101
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Freeman RK, Ascioti AJ, Dake M, Mahidhara RS. The Effects of a Multidisciplinary Care Conference on the Quality and Cost of Care for Lung Cancer Patients. Ann Thorac Surg 2015; 100:1834-8; discussion 1838. [DOI: 10.1016/j.athoracsur.2015.05.056] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 05/10/2015] [Accepted: 05/15/2015] [Indexed: 10/23/2022]
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102
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Boxer MM, Duggan KJ, Descallar J, Vinod SK. Do patients discussed at a lung cancer multidisciplinary team meeting receive guideline-recommended treatment? Asia Pac J Clin Oncol 2015; 12:52-60. [PMID: 26481765 DOI: 10.1111/ajco.12421] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Miriam M Boxer
- Cancer Therapy Centre; Liverpool Hospital; Sydney New South Wales Australia
- South Western Sydney Clinical School; University of New South Wales; Sydney New South Wales Australia
| | - Kirsten J Duggan
- South West Sydney and Sydney Local Health Districts Clinical Cancer Registry; Liverpool Hospital; Sydney New South Wales Australia
| | - Joseph Descallar
- Ingham Institute for Applied Medical Research; Liverpool Hospital; Sydney New South Wales Australia
- South Western Sydney Clinical School; University of New South Wales; Sydney New South Wales Australia
| | - Shalini K Vinod
- Cancer Therapy Centre; Liverpool Hospital; Sydney New South Wales Australia
- South Western Sydney Clinical School; University of New South Wales; Sydney New South Wales Australia
- School of Medicine; University of Western Sydney; Sydney New South Wales Australia
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103
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104
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Collins JT, Noble S, Chester J, Davies HE, Evans WD, Lester J, Parry D, Pettit RJ, Byrne A. Association of sarcopenia and observed physical performance with attainment of multidisciplinary team planned treatment in non-small cell lung cancer: an observational study protocol. BMC Cancer 2015. [PMID: 26204885 PMCID: PMC4513758 DOI: 10.1186/s12885-015-1565-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Non-small cell lung cancer (NSCLC) frequently presents in advanced stages. A significant proportion of those with reportedly good ECOG performance status (PS) fail to receive planned multidisciplinary team (MDT) treatment, often for functional reasons, but an objective decline in physical performance is not well described. Sarcopenia, or loss of muscle mass, is an integral part of cancer cachexia. However, changes in both muscle mass and physical performance may predate clinically overt cachexia, and may be present even with normal body mass index. Physical fitness for treatment is currently subjectively assessed by means of the PS score, which may be inadequate in predicting tolerance to treatment. This study aims to evaluate whether measuring physical performance and muscle mass at baseline in NSCLC patients, in addition to PS score, is able to predict commencement and successful completion of MDT-planned treatment. METHODS/DESIGN This is a prospective, single-centre exploratory study of NSCLC patients attending a Rapid Access Lung Cancer clinic. Baseline data collected are (methods in brackets): physical performance (Short Physical Performance Battery), muscle mass (bioelectrical impedance ± dual energy x-ray absorptiometry), patient and physician-assessed PS (ECOG and Karnofsky), nutritional status and presence of cachexia. Longitudinal data consists of receipt and completion of MDT treatment plan. The primary outcome measure is commencement of MDT-planned treatment, and important secondary outcomes include successful completion of treatment, length of stay in surgical patients, and risk of chemotherapy- and radiotherapy-related side effects. DISCUSSION A more comprehensive assessment of phenotype, particularly with regards to physical performance and muscle mass, will provide additional discriminatory information of patients' fitness for treatment. If positive, this study has the potential to identify targets for early intervention in those who are at risk of deterioration. This will subsequently enable optimisation of performance of patients with NSCLC, in anticipation of systemic treatment.
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Affiliation(s)
- Jemima T Collins
- Department of Palliative Medicine, University Hospital Llandough, Penarth, UK. .,Cardiff University, Cardiff, UK.
| | | | | | - Helen E Davies
- Department of Respiratory Medicine, University Hospital Llandough, Penarth, UK.
| | - William D Evans
- Department of Medical Physics and Clinical Engineering, University Hospital of Wales, Cardiff, UK.
| | | | - Diane Parry
- Department of Respiratory Medicine, University Hospital Llandough, Penarth, UK.
| | - Rebecca J Pettit
- Department of Medical Physics and Clinical Engineering, University Hospital of Wales, Cardiff, UK.
| | - Anthony Byrne
- Department of Palliative Medicine, University Hospital Llandough, Penarth, UK.
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105
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Pan CC, Kung PT, Wang YH, Chang YC, Wang ST, Tsai WC. Effects of multidisciplinary team care on the survival of patients with different stages of non-small cell lung cancer: a national cohort study. PLoS One 2015; 10:e0126547. [PMID: 25966317 PMCID: PMC4429114 DOI: 10.1371/journal.pone.0126547] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 04/03/2015] [Indexed: 01/05/2023] Open
Abstract
In Taiwan, cancer is the top cause of death, and the mortality rate of lung cancer is the highest of all cancers. Some studies have demonstrated that multidisciplinary team (MDT) care can improve survival rates of non-small cell lung cancer (NSCLC) patients. However, no study has discussed the effect of MDT care on different stages of NSCLC. The target population for this study consisted of patients with NSCLC newly diagnosed in the 2005–2010 Cancer Registry. The data was linked with the 2002–2011 National Health Insurance Research Database and the 2005–2011 Cause of Death Statistics Database. The multivariate Cox proportional hazards model was used to explore whether the involvement of MDT care had an effect on survival. This study applied the propensity score as a control variable to reduce selection bias between patients with and without involvement of MDT care. The adjusted hazard ratio (HR) of death of MDT participants with stage III & IV NSCLC was significantly lower than that of MDT non-participants (adjusted HR = 0.87, 95% confidence interval = 0.84-0.90). This study revealed that MDT care are significantly associated with higher survival rate of patients with stage III and IV NSCLC, and thus MDT care should be used in the treatment of these patients.
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Affiliation(s)
- Chien-Chou Pan
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
- Department of Public Health, China Medical University, Taichung, Taiwan
- Department of Orthopedic Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Pei-Tseng Kung
- Department of Healthcare Administration, Asia University, Taichung, Taiwan
| | - Yueh-Hsin Wang
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Yu-Chia Chang
- Department of Healthcare Administration, Asia University, Taichung, Taiwan
| | - Shih-Ting Wang
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Wen-Chen Tsai
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
- * E-mail:
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106
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Taplin SH, Weaver S, Salas E, Chollette V, Edwards HM, Bruinooge SS, Kosty MP. Reviewing cancer care team effectiveness. J Oncol Pract 2015; 11:239-46. [PMID: 25873056 PMCID: PMC4438110 DOI: 10.1200/jop.2014.003350] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE The management of cancer varies across its type, stage, and natural history. This necessitates involvement of a variety of individuals and groups across a number of provider types. Evidence from other fields suggests that a team-based approach helps organize and optimize tasks that involve individuals and groups, but team effectiveness has not been fully evaluated in oncology-related care. METHODS We undertook a systematic review of literature published between 2009 and 2014 to identify studies of all teams with clear membership, a comparator group, and patient-level metrics of cancer care. When those teams included two or more people with specialty training relevant to the care of patients with cancer, we called them multidisciplinary care teams (MDTs). After reviews and exclusions, 16 studies were thoroughly evaluated: two addressing screening and diagnosis, 11 addressing treatment, two addressing palliative care, and one addressing end-of-life care. The studies included a variety of end points (eg, adherence to quality indicators, patient satisfaction with care, mortality). RESULTS Teams for screening and its follow-up improved screening use and reduced time to follow-up colonoscopy after an abnormal screen. Discussion of cases within MDTs improved the planning of therapy, adherence to recommended preoperative assessment, pain control, and adherence to medications. We did not see convincing evidence that MDTs affect patient survival or cost of care, or studies of how or which MDT processes and structures were associated with success. CONCLUSION Further research should focus on the association between team processes and structures, efficiency in delivery of care, and mortality.
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Affiliation(s)
- Stephen H Taplin
- National Cancer Institute, Bethesda; Johns Hopkins University School of Medicine, Armstrong Institute for Patient Safety and Quality, Baltimore; Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD; University of Central Florida, Orlando, FL; American Society of Clinical Oncology, Alexandria, VA; and Scripps Clinic, La Jolla, Ca
| | - Sallie Weaver
- National Cancer Institute, Bethesda; Johns Hopkins University School of Medicine, Armstrong Institute for Patient Safety and Quality, Baltimore; Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD; University of Central Florida, Orlando, FL; American Society of Clinical Oncology, Alexandria, VA; and Scripps Clinic, La Jolla, Ca
| | - Eduardo Salas
- National Cancer Institute, Bethesda; Johns Hopkins University School of Medicine, Armstrong Institute for Patient Safety and Quality, Baltimore; Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD; University of Central Florida, Orlando, FL; American Society of Clinical Oncology, Alexandria, VA; and Scripps Clinic, La Jolla, Ca
| | - Veronica Chollette
- National Cancer Institute, Bethesda; Johns Hopkins University School of Medicine, Armstrong Institute for Patient Safety and Quality, Baltimore; Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD; University of Central Florida, Orlando, FL; American Society of Clinical Oncology, Alexandria, VA; and Scripps Clinic, La Jolla, Ca
| | - Heather M Edwards
- National Cancer Institute, Bethesda; Johns Hopkins University School of Medicine, Armstrong Institute for Patient Safety and Quality, Baltimore; Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD; University of Central Florida, Orlando, FL; American Society of Clinical Oncology, Alexandria, VA; and Scripps Clinic, La Jolla, Ca
| | - Suanna S Bruinooge
- National Cancer Institute, Bethesda; Johns Hopkins University School of Medicine, Armstrong Institute for Patient Safety and Quality, Baltimore; Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD; University of Central Florida, Orlando, FL; American Society of Clinical Oncology, Alexandria, VA; and Scripps Clinic, La Jolla, Ca
| | - Michael P Kosty
- National Cancer Institute, Bethesda; Johns Hopkins University School of Medicine, Armstrong Institute for Patient Safety and Quality, Baltimore; Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD; University of Central Florida, Orlando, FL; American Society of Clinical Oncology, Alexandria, VA; and Scripps Clinic, La Jolla, Ca
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107
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Prabhakar CN, Fong KM, Peake MD, Lam DC, Barnes DJ. The effectiveness of lung cancer MDT and the role of respiratory physicians. Respirology 2015; 20:884-8. [DOI: 10.1111/resp.12520] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 01/29/2015] [Indexed: 12/24/2022]
Affiliation(s)
- Charles N. Prabhakar
- Department of Respiratory and Sleep Medicine; Royal Prince Alfred Hospital; Sydney Australia
| | - Kwun M. Fong
- Department of Thoracic Medicine; The Prince Charles Hospital, Brisbane; Australia UQ Thoracic Research Centre; School of Medicine; University of Queensland; Brisbane Australia
| | - Michael D. Peake
- Respiratory Medicine; University Hospitals of Leicester; Leicester UK
| | - David C. Lam
- Department of Medicine; University of Hong Kong; Hong Kong
| | - David J. Barnes
- Department of Respiratory and Sleep Medicine; Royal Prince Alfred Hospital; Sydney Australia
- Department of Medicine; University of Sydney; Sydney Australia
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108
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Campbell BA, Ball D, Mornex F. Multidisciplinary Lung Cancer Meetings: Improving the practice of radiation oncology and facing future challenges. Respirology 2015; 20:192-8. [DOI: 10.1111/resp.12459] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 11/25/2014] [Indexed: 12/24/2022]
Affiliation(s)
- Belinda A. Campbell
- Department of Radiation Oncology and Cancer Imaging; Peter MacCallum Cancer Centre; Melbourne Australia
- The Sir Peter MacCallum Department of Oncology; The University of Melbourne; Melbourne Australia
| | - David Ball
- Department of Radiation Oncology and Cancer Imaging; Peter MacCallum Cancer Centre; Melbourne Australia
- The Sir Peter MacCallum Department of Oncology; The University of Melbourne; Melbourne Australia
| | - Françoise Mornex
- Centre Hospitalier Lyon Sud; Lyon France
- Université Claude Bernard Lyon 1 EMR 3738; Lyon France
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109
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Vinod SK. International patterns of radiotherapy practice for non-small cell lung cancer. Semin Radiat Oncol 2014; 25:143-50. [PMID: 25771419 DOI: 10.1016/j.semradonc.2014.11.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Radiotherapy is an important treatment modality for non-small cell lung cancer (NSCLC). There are models of radiotherapy utilization that estimate the proportion of patients with NSCLC who have an evidence-based indication for radiotherapy. These estimates range from 46%-68% for radiotherapy utilization at diagnosis and 64%-75% overall. However, actual radiotherapy utilization throughout much of the world is lower than this, ranging from 28%-53%, with the largest differences between actual and estimated radiotherapy utilization seen in stage III NSCLC. Some of this discrepancy is attributable to the assumptions in the models that are based on broad factors such as stage and performance status. Characteristics of the population with underlying lung cancer that often has comorbidities or compromised respiratory function also influence the ability to deliver radiotherapy safely. Sociodemographic factors such as race and income have been found to affect access to radiotherapy in certain jurisdictions. The type of clinician or medical setting the patient presents to initially can also influence radiotherapy use in NSCLC. Potential solutions to improve appropriate radiotherapy utilization for NSCLC include restructuring models of care to ensure that all patients with lung cancer are managed within a multidisciplinary team including a radiation oncologist.
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Affiliation(s)
- Shalini K Vinod
- Cancer Therapy Centre, Liverpool Hospital, Liverpool, New South Wales, Australia; South Western Sydney Clinical School, University of New South Wales, New South Wales, Australia; University of Western Sydney, New South Wales, Australia.
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110
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Prades J, Remue E, van Hoof E, Borras JM. Is it worth reorganising cancer services on the basis of multidisciplinary teams (MDTs)? A systematic review of the objectives and organisation of MDTs and their impact on patient outcomes. Health Policy 2014; 119:464-74. [PMID: 25271171 DOI: 10.1016/j.healthpol.2014.09.006] [Citation(s) in RCA: 248] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 09/08/2014] [Accepted: 09/09/2014] [Indexed: 02/06/2023]
Abstract
Multidisciplinary teams (MDTs) are considered the gold standard of cancer care in many healthcare systems, but a clear definition of their format, scope of practice and operational criteria is still lacking. The aims of this review were to assess the impact of MDTs on patient outcomes in cancer care and identify their objectives, organisation and ability to engage patients in their care. We conducted a systematic review of the literature in the Medline database. Fifty-one peer-reviewed papers were selected from November 2005 to June 2012. MDTs resulted in better clinical and process outcomes for cancer patients, with evidence of improved survival among colorectal, head and neck, breast, oesophageal and lung cancer patients in the study period. Also, it was observed that MDTs have been associated with changes in clinical diagnostic and treatment decision-making with respect to urological, pancreatic, gastro-oesophageal, breast, melanoma, bladder, colorectal, prostate, head and neck and gynaecological cancer. Evidence is consistent in showing positive consequences for patients' management in multiple dimensions, which should encourage the development of structured multidisciplinary care, minimum standards and exchange of best practices.
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Affiliation(s)
- Joan Prades
- Catalan Cancer Plan, Duran i Reynals Hospital, 199-203 Gran Via de l'Hospitalet Av., Hospitalet de Llobregat, 08908 Barcelona, Spain.
| | - Eline Remue
- Belgian Cancer Centre, Scientific Institute of Public Health, Rue Juliette Wytsman 14, 1050 Brussels, Belgium.
| | - Elke van Hoof
- Experimental and applied psychology, Faculty of educational an psychology sciences, Vrije Universiteit Brusel, Brussels, Belgium.
| | - Josep M Borras
- Catalan Cancer Plan, Duran i Reynals Hospital, 199-203 Gran Via de l'Hospitalet Av., Hospitalet de Llobregat, 08908 Barcelona, Spain; Department of Clinical Sciences, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona (UB), Spain.
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111
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Abstract
The interdisciplinary approach is a cornerstone of a well-functioning pediatric palliative care team. These teams are most often available as an inpatient consultation service, are composed of professionals representing multiple disciplines, and are used during the illness course of a child with life-threatening and chronic complex conditions, especially during challenging health care decision-making near end of life. This article reviews the current structure of the palliative care team, explores opportunities for inclusion of other vital team members, and proactively identifies the challenges that may occur when involving more providers in a child's and family's care.
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Affiliation(s)
- Monica Ogelby
- Pediatric Palliative Care Program, Department of Vermont Health Access, State of Vermont, 312 Hurricane Lane, Suite 201, Williston, VT 05495, USA
| | - Richard D Goldstein
- Pediatric Advanced Care Team, Boston Children's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA 02215, USA.
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112
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Dickhoff C, Hartemink K, van de Ven P, van Reij E, Senan S, Paul M, Smit E, Dahele M. Trimodality therapy for stage IIIA non-small cell lung cancer: Benchmarking multi-disciplinary team decision-making and function. Lung Cancer 2014; 85:218-23. [DOI: 10.1016/j.lungcan.2014.06.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 06/01/2014] [Accepted: 06/08/2014] [Indexed: 10/25/2022]
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113
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Brunner M, Gore SM, Read RL, Alexander A, Mehta A, Elliot M, Milross C, Boyer M, Clark JR. Head and neck multidisciplinary team meetings: Effect on patient management. Head Neck 2014; 37:1046-50. [PMID: 24710807 DOI: 10.1002/hed.23709] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 01/30/2014] [Accepted: 04/04/2014] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The purpose of this study was for us to present our findings on the prospectively audited impact of head and neck multidisciplinary team meetings on patient management. METHODS We collected clinical data, the pre-multidisciplinary team meeting treatment plan, the post-multidisciplinary team meeting treatment plans, and follow-up data from all patients discussed at a weekly multidisciplinary team meeting and we recorded the changes in management. RESULTS One hundred seventy-two patients were discussed in 39 meetings. In 52 patients (30%), changes in management were documented of which 20 (67%) were major. Changes were statistically more likely when the referring physician was a medical or radiation oncologist, when the initial treatment plan did not include surgery, and when the histology was neither mucosal squamous cell cancer nor a skin malignancy. Compliance to the multidisciplinary team meeting treatment recommendation was 84% for all patients and 70% for patients with changes in their treatment recommendation. CONCLUSION Head and neck multidisciplinary team meetings changed management in almost a third of the cases.
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Affiliation(s)
- Markus Brunner
- Sydney Head and Neck Cancer Institute, The Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Sydney, Australia
- Department of Otolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Sinclair M Gore
- Sydney Head and Neck Cancer Institute, The Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Sydney, Australia
| | - Rebecca L Read
- Sydney Head and Neck Cancer Institute, The Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Sydney, Australia
| | - Ashlin Alexander
- Sydney Head and Neck Cancer Institute, The Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Sydney, Australia
| | - Ankur Mehta
- Sydney Head and Neck Cancer Institute, The Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Sydney, Australia
| | - Michael Elliot
- Sydney Head and Neck Cancer Institute, The Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Sydney, Australia
| | - Chris Milross
- Sydney Head and Neck Cancer Institute, The Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Sydney, Australia
| | - Michael Boyer
- Sydney Head and Neck Cancer Institute, The Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Sydney, Australia
| | - Jonathan R Clark
- Sydney Head and Neck Cancer Institute, The Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Sydney, Australia
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114
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Milleron B, Gounant V. Les deuxièmes avis à l’heure des réunions de concertation pluridisciplinaires. Rev Mal Respir 2014; 31:394-5. [DOI: 10.1016/j.rmr.2014.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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115
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Ung KA, Campbell BA, Duplan D, Ball D, David S. Impact of the lung oncology multidisciplinary team meetings on the management of patients with cancer. Asia Pac J Clin Oncol 2014; 12:e298-304. [DOI: 10.1111/ajco.12192] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Kim Ann Ung
- Department of Radiation Oncology and Cancer Imaging; Peter MacCallum Cancer Centre; East Melbourne Victoria Australia
| | - Belinda A Campbell
- Department of Radiation Oncology and Cancer Imaging; Peter MacCallum Cancer Centre; East Melbourne Victoria Australia
| | - Danny Duplan
- Department of Radiation Oncology and Cancer Imaging; Peter MacCallum Cancer Centre; East Melbourne Victoria Australia
| | - David Ball
- Department of Radiation Oncology and Cancer Imaging; Peter MacCallum Cancer Centre; East Melbourne Victoria Australia
| | - Steven David
- Department of Radiation Oncology and Cancer Imaging; Peter MacCallum Cancer Centre; East Melbourne Victoria Australia
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116
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Does patient age still affect receipt of adjuvant therapy for colorectal cancer in New South Wales, Australia? J Geriatr Oncol 2014; 5:323-30. [PMID: 24656735 DOI: 10.1016/j.jgo.2014.02.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 01/14/2014] [Accepted: 02/26/2014] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To investigate the effect of patient age on receipt of stage-appropriate adjuvant therapy for colorectal cancer in New South Wales, Australia. MATERIALS AND METHODS A linked population-based dataset was used to examine the records of 580 people with lymph node-positive colon cancer and 498 people with high-risk rectal cancer who underwent surgery following diagnosis in 2007/2008. Multilevel logistic regression models were used to determine whether age remained an independent predictor of adjuvant therapy utilisation after accounting for significant patient, surgeon and hospital characteristics. RESULTS Overall, 65-73% of eligible patients received chemotherapy and 42-53% received radiotherapy. Increasing age was strongly associated with decreasing likelihood of receiving chemotherapy for lymph node-positive colon cancer (p<0.001) and radiotherapy for high-risk rectal cancer (p=0.003), even after adjusting for confounders such as Charlson comorbidity score and ASA health status. People aged over 70years for chemotherapy and over 75years for radiotherapy were significantly less likely to receive treatment than those aged less than 65. Emergency resection, intensive care admission, and not having a current partner also independently predicted chemotherapy nonreceipt. Other predictors of radiotherapy nonreceipt included being female, not being discussed at multidisciplinary meeting, and lower T stage. Adjuvant therapy rates varied widely between hospitals where surgery was performed. CONCLUSION There are continuing age disparities in adjuvant therapy utilisation in NSW that are not explained by patients' comorbidities or health status. Further exploration of these complex treatment decisions is needed. Variation by hospital and patient characteristics indicates opportunities to improve patient care and outcomes.
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117
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Spicer JO, Kraft CS, Burd EM, Armstrong WS, Guarner J. The value of case-based teaching vignettes in clinical microbiology rounds. Am J Clin Pathol 2014; 141:318-22. [PMID: 24515758 DOI: 10.1309/ajcpw71hrnssbypo] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES To describe the implementation and evaluation of a case-based microbiology curriculum during daily microbiology rounds. METHODS Vignettes consist of short cases with images and questions that facilitate discussion among microbiologists, pathologists, infectious disease physicians, and trainees (residents and fellows). We performed a survey to assess the value of these vignettes to trainees. RESULTS Motivation to come to rounds on time increased from 60% to 100%. Trainees attending rounds after implementation of the vignettes perceived the value of microbiology rounds to be significantly higher compared with those who attended rounds before implementation (P = .04). Pathology residents found that vignettes were helpful for retaining knowledge (8.3 of 10 points). CONCLUSIONS The vignettes have enhanced the value of microbiology rounds by serving as a formalized curriculum exposing trainees from multiple specialties to various microbiology topics. Emphasis on interdisciplinary interactions between clinical and laboratory personnel was highlighted with this case-based curriculum.
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Affiliation(s)
- Jennifer O. Spicer
- Departments of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Colleen S. Kraft
- Laboratory Medicine, Emory University School of Medicine, Atlanta, GA
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA
| | - Eileen M. Burd
- Laboratory Medicine, Emory University School of Medicine, Atlanta, GA
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA
| | - Wendy S. Armstrong
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA
| | - Jeannette Guarner
- Laboratory Medicine, Emory University School of Medicine, Atlanta, GA
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA
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118
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[Multidisciplinary meetings dedicated to bone metastases: a historical perspective and rationale]. Bull Cancer 2014; 100:1135-9. [PMID: 24165281 DOI: 10.1684/bdc.2013.1851] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Bone metastases of solid tumors have a strong impact on patient's autonomy and vital outcome. Drugs specifically targeting bone remodeling as well as local treatment (radiotherapy, osteoplasty, surgery) make the management of bone metastasis a multidisciplinary process. Multidisciplinary teams (MDTs) dedicated to bone metastasis aim at providing the diagnosis of certainty, defining treatment indications and monitoring follow-up. The MDTs are the place for innovation in imaging and treatments of bone metastases.
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119
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Mitchell PLR, Thursfield VJ, Ball DL, Richardson GE, Irving LB, Torn-Broers Y, Giles GG, Wright GM. Lung cancer in Victoria: are we making progress? Med J Aust 2014; 199:674-9. [PMID: 24237097 DOI: 10.5694/mja13.10331] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 09/28/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To identify areas to improve patient management in lung cancer, which remains the greatest cause of death from cancer in Australia. DESIGN AND SETTING Retrospective survey of all cases of lung cancer reported to the Victorian Cancer Registry from 1 January to 30 June 2003 and followed up for 5 years. MAIN OUTCOME MEASURES Patient and disease characteristics, investigations, staging, treatment, cause of death, survival. RESULTS 841 patients were included. Smoking data were available for 799, of whom 63 (7.9%) had never smoked. Of 655 non-small cell lung cancer (NSCLC) cases, 198 (30.2%) were treated with curative intent, 125 (19.1%) by surgery and 73 (11.1%) by radiotherapy with or without chemotherapy. Only 7 (6.9%) of surgical patients with complete R0 resection had adjuvant chemotherapy. Of 101 small cell lung cancer (SCLC) cases, a third had limited stage disease which was mostly treated with curative intent by chemotherapy with or without radiotherapy. Patients whose cases were discussed at a multidisciplinary meeting (MDM) were significantly more likely to receive anticancer treatment and had longer survival; on multivariate analysis, MDM discussion was an independent prognostic factor. Compared with a similar survey 10 years earlier, the median age of patients diagnosed with lung cancer had increased by almost 3 years, the proportion of affected men decreased and adenocarcinoma was more frequent, while 10% of patients continued to have no pathologically confirmed diagnosis and 26% continued to receive no anticancer treatment. The number of patients with NSCLC who went on to a definitive surgical procedure fell with no detriment to survival, which likely reflected better staging with the introduction of positron emission tomography scanning. CONCLUSIONS Opportunities to improve patient management included increasing the proportion with a pathologically confirmed diagnosis and greater use of postsurgical adjuvant chemotherapy. A high proportion of patients received no treatment, with underuse of chemotherapy and radiotherapy. Critically, the low rate of case discussions at MDMs needs to increase. However, effective strategies are required to identify cases early, as over two-thirds currently present with incurable disease.
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Affiliation(s)
- Paul L R Mitchell
- Olivia Newton-John Cancer and Wellness Centre, Austin Health, Melbourne, VIC, Australia.
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Effectiveness of multidisciplinary team conference on decision-making surrounding the application of continuous deep sedation for terminally ill cancer patients. Palliat Support Care 2013; 13:157-64. [PMID: 24182761 DOI: 10.1017/s1478951513000837] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Continuous deep sedation (CDS) is a way to reduce conscious experience of symptoms of severe suffering in terminally ill cancer patients. However, there is wide variation in the frequency of its reported. So we conducted a retrospective analysis to assess the prevalence and features of CDS in our palliative care unit (PCU). METHODS We performed a systemic retrospective analysis of the medical and nursing records of all 1581 cancer patients who died at the PCU at Higashi Sapporo Hospital between April 2005 and August 2011. Continuous deep sedation can only be administered safely and appropriately when a multidisciplinary team is involved in the decision-making process. Prior to administration of CDS, a multidisciplinary team conference (MDTC) was held with respect to all the patients considered for CDS by an attending physician. The main outcome measures were the frequency and characteristics of CDS (patient background, all target symptoms, medications used for sedation, duration, family's satisfaction, and distress). We mailed anonymous questionnaires to bereaved families in August 2011. RESULTS Of 1581 deceased patients, 22 (1.39%) had received CDS. Physical exhaustion 8 (36.4%), dyspnea 7 (31.8%), and pain 5 (22.7%) were the most frequently mentioned indications. Continuous deep sedation had a duration of less than 1 week in 17 (77.3%). Six patients (0.38%) did not meet the appropriate criteria for CDS according to the MDTC and so did not receive it. Although bereaved families were generally comfortable with the practice of CDS, some expressed a high level of emotional distress. SIGNIFICANCE OF RESULTS Our results indicate that the prevalence of CDS will be decreased when it is carried out solely for appropriate indications. Continuity of teamwork, good coordination, exchange of information, and communication between the various care providers are essential. A lack of any of these may lead to inadequate assessment, information discrepancies, and unrest.
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121
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Lederlin M, Revel MP, Khalil A, Ferretti G, Milleron B, Laurent F. Management strategy of pulmonary nodule in 2013. Diagn Interv Imaging 2013; 94:1081-94. [PMID: 24034970 DOI: 10.1016/j.diii.2013.05.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- M Lederlin
- Service d'imagerie médicale, Université Bordeaux Segalen, CHU Bordeaux Groupe Sud, avenue de Magellan, 33600 Pessac, France.
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Abstract
The Institute of Medicine has emphasized the roles of multidisciplinary treatment planning, evidence-based clinical practice guidelines, and regionalization of healthcare in optimizing the quality of cancer care. We discuss these critical elements as they pertain to head and neck cancer care.
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Affiliation(s)
- Carol M Lewis
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1445, Houston, TX 77030, USA.
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Riquet M, Mordant P, Henni M, Wermert D, Fabre-Guillevin E, Cazes A, Le Pimpec Barthes F. Should All Cases of Lung Cancer be Presented at Tumor Board Conferences? Thorac Surg Clin 2013; 23:123-8. [DOI: 10.1016/j.thorsurg.2013.01.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Brunelli A, Kim AW, Berger KI, Addrizzo-Harris DJ. Physiologic Evaluation of the Patient With Lung Cancer Being Considered for Resectional Surgery. Chest 2013; 143:e166S-e190S. [DOI: 10.1378/chest.12-2395] [Citation(s) in RCA: 542] [Impact Index Per Article: 49.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Ke KM, Blazeby JM, Strong S, Carroll FE, Ness AR, Hollingworth W. Are multidisciplinary teams in secondary care cost-effective? A systematic review of the literature. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2013; 11:7. [PMID: 23557141 PMCID: PMC3623820 DOI: 10.1186/1478-7547-11-7] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 03/12/2013] [Indexed: 12/21/2022] Open
Abstract
Objective To investigate the cost effectiveness of management of patients within the context of a multidisciplinary team (MDT) meeting in cancer and non-cancer teams in secondary care. Design Systematic review. Data sources EMBASE, MEDLINE, NHS EED, CINAHL, EconLit, Cochrane Library, and NHS HMIC. Eligibility criteria for selecting studies Randomised controlled trials (RCTs), cohort, case–control, before and after and cross-sectional study designs including an economic evaluation of management decisions made in any disease in secondary care within the context of an MDT meeting. Data extraction Two independent reviewers extracted data and assessed methodological quality using the Consensus on Health Economic Criteria (CHEC-list). MDTs were defined by evidence of two characteristics: decision making requiring a minimum of two disciplines; and regular meetings to discuss diagnosis, treatment and/or patient management, occurring at a physical location or by teleconferencing. Studies that reported on the costs of administering, preparing for, and attending MDT meetings and/or the subsequent direct medical costs of care, non-medical costs, or indirect costs, and any health outcomes that were relevant to the disease being investigated were included and classified as cancer or non-cancer MDTs. Results Fifteen studies (11 RCTs in non-cancer care, 2 cohort studies in cancer and non-cancer care, and 2 before and after studies in cancer and non cancer care) were identified, all with a high risk of bias. Twelve papers reported the frequency of meetings which varied from daily to three monthly and all reported the number of disciplines included (mean 5, range 2 to 9). The results from all studies showed mixed effects; a high degree of heterogeneity prevented a meta-analysis of findings; and none of the studies reported how the potential savings of MDT working may offset the costs of administering, preparing for, and attending MDT meetings. Conclusions Current evidence is insufficient to determine whether MDT working is cost-effective or not in secondary care. Further studies aimed at understanding the key aspects of MDT working that lead to cost-effective cancer and non-cancer care are required.
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Affiliation(s)
- K Melissa Ke
- School of Oral and Dental Sciences, University of Bristol, Lower Maudlin Street, Bristol BS1 2LY, UK.
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126
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Factors that can make an impact on decision-making and decision implementation in cancer multidisciplinary teams: an interview study of the provider perspective. Int J Surg 2013; 11:389-94. [PMID: 23500030 DOI: 10.1016/j.ijsu.2013.02.026] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 02/06/2013] [Accepted: 02/28/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND It is becoming a standard practice worldwide for cancer patients to be discussed by a multidisciplinary team (MDT or 'tumour board') in order to formulate an expert-derived management plan. Evidence suggests that MDTs do not always work optimally in making clinical decisions and that not all MDT decisions get implemented into care. We investigated factors influencing decision-making and decision implementation in cancer MDTs. METHODS Semi-structured interviews were carried out with expert MDT members of Urological and Gastro-Intestinal tumours of 3 London (UK) hospitals. The standardised interview protocol assessed MDT experts' views on decision-making, barriers to reaching a decision and implementing it into care, and interventions to improve this process. All interviews were audio-taped, transcribed verbatim and analysed using a standardised approach. Emergent themes were identified by 2 clinical coders and tabulated. RESULTS Twenty-two participants participated in the study and data collection achieved 'saturation' (i.e., similar themes raised by different participants). Barriers to clinical decision-making included: inadequate clinical information; lack of investigation results; non-attendance of key members; teleconferencing failures. Barriers to implementation of MDT recommendations included: non-consideration of patients' choices or co-morbidities; disease progression at the time of implementation. Proposed interventions included improving the information available for the discussion through a standardised proforma; improving video-conferencing; reducing the MDT caseload (e.g., via selective MDT review of certain patients); and including patients more in the decision process. CONCLUSIONS There is an increasing drive to improve the clinical role of the MDT within cancer care. This study demonstrates the main barriers that MDTs face in deciding on and, importantly, implementing a management plan. Further research should prospectively evaluate interventions to enhance translation of MDT decision-making into cancer care and thus to expedite and improve care.
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Bethelmie-Bryan B, Lord K, Holloway S, Safavi F, Shepard M, Rogers S, Harvey RD, Rodger K, Waller EK, El-Rayes B, Arellano M, Khoury HJ. Tools to optimize the functionality of a leukemia clinical trial team. Leuk Lymphoma 2013; 54:110-6. [DOI: 10.3109/10428194.2012.708929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Strong S, Blencowe NS, Fox T, Reid C, Crosby T, Ford HER, Blazeby JM. The role of multi-disciplinary teams in decision-making for patients with recurrent malignant disease. Palliat Med 2012; 26:954-8. [PMID: 22562966 DOI: 10.1177/0269216312445296] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND It is mandatory in many countries for decisions for all new patients with cancer to be made within multi-disciplinary teams (MDTs). Whether patients with disease recurrence should also routinely be discussed by the MDT is unknown. AIM This study investigated the role of an upper gastro intestinal (UGI) MDT in decision-making for patients with disease recurrence. DESIGN A retrospective review of prospectively kept MDT records (2010 to 2011) was performed identifying patients discussed with recurrence of oesophagogastric cancer. Information was recorded about: i) why an MDT referral was made, ii) who made the referral and iii) the final MDT recommendation. Implementation of the MDT recommendation was also examined. PARTICIPANTS All patients discussed with recurrence of cancer at a central UGI cancer MDT were included. RESULTS During the study 54 MDT meetings included discussions regarding 304 new patients and 29 with disease recurrence. Referrals to the MDT for patients with recurrence came from outpatient clinics (n=19, 65.5%) or following emergency admission (n=10). Most referrals were made by the surgical team (n=25, 86.2%). MDT recommendations were best supportive care (n=11, 37.9%), palliative chemotherapy (n=9, 31.0%), stent (n=5, 17.2%), palliative radiotherapy (n=3, 10.3%) and further surgery (n=1, 3.4%), with 25 (86.2%) of these implemented. CONCLUSION UGI MDTs focus on new referrals and only a small proportion of patients with recurrent disease are re-discussed. Many patients go on to receive further treatments. Whether such patients are optimally managed within the standard MDT is uncertain, however, and warrants further consideration.
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Affiliation(s)
- Sean Strong
- School of Social and Community Medicine, Canynge Hall, University of Bristol, Bristol, UK
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Exhaustivité et qualité des réunions de concertation pluridisciplinaire : l'exemple du cancer du sein dans le département du Tarn. Bull Cancer 2012; 99:815-26. [DOI: 10.1684/bdc.2012.1622] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Affiliation(s)
- Brahmajee K. Nallamothu
- From the VA Health Services Research and Development Center of Excellence, VA Ann Arbor Healthcare System, Department of Internal Medicine and Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor (B.K.N.); and Saint-Luke's Mid America Heart Institute and University of Missouri–Kansas City (D.J.C.)
| | - David J. Cohen
- From the VA Health Services Research and Development Center of Excellence, VA Ann Arbor Healthcare System, Department of Internal Medicine and Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor (B.K.N.); and Saint-Luke's Mid America Heart Institute and University of Missouri–Kansas City (D.J.C.)
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Holloway S, Lord K, Bethelmie-Bryan B, Shepard MW, Neely J, McLemore M, Reddy SK, Montero A, Jonas WS, Gladney SP, Khanwani SL, Reddy SC, Lahiry AK, Heffner LT, Winton E, Arellano M, Khoury HJ. Managing Chronic Myeloid Leukemia: A Coordinated Team Care Perspective. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2012; 12:88-93. [DOI: 10.1016/j.clml.2011.10.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Revised: 10/24/2011] [Accepted: 10/27/2011] [Indexed: 11/27/2022]
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[We must remove the taxi driver from the tumour committee]. ACTA ACUST UNITED AC 2011; 27:117-22. [PMID: 22119226 DOI: 10.1016/j.cali.2011.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Revised: 08/09/2011] [Accepted: 08/30/2011] [Indexed: 11/23/2022]
Abstract
The increasing complexity of cancer care makes organisation of clinical decision-making one of the key elements in high-quality cancer care. The great number of professionals involved in this disease means that communication and co-ordination among such professionals is of pivotal importance. The prospect of an organised multidisciplinary care is highlighted for its ability to move from a sequential model of care to progress towards an inclusive process led by a multidisciplinary team. Scientific evidence shows that such a perspective contributes to improved survival and quality of life of cancer patients. In the context of highly frequent, costly and clinically complex cancer diseases, the priority is to develop a different approach to its management, based on the expertise of professionals and teams by tumour location. The organisation and management of many hospitals, however, does not generally reflect this dimension. The process of care is based on very rigid hospital services which restrict cross-communication. This hinders a redistribution of responsibilities of the professionals with the greatest potential to improve clinical effectiveness. The present paper shows the difficulty in developing a model of integrated professional cooperation and identifies the different models of implementation of multidisciplinary care, using cancer as an example, in the context of the Spanish National Health System.
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Abstract
This article reviews an evidence-based approach to the physiologic evaluation of patients under consideration for surgical resection of lung cancer. Adequate physiologic evaluation often includes a multidisciplinary evaluation, with complete identification of risk factors for perioperative complications and long-term disability including cardiovascular risk, assessment of pulmonary function, and smoking cessation counseling. Consideration of tumor-related anatomic obstruction, atelectasis, or vascular occlusion may alter measurements. Careful preoperative physiologic assessment helps to identify patients at increased risk of morbidity and mortality after lung resection. These evaluations are helpful in identifying patients who may not benefit from surgical management of their lung cancer.
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