The Multidisciplinary Team (MDT) Approach and Quality of Care

Effectiveness of integrated care interventions for patients with long-term conditions: a review of systematic reviews

To examine the effectiveness of integrated care intervention (ICI) models (stand-alone or combination of self-management, discharge management, case management and multidisciplinary teams models) targeting patients with one or more chronic conditions, and to identify outcome measures/indicators of effectiveness, we conducted a systematic review of published systematic reviews and meta-analyses. Included reviews comprise ICIs targeting adult patients with one or more long-term conditions. We searched MEDLINE, CINAHL and the Cochrane Database of Systematic Reviews: 60 reviews were included in the final analysis; 28 reviews evaluated ICIs focused on self-management, 4 on case management, 10 on discharge management and 5 on multidisciplinary teams; 13 reviews assessed multiple interventions that were labelled as complex. Across all reviews, only 19 reviews included intervention with multiple ICIs. Overall, interventions with multiple components, compared with interventions with single components, were more likely to improve hospital use outcomes effectively. Clinical/lifestyle/condition-specific outcomes were more likely to be improved by self-management interventions. Outcome measures identified could be classified into three main categories: organisational, patient-centred and clinical/lifestyle/condition-specific. The findings of this review may provide inputs to future design and evaluation of ICIs.

Improving Care in Eosinophil-Associated Diseases: A Charter

Eosinophil-associated diseases (EADs) are a range of heterogeneous conditions in which eosinophils are believed to play a critical pathological role. EADs include common illnesses such as eosinophilic asthma and chronic rhinosinusitis and rare conditions such as hypereosinophilic syndromes (HES) and eosinophilic gastrointestinal disorders (EGIDs). EADs are associated with substantial burdens for the patient, including chronic, debilitating symptoms, increased financial burden, decreased health-related quality of life, and the need for repeated visits to multiple different healthcare professionals (HCPs), emergency departments, and/or hospitals. Poor EAD recognition by HCPs often contributes to delayed diagnoses, which further delays patient access to appropriate care and effective treatments, contributing to poor health outcomes. The objective of this charter is to outline key patient rights and expectations with respect to the management of their condition(s) and to set forth an ambitious action plan to improve health outcomes for patients with EADs: (1) people with EADs, their caretakers, HCPs, and the public must have greater awareness and education about EADs; (2) people with EADs must receive a timely, accurate diagnosis; (3) all people with EADs must have access to an appropriate multidisciplinary team, when necessary; and (4) people with EADs must have access to safe and effective treatment options without unnecessary regulatory delays. The principles described in this charter demonstrate the core elements of quality care that people with EADs must receive, and they represent clear steps by which to reduce patient and caregiver burden and improve patient outcomes. We urge HCPs, healthcare systems, and policymakers worldwide to swiftly adopt these principles to ensure patients with EADs have an accurate diagnosis in a timely manner and access to high-level care and treatment in an appropriate setting.

Diet and exercise advice and referrals for cancer survivors: an integrative review of medical and nursing perspectives

Purpose

To examine the perspectives of medical and nursing health professionals concerning their roles and responsibilities in providing dietary and exercise advice to cancer survivors, and referrals to allied health professionals.

Methods

An integrative review. PubMed, CINAHL, PsycINFO, Embase, Web of Science databases, and bibliographies of relevant studies were searched from December 2011 to June 2021. All studies were eligible for inclusion. The Mixed-Methods Appraisal Tool (MMAT) was used to critically appraise included studies. Data were extracted and synthesised regarding the perspectives of medical and nursing health professionals on their roles, responsibilities, barriers, and facilitators.

Results

Twenty-one studies involving 3401 medical and nursing health professionals and 264 cancer survivors of diverse cancer types were included. Ten quantitative, nine qualitative, and two mixed-methods studies were eligible. All included studies met at least 80% of the quality criteria in the MMAT. Major findings include the following: (1) medical and nursing health professionals were unclear on their roles in providing dietary and exercise advice to cancer survivors but agreed they play a key role in referrals to dietitians and exercise professionals; (2) most cancer survivors valued the involvement of their general practitioner when receiving dietary and exercise advice.

Conclusion

Although medical and nursing health professionals understand that referrals to allied health professionals form part of their role, there is a lack of clarity regarding their roles to provide dietary and exercise advice to cancer survivors. Future studies should address barriers and facilitators of dietary and exercise advice and referral by medical and nursing health professionals.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00520-022-07152-w.

Decision Support for Oropharyngeal Cancer Patients Based on Data-Driven Similarity Metrics for Medical Case Comparison

Making complex medical decisions is becoming an increasingly challenging task due to the growing amount of available evidence to consider and the higher demand for personalized treatment and patient care. IT systems for the provision of clinical decision support (CDS) can provide sustainable relief if decisions are automatically evaluated and processed. In this paper, we propose an approach for quantifying similarity between new and previously recorded medical cases to enable significant knowledge transfer for reasoning tasks on a patient-level. Methodologically, 102 medical cases with oropharyngeal carcinoma were analyzed retrospectively. Based on independent disease characteristics, patient-specific data vectors including relevant information entities for primary and adjuvant treatment decisions were created. Utilizing the ϕK correlation coefficient as the methodological foundation of our approach, we were able to determine the predictive impact of each characteristic, thus enabling significant reduction of the feature space to allow for further analysis of the intra-variable distances between the respective feature states. The results revealed a significant feature-space reduction from initially 19 down to only 6 diagnostic variables (ϕK correlation coefficient ≥ 0.3, ϕK significance test ≥ 2.5) for the primary and 7 variables (from initially 14) for the adjuvant treatment setting. Further investigation on the resulting characteristics showed a non-linear behavior in relation to the corresponding distances on intra-variable level. Through the implementation of a 10-fold cross-validation procedure, we were further able to identify 8 (primary treatment) matching cases with an evaluation score of 1.0 and 9 (adjuvant treatment) matching cases with an evaluation score of 0.957 based on their shared treatment procedure as the endpoint for similarity definition. Based on those promising results, we conclude that our proposed method for using data-driven similarity measures for application in medical decision-making is able to offer valuable assistance for physicians. Furthermore, we consider our approach as universal in regard to other clinical use-cases, which would allow for an easy-to-implement adaptation for a range of further medical decision-making scenarios.

Repair of a postaural fistula with a suprafascial radial forearm free flap

We describe the case of a patient with the rare complication of a chronic postaural fistula following repeated and extensive surgery and adjuvant radiotherapy to the head and neck for a pleomorphic adenoma of the parotid gland. This case demonstrates the importance and value of thorough preoperative planning for major head and neck reconstruction, particularly if the area for reconstruction has distorted anatomy due to prior treatment or damage. In complex free flap reconstruction, it is important to investigate the recipient site with the help of arteriography and give due consideration to the donor site and its postoperative management. We highlight the importance of multidisciplinary work for the care of these patients not only intraoperatively, but also in the preoperative planning stage, and perhaps most importantly in the postoperative care.

Management of elderly patients with head and neck cancer

There are no established guidelines for managing older patients with head and neck cancer. Most clinical trials that define current standard therapy included few elderly patients. On the other hand, there is great variability in patients' comorbidities, physical functions, cognitive function, familial and financial background and values. The key point appears to be appropriate geriatric assessment, clarifying the patients' outcomes and a multidisciplinary team approach, including the treatment decision-making policy. Although these processes should be scientific in nature, the evidence for the treatment of elderly head and neck patients is very limited. This review summarizes the evidence available regarding the management of geriatric assessment, each treatment modality and the multidisciplinary team approach for older patients with head and neck cancers.

Thyroid surgery outcomes at a children's hospital: The value of a multidisciplinary team approach

BACKGROUND

Our purpose is to describe the structure, function and outcomes of our multidisciplinary pediatric thyroid program and to evaluate our experience in comparison to other high-volume centers.

METHODS

We reviewed all thyroid operations performed 10/2012 through 09/2019, and examined number of cases per year, patient demographics, procedures, final diagnoses and results. Primary outcomes were hypoparathyroidism and recurrent laryngeal nerve (RLN) injury at 12 months. Data were analyzed using descriptive statistics and univariate analyses.

RESULTS

We performed 294 thyroid operations on 279 patients. Seventy-nine percent were female. Median age was 15 years (IQR: 12-17). Operations included total thyroidectomy (65%), lobectomy (30%) and completion thyroidectomy (5%). Most common diagnoses were Graves' disease (35%), malignancy (29%), and benign nodule (20%). We developed an evidence-based clinical pathway and conducted weekly multidisciplinary meetings. A clinical data specialist reviewed process and outcome measures routinely. Overall, 6 patients (2.0%) had hypoparathyroidism and 2 (0.7%) had unilateral RLN injury at 12 months. Two of the patients with clinical suspicion of permanent hypoparathyroidism were ultimately weaned off calcium. Both patients with RLN injury had extensive locally advanced malignant disease involving the nerve.

CONCLUSIONS

Our multidisciplinary team achieved excellent long-term outcomes for pediatric thyroid surgery comparable to other high-volume pediatric and adult centers.

A Review of Web-Based Nutrition Information in Spanish for Cancer Patients and Survivors

Nutrition education resources are of interest for cancer patients and survivors throughout the cancer continuum. We examined the web-based nutrition information in Spanish for cancer patients and survivors provided by national cancer organizations (NCOs). The Guide to Internet Resources for Cancer and the membership list of the Union for International Cancer Control were searched to identify the NCOs. The International Patients Decisions Aid Standards (IPDAS) was used to describe the quality of the available information. We identified 20 NCOs that provided nutrition information aimed at a general audience on their websites. Web-based resources of nine NCOs were selected for presentation in this review. Website scores ranged between 20 and 24 in the IPDAS scale (maximum score = 31). The selected NCOs offered reliable and safe information. Healthy eating information for cancer patients and management of side-effects was provided by all websites. Information was more limited for cancer survivors. We recommend that NCOs increase the possibilities for personalized recommendations and interaction with the content by including instrumental tools on their websites.

Oral Facial Manifestations of Sanjad-Sakati Syndrome: A Literature Review

Aim: To perform a comprehensive review of orofacial manifestations of Sanjad–Sakati syndrome (SSS). Methods: A comprehensive electronic literature search was performed using PubMed, Scopus and Cochrane library databases. The search keywords included were “Sanjad–Sakati syndrome (SSS)”, “dental manifestations”, “dental management”, “oral health”, “dental care for patients with SSS”, “dental health of people with SSS”, “caries”, and “oral hygiene”. The inclusion criteria were papers published only in English, papers published by August 2021, and papers discussing orofacial manifestations of SSS and language. Results: The search of the databases retrieved eleven case reports and three case series studies. Overall, 56 cases (11 case reports and 3 case series studies) were reported on Sanjad–Sakati syndrome in the published literature. The majority of the reports are from the Middle Eastern region. Conclusions: The reported orofacial manifestations of SSS include beaked nose, depressed nasal bridge, enamel hypoplasia, hypodontia, low-set ears, posteriorly rotated ears, deep-set eyes, microcephaly, microdontia, micrognathia, prominent forehead, retrognathia, and thin lips. The review paper also establishes the importance of the dental under general anesthesia in SSS individuals.

Strategies for Improving Access to Cancer Services in Rural Communities: A Pre-implementation Study

Background

Implementation science is defined as the scientific study of methods and strategies that facilitate the uptake of evidence-based practice into regular use by practitioners. Failure of implementation is more common in resource-limited settings and may contribute to health disparities between rural and urban communities. In this pre-implementation study, we aimed to (1) evaluate barriers and facilitators for implementation of guideline-concordant healthcare services for cancer patients in rural communities in Upstate New York and (2) identify key strategies for successful implementation of cancer services and supportive programs in resource-poor settings.

Methods

The mixed methods study was guided by the Consolidated Framework for Implementation Research (CFIR). Using engagement approaches from Community-Based Participatory Research, we collected qualitative and quantitative data to assess barriers and facilitators to implementation of rural cancer survivorship services (three focus groups, n = 43, survey n = 120). Information was collected using both in-person and web-based approaches and assessed attitude and preferences for various models of cancer care organization and delivery in rural communities. Stakeholders included cancer survivors, their families and caregivers, local public services administrators, health providers, and allied health-care professionals from rural and remote communities in Upstate New York. Data was analyzed using grounded theory.

Results

Responders reported preferences for cross-region team-based cancer care delivery and emphasized the importance of connecting local providers with cancer care networks and multidisciplinary teams at large urban cancer centers. The main reported barriers to rural cancer program implementation included regional variation in infrastructure and services delivery practices, inadequate number of providers/specialists, lack of integration among oncology, primary care and supportive services within the regions, and misalignment between clinical guideline recommendations and current reimbursement policies.

Conclusions

Our findings revealed a unique combination of community, socio-economic, financial, and workforce barriers to implementation of guideline-concordant healthcare services for cancer patients in rural communities. One strategy to overcome these barriers is to improve provider cross-region collaboration and care coordination by means of teamwork and facilitation. Augmenting implementation framework with provider team-building strategies across and within regions could improve rural provider confidence and performance, minimize chances of implementation failure, and improve continuity of care for cancer patients living in rural areas.

Temporal Changes of Metabolic Indicators and Quality of Life by a Two-Day Patient Education Program for Metabolic Syndrome Patients

Metabolic syndrome (MetS) is a disease with a high prevalence that threatens the health of modern people. Patient education is essential to control MetS. This prospective study aimed to evaluate 6-month changes in health indicators following a two-day education program for patients with MetS aged 45 or older. Education about MetS, lifestyle modification, nutrition, and physical activity was provided. At 3 and 6 months after the program, participants visited for follow-up. Twenty-two patients completed the 6-month study. Waist circumference was reduced, and life quality and depression index improved in 3 and 6 months compared to pre-education. Blood pressure decreased, and anxiety index improved at three months. Nutritional knowledge was well maintained for 3 and 6 months. High-density lipoprotein-cholesterol levels increased at six months. Three out of twenty-two patients did not satisfy MetS criteria at the end of the study due to improved indicators. A two-day multidisciplinary education program positively affected health indicators in MetS patients. Participation in the program also help with life satisfaction and positive emotional condition. However, some indicators improved in 3 months, but the effect disappeared 6 months after the program.

Setup of multidisciplinary team discussions for patients with cholangiocarcinoma: current practice and recommendations from the European Network for the Study of Cholangiocarcinoma (ENS-CCA)

BACKGROUND

Cholangiocarcinomas (CCAs) are a rare group of malignancies characterized by dismal prognosis. There are currently no standardized guidelines for multidisciplinary teams (MDTs) in CCAs.

MATERIAL AND METHODS

An online survey was built with the aim of defining the current practice of MDTs in CCAs and identifying possible areas of improvement, providing minimum standards of practice for an ideal CCA MDT. Analysis of the replies regarding current and ideal MDT practice was carried out by calculating weighted average (WA) of likelihood of every item. The survey was shared with members of the European Network for the Study of Cholangiocarcinoma and other medical centers with expertise in biliary tract cancer part of the EURO-CHOLANGIO-NET (European Cholangiocarcinoma Network: https://eurocholangionet.eu/) COST Action CA18122 initiative.

RESULTS

The role of the MDT coordinator was a recognized priority in an ideal well-functioning MDT (WA 3.31/4), together with providing minimum clinical information before the meeting to secure adequate case preparation (WA 3.54/4). Optimal frequency of MDT meetings was weekly according to 76.92% of the participants; 73.06% believed that ideally all newly diagnosed patients and each new treatment should be discussed, although that happened only in less than half of the MDTs (46.15%) in current practice. Most participants stated that they always (46.15%) or often (50.00%) used guidelines, mainly international (61.00%) (European and American), followed by national/local (39.00%). We defined the ideal setup of a CCA MDT, identifying specialists whose presence is mandatory with WA >3.0 (oncologist, clinician responsible for patient's care, surgeon, diagnostic and interventional radiologist, hepatologist, pathologist, endoscopist and gastroenterologist) and those whose presence would be recommended with a WA <3.0 (palliative care, nurse, dietitian, basic researcher, psychologist and social worker).

CONCLUSIONS

Our identified minimum requirements should be taken into account at the time of CCA MDT setup and quality assessment.

The neuropalliative multidisciplinary team-Members and their roles

Neurodegenerative conditions are prominent contributors to both morbidity and mortality worldwide. They pose a significant challenge to health professionals, health systems, and the often unpaid, untrained family members and carers. The many and varied challenges encountered are best managed by a multidisciplinary neuropalliative team, as it is impossible for a single clinician to possess and deliver the wide range of skills and services required to optimally care for these patients. This chapter discusses the assembly, maintenance, and care of such a team, as well as potential difficulties and solutions in domains such as funding, training, geographical remoteness, as well as the potential lack of awareness and acceptance by colleagues. A comprehensive description of the role of all possible team members is discussed. The chapter outlines the concept, content, and potential benefits of a multidisciplinary team in neuropalliative care. Its thesis is twofold: that multidisciplinary care is vital and, second, that the sum of the whole of a team can be greater than the individual parts with respect to organization, planning, experience, and creativity of approach. With all these factors considered, and implemented wherever possible, we may all move closer to optimizing the comfort and care of our shared neuropalliative patients.

IMPROVING CLINICAL MANAGEMENT OF PATIENTS WITH THYROID CANCER

OBJECTIVE

The aim: Obtaining evidence for an interdisciplinary approach to the clinical management of patients with thyroid cancer, identifying weak areas and justifying opportunities for improvement.

PATIENTS AND METHODS

Materials and methods: Data from 410 medical records of inpatients with thyroid cancer and 17 units of formalized documents of the health care facility where the study was conducted. Methods: statistical, graphic, comparative analysis, descriptive modeling, generalization.

RESULTS

Results: Patients' need for interdisciplinary care were determined by cancer itself and by the presence of 234 cases of accompanying pathologies and complications in 147 (35.9%) patients. Interdisciplinary interaction is positioned as the provision of medical care by the medical staff of the unit where the patient stays and receives expert care. Treatment planning is carried out through the advisory participation of physicians of different specialties, rather than multidisciplinary consensus. Clinical management of the patient and discharge are carried out by the attending physician. Clinical pathways are designed for the department where the patient is hospitalized. Opportunities for pre- and postoperative rehabilitation are not used. Interaction with primary and secondary care facilities is limited.

CONCLUSION

Conclusions: The key directions of improving the clinical management of patients with thyroid cancer are identified: to improve the patient's clinical path, to strengthen interdisciplinary interaction of specialists through the use of digital technologies, to make clinical decision through the multidisciplinary consensus.

What Do We Know About Teamwork in Chinese Hospitals? A Systematic Review

Background and Objective: Improving quality of care is one of the primary goals in current Chinese hospital reforms. Teamwork can play an essential role. Characteristics of teamwork and interventions for improving teamwork in hospitals have been widely studied. However, most of these studies are from a Western context; evidence from China is scarce. Because of the contextual differences between China and Western countries, empirical evidence on teamwork from Western hospitals may have limited validity in China. This systematic review aims to advance the evidence base and understanding of teamwork in Chinese hospitals. Methods: Both English (i.e., Embase, Medline, and Web of Science) and Chinese databases (i.e., CNKI, CQVIP, and Wanfang) were searched for relevant articles until February 6, 2020. We included the studies that empirically researched teamwork in Chinese hospitals. Studies were excluded if they (1) were not conducted in hospitals in Mainland China, (2) did not research teamwork on team interventions, (3) were not empirical, (4) were not written in English or Chinese, (5) were not published in peer-reviewed journals, and (6) were not conducted in teams that provide direct patient care. Both deductive and inductive approaches were used to analyze data. The Mixed Methods Appraisal Tool (MMAT) was used to assess their methodological quality. Results: A total of 70 articles (i.e., 39 English articles and 31 Chinese articles) were included. The results are presented in two main categories: Teamwork components and Team interventions. The evidence regarding the relationships among inputs, processes, and outcomes is scarce and mostly inconclusive. The only conclusive evidence shows that females perceive better team processes than males. Similar types of training and tools were introduced as can be found in Western literature, all showing positive effects. In line with the Chinese health reforms, many of the intervention studies regard the introduction of multidisciplinary teams (MDTs). The evidence on the implementation of MDTs reveals that they have led to lower complication rates, shorter hospital stays, higher diagnosis accuracy, efficiency improvement, and a variety of better disease-specific clinical outcomes. Evidence on the effect on patient survival is inconclusive. Conclusion: The Chinese studies on teamwork components mainly focus on the input-process relationship. The evidence provided on this relationship is, however, mostly inconclusive. The intervention studies in Chinese hospitals predominantly focus on patient outcomes rather than organizational and employee outcomes. The introduction of training, tools, and MDTs generally shows promising results. The evidence from primary hospitals and rural areas, which are prioritized in the health reforms, is especially scarce. Advancing the evidence base on teamwork, especially in primary hospitals and rural areas, is needed and can inform policy and management to promote the health reform implementation. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020175069, identifier CRD42020175069.

Psychosocial Adjustments after Advanced Laryngeal Cancer Treatment - A Systematic Review

Psychosocial adjustments are alterations needed by a person after a life-altering event. The present review explored the psychosocial adjustments after advanced laryngeal cancer treatment. Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, PubMed and Scopus were searched. Two hundred and three hits, after the three-stage screening, 13 articles were included. Mixed methods appraisal tool was used to perform the quality appraisal. The findings from 1109 laryngeal cancer survivors and 154 spouses of total laryngectomy patients helped to identify the barriers and coping mechanism toward psychosocial adjustments. The barriers included reactions of spouse or family members, effect of voice, communication and speech intelligibility and work and family relationships. The coping was enhanced with a better awareness, motivation and support system. These findings would help in improving the training programs and enhance the pre- and post-treatment counselling based on the priorities and demands of the patient.

Physicians' Knowledge of Clinical Nutrition Discipline in Riyadh Saudi Arabia

Background: Nutrition plays a major role in the prevention and management of diet-related disease. With the absence of clinical nutrition dietitians, physicians are considered responsible for prescribing nutritional support. Identifying weaknesses in nutritional knowledge among Saudi physicians may provide guidance to improve their nutritional knowledge. Methods: A cross-sectional study that used an anonymous electronic questionnaire to investigate physicians’ knowledge of the clinical nutrition discipline. In addition to demographics, the questionnaire consisted of 15 questions covering six areas in the clinical nutrition discipline (macro- and micronutrients, nutrition and chronic diseases, nutrition and metabolic diseases, nutrition care process, nutrition support therapy, and research). For continuous variables, independent t-tests and one-way ANOVA were used. Results: A total of 332 had completed the questionnaire and were included in the study. Most of the physicians were Saudi (87%), male (73.5%), aged between 26 and 35 years (63.3%), and without health problems (56.3%). The mean score of the physicians’ knowledge was 5.3 ± 1.97 out of 15. Physicians who reported that they received some sort of nutritional training or course (M = 5.57, SD = 2.08) scored significantly more than physicians who did not (M = 5.10, SD = 1.86); t(330) = −2.174, p = 0.30. Conclusions: Nutrition should be reinforced as an important component of continuing medical education. There is a need for hiring more dietitians in health care settings in Saudi Arabia as an integral part of a multidisciplinary team delivering medical care services.

To Tweet or Not to Tweet: A Longitudinal Analysis of Social Media Use by Global Diabetes Researchers

BACKGROUND

Engaging influential stakeholders in meaningful exchange is essential for pharmaceutical companies aiming to improve care. At a time where opportunities for face-to-face engagement are limited, the ability to interact, learn and generate actionable insights through digital channels such as Twitter, is of considerable value.

AIM

The aim of this study was to evaluate digital engagement among global diabetes mellitus researchers.

MATERIALS AND METHODS

We identified every global tweet (20,614,515) and scientific publication (44,135) regarding diabetes mellitus from 1 August 2018 to 1 August 2020. Through author matching we combined datasets, resulting in a list of digitally active scientific authors. Generalised linear modelling identified factors predicting their digital engagement.

FINDINGS

Globally, 2686 diabetes researchers used Twitter to discuss the management of diabetes mellitus, posting 110,346 diabetes-related tweets. As Twitter followers increased, so did tweet frequency (p < 0.001), retweets (p < 0.001) and replies (p < 0.001) to their content. Publication count (overall/per month) and proportion of first/last authorships were unrelated to tweet frequency and the likelihood of being retweeted or replied to (p > 0.05). Those with the most  academic co-authors were significantly less likely to tweet than those with smaller networks (< 50; p = 0.001). Finally, those publishing most frequently on specific themes, including insulin (p = 0.041) and paediatrics (p < 0.001), were significantly more likely to tweet about these themes.

CONCLUSION

Academic expertise and seniority cannot be assumed as proxies for digital influence. Those aiming to promote science and obtain digital insights regarding condition management should consider looking beyond well-known 'key opinion leaders' to perhaps lesser known 'digital opinion leaders' with smaller academic networks, who are likely to specialise in the delivery of highly specific content to captive audiences.

Head and neck cancers: Monitoring quality and reporting outcomes

INTRODUCTION

Head and neck cancers (HNC) require high level multidisciplinary care to achieve optimal outcomes. Reporting of quality indicators (QIs) has been instigated by some health services in an effort to improve quality of care. The aim of this study was to determine the quality of care provided to patients with HNC at a single institution by analysing compliance with QIs and to explore the feasibility and utility of collecting this data.

METHODS

This was a single institution retrospective chart review of all patients with squamous cell HNC at Townsville Hospital who were treated with curative intent between June 2011 and June 2019. Data was entered into a RedCap database and then exported to Stata V16 for analysis.

RESULTS

A total of 537 patients were included in the overall study, with six patients who had a synchronous non-HNC and two patients who received previous radiotherapy (RT) to the head and neck region excluded from the outcome analysis. Overall, compliance with pre-treatment, treatment and post-treatment QIs was high, with the exception of smoking cessation support (66%), post-treatment dental review and time to post-operative RT (33% of patients within 6 weeks). The 5-year overall survival was 69.4% (CI; 64-73.2%). The cumulative incidence of locoregional relapse for the overall study cohort was 18% (CI; 14.8-21.4%).

CONCLUSION

Collecting and evaluating quality metrics is feasible and helps identify areas for improvement. Centres treating HNC patients should strive towards monitoring quality against benchmarks and demonstrate transparency in outcome data.

Fanconi anemia and hematopoietic stem cell transplant as risk factors for oral squamous cell carcinoma: A case report with a 12-year follow-up

Fanconi anemia is a rare disorder resulting from defects in genes responsible for DNA damage responses. It is characterized by congenital anomalies, aplastic anemia, and a predisposition to cancer. Currently, hematopoietic stem cell transplant (HSCT) is the only curative treatment available for bone marrow failure; however, HSCT increases oral squamous cell carcinoma (OSCC) risk. Here we report the case of a patient diagnosed with Fanconi anemia in childhood who was treated with HSCT and later diagnosed with multiple OSCCs during a 12-year follow-up. Despite multiple surgical interventions and radiotherapy regimens, the patient`s health deteriorated. Management of individuals with Fanconi anemia is challenging and must be provided by a multidisciplinary healthcare team to ensure better staging, treatment planning, and coordination.

Quality indicators and excellence requirements for a multidisciplinary lung cancer tumor board by the Spanish Lung Cancer Group

Multidisciplinary care is needed to decide the best therapeutic approach and to provide optimal care to patients with lung cancer (LC). Multidisciplinary teams (MDTs) are optimal strategies for the management of patients with LC and have been associated with better outcomes, such as an increase in quality of life and survival. The Spanish Lung Cancer Group has promoted this review about the current situation of the existing national LC-MDTs, which also offers a set of excellence requirements and quality indicators to achieve the best care in any patient with LC. Time and sufficient resources; leadership; administrative and institutional support; and recording of activity are key factors for the success of LC-MDTs. A set of excellence requirements in terms of staff, resources and organization of the LC-MDT have been proposed. At last, a list of quality indicators has been agreed to achieve and measure the performance of current LC-MDTs.

The role of the medical oncologist in the holistic care of patients with cancer in the Philippines

In the past decade, cancer care in the Philippines has advanced in response to the complex heterogeneity inherent to the disease and the constantly increasing number of patients. Central to this development is the increased awareness and universal acceptance of the multidisciplinary team (MDT) approach in providing cancer care to optimize outcomes where medical oncologists play a vital role. This position paper summarizes the unique and multifaceted roles of the medical oncologist in ensuring that the best possible care is given to patients with cancer by actively participating in the whole spectrum of the patient’s journey—from diagnosis, treatment, supportive care, until providing palliative care and addressing end-of-life issues

Ibero-American Expert Consensus on Squamous Cell Carcinoma of the Head and Neck Treatment in Patients Unable to Receive Cisplatin: Recommendations for Clinical Practice

Cisplatin is the standard of treatment for squamous cell carcinoma of the head and neck (SCCHN) that has demonstrated efficacy, either in locally advanced disease when combined with radiotherapy at high doses, or in metastatic/recurrent disease when combined with other agents. However, the usual toxicities related to cisplatin, such as neurotoxicity, nephrotoxicity, ototoxicity, and hematologic toxicities, especially when high doses have been administered, have important implications in the patients' quality of life. The decision to administer cisplatin depends on several patient factors, such as age, performance status, weight loss, comorbidities, previous toxicities, chronic viral infection, or even the current SARS-CoV-2 pandemic. In order to establish recommendations for the management of patients with SCCHN, a group of experts in medical and radiation oncology from Spain and Latin-American discussed how to identify patients who are not candidates for cisplatin to offer them the most suitable therapeutic alternative.

Eliciting Preferences of Providers in Primary Care Settings for Post Hospital Discharge Patient Follow-Up

Background: Post-hospital discharge follow-up has been a principal intervention in addressing gaps in care pathways. However, evidence about the willingness of primary care providers to deliver post-discharge follow-up care is lacking. This study aims to assess primary care providers’ preferences for delivering post-discharge follow-up care for patients with chronic diseases. Methods: An online questionnaire survey of 623 primary care providers who work in a hospital group of southeast China. Face-to-face interviews with 16 of the participants. A discrete choice experiment was developed to elicit preferences of primary care providers for post-hospital discharge patient follow-up based on six attributes: team composition, workload, visit pattern, adherence of patients, incentive mechanism, and payment. A conditional logit model was used to estimate preferences, willingness-to-pay was modelled, a covariate-adjusted analysis was conducted to identify characteristics related to preferences, 16 interviews were conducted to explore reasons for participants’ choices. Results: 623 participants completed the discrete choice experiment (response rate 86.4%, aged 33 years on average, 69.5% female). Composition of the follow-up team and adherence of patients were the attributes of greatest relative importance with workload and incentives being less important. Participants were indifferent to follow-up provided by home visit or as an outpatient visit. Conclusion: Primary care providers placed the most importance on the multidisciplinary composition of the follow-up team. The preference heterogeneity observed among primary care providers suggests personalized management is important in the multidisciplinary teams, especially for those providers with relatively low educational attainment and less work experience. Future research and policies should work towards innovations to improve patients’ engagement in primary care settings.

Analysis of referrals to the stomatology service in a Southern Brazilian hospital: a retrospective study

This paper intends to describe the demand for referrals to the stomatology service requested by the medical teams for inpatients in a reference hospital in the south of Brazil. This research is a retrospective cross-sectional descriptive study focusing on data collection and assessment of information about referrals to the stomatology unit carried out from January 2008 to December 2018. All information was obtained from the hospital management software database, then transferred and analyzed individually for descriptive statistics. A total of 4433 cases were referred to the stomatology team, with an average of 403 cases by year. Hematology/hemato-oncology (37.3%) was the specialty asking for the majority of the referrals, followed by Oncology (20.4%) and Pneumology (8.2%). The mean patients' profile was males (55.5%), receiving a diagnosis of oral mucositis (43.5%), and with the first and second decades of life being the most prevalent ones (34.9%), with a mean age of 34.8±22.3 years. The most common treatment performed by the stomatology team was the photobiomodulation therapy (44.8%). This retrospective study demonstrated the important profile of the stomatological care in hospitalized patients from a specific hospital, especially referred by the hematology/hemato-oncology team. These results evidenced the importance of the stomatology specialty in the hospital environment.

Prophylactic gastrostomy in locally advanced head and neck cancer: results of a national survey among radiation oncologists

BACKGROUND

Nutritional complications in patients with locally advanced head and neck cancer (LA-HNC) treated by concurrent chemoradiotherapy (CCRT) often lead to placement of a prophylactic gastrostomy (PG) tube, while indication lacks harmonization. Our aim was to explore the current PG tube utilization among Belgian radiation oncology centers.

METHODS

A survey was distributed to all 24 Belgian Radiation oncology departments, with questions about the number of patient treated per year, whether the PG indication is discussed at the multidisciplinary board, placement technique, time of starting nutrition and removal, its impact on swallowing function and importance of clinical factors. For the latter Relative Importance and Discordance Indexes were calculated to describe the ranking and agreement.

RESULTS

All 24 centers submitted the questionnaire. Twenty three treat more than 20 head and neck (HNC) patients per year, while four (1 in 21-50; 3 in 51-100) are not discussing the gastrostomy tube indication at the multidisciplinary board. For the latter, endoscopic placement (68%) is the dominant technique, followed by the radiologic (16%) and laparoscopic (16%) methods. Seventy-five percent start the enteral nutrition when clinically indicated, 17% immediately and 8% from the start of radiotherapy. Majority of specialists (19/24) keep the gastrostomy tube until the patient assume an adequate oral feeding. Fifteen centres are considering PG decrease swallowing function. Regarding factors and their importance in the decision for the PG, foreseen irradiated volume reached highest importance, followed by 'anatomical site', 'patients' choice' and 'postoperative versus definitive' and 'local expertise', with decreasing importance respectively. Disagreement indexes showed moderate variation.

CONCLUSIONS

The use of a PG tube for LAHNC patients treated by CCRT shows disparity at national level. Prospective studies are needed to ensure proper indication of this supportive measure.

An Overview on Patient-Centered Clinical Services

Drug-related problems (DRPs) had often been a concern in the system that needed to be detected, avoided, and addressed as soon as possible. The need for a clinical pharmacist becomes even more important. He is the one who can not only share the load but also be an important part of the system by providing required advice. They fill out the patient's pharmacotherapy reporting form and notify the medical team's head off any drug-related issues. General practitioners register severe adverse drug reactions (ADRs) yearly. As a result of all of this, a clinical pharmacist working in and around the healthcare system is expected to advance the pharmacy industry. Its therapy and drugs can improve one's health quality of life by curing, preventing, or diagnosing a disease, sign, or symptom. The sideshows, on the other hand, do much harm. Because of the services they offer, clinical pharmacy has grown in popularity. To determine the overall effect and benefits of the emergency department (ED) clinical pharmacist, a systematic review of clinical practice and patient outcomes will be needed. A clinical pharmacist's anatomy, toxicology, pharmacology, and medicinal chemistry expertise significantly improves a patient's therapy enforcement. It is now important to examine the failure points of healthcare systems as well as the individuals involved.

Trends in health-related quality of life of female breast cancer survivors using the Medical Expenditure Panel Survey (MEPS), 2008-2016

PURPOSE

In recent years, breast cancer detection and treatment have advanced. As a result, increased attention to breast cancer survivorship should have improved their health-related quality of life (HRQoL). Our aim was to examine the trends in the HRQoL of female breast cancer survivors between 2008 and 2016, to determine whether or not the increased focus on survivorship has translated into improved HRQoL. Furthermore, stratified analyses were conducted by race/ethnicity and age group and these were compared to a similar group of women without a breast cancer history.

METHODS

Repeated cross-sectional analyses using the Medical Expenditure Panel Survey between 2008 and 2016 were conducted. Pooled ordinary least squares (OLS) regression was used to examine the trends in physical component scores (PCS-12) and mental component scores (MCS-12) among breast cancer survivors and a similar population of women without a breast cancer history. Analyses stratified by race/ethnicity and age group were also conducted.

RESULTS

Among breast cancer survivors, after adjusting for confounders, there was no change in PCS-12 scores over time, but the MCS-12 scores increased by 0.27 points (95% CI 0.09-0.45). Those without a history of breast cancer had mean PCS-12 scores that were 0.13 points greater each year (95% CI 0.02-0.24) while their mean MCS-12 scores were 0.10 (95% CI 0.00-0.21) points greater each year. After stratifying by race/ethnicity, Hispanic breast cancer survivors had a small increase in PCS-12 (β: 0.65; 95% CI 0.01-1.29), and MCS-12 scores (β: 0.70; 95% CI 0.06-1.33) over time. Similar small effects were found when stratified by age group, both among breast cancer survivors and those without a history of breast cancer. The younger age group (< 50 years) reported poorer MCS-12 than the older population (age 50 years and above).

CONCLUSION

Our study generated findings showing the trends in the HRQoL of breast cancer survivors and compared these to a similar population of women without a history of breast cancer. This paper highlights the importance of focusing on the mental health of young breast cancer survivors to improve their prospects at a good quality of life post-breast cancer diagnosis and treatment.

Using multi-disciplinary teams to treat obese patients helps improve clinical efficacy: the general practitioner's perspective

OBJECTIVE

This paper aims to explore the influences of multi-disciplinary teams (MDT) from the general practitioner's (GP's) perspective on the clinical efficacy of treating obese patients.

METHODS

Admitted to our hospital from January 2018 to October 2019, 127 obese patients were divided into two groups based on the different models of diagnosis and treatment each underwent. The routine diagnostic and treatment model was administered to the patients in the control group (60 cases), and the MDT model was administered to the patients in the research group (67 cases). The weight loss success rates in both groups were observed. Before and after the treatment, the blood glucose, blood lipid, tumor necrosis factor-α (TNF-α), adiponectin (APN), leptin (LP), and recombinant human fibroblast growth factor 21 (FGF-21) levels were measured. The SAS and SDS scores were evaluated.

RESULTS

After the treatment, the weight loss success rate in the research group was significantly higher than it was in the control group, and the FPG and the 2hPBG levels were significantly lower in the research group. Compared with the control group, the TC, TG, and LDL-C levels were remarkably lower in the study group, and the HDL-C levels were remarkably higher in the research group. The TNF-α, LP, and FGF-21 levels were significantly lower in the research group, and the APN levels were significantly higher. The research group had significantly lower SAS and SDS scores and higher GSES scores.

CONCLUSION

MDTs from the GP's perspective are conducive to increasing the weight loss success rate and improving the blood glucose, blood lipid and adipokine levels in obese patients.

Tagraxofusp Treatment: Implications for Patients With Blastic Plasmacytoid Dendritic Cell Neoplasm

BACKGROUND

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare, clinically aggressive, and often fatal hematologic malignancy. BPDCN is not a new entity, but it has been renamed and reclassified, which, in part, contributes to it being underrecognized. In 2018, tagraxofusp became the first U.S. Food and Drug Administration-approved therapy for BPDCN.

OBJECTIVES

This article aims to educate oncology nurses about tagraxofusp's dosing regimen, side effects, and how to manage patients undergoing treatment in inpatient and outpatient settings.

METHODS

The authors reviewed content related to the safety and clinical management of tagraxofusp, as well as content that supports patient and provider education.

FINDINGS

Capillary leak syndrome (CLS) is the most serious adverse event reported with tagraxofusp; therefore, nurses should stop tagraxofusp administration until all CLS-related symptoms have resolved. Hypersensitivity reactions and hepatotoxicity have also been observed in patients treated with tagraxofusp and should be monitored during treatment cycles.

Quality of life, coping strategies, and supportive care needs in head and neck cancer survivors: a qualitative study

PURPOSE

The purpose of this qualitative study was to better understand the lived experience of head and neck cancer (HNC) survivors between 6 months to 9 years post-radiation. Quality of life, coping strategies, concerns for the future, and preferences for supportive care were explored.

METHODS

Semi-structured interviews were conducted in 31 HNC survivors from a Midwestern hospital. Interviews were recorded, transcribed verbatim and analyzed using qualitative thematic analysis.

RESULTS

Survivors described restrictions on daily living, social eating, and financial concerns. Despite these restrictions, survivors reported an overall high mentality and enjoyment of life. Coping considerations included adapting to a new normal and increased involvement in cancer support and faith groups. Preferences for supportive care included receiving more information about and being more involved in the treatment care plan, referrals to therapy and support groups, and more comprehensive follow-up in survivorship.

CONCLUSIONS

While long-term HNC survivors adapt to daily living restrictions, a high proportion continue to have unmet needs. This data can guide the development of HNC survivorship interventions to inform optimal clinical guidelines based on patients' perceived needs. This qualitative study uncovered distinct perceived needs of HNC survivors which can inform future service development. Incorporating referrals to supportive care services including speech language pathologist, physical therapists, and dietitians into the standard of care before, during, and after treatment would assist survivors in adapting to life after treatment and managing long-term health consequences of their disease.

ESMO Management and treatment adapted recommendations in the COVID-19 era: Lung cancer

The COVID-19 pandemic, characterised by a fast and global spread during the first months of 2020, has prompted the development of a structured set of recommendations for cancer care management, to maintain the highest possible standards. Within this framework, it is crucial to ensure no disruption to essential oncological services and guarantee the optimal care.This is a structured proposal for the management of lung cancer, comprising three levels of priorities, namely: tier 1 (high priority), tier 2 (medium priority) and tier 3 (low priority)-defined according to the criteria of the Cancer Care Ontario, Huntsman Cancer Institute and Magnitude of Clinical Benefit Scale.The manuscript emphasises the impact of the COVID-19 pandemic on lung cancer care and reconsiders all steps from diagnosis, staging and treatment.These recommendations should, therefore, serve as guidance for prioritising the different aspects of cancer care to mitigate the possible negative impact of the COVID-19 pandemic on the management of our patients.As the situation is rapidly evolving, practical actions are required to guarantee the best patients' treatment while protecting and respecting their rights, safety and well-being. In this environment, cancer practitioners have great responsibilities: provide timely, appropriate, compassionate and justified cancer care, while protecting themselves and their patients from being infected with COVID-19. In case of shortages, resources must be distributed fairly. Consequently, the following recommendations can be applied with significant nuances, depending on the time and location for their use, considering variable constraints imposed to the health systems. An exceptional flexibility is required from cancer caregivers.