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Hermes-Moll K, Dengler R, Riese C, Baumann W. Tumor Boards from the Perspective of Ambulant Oncological Care. Oncol Res Treat 2016; 39:377-83. [PMID: 27260517 DOI: 10.1159/000446311] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 04/20/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cancer therapy requires the cooperation of physicians from different disciplines. At the core of the collaboration are 'tumor boards' (also known as 'multidisciplinary team meetings' and 'tumor conferences'). However, there is limited health care research that addresses the multiple facets of such meetings. MATERIAL AND METHODS Data were analyzed from 3 routinely conducted surveys comprising information from (i) office-based hematologists and oncologists, (ii) their patients, and (iii) quality indicators. RESULTS Most office-based oncologists stated that they participate in tumor boards taking place in hospitals. Although tumor boards are viewed as time intensive and lack financial compensation, they are considered as beneficial for patient care. Less than half of patients knew that their cases were discussed at a tumor board; those who knew rated the collaboration between their treating doctors as more positive, but also experienced slightly higher distress levels. The quality indicators showed that tumor board meetings were documented in three-quarters of the patient charts, but only half included the tumor board's recommendation. CONCLUSIONS Participation in tumor boards is perceived as beneficial by oncologists and not just considered as a fulfillment of societies' recommendations or guidelines. The higher distress levels in patients who knew that their case was discussed at a tumor board may have occurred because more difficult cases are discussed at tumor boards and since the oncologists spend more time explaining the therapy process in complex cases, including the tumor board results.
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Affiliation(s)
- Kerstin Hermes-Moll
- Wissenschaftliches Institut der Niedergelassenen Hx00E4;matologen und Onkologen (WINHO) GmbH, Cologne, Germany
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Pavlidis AN, Perera D, Karamasis GV, Bapat V, Young C, Clapp BR, Blauth C, Roxburgh J, Thomas MR, Redwood SR. Implementation and consistency of Heart Team decision-making in complex coronary revascularisation. Int J Cardiol 2016; 206:37-41. [DOI: 10.1016/j.ijcard.2016.01.041] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 11/04/2015] [Accepted: 01/01/2016] [Indexed: 12/31/2022]
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Hu JY, Yi W, Zhang MY, Xu R, Zeng LS, Long XR, Zhou XM, Zheng XFS, Kang Y, Wang HY. MicroRNA-711 is a prognostic factor for poor overall survival and has an oncogenic role in breast cancer. Oncol Lett 2016; 11:2155-2163. [PMID: 26998141 DOI: 10.3892/ol.2016.4217] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 12/21/2015] [Indexed: 12/16/2022] Open
Abstract
MicroRNAs are important in cancer development and progression. In the present study, the clinical significance and function of microRNA-711 (miR-711) expression in breast cancer were investigated. The expression level of miR-711 was analyzed in breast cancer tissue samples using reverse transcription-quantitative polymerase chain reaction. Cell proliferation, colony formation, apoptosis and Transwell assays were performed in breast cancer cell lines transfected with miR-711 mimics or inhibitors, or control sequence. miR-711 was found to be upregulated in 30 formalin-fixed paraffin-embedded breast cancer tissue samples compared with paired non-cancerous breast tissues (P<0.05). Furthermore, a higher miR-711 expression was demonstrated to be associated with poor overall and disease-free survival times in 161 breast cancer patients, and miR-711 was identified as an independent prognostic factor using multivariate Cox regression analysis. In vitro, overexpression of miR-711 resulted in a significant increase in proliferation, colony formation, migration and invasion of breast cancer cells. By contrast, downregulating miR-711 inhibited cell proliferation, colony formation, migration and invasion and enhanced the rate of apoptosis of breast cancer cells. To the best of our knowledge, the present study is the first to demonstrate that miR-711 is an independent prognostic factor and serves an important oncogenic function in breast cancer, suggesting that miR-711 is a potential biomarker of prognosis and a molecular therapeutic target in breast cancer.
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Affiliation(s)
- Jing-Ye Hu
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong 510060, P.R. China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong 510060, P.R. China; Guiyan College of Traditional Chinese Medicine, Guiyang, Guizhou 550001, P.R. China
| | - Wei Yi
- Department of Radiation Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, P.R. China
| | - Mei-Yin Zhang
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong 510060, P.R. China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong 510060, P.R. China
| | - Rui Xu
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong 510060, P.R. China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong 510060, P.R. China
| | - Li-Si Zeng
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong 510060, P.R. China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong 510060, P.R. China
| | - Xiao-Ran Long
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong 510060, P.R. China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong 510060, P.R. China
| | - Xiao-Min Zhou
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong 510060, P.R. China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong 510060, P.R. China
| | - Xiao-Feng Steven Zheng
- Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ 08903-2681, USA
| | - Yibin Kang
- Department of Molecular Biology, Princeton University, Princeton, NJ 08544-1014, USA
| | - Hui-Yun Wang
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong 510060, P.R. China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong 510060, P.R. China
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Baird R, Banks I, Cameron D, Chester J, Earl H, Flannagan M, Januszewski A, Kennedy R, Payne S, Samuel E, Taylor H, Agarwal R, Ahmed S, Archer C, Board R, Carser J, Copson E, Cunningham D, Coleman R, Dangoor A, Dark G, Eccles D, Gallagher C, Glaser A, Griffiths R, Hall G, Hall M, Harari D, Hawkins M, Hill M, Johnson P, Jones A, Kalsi T, Karapanagiotou E, Kemp Z, Mansi J, Marshall E, Mitchell A, Moe M, Michie C, Neal R, Newsom-Davis T, Norton A, Osborne R, Patel G, Radford J, Ring A, Shaw E, Skinner R, Stark D, Turnbull S, Velikova G, White J, Young A, Joffe J, Selby P. An Association of Cancer Physicians' strategy for improving services and outcomes for cancer patients. Ecancermedicalscience 2016; 10:608. [PMID: 26913066 PMCID: PMC4762575 DOI: 10.3332/ecancer.2016.608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Indexed: 12/02/2022] Open
Abstract
The Association of Cancer Physicians in the United Kingdom has developed a strategy to improve outcomes for cancer patients and identified the goals and commitments of the Association and its members.
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Affiliation(s)
- Richard Baird
- ACP Executive Member
- ACP Strategy Drafting Group
- Supporting Chapter Author
- Addenbrooke’s Hospital, Cambridge, UK
| | - Ian Banks
- ACP Strategy Drafting Group
- Supporting Chapter Author
- University of Leeds, Leeds LS2 9JT, UK
| | - David Cameron
- ACP Executive Member
- ACP Strategy Drafting Group
- Edinburgh Cancer Research Centre, UK
| | - John Chester
- ACP Executive Member
- ACP Strategy Drafting Group
- Supporting Chapter Author
- Wales Cancer Research Centre, Cardiff, UK
| | - Helena Earl
- ACP Executive Member
- ACP Strategy Drafting Group
- Supporting Chapter Author
- Addenbrooke’s Hospital, Cambridge, UK
| | - Mark Flannagan
- ACP Strategy Drafting Group
- Supporting Chapter Author
- Beating Bowel Cancer, Harlequin House, 7 High St, Teddington, Middlesex TW11 8EE, UK
| | - Adam Januszewski
- ACP Executive Member
- ACP Strategy Drafting Group
- Supporting Chapter Author
- London Deanery, Stewart House, 32 Russell Square, London WC1B 5DN, UK
| | | | - Sarah Payne
- ACP Executive Member
- ACP Strategy Drafting Group
- Supporting Chapter Author
- Guy’s and St Thomas’s Hospital, London, UK and Medical Affairs Manager, Pfizer
| | - Emlyn Samuel
- ACP Strategy Drafting Group
- Cancer Research UK, Angel Building, 407 St John Street, London EC1V 4AD, UK
| | - Hannah Taylor
- ACP Executive Member
- ACP Strategy Drafting Group
- Supporting Chapter Author
- Severn Deanery, Vantage Office Park Old Gloucester Road, Hambrook, Avon, Bristol BS16 1GW, UK
| | - Roshan Agarwal
- ACP Executive Member
- Northampton General Hospital, Cliftonville, Northampton NN1 5BD, UK
| | - Samreen Ahmed
- ACP Executive Member
- University Hospitals of Leicester, Infirmary Square, Leicester LE1 5WW, UK
| | - Caroline Archer
- ACP Executive Member
- Queen Alexandra Hospital, Portsmouth, UK
| | - Ruth Board
- ACP Executive Member
- Lancashire Teaching Hospitals, UK
| | - Judith Carser
- ACP Executive Member
- Southern Health and Social Care Trust, Southern College of Nursing, Craigavon Area Hospital, 68 Lurgan Road, Portadown, BT63 5QQ, UK
| | - Ellen Copson
- Supporting Chapter Author
- University of Southampton, University Rd, Southampton SO17 1BJ, UK
| | - David Cunningham
- ACP Executive Member
- Supporting Chapter Author
- NIHR Biomedical Research Centre, Royal Marsden Hospital, London, UK
| | - Rob Coleman
- ACP Executive Member
- Weston Park Hospital, Sheffield, UK
| | - Adam Dangoor
- ACP Executive Member
- Supporting Chapter Author
- University Hospitals Bristol, Bristol, UK
| | - Graham Dark
- Supporting Chapter Author
- Freeman Hospital, Newcastle, UK
| | - Diana Eccles
- Supporting Chapter Author
- University of Southampton, University Rd, Southampton SO17 1BJ, UK
| | | | - Adam Glaser
- Supporting Chapter Author
- University of Leeds, Leeds LS2 9JT, UK
| | - Richard Griffiths
- ACP Executive Member
- Supporting Chapter Author
- Clatterbridge Cancer Centre, Clatterbridge Health Park, Clatterbridge Rd, Wirral, Merseyside CH63 4JY, UK
| | - Geoff Hall
- Supporting Chapter Author
- Leeds Cancer Centre, St James’s University Hospital, Leeds, UK
| | - Marcia Hall
- ACP Executive Member
- Mount Vernon Cancer Centre, Northwood, UK
| | - Danielle Harari
- Supporting Chapter Author
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Michael Hawkins
- Supporting Chapter Author
- University of Birmingham, Edgbaston, Birmingham, West Midlands B15 2TT, UK
| | - Mark Hill
- ACP Executive Member
- Kent Oncology Centre, Maidstone, Kent, UK
| | - Peter Johnson
- Supporting Chapter Author
- University of Southampton, University Rd, Southampton SO17 1BJ, UK
| | - Alison Jones
- ACP Executive Member
- Royal Free and University College Hospital, London, UK
| | - Tania Kalsi
- Supporting Chapter Author
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | | | - Zoe Kemp
- Supporting Chapter Author
- Royal Marsden Hospital, London, UK
| | - Janine Mansi
- ACP Executive Member
- Supporting Chapter Author
- Guy’s and St Thomas’ Hospitals, London, UK
| | - Ernie Marshall
- Supporting Chapter Author
- Clatterbridge Cancer Centre, Clatterbridge Health Park, Clatterbridge Rd, Wirral, Merseyside CH63 4JY, UK
| | - Alex Mitchell
- Supporting Chapter Author
- University of Leicester, University Rd, Leicester LE1 7RH, UK
| | - Maung Moe
- ACP Executive Member
- North Middlesex University Hospital, UK
| | | | - Richard Neal
- Supporting Chapter Author
- University of Bangor, Bangor, Gwynedd LL57 2DG , Wales, UK
| | - Tom Newsom-Davis
- Supporting Chapter Author
- Chelsea and Westminster Hospital, London, UK
| | | | - Richard Osborne
- Supporting Chapter Author
- Poole Hospital, Longfleet Rd, Poole, Dorset BH15 2JB, UK
| | - Gargi Patel
- ACP Executive Member
- Brighton and Sussex University Hospitals, UK
| | - John Radford
- Supporting Chapter Author
- University of Manchester, Oxford Rd, Manchester M13 9PL, UK
| | - Alistair Ring
- Supporting Chapter Author
- Royal Marsden Hospital, London, UK
| | - Emily Shaw
- Supporting Chapter Author
- Southampton General Hospital, Tremona Rd, Southampton, Hampshire SO16 6YD, UK
| | - Rod Skinner
- Supporting Chapter Author
- Royal Victoria Infirmary, Newcastle, UK
| | - Dan Stark
- Supporting Chapter Author
- Leeds Cancer Centre, St James’s University Hospital, Leeds, UK
| | - Sam Turnbull
- ACP Executive Member
- Leeds Cancer Centre, St James’s University Hospital, Leeds, UK
| | - Galina Velikova
- Supporting Chapter Author
- University of Leeds, Leeds LS2 9JT, UK
| | - Jeff White
- Supporting Chapter Author
- Beatson West of Scotland Cancer Centre, Glasgow, Scotland, UK
| | - Alison Young
- ACP Executive Member
- Supporting Chapter Author
- Leeds Cancer Centre, St James’s University Hospital, Leeds, UK
| | - Johnathan Joffe
- ACP Executive Member
- ACP Strategy Drafting Group
- Supporting Chapter Author
- Senior Author
- Huddersfield Royal Infirmary, Acre St, Huddersfield, West Yorkshire HD3 3EA, UK
| | - Peter Selby
- ACP Executive Member
- ACP Strategy Drafting Group
- Supporting Chapter Author
- Senior Author
- Leeds Cancer Centre, St James’s University Hospital, Leeds, UK
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105
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Kim JH, Ahn JB. Review on history and current practices of cancer multidisciplinary care. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2016. [DOI: 10.5124/jkma.2016.59.2.88] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Affiliation(s)
- Joo Hoon Kim
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Joong Bae Ahn
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
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106
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107
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Saghatchian M, Fadoukhair Z, Hofert K, Lanoy E, Mathieu MC, Mazouni C, Delaloge S. Uncovering Professional Attitudes Toward Treatment of Rare Carcinomas of the Breast: An International Practice e-Survey Involving 32 Countries. Breast J 2015; 22:96-100. [PMID: 26511594 DOI: 10.1111/tbj.12525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
World Health Organization classification has identified a dozen rare subtypes accounting for less than 10% of all breast cancers (BC), generally not taken into account in treatment guidelines. We evaluated professionals' attitudes toward decision-making regarding rare BC and consensus guidelines needs. In this international e-survey, 236 BC experts from all specialties were contacted through email to fill an online questionnaire about their practices. Eighty-six experts from 32 countries participated (36%); 50% medical oncologists, 21% surgeons, 17% pathologists, and 12% radiation oncologists. General BC care decisions were based on consensus guidelines in 77% of expert, whereas routine individual treatment decisions for BC were made by multi-disciplinary boards in 76%. Only 10% strongly considered rare BC should be treated following existing standard guidelines. Interestingly, 50-80% described individualizing treatment for rare BC according to pathologic subtype. More than 90% of experts would welcome international recommendations for rare BC. This large scale international multi-disciplinary survey revealed overarching concerns centered on several key themes: the lack of resources and data to address these less common BC; the heterogeneous management of rare BC depending on geographical location and specialist training; the demand for international consensus guidelines regarding their diagnosis and treatment.
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Affiliation(s)
- Mahasti Saghatchian
- Department of Medical Oncology, Breast Cancer Unit, Gustave Roussy, Villejuif, France
| | - Zouhour Fadoukhair
- Department of Medical Oncology, Breast Cancer Unit, Gustave Roussy, Villejuif, France
| | | | - Emilie Lanoy
- Biostatistics and Epidemiology Unit, Gustave Roussy, Villejuif, France
| | | | - Chafika Mazouni
- Department of Surgery, Unit of Breast and Plastic Surgery, Gustave Roussy, Villejuif, France
| | - Suzette Delaloge
- Department of Medical Oncology, Breast Cancer Unit, Gustave Roussy, Villejuif, France
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108
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Hahlweg P, Hoffmann J, Härter M, Frosch DL, Elwyn G, Scholl I. In Absentia: An Exploratory Study of How Patients Are Considered in Multidisciplinary Cancer Team Meetings. PLoS One 2015; 10:e0139921. [PMID: 26441328 PMCID: PMC4595280 DOI: 10.1371/journal.pone.0139921] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 09/18/2015] [Indexed: 11/18/2022] Open
Abstract
Background Multidisciplinary team meetings and shared decision-making are potential means of delivering patient-centred care. Not much is known about how those two paradigms fit together in cancer care. This study aimed to investigate how decisions are made in multidisciplinary team meetings and whether patient perspectives are incorporated in these decisions. Materials and Methods A qualitative study was conducted using non-participant observation at multidisciplinary team meetings (also called tumor boards) at the University Cancer Center Hamburg-Eppendorf, Germany. Two researchers recorded structured field notes from a total of N = 15 multidisciplinary team meetings. Data were analyzed using content analysis and descriptive statistics. Results Physicians mainly exchanged medical information and based their decision-making on this information. Individual patient characteristics or their treatment preferences were rarely considered or discussed. In the few cases where patient preferences were raised as a topic, this information did not seem to be taken into account in decision-making processes about treatment recommendations. Conclusion The processes in multidisciplinary team meetings we observed did not exhibit shared decision-making. Patient perspectives were absent. If multidisciplinary team meetings wish to become more patient-centred they will have to modify their processes and find a way to include patient preferences into the decision-making process.
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Affiliation(s)
- Pola Hahlweg
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
| | - Jana Hoffmann
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dominick L Frosch
- Gordon and Betty Moore Foundation, Palo Alto, California, United States of America
- Department of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, New Hampshire, United States of America
| | - Isabelle Scholl
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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109
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Interstitial brachytherapy technique for chest wall refractory recurrence of breast cancer. J Contemp Brachytherapy 2015; 7:290-4. [PMID: 26622232 PMCID: PMC4643729 DOI: 10.5114/jcb.2015.53868] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 06/12/2015] [Accepted: 07/10/2015] [Indexed: 11/17/2022] Open
Abstract
Purpose To report the treatment effect of interstitial brachytherapy for chest wall locoregional recurrence of breast cancer. Material and methods This 44-year-old female presented with chest wall recurrence seven years after modified radical mastectomy for stage II breast cancer. Despite external beam radiation and chemotherapy, the lesion expanded as 5.3 × 5.1 × 3.0 cm3, and 8.0 × 5.1 × 4.0 cm3. The locoregional recurrent tumor was treated with interstitial brachytherapy under ultrasound guidance. The brachytherapy dose was 30 Gy in 6 fractions of 5 Gy each. Results Removal of the recurrent tumor was securely achieved by interstitial brachytherapy guided with ultrasound scanning. The refractory tumor in patient healed uneventfully after interstitial brachytherapy without recurrence during the 7 months of follow-up. Conclusions The ultrasound-guided interstitial brachytherapy may be effective for refractory recurrence of breast cancer.
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110
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Chen P, Liu R, Chen L, Aihara K. Identifying critical differentiation state of MCF-7 cells for breast cancer by dynamical network biomarkers. Front Genet 2015; 6:252. [PMID: 26284108 PMCID: PMC4516973 DOI: 10.3389/fgene.2015.00252] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 07/13/2015] [Indexed: 12/20/2022] Open
Abstract
Identifying the pre-transition state just before a critical transition during a complex biological process is a challenging task, because the state of the system may show neither apparent changes nor clear phenomena before this critical transition during the biological process. By exploring rich correlation information provided by high-throughput data, the dynamical network biomarker (DNB) can identify the pre-transition state. In this work, we apply DNB to detect an early-warning signal of breast cancer on the basis of gene expression data of MCF-7 cell differentiation. We find a number of the related modules and pathways in the samples, which can be used not only as the biomarkers of cancer cells but also as the drug targets. Both functional and pathway enrichment analyses validate the results.
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Affiliation(s)
- Pei Chen
- School of Computer Science, South China University of Technology Guangzhou, China
| | - Rui Liu
- School of Mathematics, South China University of Technology Guangzhou, China
| | - Luonan Chen
- Collaborative Research Center for Innovative Mathematical Modelling, University of Tokyo Tokyo, Japan ; Key Laboratory of Systems Biology, Innovation Center for Cell Signaling Network, Institute of Biochemistry and Cell Biology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences Shanghai, China
| | - Kazuyuki Aihara
- Collaborative Research Center for Innovative Mathematical Modelling, University of Tokyo Tokyo, Japan
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111
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Yeo B, Zabaglo L, Hills M, Dodson A, Smith I, Dowsett M. Clinical utility of the IHC4+C score in oestrogen receptor-positive early breast cancer: a prospective decision impact study. Br J Cancer 2015; 113:390-5. [PMID: 26180920 PMCID: PMC4522631 DOI: 10.1038/bjc.2015.222] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 05/13/2015] [Accepted: 05/25/2015] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Most oestrogen receptor (ER)-positive early breast cancer diagnosed today is highly curable with multimodality treatment. Systemic adjuvant treatments including endocrine therapy and chemotherapy have made a significant contribution to the increasing cure rates over the past three decades. However not all women will require chemotherapy. The IHC4+C score is a prognostic tool that integrates four immunohistochemical measures with clinicopathological features to estimate the residual risk of distant recurrence at 10 years in post-menopausal women with ER-positive breast cancer who have received 5 years of endocrine therapy. Retrospective studies indicate that the test can identify a set of women that are at such low risk of recurrence that chemotherapy can be of little benefit. METHODS In this study, 124 patients were prospectively selected from the multidisciplinary team meeting between January 2013 and April 2014 for IHC4+C testing. Adjuvant systemic treatment recommendations by clinicians were recorded without and with the availability of the score in addition to the patient's decision. RESULTS There was concordance in the MDT's recommendation without and with the availability of the score in 73% of cases. Clinicians recommended chemotherapy or at least its discussion to 74 (59%) patients, which fell to 32 (34%) patients after the IHC4+C score was made available, sparing one in four tested patients a chemotherapy recommendation, along with its toxicity and expense. CONCLUSION This decision impact study shows that when used by clinicians in the multidisciplinary team meeting for adjuvant decision-making, a significant proportion of patients are spared chemotherapy recommendations.
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Affiliation(s)
- B Yeo
- Department of Medicine, Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK
- Academic Department of Biochemistry, Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK
- Institute of Cancer Research, Fulham Road, London SW3 6JB, UK
| | - L Zabaglo
- Academic Department of Biochemistry, Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK
- Institute of Cancer Research, Fulham Road, London SW3 6JB, UK
| | - M Hills
- Academic Department of Biochemistry, Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK
| | - A Dodson
- Academic Department of Biochemistry, Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK
| | - I Smith
- Department of Medicine, Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK
| | - M Dowsett
- Academic Department of Biochemistry, Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK
- Institute of Cancer Research, Fulham Road, London SW3 6JB, UK
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112
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Generali D, Rossi C, Bottini A. Treatment decision-making in breast cancer: role of the multidisciplinary team meeting in a breast unit. BREAST CANCER MANAGEMENT 2015. [DOI: 10.2217/bmt.15.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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113
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Li X, An Y, Jin J, Zhu Z, Hao L, Liu L, Shi Y, Fan D, Ji T, Yang CJ. Evolution of DNA aptamers through in vitro metastatic-cell-based systematic evolution of ligands by exponential enrichment for metastatic cancer recognition and imaging. Anal Chem 2015; 87:4941-8. [PMID: 25867099 DOI: 10.1021/acs.analchem.5b00637] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Metastasis, the capability of tumor cells to spread and grow at distant sites, is the primary factor in cancer mortality. Because metastasis in sentinel lymph nodes suggests the original spread of tumors from a primary site, the detection of lymph node involvement with cancer serves as an important prognostic and treatment parameter. Here we have developed a panel of DNA aptamers specifically binding to colon cancer cell SW620 derived from metastatic site lymph node, with high affinity after 14 rounds of selection by the cell-SELEX (systematic evolution of ligands by exponential enrichment) method. The binding affinities of selected aptamers were evaluated by flow cytometry. Aptamer XL-33 with the best binding affinity (0.7 nM) and its truncated sequence XL-33-1 with 45 nt showed excellent selectivity for recognizing target cell SW620. The binding entity of the selected aptamer has been preliminarily determined as a membrane protein on the cell surface. Tissue imaging results showed that XL-33-1 was highly specific to the metastatic tumor tissue or lymph node tissue with corresponding cancer metastasis and displayed an 81.7% detection rate against colon cancer tissue with metastasis in regional lymph nodes. These results suggest that XL-33-1 has great potential to become a molecular imaging agent for early detection of lymph node tissue with colon cancer metastasis. More importantly, this study clearly demonstrates that DNA ligands selectively recognizing metastatic cancer cells can be readily generated by metastatic-cell-based SELEX for potential applications in metastatic cancer diagnosis and treatment.
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Affiliation(s)
- Xilan Li
- †State Key Laboratory of Physical Chemistry of Solid Surfaces, The MOE Key Laboratory of Spectrochemical Analysis and Instrumentation, Collaborative Innovation Center of Chemistry for Energy Materials, Key Laboratory for Chemical Biology of Fujian Province, Department of Chemical Biology, College of Chemistry and Chemical Engineering, Affiliated Chenggong Hospital, Xiamen University, Xiamen 361005, People's Republic of China
| | - Yuan An
- †State Key Laboratory of Physical Chemistry of Solid Surfaces, The MOE Key Laboratory of Spectrochemical Analysis and Instrumentation, Collaborative Innovation Center of Chemistry for Energy Materials, Key Laboratory for Chemical Biology of Fujian Province, Department of Chemical Biology, College of Chemistry and Chemical Engineering, Affiliated Chenggong Hospital, Xiamen University, Xiamen 361005, People's Republic of China
| | - Jiang Jin
- ‡State Key Laboratory of Cancer Biology and Xijing Hospital of Digestive Diseases, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, Shaanxi Province, People's Republic of China
| | - Zhi Zhu
- †State Key Laboratory of Physical Chemistry of Solid Surfaces, The MOE Key Laboratory of Spectrochemical Analysis and Instrumentation, Collaborative Innovation Center of Chemistry for Energy Materials, Key Laboratory for Chemical Biology of Fujian Province, Department of Chemical Biology, College of Chemistry and Chemical Engineering, Affiliated Chenggong Hospital, Xiamen University, Xiamen 361005, People's Republic of China
| | - Linlin Hao
- §State Key Laboratory of Urban Water Resource and Environment, School of Municipal and Environmental Engineering, Harbin Institute of Technology, Harbin 150090, People's Republic of China
| | - Lu Liu
- †State Key Laboratory of Physical Chemistry of Solid Surfaces, The MOE Key Laboratory of Spectrochemical Analysis and Instrumentation, Collaborative Innovation Center of Chemistry for Energy Materials, Key Laboratory for Chemical Biology of Fujian Province, Department of Chemical Biology, College of Chemistry and Chemical Engineering, Affiliated Chenggong Hospital, Xiamen University, Xiamen 361005, People's Republic of China
| | - Yongquan Shi
- ‡State Key Laboratory of Cancer Biology and Xijing Hospital of Digestive Diseases, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, Shaanxi Province, People's Republic of China
| | - Daiming Fan
- ‡State Key Laboratory of Cancer Biology and Xijing Hospital of Digestive Diseases, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, Shaanxi Province, People's Republic of China
| | - Tianhai Ji
- †State Key Laboratory of Physical Chemistry of Solid Surfaces, The MOE Key Laboratory of Spectrochemical Analysis and Instrumentation, Collaborative Innovation Center of Chemistry for Energy Materials, Key Laboratory for Chemical Biology of Fujian Province, Department of Chemical Biology, College of Chemistry and Chemical Engineering, Affiliated Chenggong Hospital, Xiamen University, Xiamen 361005, People's Republic of China
| | - Chaoyong James Yang
- †State Key Laboratory of Physical Chemistry of Solid Surfaces, The MOE Key Laboratory of Spectrochemical Analysis and Instrumentation, Collaborative Innovation Center of Chemistry for Energy Materials, Key Laboratory for Chemical Biology of Fujian Province, Department of Chemical Biology, College of Chemistry and Chemical Engineering, Affiliated Chenggong Hospital, Xiamen University, Xiamen 361005, People's Republic of China
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Dew K, Stubbe M, Signal L, Stairmand J, Dennett E, Koea J, Simpson A, Sarfati D, Cunningham C, Batten L, Ellison-Loschmann L, Barton J, Holdaway M. Cancer care decision making in multidisciplinary meetings. QUALITATIVE HEALTH RESEARCH 2015; 25:397-407. [PMID: 25281239 DOI: 10.1177/1049732314553010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Little research has been undertaken on the actual decision-making processes in cancer care multidisciplinary meetings (MDMs). This article was based on a qualitative observational study of two regional cancer treatment centers in New Zealand. We audiorecorded 10 meetings in which 106 patient cases were discussed. Members of the meetings categorized cases in varying ways, drew on a range of sources of authority, expressed different value positions, and utilized a variety of strategies to justify their actions. An important dimension of authority was encountered authority-the authority a clinician has because of meeting the patient. The MDM chairperson can play an important role in making explicit the sources of authority being drawn on and the value positions of members to provide more clarity to the decision-making process. Attending to issues of process, authority, and values in MDMs has the potential to improve cancer care decision making and ultimately, health outcomes.
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Affiliation(s)
- Kevin Dew
- Victoria University of Wellington, Wellington, New Zealand
| | | | | | | | | | | | | | | | | | | | | | - Josh Barton
- Victoria University of Wellington, Wellington, New Zealand
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115
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Yan JH, Pan L, Zhang XM, Sun CX, Cui GH. Lack of efficacy of Tai Chi in improving quality of life in breast cancer survivors: a systematic review and meta-analysis. Asian Pac J Cancer Prev 2015; 15:3715-20. [PMID: 24870782 DOI: 10.7314/apjcp.2014.15.8.3715] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is controversial whether Tai Chi (TC) benefits breast cancer survivors (BCS) on quality of life (QoL). We therefore undertook a meta-analysis to assess this question. MATERIALS AND METHODS A computerized search through electronic databases was performed to identify relevant randomized controlled trials (RCTs). The primary outcome was QoL, while secondary outcomes included body mass index (BMI), bone mineral density (BMD), and muscle strength. RESULTS Five RCTs involving 407 patients were included in the meta-analysis. The pooled standardized mean differences were 0.10 (95% confidence interval (CI): -0.35-0.54) for physical well- being, 0.03 (95%CI: -0.18-0.25) for social/family well-being, 0.24 (95%CI: 0.02-0.45) for emotional well-being, 0.23 (95%CI: -0.03-0.49) for functional well-being, and 0.09 (95%CI: -0.19-0.36) for additional concerns. TC failed to improve BMI, BMD, and muscle strength. CONCLUSIONS There is currently lack of sufficient evidence to support TC improving QoL and other important clinical endpoints.
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Affiliation(s)
- Jun-Hong Yan
- Department of Clinical Medical Technology, Affiliated Hospital of Binzhou Medical College, Binzhou, China E-mail :
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116
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Çiçek MS. WITHDRAWN: Medicine without teamwork: A deadly sin or a common practice? J Thorac Cardiovasc Surg 2014:S0022-5223(14)02018-2. [PMID: 25595380 DOI: 10.1016/j.jtcvs.2014.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 12/03/2014] [Indexed: 11/26/2022]
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
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Affiliation(s)
- M Sertaç Çiçek
- Anadolu Medical Center, Section of Cardiovascular Surgery, Gebze, Kocaeli Province, Turkey
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117
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Tsai CH, Tzeng HE, Juang WK, Chu PG, Fann P, Fong YC, Hsu HC, Yen Y. Curative use of forequarter amputation for recurrent breast cancer over an axillary area: a case report and literature review. World J Surg Oncol 2014; 12:346. [PMID: 25407045 PMCID: PMC4246546 DOI: 10.1186/1477-7819-12-346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 08/16/2014] [Indexed: 11/28/2022] Open
Abstract
Axillary recurrence of breast cancer that involves the brachial neurovascular bundle is uncommon. However, for many patients with such recurrence, forequarter amputation can play a palliative role in relieving excruciating pain and paralysis of the upper limb. Further, for those patients who do not have distant metastasis or other local-regional recurrence, forequarter amputation provides a chance for a cure. Only a few case reports of curative amputations for recurrent breast cancer are present in the literature. Here, we report a case of forequarter amputation for curative treatment of axillary recurrent breast cancer, together with a literature review. To date, we have followed the patient for three years after amputation, during which there has been no evidence of recurrence or metastasis. Although radical resection is feasible, it can be accompanied by surgical wound complications and psychosocial stress. Therefore, an organized multidisciplinary approach is needed to ensure the success of radical resection.
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Affiliation(s)
| | | | | | | | | | | | | | - Yun Yen
- Department of Molecular Pharmacology, City of Hope National Medical Center and Beckman Research Center, 1500 East Duarte Road, Duarte, CA 91010, USA.
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118
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Prades J, Borras JM. Shifting sands: adapting the multidisciplinary team model to technological and organizational innovations in cancer care. Future Oncol 2014; 10:1995-8. [DOI: 10.2217/fon.14.125] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Joan Prades
- Catalonian Cancer Strategy, University of Barcelona, IDIBELL, Gran via 199, 08908-Hospitalet, Barcelona, Spain
- Department of Health, University of Barcelona, IDIBELL, Gran via 199, 08908-Hospitalet, Barcelona, Spain
| | - Josep M Borras
- Catalonian Cancer Strategy, University of Barcelona, IDIBELL, Gran via 199, 08908-Hospitalet, Barcelona, Spain
- Department of Health, University of Barcelona, IDIBELL, Gran via 199, 08908-Hospitalet, Barcelona, Spain
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119
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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: 246] [Impact Index Per Article: 24.6] [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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120
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Lamb BW, Jalil RT, Sevdalis N, Vincent C, Green JSA. Strategies to improve the efficiency and utility of multidisciplinary team meetings in urology cancer care: a survey study. BMC Health Serv Res 2014; 14:377. [PMID: 25196248 PMCID: PMC4162937 DOI: 10.1186/1472-6963-14-377] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 09/04/2014] [Indexed: 12/24/2022] Open
Abstract
Background The prevalence of multidisciplinary teams (MDT) for the delivery of cancer care is increasing globally. Evidence exists of benefits to patients and healthcare professionals. However, MDT working is time and resource intensive. This study aims to explore members’ views on existing practices of urology MDT working, and to identify potential interventions for improving the efficiency and productivity of the MDT meeting. Methods Members of urology MDTs across the UK were purposively recruited to participate in an online survey. Survey items included questions about the utility and efficiency of MDT meetings, and strategies for improving the efficiency of MDT meetings: treating cases by protocol, prioritising cases, and splitting the MDT into subspeciality meetings. Results 173 MDT members participated (Oncologists n = 77, Cancer Nurses n = 54, Urologists n = 30, other specialities n = 12). 68% of respondents reported that attending the MDT meeting improves efficiency in care through improved clinical decisions, planning investigations, helping when discussing plans with patients, speciality referrals, documentation/patient records. Participants agreed that some cases including low risk, non-muscle invasive bladder cancer and localised, low-grade prostate cancer could be managed by pre-agreed pathways, without full MDT review. There was a consensus that cases at the MDT meeting could be prioritised by complexity, tumour type, or the availability of MDT members. Splitting the MDT meeting was unpopular: potential disadvantages included loss of efficiency, loss of team approach, unavailability of members and increased administrative work. Conclusion Key urology MDT members find the MDT meeting useful. Improvements in efficiency and effectiveness may be possible by prioritising cases or managing some low-risk cases according to previously agreed protocols. Further research is needed to test the effectiveness of such strategies on MDT meetings, cancer care pathways and patient outcomes in clinical practice.
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Affiliation(s)
- Benjamin W Lamb
- Department of Surgery and Cancer, Imperial College London, 5th Floor Medical School Building, St, Mary's Hospital, London W2 1PG, UK.
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121
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Khuroo T, Verma D, Talegaonkar S, Padhi S, Panda AK, Iqbal Z. Topotecan-tamoxifen duple PLGA polymeric nanoparticles: investigation of in vitro, in vivo and cellular uptake potential. Int J Pharm 2014; 473:384-94. [PMID: 25051112 DOI: 10.1016/j.ijpharm.2014.07.022] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 07/12/2014] [Accepted: 07/16/2014] [Indexed: 11/16/2022]
Abstract
The dual drug loaded poly(dl-lactic-co-glycolic acid) (PLGA(1)) nanoparticles (TOP-TAM NPs(2)) concurrently delivering topotecan hydrochloride (TOP(3)) and tamoxifen citrate (TAM(4)) were developed to achieve synergism for the treatment of breast cancer by enhancing the permeation of TOP through the gut and the cells present in the breast. TAM acted as P-glycoprotein (P-gp(5)) inhibitor, reduced the side effects of individual drugs by reducing the dose. The NPs were prepared by double emulsion (w/o/w) method. The optimized TOP-TAM NPs were found to have smooth and spherical morphology by using SEM(6) and TEM(7) technique. Similarly size of nanoparticles was found to be 151.2 ± 1.6 nm with 0.147 ± 0.03 polydispersity index (PDI(8)). The percentage entrapment efficiency of 95.17 ± 3.57 and 57.77 ± 2.2 was found for TAM and TOP respectively. The lyophillized nanoparticles under DSC(9) showed amorphous nature of both TOP and TAM. In an in vitro release study the release of drugs from TOP-TAM NPs was found to follow the Higuchi pattern. The ex vivo gut permeation study revealed that the TAM enhanced the permeation of TOP and increased its bioavailability by 1.9 folds. The permeation and activity of combination of drugs were further confirmed by carrying out cell line studies on MCF-7 cells.
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Affiliation(s)
- Tahir Khuroo
- Department of Pharmaceutics, Faculty of Pharmacy Jamia Hamdard, Hamdard Nagar, New Delhi 110062, India; Product Development Cell-II, National Institute of Immunology, New Delhi 110067, India; Clinical Pharmacology and Pharmacokinetics, Ranbaxy Laboratories Limited, Gurgaon 122015, Haryana, India.
| | - Devina Verma
- Department of Pharmaceutics, Faculty of Pharmacy Jamia Hamdard, Hamdard Nagar, New Delhi 110062, India
| | - Sushama Talegaonkar
- Department of Pharmaceutics, Faculty of Pharmacy Jamia Hamdard, Hamdard Nagar, New Delhi 110062, India
| | - Santwana Padhi
- Department of Pharmaceutics, Faculty of Pharmacy Jamia Hamdard, Hamdard Nagar, New Delhi 110062, India
| | - Amulya K Panda
- Product Development Cell-II, National Institute of Immunology, New Delhi 110067, India
| | - Zeenat Iqbal
- Department of Pharmaceutics, Faculty of Pharmacy Jamia Hamdard, Hamdard Nagar, New Delhi 110062, India.
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122
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Brar SS, Hong NL, Wright FC. Multidisciplinary cancer care: does it improve outcomes? J Surg Oncol 2014; 110:494-9. [PMID: 24986235 DOI: 10.1002/jso.23700] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 05/22/2014] [Indexed: 12/24/2022]
Abstract
Multidisciplinary care has been advocated as a solution for increasingly complex treatment decisions in cancer patients. The impact of multidisciplinary care on patient survival has been studied, but evidence is limited by poor methodological quality. Lack of conclusive evidence for increased survival is balanced against improvements in quality of care, guideline adherence, reduction in wait times, and greater satisfaction for patients and care providers.
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Affiliation(s)
- Savtaj S Brar
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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123
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Saini KS, Agarwal G, Jagannathan R, Metzger-Filho O, Saini ML, Mistry K, Ali R, Gupta S. Challenges in launching multinational oncology clinical trials in India. South Asian J Cancer 2014; 2:44-9. [PMID: 24455545 PMCID: PMC3876625 DOI: 10.4103/2278-330x.105896] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
In the recent past, there has been an impressive growth in the number of clinical trials launched worldwide, including India. Participation in well-designed oncology clinical trials is of advantage to Indian healthcare system in general, and cancer patients in particular. However, the number of clinical trials being run in India is not commensurate with the cancer burden prevailing in the country. In this article, the authors investigate the reasons for this discrepancy, highlight critical bottlenecks, and propose ways to ameliorate the situation.
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Affiliation(s)
- Kamal S Saini
- Breast International Group, Department of Medical Oncology, Jules Bordet Institute, Université libre de Bruxelles, Brussels, Belgium
| | - Gaurav Agarwal
- Department of Endocrine and Breast Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ramesh Jagannathan
- Clinical Research, AstraZeneca Pharma India Ltd., Bangalore, Karnataka, India
| | | | - Monika L Saini
- Department of Anatomie Pathologique, Cliniques Saint Luc, Université catholique de Louvain, Brussels, Belgium
| | - Khurshid Mistry
- Indian Cooperative Oncology Network, Mumbai, Maharashtra, India
| | - Raghib Ali
- INDOX Cancer Research Network, University of Oxford, Oxford, UK
| | - Sudeep Gupta
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
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124
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Yilmaz OC, Cantürk NZ, Kebudi A, Güler SA, Erkek A, Rezai M, Güllüoğlu BM. The emerging role of national academies in surgical training: an inspiring environment for increasing the quality of health care in breast cancer management. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2014; 29:395-400. [PMID: 24515563 DOI: 10.1007/s13187-014-0626-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Medical education, both graduate and postgraduate, is given at medical schools and affiliated teaching hospitals. The training at these institutions is necessary and valuable. In each field of the medical profession, the relevant science is being developed and changed constantly. Training of medical staff and auxilliary professionals must be adaptable to changes in the field. Also, the development of standards for the diagnosis and treatment of diseases is important. Independent institutions, called academies, serve an extremely useful task in the continuing further training that needs to be adjusted according to individual needs. Academies are independent and free from bureaucracies. Standardized records are uniform and comparable at these institutions. Both patients and medical staff receive training from these institutions. In this way, a high standard is provided in medicine, error rates are decreased and patient satisfaction is increased. Breast cancer, the most common tumor in women, is a serious cause of morbidity and mortality. The European Institute of Oncology (EIO) in Milan, Italy and the European Academy of Senology in Duesseldorf, Germany play important roles in establishing the standards of breast care. They provide substantial training for physicians to achieve high quality in breast cancer management. SENATURK (Senoloji Akademisi, Turkish Academy of Senology) was established in 2010 in Istanbul, Turkey. Both national and international scientists and physicians including eminent senologists are currently faculty members of this young organization. SENATURK collaborates with other institutions in Europe. Its missions include developing training programs for each level of the profession, as well as developing data recording systems and electronic learning tools for breast cancer prevention, diagnosis, treatment, rehabilitation and palliation. Briefly, SENATURK plays a significant role as the opinion leader on every aspect of health care related to conditions and diseases of the breast.
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Affiliation(s)
- Osman Cem Yilmaz
- Department of Surgery, Breast Unit, Academic Hospital, Istanbul, Turkey
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125
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Jonker J, Smorenburg C, Schiphorst A, van Rixtel B, Portielje J, Hamaker M. Geriatric oncology in the Netherlands: a survey of medical oncology specialists and oncology nursing specialists. Eur J Cancer Care (Engl) 2014; 23:803-10. [DOI: 10.1111/ecc.12193] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2014] [Indexed: 12/27/2022]
Affiliation(s)
- J.M. Jonker
- Department of Geriatric Medicine; Rijnland Hospital; Leiderdorp the Netherlands
| | - C.H. Smorenburg
- Department of Internal Medicine; Medical Centre Alkmaar; Alkmaar the Netherlands
| | - A.H. Schiphorst
- Department of Surgery; Diakonessenhuis; Utrecht the Netherlands
| | | | - J.E.A. Portielje
- Department of Internal Medicine; Haga Hospital; Den Haag the Netherlands
| | - M.E. Hamaker
- Department of Geriatric Medicine; Diakonessenhuis; Utrecht the Netherlands
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126
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Mazouni C, Deneuve J, Arnedos M, Prenois F, Saghatchian M, André F, Bourgier C, Delaloge S. Decision-making from multidisciplinary team meetings to the bedside: Factors influencing the recruitment of breast cancer patients into clinical trials. Breast 2014; 23:170-4. [DOI: 10.1016/j.breast.2013.12.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 12/05/2013] [Accepted: 12/14/2013] [Indexed: 11/29/2022] Open
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127
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Silbermann M, Pitsillides B, Al-Alfi N, Omran S, Al-Jabri K, Elshamy K, Ghrayeb I, Livneh J, Daher M, Charalambous H, Jafferri A, Fink R, El-Shamy M. Multidisciplinary care team for cancer patients and its implementation in several Middle Eastern countries. Ann Oncol 2014; 24 Suppl 7:vii41-47. [PMID: 24001762 DOI: 10.1093/annonc/mdt265] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
This article introduces palliative care to cancer patients in Middle Eastern countries. It considers the importance of the multidisciplinary team in providing an adequate service to the patient and his/her family. It provides views of professionals from the various countries with regard to the role of the nurse in such teams; whereby the three elements of palliative care nursing entail: 1. Working directly with patients and families; 2. Working with other health and social care professionals to network and co-ordinate services; and 3. working at an organizational level to plan, develop and manage service provision in local, regional and national settings. This article also details the challenges that nurses face in the Middle East and outlines the preferable ways to overcome such challenges. The latter include more focused educational activities at the undergraduate and graduate levels and continuous clinical training throughout their work as palliative care nurse specialists.
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Affiliation(s)
- M Silbermann
- Technion-Israel Institute of Technology, and the Middle East Cancer Consortium, 15 Kiryat Sefer Street, Haifa, Israel.
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128
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Hamaker ME, Schiphorst AH, ten Bokkel Huinink D, Schaar C, van Munster BC. The effect of a geriatric evaluation on treatment decisions for older cancer patients--a systematic review. Acta Oncol 2014; 53:289-96. [PMID: 24134505 DOI: 10.3109/0284186x.2013.840741] [Citation(s) in RCA: 135] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
AIM The aim of this systematic review is to summarise all available data on the effect of a geriatric evaluation on the multidisciplinary treatment of older cancer patients, focussing on oncologic treatment decisions and the implementation of non-oncologic interventions. METHODS A systematic search in MEDLINE and EMBASE for studies on the effect of a geriatric evaluation on oncologic and non-oncologic treatment for older cancer patients. RESULTS Literature search identified 1654 reports (624 from Medline and 1030 from Embase), of which 10 studies were included in the review. Three studies used a geriatric consultation while seven used a geriatric assessment performed by a cancer specialist, healthcare worker or (research) nurse. Six studies addressed a change in oncologic treatment, the initial treatment plan was modified in a median of 39% of patients after geriatric evaluation, of which two thirds resulted in less intensive treatment. Seven studies focused on the implementation of non-oncologic interventions based on the results of the geriatric evaluation; all but one reported that interventions were suggested for over 70% of patients, even in studies that did not focus specifically on frail older patients. In the other study, implementation of non-oncologic interventions was left to the cancer specialist's discretion. CONCLUSION A geriatric evaluation has significant impact on oncologic and non-oncologic treatment decisions in older cancer patients and deserves consideration in the oncologic work-up for these patients.
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Affiliation(s)
- Marije E Hamaker
- Department of Geriatric Medicine, Diakonessenhuis Utrecht , The Netherlands
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129
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Zardavas D, Ades F, Spasojevic IB, Pugliano L, Capelan M, Paesmans M, de Azambuja E, Piccart M. Controversial issues in early-stage breast cancer: a global collaborative survey, supported by the European Society for Medical Oncology (ESMO). Ann Oncol 2014; 25:1558-62. [PMID: 24562450 DOI: 10.1093/annonc/mdu093] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND To explore the current clinical management of early-stage breast cancer (BC) patients, identify areas of controversy, and interrogate how treating physicians implement latest advances. METHODS We conducted a 27-item survey, disseminated in two stages: paper distribution at selected BC sessions at the ESMO 2012 Congress, and dedicated mailings to ESMO members. Descriptive statistical analysis and logistic regression analysis were applied to explore potential associations between the demographic characteristics of the participants and replies. RESULTS A total of 512 physicians from 79 countries participated in the study, accounting for 465 (91%) fully completed questionnaires. The majority of the participants were ESMO members (66%), medical oncologists (86.5%), and working in multidisciplinary teams (91.6%). Heterogeneous results were captured, such as the following: 40.9% of the participants consider no genetic test useful for making adjuvant treatment decisions; 15.3% consider PET-CT a useful imaging modality for staging; 68.8% consider that postmenopausal patients with hormone receptor positive disease should always be offered an aromatase inhibitor as part of their adjuvant therapy; 78.7% prefer to administer trastuzumab concurrently with the taxane component of chemotherapy; and 27% would consider bevacizumab in the neoadjuvant setting. The logistic regression analysis did not identify any strong predictor of the probability of giving a reply fully compatible with evidence in the literature. CONCLUSION This survey captures clinical practice and whether the latest research advances are implemented in the treatment of early-stage BC by an extended number of physicians. Significant individual differences were found. Areas of controversy were detected, and they deserve further exploration in order to generate 'tailored' educational tools, with the final goal being the standardization of the treatment of early-stage BC patients.
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Affiliation(s)
- D Zardavas
- Department of Medical Oncology, Institut Jules Bordet, Brussels
| | - F Ades
- Department of Medical Oncology, Institut Jules Bordet, Brussels
| | - I B Spasojevic
- Department of Medical Oncology, Institut Jules Bordet, Brussels
| | - L Pugliano
- Department of Medical Oncology, Institut Jules Bordet, Brussels
| | - M Capelan
- Department of Medical Oncology, Institut Jules Bordet, Brussels
| | - M Paesmans
- Data Centre, Institut Jules Bordet, Brussels, Belgium
| | - E de Azambuja
- Department of Medical Oncology, Institut Jules Bordet, Brussels
| | - M Piccart
- Department of Medical Oncology, Institut Jules Bordet, Brussels
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130
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Popescu R, Schäfer R, Califano R, Eckert R, Coleman R, Douillard JY, Cervantes A, Casali P, Sessa C, Van Cutsem E, de Vries E, Pavlidis N, Fumasoli K, Wörmann B, Samonigg H, Cascinu S, Cruz Hernández J, Howard A, Ciardiello F, Stahel R, Piccart M. The current and future role of the medical oncologist in the professional care for cancer patients: a position paper by the European Society for Medical Oncology (ESMO). Ann Oncol 2014; 25:9-15. [DOI: 10.1093/annonc/mdt522] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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131
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Borras JM, Albreht T, Audisio R, Briers E, Casali P, Esperou H, Grube B, Hamoir M, Henning G, Kelly J, Knox S, Nabal M, Pierotti M, Lombardo C, van Harten W, Poston G, Prades J, Sant M, Travado L, Valentini V, van de Velde C, van den Bogaert S, van den Bulcke M, van Hoof E, van den Neucker I, Wilson R. Policy statement on multidisciplinary cancer care. Eur J Cancer 2013; 50:475-80. [PMID: 24321260 DOI: 10.1016/j.ejca.2013.11.012] [Citation(s) in RCA: 216] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 11/14/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cancer care is undergoing an important paradigm shift from a disease-focused management to a patient-centred approach, in which increasingly more attention is paid to psychosocial aspects, quality of life, patients' rights and empowerment and survivorship. In this context, multidisciplinary teams emerge as a practical necessity for optimal coordination among health professionals and clear communication with patients. The European Partnership for Action Against Cancer (EPAAC), an initiative launched by the European Commission in 2009, addressed the multidisciplinary care from a policy perspective in order to define the core elements that all tumour-based multidisciplinary teams (MDTs) should include. To that effect, a working group conference was held in January 2013 within the EPAAC Work Package 7 (on Healthcare) framework. METHODS The consensus group consisted of high-level representatives from the following European scientific societies, patient associations and stakeholders: European CanCer Organisation (ECCO), European SocieTy for Radiology & Oncology (ESTRO), European Society for Medical Oncology (ESMO), European Society of Surgical Oncology (ESSO), International Society of Geriatric Oncology (SIOG), European Association for Palliative Care (EAPC), European Oncology Nursing Society (EONS), International Psycho-Oncology Society (IPOS),European Cancer Patient Coalition (ECPC), EuropaColon, Europa Donna - The European Breast Cancer Coalition, Association of European Cancer Leagues (ECL), Organisation of European Cancer Institutes (OECI), EUSOMA - European Society of Breast Cancer Specialists, European Hospital and Healthcare Federation (HOPE) and EPAAC Work Packages 5 (Health promotion and prevention), 7, 8 (Research), 9 (Information systems) and 10 (Cancer plans). A background document with a list of 26 core issues drawn from a systematic review of the literature was used to guide the discussion. Five areas related to MDTs were covered: care objectives, organisation, clinical assessment, patients' rights and empowerment and policy support. Preliminary drafts of the document were widely circulated for consultation and amendments by the working group before final approval. RESULTS The working group unanimously formulated a Policy Statement on Multidisciplinary Cancer Care to define the core elements that should be implemented by all tumour-based MDTs. This document identifies MDTs as the core component in cancer care organisation and sets down the key elements to guide changes across all European health systems. CONCLUSION MDTs are an essential instrument of effective cancer care policy, and their continued development crucial to providing patients the care they need and deserve. While implementation must remain in local hands, European health systems can still benefit from having a basis for an effective multidisciplinary model of cooperation. This policy statement is intended to serve as a reference for policymakers and healthcare providers who wish to improve the services currently provided to the cancer patients whose lives and well-being depend on their action.
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Affiliation(s)
| | - Josep M Borras
- Catalonian Institute of Oncology (ICO) & University of Barcelona (UB), Barcelona, Spain.
| | - Tit Albreht
- EPAAC, Work Package 10 Cancer Plans & National Institute of Public Health of Slovenia (IVZ), Ljubljana, Slovenia
| | | | | | | | - Hélène Esperou
- European Hospital and Healthcare Federation (HOPE) & UNICANCER
| | | | - Marc Hamoir
- Cliniques Universitaires Saint-Luc, UCL, Brussels, Belgium
| | | | - Joan Kelly
- Association of European Cancer Leagues(ECL) & Work Package 5 Health Promotion Prevention
| | - Susan Knox
- Europa Donna - The European Breast Cancer Coalition
| | - Maria Nabal
- European Association for Palliative Care (EAPC)
| | | | | | | | | | - Joan Prades
- EPAAC, Work Package 7 Healthcare & Catalonian Cancer Plan, Barcelona, Spain
| | - Milena Sant
- EPAAC, Work Package 9 Information Systems & Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | | | | | | | | | | | | | - Robin Wilson
- EUSOMA - European Society of Breast Cancer Specialists
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132
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Taylor C, Shewbridge A, Harris J, Green JS. Benefits of multidisciplinary teamwork in the management of breast cancer. BREAST CANCER-TARGETS AND THERAPY 2013; 5:79-85. [PMID: 24648761 PMCID: PMC3929250 DOI: 10.2147/bctt.s35581] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The widespread introduction of multidisciplinary team (MDT)-work for breast cancer management has in part evolved due to the increasing complexity of diagnostic and treatment decision-making. An MDT approach aims to bring together the range of specialists required to discuss and agree treatment recommendations and ongoing management for individual patients. MDTs are resource-intensive yet we lack strong (randomized controlled trial) evidence of their effectiveness. Clinical consensus is generally favorable on the benefits of effective specialist MDT-work. Many studies have shown the benefits of receiving treatment from a specialist center, and evidence continues to accrue from comparative studies of clinical benefits of an MDT approach, including improved survival. Patients’ views of the MDT model of decision-making (and in particular its impact on involvement in decisions about their care) have been under-researched. Barriers to effective teamwork and poor decision-making include excessive caseload, low attendance at meetings, lack of leadership, poor communication, role ambiguity, and failure to consider patients’ holistic needs. Breast cancer nurses have a key role in relation to assessing holistic needs, and their specialist contribution has also been associated with improved patient experience and quality of life. This paper examines the evidence for the benefits of MDT-work, in particular for breast cancer. Evidence is considered within a context of growing cancer incidence at a time of increased financial restraint, and it may now be important to reevaluate the structure and models of MDT-work to ensure that MDTs are an efficient use of resources.
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Affiliation(s)
- Cath Taylor
- Florence Nightingale School of Nursing and Midwifery, King's College London, London UK
| | - Amanda Shewbridge
- Breast Cancer Services, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jenny Harris
- Florence Nightingale School of Nursing and Midwifery, King's College London, London UK
| | - James S Green
- Department of Urology, Barts Health NHS Trust, London, UK ; Department of Health and Social Care, London South Bank University, London, UK
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Rajan S, Foreman J, Wallis MG, Caldas C, Britton P. Multidisciplinary decisions in breast cancer: does the patient receive what the team has recommended? Br J Cancer 2013; 108:2442-7. [PMID: 23736032 PMCID: PMC3694248 DOI: 10.1038/bjc.2013.267] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 05/08/2013] [Accepted: 05/12/2013] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND A multidisciplinary team (MDT) approach to breast cancer management is the gold standard. The aim is to evaluate MDT decision making in a modern breast unit. METHODS All referrals to the breast MDT where breast cancer was diagnosed from 1 July 2009 to 30 June 2011 were included. Multidisciplinary team decisions were compared with subsequent patient management and classified as concordant or discordant. RESULTS Over the study period, there were 3230 MDT decisions relating to 705 patients. Overall, 91.5% (2956 out of 3230) of decisions were concordant, 4.5% (146 out of 3230), were discordant and 4% (128 out of 3230) had no MDT decision. Of 146 discordant decisions, 26 (17.8%) were considered 'unjustifiable' as there was no additional information available after the MDT to account for the change in management. The remaining 120 discordant MDT decisions were considered 'justifiable', as management was altered due to patient choice (n=61), additional information available after MDT (n=54) or MDT error (n=5). CONCLUSION The vast majority of MDT decisions are implemented. Management alteration was most often due to patient choice or additional information available after the MDT. A minority of management alterations were 'unjustifiable' and the authors recommend that any patient whose treatment is subsequently changed should have MDT rediscussion prior to treatment.
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Affiliation(s)
- S Rajan
- Cambridge Breast Unit, Box 97, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK.
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Abstract
Background: Multidisciplinary team meetings (MDTs), also known as tumour boards or multidisciplinary case conferences, are an integral component of contemporary cancer care. There are logistical problems with setting up and maintaining participation in these meetings. An ill-defined concept, the virtual MDT (vMDT), has arisen in response to these difficulties. We have, in order to provide clarity and to generate discussion, attempted to define the concept of the vMDT, outline its advantages and disadvantages, and consider some of the practical aspects involved in setting up a virtual MDT. Methods: This is an unstructured review of published evidence and personal experience relating to virtual teams in general, and to MDTs in particular. Results: We have devised a simple taxonomy for MDTs, discussed some of the practicalities involved in setting up a vMDT, and described some of the potential advantages and disadvantages associated with vMDTs. Conclusion: The vMDT may be useful for discussions concerning rare or unusual tumours, or for helping guide the assessment and management of patients with uncommon complications related to treatment. However, the vMDT is a niche concept and is currently unlikely to replace the more traditional face-to-face MDT in the management of common tumours at specific sites.
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Criscitiello C, Azim HA, Agbor-tarh D, de Azambuja E, Piccart M, Baselga J, Eidtmann H, Di Cosimo S, Bradbury I, Rubio IT. Factors associated with surgical management following neoadjuvant therapy in patients with primary HER2-positive breast cancer: results from the NeoALTTO phase III trial. Ann Oncol 2013; 24:1980-5. [PMID: 23567146 DOI: 10.1093/annonc/mdt129] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The NeoALTTO trial showed that dual HER2 blockade nearly doubles the rate of pathologic complete response (pCR) in patients with primary HER2-positive breast cancer. However, this did not translate into a higher rate of breast-conserving surgery (BCS). PATIENTS AND METHODS In NeoALTTO, patients with HER2-positive breast cancer were randomly assigned to either trastuzumab, lapatinib or their combination with paclitaxel before surgery with pCR as the primary end point. We investigated the association between the surgery type and clinicopathological factors and response to treatment, adjusting for the treatment arm. RESULTS Four hundred and twenty-nine patients were subjected to breast surgery. Two hundred and forty-two (56%) and 187 (44%) patients underwent mastectomy and BCS, respectively. In a logistic regression model, negative estrogen receptor (ER), multicentricity and the presence of a palpable mass before surgery were significantly associated with a low chance of BCS. Conversely, patients with small tumors and those eligible for BCS at diagnosis were managed more with BCS, independent of the treatment arm. Radiological response was not associated with the surgical decision. CONCLUSIONS Tumor characteristics before neoadjuvant therapy play a main role in deciding the type of surgery calling for a clear consensus on the role of BCS in patients responding to neoadjuvant therapy.
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Affiliation(s)
- C Criscitiello
- Division of Medical Oncology, Department of Medicine, European Institute of Oncology, Milan, Italy
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Head SJ, Kaul S, Mack MJ, Serruys PW, Taggart DP, Holmes DR, Leon MB, Marco J, Bogers AJJC, Kappetein AP. The rationale for Heart Team decision-making for patients with stable, complex coronary artery disease. Eur Heart J 2013; 34:2510-8. [PMID: 23425523 DOI: 10.1093/eurheartj/eht059] [Citation(s) in RCA: 139] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Stable complex coronary artery disease can be treated with coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), or medical therapy. Multidisciplinary decision-making has gained more emphasis over the recent years to select the most optimal treatment strategy for individual patients with stable complex coronary artery disease. However, the so-called 'Heart Team' concept has not been widely implemented. Yet, decision-making has shown to remain suboptimal; there is large variability in PCI-to-CABG ratios, which may predominantly be the consequence of physician-related factors that have raised concerns regarding overuse, underuse, and inappropriate selection of revascularization. In this review, we summarize these and additional data to support the statement that a multidisciplinary Heart Team consisting of at least a clinical/non-invasive cardiologist, interventional cardiologist, and cardiac surgeon, can together better analyse and interpret the available diagnostic evidence, put into context the clinical condition of the patient as well as consider individual preference and local expertise, and through shared decision-making with the patient can arrive at a most optimal joint treatment strategy recommendation for patients with stable complex coronary artery disease. In addition, other aspects of Heart Team decision-making are discussed: the organization and logistics, involvement of physicians, patients, and assisting personnel, the need for validation, and its limitations.
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Affiliation(s)
- Stuart J Head
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
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Lee MC, Joh JE, Chau A. Axillary Staging Prior to Neoadjuvant Chemotherapy: The Roles of Sentinel Lymph Node Biopsy and Axillary Ultrasonography. Cancer Control 2012; 19:277-285. [DOI: 10.1177/107327481201900404] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Affiliation(s)
- Marie Catherine Lee
- Comprehensive Breast Program at the H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
- Division of Oncologic Sciences at the University of South Florida, Tampa, Florida
| | - Jennifer E. Joh
- Comprehensive Breast Program at the H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
- Hoffberger Breast Center at Mercy, Mercy Medical Center, Baltimore, Maryland
| | - Alec Chau
- Diagnostic Imaging Program at the H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
- Division of Oncologic Sciences at the University of South Florida, Tampa, Florida
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Taylor C, Brown K, Lamb B, Harris J, Sevdalis N, Green JSA. Developing and testing TEAM (Team Evaluation and Assessment Measure), a self-assessment tool to improve cancer multidisciplinary teamwork. Ann Surg Oncol 2012; 19:4019-27. [PMID: 22820934 DOI: 10.1245/s10434-012-2493-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Indexed: 12/24/2022]
Abstract
BACKGROUND Cancer multidisciplinary teams (MDTs) are well established worldwide and are an expensive resource yet no standardised tools exist to measure performance. We aimed to develop and test an MDT self-assessment tool underpinned by literature review and consensus from over 2000 UK MDT members about the "characteristics of an effective MDT." METHODS Questionnaire items relating to all characteristics of MDTs (particularly Leadership and Chairing; Teamworking and Culture; Patient-centred care; Clinical decision-making process; and Organisation and administration during meetings) were developed by an expert panel. Acceptability, feasibility and psychometric properties were tested by online completion of the questionnaire by 23 MDTs from 4 UK NHS Trusts followed by interviews with 74 team members including members from all teams and nonresponders. 10 of the MDTs also completed questionnaires that directly translated each characteristic to an item (for the five domains above) to test content validity. RESULTS A total of 47 items were created, each rated for agreement on a 5-point scale. A total of 329 (52 %) of 637 team members completed the questionnaire, including representation from medical, nursing and clerical MDT members. Responses correlated well with domain-specific questionnaires (r > 0.67, p = 0.01), most domain-scales had acceptable internal consistency (Cronbach alpha > 0.60), and good item discrimination (majority of items r < 0.20). Team members were positive about its value. CONCLUSIONS Self-assessment of team performance using this tool may support MDT development.
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Affiliation(s)
- C Taylor
- Florence Nightingale School of Nursing and Midwifery, King's College London, London, England.
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139
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Kesson EM, Allardice GM, George WD, Burns HJG, Morrison DS. Effects of multidisciplinary team working on breast cancer survival: retrospective, comparative, interventional cohort study of 13 722 women. BMJ 2012; 344:e2718. [PMID: 22539013 PMCID: PMC3339875 DOI: 10.1136/bmj.e2718] [Citation(s) in RCA: 382] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/16/2012] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To describe the effect of multidisciplinary care on survival in women treated for breast cancer. DESIGN Retrospective, comparative, non-randomised, interventional cohort study. SETTING NHS hospitals, health boards in the west of Scotland, UK. PARTICIPANTS 14,358 patients diagnosed with symptomatic invasive breast cancer between 1990 and 2000, residing in health board areas in the west of Scotland. 13,722 (95.6%) patients were eligible (excluding 16 diagnoses of inflammatory cancers and 620 diagnoses of breast cancer at death). INTERVENTION In 1995, multidisciplinary team working was introduced in hospitals throughout one health board area (Greater Glasgow; intervention area), but not in other health board areas in the west of Scotland (non-intervention area). MAIN OUTCOME MEASURES Breast cancer specific mortality and all cause mortality. RESULTS Before the introduction of multidisciplinary care (analysed time period January 1990 to September 1995), breast cancer mortality was 11% higher in the intervention area than in the non-intervention area (hazard ratio adjusted for year of incidence, age at diagnosis, and deprivation, 1.11; 95% confidence interval 1.00 to 1.20). After multidisciplinary care was introduced (time period October 1995 to December 2000), breast cancer mortality was 18% lower in the intervention area than in the non-intervention area (0.82, 0.74 to 0.91). All cause mortality did not differ significantly between populations in the earlier period, but was 11% lower in the intervention area than in the non-interventional area in the later period (0.89, 0.82 to 0.97). Interrupted time series analyses showed a significant improvement in breast cancer survival in the intervention area in 1996, compared with the expected survival in the same year had the pre-intervention trend continued (P=0.004). This improvement was maintained after the intervention was introduced. CONCLUSION Introduction of multidisciplinary care was associated with improved survival and reduced variation in survival among hospitals. Further analysis of clinical audit data for multidisciplinary care could identify which aspects of care are most associated with survival benefits.
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Affiliation(s)
- Eileen M Kesson
- NHS Greater Glasgow and Clyde, West House, Gartnavel Royal Hospital, Glasgow, UK.
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