis, inflammation, and fibrosis of tumor tissue in a mouse subcutaneous transplantation breast tumor model. DADA treatment inhibited Ki67 expression in tumor tissue. In vitro experiments showed that DADA could inhibit lactic acid production and glucose uptake in MDA-MB-231 cells at 10 mmol/L and these effects were stronger than DCA. DADA administration also induced complete autophagy during early treatment stages and incomplete autophagy and cell death at later treatment stages. In conclusion, DADA showed better anti-tumor efficacy than DCA in a breast cancer model.

Uptake of adjuvant breast cancer treatments recommended by multi-disciplinary meetings

BACKGROUND

Adjuvant therapy for breast cancer is routinely discussed and recommended in multi-disciplinary meetings (MDMs). Current literature explores how treatments received by patients differ from national guidelines; however, it does not explore whether treatment is concordant with MDMs. This study provides an Australian perspective on the uptake of MDM recommendations and reasons for non-concordance.

METHODS

A retrospective cohort study of patients with breast cancer presented at The Royal Melbourne Hospital MDM in 2010 and 2014 to investigate the concordance between MDM recommendations and treatment received.

RESULTS

The study group comprised 441 patients (161 from 2010 and 280 from 2014). A total of 375 patients were included in the analyses. Overall, 82% of patients had perfect concordance between recommended and received treatment for all modes of adjuvant therapy. Concordance to endocrine therapy was higher for invasive cancers than ductal carcinoma in situ (97% versus 81%, P < 0.0001). Concordance to radiotherapy was high and did not differ according to type of cancer or surgery (ranging from 88 to 91%). Concordance to chemotherapy recommendations was high overall (92%) and did not vary with nodal status. Women aged over 65 years were least likely to be recommended for adjuvant therapy but most likely to concordant with the recommendation.

CONCLUSIONS

Uptake of MDM-recommended treatments is high. There is a minority of patients in whom MDM recommendations are not followed, highlighting that there are extra steps between recommendations at an MDM and decisions with patients. More attention to this issue is appropriate, and the reasons for non-concordance warrant further study.

Evaluation of Immunohistochemical Profile of Breast Cancer for Prognostics and Therapeutic Use

Introduction

Breast cancer is leading cancer in women, and the incidence of breast cancer in India is on the rise. The most common histologic type of breast cancer is infiltrating ductal carcinoma. Prognostic and predictive factors are used in the management of breast cancer. Estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 (HER2/neu) are immunohistochemical markers of prognosis as well as predictors of response to therapy.

Aims and Objectives

The study was conducted to evaluate ER, PR, and HER2/neu expressions in invasive ductal carcinomas of the breast by immunohistochemistry, to explore the correlation of these markers to each other and to various clinicopathological parameters: age of the patient, histological grade, tumor size, and lymph node metastasis.

Materials and Methods

This prospective study was conducted on 100 cases of infiltrating ductal carcinoma. Slides were prepared from blocks containing cancer tissue, and immunohistochemical staining was done for ER, PR, and HER2/neu expressions. Interpretation of expressions was done using Allred scoring system for ER/PR and the American Society of Clinical Oncology/College of American Pathologists guidelines for HER2/neu. Statistical analysis was performed to determine the statistical significance by applying Chi-square test.

Results

Majority of tumors were ER and PR positive and HER2/neu negative. ER and PR correlated significantly with age, tumor size, and tumor grade; whereas, HER2/neu correlated significantly with tumor size only. No association was seen with axillary lymph node metastasis. ER and PR expression correlated with each other, but none correlated with HER2/neu.

Conclusions

As the majority of the tumors are ER, PR positive and since ER and PR correlate with each other as well as with age, tumor size, and grade. Therefore, routine assessment of hormone receptors is recommended for prognostic and therapeutic information in breast cancer cases.

[Evidence based tailoring of cancer care for older patients]

Cancer is a disease that disproportionately affects the elderly. Evidence-based treatment is the golden standard of current medical care, and this is also true for older cancer patients. In developing guidelines, all available evidence is collected, appraised and summarized. Subsequent recommendations are then translate to criteria used to judge the quality of care. The heterogeneity of the elderly population requires tailoring of care, which is the opposite of the often strictly formulated treatment recommendations in guidelines and protocols. This paper discusses several issues regarding evidence based treatment versus tailored care for older cancer patients.

A survey by the European Society of Breast Imaging on the utilisation of breast MRI in clinical practice

OBJECTIVES

While magnetic resonance imaging (MRI) is considered a helpful diagnostic tool in breast imaging, discussions are ongoing about appropriate protocols and indications. The European Society of Breast Imaging (EUSOBI) launched a survey to evaluate the utilisation of breast MRI in clinical practice.

METHODS

An online survey reviewed by the EUSOBI board and committees was distributed amongst members. The questions encompassed: training and experience; annual breast MRI and MRI-guided-intervention workload; examination protocols; indications; reporting habits and preferences. Data were summarised and subgroups compared using χ² test.

RESULTS

Of 647 EUSOBI members, 177 (27.4%) answered the survey. The majority were radiologists (90.5%), half of them based in academic centres (51.9%). Common indications for MRI included cancer staging, treatment monitoring, high-risk screening and problem-solving, and differed significantly between countries (p≤0.03). Structured reporting and BI-RADS were mostly used. Breast radiologists with ≤10 years of experience preferred inclusion of additional techniques, such as T2/STIR (p=0.03) and DWI (p=0.08) in the scan protocol. MRI-guided interventions were performed by a minority of participants (35.4%).

CONCLUSIONS

The utilisation of breast MRI in clinical practice is generally in line with international recommendations. There are substantial differences between countries. MRI-guided interventions and functional MRI parameters are not widely available.

KEY POINTS

• MRI is commonly used for the detection and characterisation of breast lesions. • Clinical practice standards are generally in line with current recommendations. • Standardised criteria and diagnostic categories (mainly BI-RADS) are widely adopted. • Younger radiologists value additional techniques, such as T2/STIR and DWI. • MRI-guided breast biopsy is not widely available.

Process quality of decision-making in multidisciplinary cancer team meetings: a structured observational study

BACKGROUND

The quality of decision-making in multidisciplinary team meetings (MDTMs) depends on the quality of information presented and the quality of team processes. Few studies have examined these factors using a standardized approach. The aim of this study was to objectively document the processes involved in decision-making in MDTMs, document the outcomes in terms of whether a treatment recommendation was given (none vs. singular vs. multiple), and to identify factors related to type of treatment recommendation.

METHODS

An adaptation of the observer rating scale Multidisciplinary Tumor Board Metric for the Observation of Decision-Making (MDT-MODe) was used to assess the quality of the presented information and team processes in MDTMs. Data was analyzed using descriptive statistics and mixed logistic regression analysis.

RESULTS

N = 249 cases were observed in N = 29 MDTMs. While cancer-specific medical information was judged to be of high quality, psychosocial information and information regarding patient views were considered to be of low quality. In 25% of the cases no, in 64% one, and in 10% more than one treatment recommendations were given (1% missing data). Giving no treatment recommendation was associated with duration of case discussion, duration of the MDTM session, quality of case history, quality of radiological information, and specialization of the MDTM. Higher levels of medical and treatment uncertainty during discussions were found to be associated with a higher probability for more than one treatment recommendation.

CONCLUSIONS

The quality of different aspects of information was observed to differ greatly. In general, we did not find MDTMs to be in line with the principles of patient-centered care. Recommendation outcome varied substantially between different specializations of MDTMs. The quality of certain information was associated with the recommendation outcome. Uncertainty during discussions was related to more than one recommendation being considered. Time constraints were found to play an important role. Some of those aspects seem modifiable, which offers possibilities for the reorganization of MDTMs.

Indoleamine-2,3-dioxygenase and Interleukin-6 associated with tumor response to neoadjuvant chemotherapy in breast cancer

Purpose

Indoleamine-2,3-dioxygenase (IDO) and Interleukin-6 (IL-6) contribute to poor therapeutic effects, tumor relapse and aggressive tumor growth. IDO and IL-6 incorporate a positive feedback signal loop to maintain IDO and IL-6 constitutive expression and facilitate tumor progression.

Results

IDO expression was associated with IL-6 expression and plasma IL-6 level (P<0.05). Concentrating on clinicopathological features prior neoadjuvant chemotherapy, both IDO expression and plasma IL-6 level were associated with clinical T stage and N stage (P<0.05). IL-6 expression was associated with clinical T stage (P=0.016). The co-expression of IDO/IL-6 was correlated with clinical T, N stage and estrogen receptor (ER) status (P<0.05). IDO, IL-6 expression, clinical T stage, pathological T stage, ER status and Luminal type were correlated with clinical response to neoadjuvant chemotherapy (P<0.05). Multivariate analysis showed that IDO expression were correlated with clinical response to neoadjuvant chemotherapy (P=0.034). IL-6 expression and pathological T stage were correlated with pCR (P<0.05). In the multivariate analysis, postoperative pathological T stage associated with pCR (P=0.041). In the prognostic analysis, only clinical T stage was significant correlated with overall survival (P=0.003).

Materials and Methods

46 breast cancer patients received neoadjuvant chemotherapy enrolled in this study. Immunohistochemistry was applied for evaluating IDO and IL-6 expression in biopsy tissues prior neoadjuvant chemotherapy. Immunofluorescence was applied to observe the co-localization of IDO and IL-6. Serum IL-6 level was examined via ELISA. The associations between IDO, IL-6, Serum IL-6 level and clinicopathological features, response to neoadjuvant chemotherapy were analyzed.

Conclusion

IDO and IL-6 expression associated with advanced breast cancer and poor response to neoadjuvant chemotherapy.

Cancer multidisciplinary team meetings in practice: Results from a multi-institutional quantitative survey and implications for policy change

AIM

Multidisciplinary care is advocated as best practice in cancer care. Relatively little is documented about multidisciplinary team (MDT) meeting functioning, decision making and the use of evidence to support decision making in Australia. This descriptive study aimed to examine team functioning, the role of team meetings and evidence use in MDTs whose institutions are members of Sydney Catalyst Translational Cancer Research Centre.

METHODS

We designed a structured 40-item survey instrument about topics that included meeting purpose, organization, resources and documentation; caseload estimates; use of evidence and quality assurance; patient involvement and supportive care needs; and open-ended items about the MDTs strengths and weaknesses. Participants were invited to participate via email and the survey was administered online. Data were analyzed using descriptive and comparative statistics.

RESULTS

Thirty-seven MDTs from seven hospitals participated (100% response) and represented common (70%) and rare tumor groups (30%). MDT meeting purpose was reported as treatment (100%) or diagnostic decision making (88%), or for education purposes (70%). Most MDTs based treatment decisions on group consensus (92%), adherence to clinical practice guidelines (57%) or other evidence-based medicine sources (33%). The majority of MDTs discussed only a proportion of new patients at each meeting emphasizing the importance of educational aspects for other cases. Barriers exist in the availability of data to enable audit and reflection on evidence-based practice. MDT strengths included collaboration and quality discussion about patients.

CONCLUSIONS

MDT meetings focus on treatment decision making, with group consensus playing a significant role in translating research evidence from guidelines into clinical decision making. With a varying proportion of patients discussed in each MDT meeting, a wider audit of multidisciplinary care would enable more accurate assessments of whether treatment recommendations are in accordance with best-practice evidence.

The need for multidisciplinarity in specialist training to optimize future patient care

Harmonious interactions between radiation, medical, interventional and surgical oncologists, as well as other members of multidisciplinary teams, are essential for the optimization of patient care in oncology. This multidisciplinary approach is particularly important in the current landscape, in which standard-of-care approaches to cancer treatment are evolving towards highly targeted treatments, precise image guidance and personalized cancer therapy. Herein, we highlight the importance of multidisciplinarity and interdisciplinarity at all levels of clinical oncology training. Potential deficits in the current career development pathways and suggested strategies to broaden clinical training and research are presented, with specific emphasis on the merits of trainee involvement in functional multidisciplinary teams. Finally, the importance of training in multidisciplinary research is discussed, with the expectation that this awareness will yield the most fertile ground for future discoveries. Our key message is for cancer professionals to fulfil their duty in ensuring that trainees appreciate the importance of multidisciplinary research and practice.

Screening of the prognostic targets for breast cancer based co-expression modules analysis

The purpose of the present study was to screen the prognostic targets for breast cancer based on a co-expression modules analysis. The microarray dataset GSE73383 was downloaded from the Gene Expression Omnibus (GEO) database, including 15 breast cancer samples with good prognosis and 9 breast cancer samples with poor prognosis. The differentially expressed genes (DEGs) were identified with the limma package. The Database for Annotation, Visualization and Integrated Discovery was used to perform Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis. Furthermore, the co-expression analysis of DEGs was conducted with weighted correlation analysis. The interaction associations were analyzed with the Human Protein Reference Database and BioGRID. The protein-protein interactions (PPI) network was constructed and visualized by Cytoscape software. A total of 491 DEGs were identified in breast cancer samples with poor prognosis compared with those with good prognosis, and they were enriched in 85 GO terms and 4 KEGG pathways. 368 DEGs were co-expressed with others, and they were clustered into 10 modules. Module 6 was the most relevant to the clinical features, and 21 genes and 273 interaction pairs were selected out. Abnormal expression levels of required for meiotic nuclear division 5 homolog A (RMND5A) and angiopoietin-like protein 1 (ANGPTL1) were associated with a poor prognosis. It was indicated that SWI/SNF related, matrix associated, actin dependent regulator of chromatin, subfamily D, member 1, SWI/SNF related, matrix associated, actin dependent regulator of chromatin, subfamily D, member 1, dihydropyrimidinase-like 2, RMND5A and ANGPTL1 were potential prognostic markers in breast cancer, and the cell cycle may be involved in the regulation of breast cancer.

How admissions to various medical specialty divisions determines the outcome of patients with hepatocellular carcinoma: results from a retrospective study in a large hospital of northwest China

Background and objective

The treatment of hepatocellular carcinoma (HCC) involves multidisciplinary clinical divisions and patients may be admitted to clinical divisions of different disciplinary nature. Few studies have assessed the potential effect of hospital admissions into different divisions on patient treatment options and survival. This study aimed to analyze this potential effect.

Methods

We analyzed data of HCC patients between 2002 and 2011 in a large hospital of northwest China and compared the treatment options and patient outcomes following initial admission into two major clinical disciplinary divisions: internal medicine and surgical. Barcelona Clinic Liver Cancer criteria were used for staging.

Results

The study included 2,045 patients. Analysis showed that more patients initially admitted to surgical divisions received curative treatments (resection, transplantation, and local ablation) than those admitted to internal medicine divisions; while more patients initially hospitalized to internal medicine divisions chose supportive care than those admitted to surgical divisions. Stages 0, A, and B patients initially admitted to surgical divisions had higher survival rates compared with those initially admitted to internal medicine divisions (P=0.036, 0.057 and 0.001, respectively). Survival rates of patients who were in stages C and D showed no differences. The survival differences between patients initially admitted to internal medicine and surgical divisions vanished after adjusting for treatment distribution.

Conclusion

This study showed that the initial hospitalization divisions may affect the outcome of HCC patients because of different treatment options, suggesting that enforcing multidisciplinary collaboration to optimize the treatment of HCC patients at various stages may improve patient survival.

Multidisciplinary Gynecologic Oncology Clinic in Botswana: A Model for Multidisciplinary Oncology Care in Low- and Middle-Income Settings

Purpose

Cervical cancer is a major cause of mortality in low- and middle-income countries (LMICs) and the most common cancer diagnosed in women in Botswana. Most women present with locally advanced disease, requiring chemotherapy and radiation. Care co-ordination requires input from a multidisciplinary team (MDT) to deliver appropriate, timely treatment. However, there are limited published examples of MDT implementation in LMICs.

Methods

In May 2015, a weekly MDT clinic for gynecologic cancer care was initiated at Botswana’s national referral facility. The MDT clinic served as a forum for discussion and coordination of patients with gynecologic cancer and consisted of a gynecologist, pathologist, medical oncologist, radiation oncologist, palliative care specialist, and nurse coordinator.

Results

Between May 2015 and December 2015, 135 patients were seen in the MDT clinic. The mean age of the patients was 49 years. Most (60%) of the patients were HIV positive. The most common diagnosis was cervical cancer (60%), followed by high-grade cervical intraepithelial neoplastic lesions (12%) and vulvar cancer (11%). Only data up to September 2015 were assessed for treatment delays. It was found that only 38% of patients needed more than one visit for care coordination before treatment initiation. Among patients with cervical cancer, the median delay from date of biopsy to start of radiation treatment was 39 days (interquartile range, 34 to 57 days) for patients treated after MDT initiation, compared with 108 days (interquartile range, 71 to 147 days) for patients treated before MDT initiation (P < .001).

Conclusion

Implementation of MDT clinics in LMICs is feasible and can help reduce delays in treatment initiation, as demonstrated by a gynecologic MDT clinic in Botswana. Streamlining care through MDT clinics can enhance care coordination and improve clinical outcomes. This model can apply to cancer care in other LMICs.

European Breast Cancer Conference manifesto on breast centres/units

MANIFESTO-CALL TO ACTION.

Computational prediction of multidisciplinary team decision-making for adjuvant breast cancer drug therapies: a machine learning approach

BACKGROUND

Multidisciplinary team (MDT) meetings are used to optimise expert decision-making about treatment options, but such expertise is not digitally transferable between centres. To help standardise medical decision-making, we developed a machine learning model designed to predict MDT decisions about adjuvant breast cancer treatments.

METHODS

We analysed MDT decisions regarding adjuvant systemic therapy for 1065 breast cancer cases over eight years. Machine learning classifiers with and without bootstrap aggregation were correlated with MDT decisions (recommended, not recommended, or discussable) regarding adjuvant cytotoxic, endocrine and biologic/targeted therapies, then tested for predictability using stratified ten-fold cross-validations. The predictions so derived were duly compared with those based on published (ESMO and NCCN) cancer guidelines.

RESULTS

Machine learning more accurately predicted adjuvant chemotherapy MDT decisions than did simple application of guidelines. No differences were found between MDT- vs. ESMO/NCCN- based decisions to prescribe either adjuvant endocrine (97%, p = 0.44/0.74) or biologic/targeted therapies (98%, p = 0.82/0.59). In contrast, significant discrepancies were evident between MDT- and guideline-based decisions to prescribe chemotherapy (87%, p < 0.01, representing 43% and 53% variations from ESMO/NCCN guidelines, respectively). Using ten-fold cross-validation, the best classifiers achieved areas under the receiver operating characteristic curve (AUC) of 0.940 for chemotherapy (95% C.I., 0.922-0.958), 0.899 for the endocrine therapy (95% C.I., 0.880-0.918), and 0.977 for trastuzumab therapy (95% C.I., 0.955-0.999) respectively. Overall, bootstrap aggregated classifiers performed better among all evaluated machine learning models.

CONCLUSIONS

A machine learning approach based on clinicopathologic characteristics can predict MDT decisions about adjuvant breast cancer drug therapies. The discrepancy between MDT- and guideline-based decisions regarding adjuvant chemotherapy implies that certain non-clincopathologic criteria, such as patient preference and resource availability, are factored into clinical decision-making by local experts but not captured by guidelines.

Promoting High-Quality Cancer Care and Equity Through Disciplinary Diversity in Team Composition

Disciplinary diversity in team composition is a valuable vehicle for oncology care teams to provide high-quality, person-centered comprehensive care. Such diversity facilitates care that effectively addresses the complex needs (biologic, psychosocial, and spiritual) of the whole person. The concept of professional or disciplinary diversity centers on differences in function, education, and culture, reflecting variety and heterogeneity in the perspectives of team members contributing to care. Thorough understanding of the skills, knowledge, and education related to each team member's professional or lay expertise is critical for members to be able to optimize the team's potential. Furthermore, respect and appreciation for differences and similarities across disciplinary cultures allow team members to create a positive collaboration dynamic that maintains a focus on the care of the person with cancer. We present a case study of one oncology team's provision of care to the patient, a Chinese immigrant woman with breast cancer. The case illuminates the strengths and challenges of disciplinary diversity in team composition in assessing and addressing potential barriers to care. Coordinated sharing of information among the varied team members facilitated understanding and care planning focused on the patient's concerns, needs, and strengths. Importantly, collaboration across the disciplinarily diverse set of team members facilitated high-quality oncology care and promoted equity in access to the full range of care options, including enrollment on a National Cancer Institute-sponsored clinical trial. Further implications of disciplinary diversity in oncology care teams are considered for both clinical practice and research.

Down-regulation of miR-199b-5p is correlated with poor prognosis for breast cancer patients

OBJECTIVES

The purpose of the present study was to evaluate the prognostic value of miR-199b-5p in breast cancer patients, as well as explore its effects on breast cancer cells.

METHODS

The expression level of miR-199b-5p in breast cancer tissues and paired non-cancerous tissues were detected by quantitative real-time polymerase chain reaction (qRT-PCR). Chi-square test was used to evaluate the relationship between miR-199b-5p expression and clinical parameters. Besides, overall survival analysis was carried out with Kaplan-Meier curve with log rank test, and the prognostic value of miR-199b-5p in breast cancer was evaluated by cox regression model. In addition, MTT and transwell assays in vitro were used to estimate the effects of miR-199b-5p on breast cancer cells.

RESULTS

MiR-199b-5p was down-regulated in breast cancer tissues, compared with adjacent normal tissues (P<0.05). Moreover, its decreased level was significantly correlated with advanced TNM stage (P=0.008) and positive lymph node metastasis (P=0.013). Cell experiments suggested that miR-199b-5p could regulate proliferation and invasion of breast cancer cells. In addition, we found that breast cancer patients with low miR-199b-5p expression level had poorer overall survival than those with high level (log rank test, P=0.021). MiR-199b-5p was an independent prognostic factor for breast cancer patients (HR=2.318, 95%CI=1.086-4.949, P=0.030).

CONCLUSION

Down-regulated miR-199b-5p in breast cancer patients is associated with malignant clinical characteristics. MiR-199b-5p may be a potential prognostic biomarker for breast cancer.

Overexpression of synuclein-γ predicts lack of benefit from radiotherapy for breast cancer patients

Background

Although radiotherapy following mastectomy was demonstrated to reduce the recurring risk and improve the prognosis of patients with breast cancer, it is also notorious for comprehensive side effects, hence only a selected group of patients can benefit. Therefore, the screening of molecular markers capable of predicting the efficacy of radiotherapy is essential.

Methods

We have established a cohort of 454 breast cancer cases and selected 238 patients with indications for postoperative radiotherapy. Synuclein-γ (SNCG) protein levels were assessed by immunohistochemistry, and SNCG status was retrospectively correlated with clinical features and survival in patients treated or not treated with radiotherapy. Gene Set Enrichment Analysis (GSEA) and survival analysis for online datasets were also performed for further validation.

Results

Among patients that received radiotherapy (82/238), those demonstrating positive SNCG expression had a 55.0 month shorter median overall survival (OS) in comparison to those demonstrating negative SNCG expression (78.4 vs. 133.4 months, log rank χ² = 16.13; p < 0.001). Among the patients that received no radiotherapy (156/238), SNCG status was not correlated with OS (log rank χ² = 2.40; p = 0.121). A COX proportional hazard analysis confirmed SNCG as an independent predictor of OS, only for patients who have received radiotherapy. Similar results were also obtained for distant metastasis-free survival (DMFS). A GSEA analysis indicated that SNCG was strongly associated with genes related to a radiation stress response. A survival analysis was performed with online databases consisting of breast cancer, lung cancer, and glioblastoma and further confirmed SNCG’s significance in predicting the survival of patients that have received radiotherapy.

Conclusion

A positive SNCG may serve as a potential marker to identify breast cancer patients who are less likely to benefit from radiotherapy and may also be extended to other types of cancer. However, the role of SNCG in radiotherapy response still needs to be further validated in randomized controlled trials prior to being exploited in clinical practice.

Electronic supplementary material

The online version of this article (doi:10.1186/s12885-016-2750-y) contains supplementary material, which is available to authorized users.