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Rudolph V, Leven AS, Eisenburger R, Schadendorf D, Wiegand S. Interdisciplinary management of skin cancer. Laryngorhinootologie 2024; 103:S100-S124. [PMID: 38697144 DOI: 10.1055/a-2171-4570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
The interdisciplinary treatment of skin cancer in the head and neck area requires close collaboration between different specialist disciplines. The most common non-melanoma skin cancer tumor entities are cutaneous squamous cell carcinoma and basal cell carcinoma as well as their precursor lesions. One of the less common tumors is Merkel cell carcinoma, which also occurs primarily in light-exposed areas and, in contrast to squamous and basal cell carcinoma, is more likely to metastasize. Due to the low tendency of basal cell carcinoma as well as cutaneous squamous cell carcinoma to metastasize, a cure can often be achieved by surgery. If the tumor growth exceeds certain levels it may require collaboration between dermatology and otorhinolaryngology. The primary goal of this interdisciplinary collaboration is to achieve a functional, cosmetically and aesthetically acceptable result in addition to adequate tumor treatment. Depending on the stage of the tumor and the clinical course, a case may be discussed in an interdisciplinary tumor board in order to determine a personalised, appropriate and adequate treatment concept for each patient, including prevention, therapy and follow-up.
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Affiliation(s)
- Victoria Rudolph
- Klinik für Dermatologie, Universitätsmedizin Essen & Westdeutsches Tumorzentrum, Essen & Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partnerstandort Essen/Düsseldorf & Nationales Centrum für Tumorerkrankungen (NCT)-West, Campus Essen, & Research Alliance Ruhr, Research Center One Health, Universität Duisburg-Essen, Essen, Germany
| | - Anna-Sophia Leven
- Klinik für Dermatologie, Universitätsmedizin Essen & Westdeutsches Tumorzentrum, Essen & Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partnerstandort Essen/Düsseldorf & Nationales Centrum für Tumorerkrankungen (NCT)-West, Campus Essen, & Research Alliance Ruhr, Research Center One Health, Universität Duisburg-Essen, Essen, Germany
| | - Robin Eisenburger
- Klinik für Dermatologie, Universitätsmedizin Essen & Westdeutsches Tumorzentrum, Essen & Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partnerstandort Essen/Düsseldorf & Nationales Centrum für Tumorerkrankungen (NCT)-West, Campus Essen, & Research Alliance Ruhr, Research Center One Health, Universität Duisburg-Essen, Essen, Germany
| | - Dirk Schadendorf
- Klinik für Dermatologie, Universitätsmedizin Essen & Westdeutsches Tumorzentrum, Essen & Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partnerstandort Essen/Düsseldorf & Nationales Centrum für Tumorerkrankungen (NCT)-West, Campus Essen, & Research Alliance Ruhr, Research Center One Health, Universität Duisburg-Essen, Essen, Germany
| | - Susanne Wiegand
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Leipzig, Leipzig, Deutschland
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Vagnini D, Grassi MM, Valenti F, Bombardieri E, Saita E. Beauty Therapy to Support Psychosocial Recovery from Oncological Care: A Qualitative Research on the Lived Experience of Women with Breast Cancer Treated with Chemotherapy. Curr Oncol 2024; 31:2527-2541. [PMID: 38785470 PMCID: PMC11119433 DOI: 10.3390/curroncol31050189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/12/2024] [Accepted: 04/22/2024] [Indexed: 05/25/2024] Open
Abstract
During the oncological care path, breast cancer patients treated with chemotherapy suffer from a number of psycho-physical changes, and appearance-related side effects are among the primary determinants of psychosocial impairment. Appropriate interventions are needed due to the fact that treatment-induced transformations have been associated with a decline in overall quality of life, interpersonal and sexual difficulties, and adverse effects on therapeutic adherence. In the framework of integrative oncology, beauty therapy is an affordable and straightforward intervention that could be used in the clinical management of breast cancer side effects. This study aims to comprehend the emotional and lived experiences of women undergoing chemotherapy after a brief beauty therapy intervention with licensed beauticians. The Interpretative Phenomenological Analysis was used as a methodological guideline. Sixteen women were purposefully recruited in a day hospital of a cancer unit, where the beauty therapy was implemented. At the end of the intervention, data were gathered using a semi-structured interview with open-ended questions. A thematic analysis was performed on verbatim transcriptions. Findings support the proposal of beauty therapy for patients undergoing chemotherapy. Assuming a relational viewpoint, beauty therapy could improve patients' feelings about themselves and the way they feel about others, even if they do not declare a specific interest in their outward appearance.
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Affiliation(s)
- Denise Vagnini
- Department of Psychology, Università Cattolica del Sacro Cuore, 20123 Milan, Italy
| | | | | | | | - Emanuela Saita
- Department of Psychology, Università Cattolica del Sacro Cuore, 20123 Milan, Italy
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3
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Biffoni M, Grani G, Melcarne R, Geronzi V, Consorti F, Ruggieri GD, Galvano A, Razlighi MH, Iannuzzi E, Engel TD, Pace D, Di Gioia CRT, Boniardi M, Durante C, Giacomelli L. Drawing as a Way of Knowing: How a Mapping Model Assists Preoperative Evaluation of Patients with Thyroid Carcinoma. J Clin Med 2024; 13:1389. [PMID: 38592234 PMCID: PMC10931768 DOI: 10.3390/jcm13051389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 02/08/2024] [Accepted: 02/26/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Effective pre-surgical planning is crucial for achieving successful outcomes in endocrine surgery: it is essential to provide patients with a personalized plan to minimize operative and postoperative risks. Methods: Preoperative lymph node (LN) mapping is a structured high-resolution ultrasonography examination performed in the presence of two endocrinologists and the operating surgeon before intervention to produce a reliable "anatomical guide". Our aim was to propose a preoperative complete model that is non-invasive, avoids overdiagnosis of thyroid microcarcinomas, and reduces medical expenses. Results: The use of 'preoperative echography mapping' has been shown to be successful, particularly in patients with suspected or confirmed neoplastic malignancy. Regarding prognosis, positive outcomes have been observed both post-surgery and in terms of recurrence rates. We collected data on parameters such as biological sex, age, BMI, and results from cytologic tests performed with needle aspiration, and examined whether these parameters predict tumor malignancy or aggressiveness, calculated using a multivariate analysis (MVA). Conclusions: A standard multidisciplinary approach for evaluating neck lymph nodes pre-operation has proven to be an improved diagnostic and preoperative tool.
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Affiliation(s)
- Marco Biffoni
- Department of General and Specialist Surgery, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (M.B.); (V.G.); (G.D.R.); (A.G.); (M.H.R.); (E.I.); (T.D.E.); (L.G.)
| | - Giorgio Grani
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (G.G.); (C.D.)
| | - Rossella Melcarne
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (G.G.); (C.D.)
| | - Valerio Geronzi
- Department of General and Specialist Surgery, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (M.B.); (V.G.); (G.D.R.); (A.G.); (M.H.R.); (E.I.); (T.D.E.); (L.G.)
| | - Fabrizio Consorti
- Department of General Surgery, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy;
| | - Giuseppe De Ruggieri
- Department of General and Specialist Surgery, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (M.B.); (V.G.); (G.D.R.); (A.G.); (M.H.R.); (E.I.); (T.D.E.); (L.G.)
| | - Alessia Galvano
- Department of General and Specialist Surgery, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (M.B.); (V.G.); (G.D.R.); (A.G.); (M.H.R.); (E.I.); (T.D.E.); (L.G.)
| | - Maryam Hosseinpour Razlighi
- Department of General and Specialist Surgery, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (M.B.); (V.G.); (G.D.R.); (A.G.); (M.H.R.); (E.I.); (T.D.E.); (L.G.)
| | - Eva Iannuzzi
- Department of General and Specialist Surgery, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (M.B.); (V.G.); (G.D.R.); (A.G.); (M.H.R.); (E.I.); (T.D.E.); (L.G.)
| | - Tal Deborah Engel
- Department of General and Specialist Surgery, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (M.B.); (V.G.); (G.D.R.); (A.G.); (M.H.R.); (E.I.); (T.D.E.); (L.G.)
| | - Daniela Pace
- Department of Endocrinology, Valmontone Hospital, 00038 Valmontone, Italy;
| | - Cira Rosaria Tiziana Di Gioia
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy;
| | - Marco Boniardi
- Endocrine Surgery Unit, Niguarda Hospital, 20162 Milan, Italy;
| | - Cosimo Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (G.G.); (C.D.)
| | - Laura Giacomelli
- Department of General and Specialist Surgery, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (M.B.); (V.G.); (G.D.R.); (A.G.); (M.H.R.); (E.I.); (T.D.E.); (L.G.)
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Polomeni A, Bordessoule D, Malak S. Multidisciplinary team meetings in Hematology: a national mixed-methods study. BMC Cancer 2023; 23:950. [PMID: 37805458 PMCID: PMC10560417 DOI: 10.1186/s12885-023-11431-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 09/21/2023] [Indexed: 10/09/2023] Open
Abstract
Multidisciplinary team meetings are a current international practice in cancer care, but to date, few data exist on the specificity of its practice in hematology.In this manuscript, we present the result of the first national study, realized with quantitative and qualitative methods in France, which brings new insights in order to improve the collegial decision-making process.To improve the effectiveness of MDTMs, the needs to focus on complex cases, to enhance patient centeredness and teamwork are relevant aspects, and a specific focus on hematological particularities is warranted to truly improve process.Background Understanding the Multidisciplinary team meetings (MDTMs) process in different medical specialties facilitates the identification of core factors supporting effective MDTM work. Our mixed-methods study explores the participants' perceptions of hematology MDTMs.Design Online questionnaires collected data concerning the decision-making process, benefits and inconveniences of MDTMs for both patients and professionals. Semi-directive phone interviews were conducted and analyzed, thereby supplying qualitative data.Results A total of 205 professionals responded to the questionnaire and 22 participated in the qualitative interviews. The data indicate the unique characteristics of hematology, including a specific definition of collegiality, the frequent solicitation of expert advice and the anticipation of treatment even prior to the occurrence of MDTMs. Additional information concerning patients' wishes and psychosocial conditions are also needed. Participants emphasize the subjective aspects and the impact of the climate of MDTMs on medical decisions.Conclusion Although MDTMs are recognized to be a valuable tool, organizational and relational issues may interfere with their efficiency.To improve the effectiveness of MDTMs, the needs to focus on complex cases, to enhance patient centeredness and teamwork are relevant aspects. A specific focus on hematological particularities might be warranted to truly improve the collegial decision-making process in the context of hematology.
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Affiliation(s)
- Alice Polomeni
- Clinical Hematology and Cellular Therapy Department, Hôpital Saint-Antoine - Assistance Publique- Hôpitaux de Paris, 184 Rue du Fbg Saint Antoine, 75012, Paris, France.
- Ethics Commission of the French Society of Hematology, Grenoble, France.
| | - Dominique Bordessoule
- Ethics Commission of the French Society of Hematology, Grenoble, France
- Hematology Department, Centre Hospitalo-Universitaire de Limoges, 2 Avenue Martin Luther King, 87000, Limoges, France
| | - Sandra Malak
- Ethics Commission of the French Society of Hematology, Grenoble, France
- Hematology Department of Institut Curie Hospital, Institut Curie-Saint-Cloud, 35 Rue Dailly, 92210, Saint-Cloud, France
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Luijten JCHBM, Vissers PAJ, Geerts J, Lemmens VEP, van Hillegersberg R, Beerepoot L, Walraven JEW, Curvers W, Voncken FEM, van der Sangen M, Verhoeven RHA, Nieuwenhuijzen GAP. Hospital practice variation in the proportion of patients with esophagogastric cancer discussed during an expert multidisciplinary team meeting. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:106880. [PMID: 37055281 DOI: 10.1016/j.ejso.2023.03.216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 02/05/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023]
Abstract
BACKGROUND Multidisciplinary team meetings (MDTM) and especially MDTMs in which expert centres are involved (expert MDTMs) are a key element in adequate cancer care. However, variation among hospitals in the proportion of patients presented during an expert MDTM has been described. This study aims to investigate national practice variation in the proportion of patients with oesophageal or gastric cancer being discussed during an expert MDTM. METHODS Patients diagnosed with oesophageal or gastric cancer in 2018-2019 were selected from the Netherlands Cancer Registry (n = 6,921). Multilevel logistic regression analyses were used to analyse the association between patient, and tumour characteristics, and the probability to be discussed in an expert MDTM. Variation was analysed according to the hospital and region of diagnosis for: all patients, patients with a potentially curable (cT1-4A cTX, any cN, cM0) or incurable tumour stage (cT4b and/or cM1). RESULTS In total, 79% of patients were discussed during an expert MDTM, of whom 84% (n = 3,424) and 71% (n = 2,018) with potentially curable, or incurable oesophageal or gastric cancer, respectively. The proportion of patients discussed during an expert MDTM ranged from 54% to 98%, and 17% to 100% between hospitals for potentially curable and incurable patients, respectively (all p < 0.0001). Adjusted analyses showed significant hospital (all p < 0.0001), but no regional variation regarding the patients discussed during an expert MDTM. CONCLUSION For patients with oesophageal or gastric cancer the probability of being discussed during an expert MDTM varies considerably according to the hospital of diagnosis.
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Affiliation(s)
- Josianne C H B M Luijten
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands
| | - Pauline A J Vissers
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands; Department of Surgery, Radboudumc, Nijmegen, the Netherlands
| | - Julie Geerts
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Valery E P Lemmens
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands; Department of Public Health, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Richard van Hillegersberg
- Department of Surgery, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Laurens Beerepoot
- Department of Medical Oncology, Elisabeth Tweesteden Hospital, Tilburg, the Netherlands
| | - Janneke E W Walraven
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Wouter Curvers
- Department of Gastroenterology, Catharina Hospital, Eindhoven, the Netherlands
| | - Francine E M Voncken
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | | | - Rob H A Verhoeven
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands; Department of Medical Oncology, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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Mäurer M, Staudacher J, Meyer R, Mäurer I, Lazaridis L, Müther M, Huber T, Sommer NP, Fleischmann DF, Käsmann L, Ziegler S, Kropf-Sanchen C, Wikert J, Pietzner K, Holzgreve A, Nestler T, Siech C, Sturm MJ, Sulzer S, Heinrich K, Stahler A. Importance of interdisciplinarity in modern oncology: results of a national intergroup survey of the Young Oncologists United (YOU). J Cancer Res Clin Oncol 2023; 149:10075-10084. [PMID: 37261525 PMCID: PMC10423150 DOI: 10.1007/s00432-023-04937-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 05/24/2023] [Indexed: 06/02/2023]
Abstract
PURPOSE Modern, personalized treatment concepts in oncology require an interdisciplinary and multiprofessional collaboration. In addition to its relevance in patient care, interdisciplinary collaboration is also becoming increasingly important in clinical research as well as medical education and resident training in oncology. METHODS Between November 2021 and March 2022, an online survey was conducted among German early career research groups, represented by Young Oncologists United (YOU). The aim was to identify the status and need for interdisciplinarity at clinic, educational, and research levels. RESULTS A total of 294 participants completed the questionnaire in full. 90.7% of the respondents fully or predominantly agreed with the statement that interdisciplinary work plays a major role in their daily clinical work. 78.9% wished for more interdisciplinary collaboration. Of the 49.7% of participants who have never participated in an interdisciplinary research project, 80.1% said they would like to participate in such a study project in the future. Lack of time resources, too much organizational effort, and possible political conflicts between institutions were identified as factors that make practical implementation difficult. 74.1% declared their willingness to become active in an oncology early career research group. CONCLUSION Interdisciplinary collaboration has become increasingly important in oncology. Networks that span different disciplines could help to promote interdisciplinary research projects among young scientists and improve exchange in professional practice and education with the implication of improved patient care.
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Affiliation(s)
- Matthias Mäurer
- Department of Radiotherapy and Radiation Oncology, University Hospital Jena, Jena, Germany.
| | - Jonas Staudacher
- Department of Gastroenterology, Rheumatology and Infectiology, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Robert Meyer
- Institute of Human Genetics and Genomic Medicine, University Hospital Aachen, Medical Faculty, RWTH Aachen University, Aachen, Germany
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, University Hospital Aachen, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Bonn, Germany
| | - Irina Mäurer
- Department of Neurology, Neurooncology Center, University Hospital Jena, Jena, Germany
| | - Lazaros Lazaridis
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Division of Clinical Neurooncology, University Medicine Essen, University Duisburg-Essen, Essen, Germany
| | - Michael Müther
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Tobias Huber
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Mainz, Germany
| | - Nils P Sommer
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Bonn, Bonn, Germany
| | - Daniel F Fleischmann
- Clinic and Polyclinic for Radiotherapy and Radiooncology, LMU Clinic Munich, LMU Munich, Munich, Germany
| | - Lukas Käsmann
- Clinic and Polyclinic for Radiotherapy and Radiooncology, LMU Clinic Munich, LMU Munich, Munich, Germany
| | - Sonia Ziegler
- Clinic and Polyclinic for Radiation Therapy and Radiooncology, University Medical Center Göttingen, Göttingen, Germany
| | | | - Julia Wikert
- Clinic and Polyclinic for Palliative Medicine, LMU Klinikum München, Munich, Germany
| | - Klaus Pietzner
- Department of Gynecology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Adrien Holzgreve
- Clinic and Polyclinic for Nuclear Medicine, University Hospital Munich, LMU Munich, Munich, Germany
| | - Tim Nestler
- Clinic for Urology, Bundeswehr Central Hospital Koblenz, Koblenz, Germany
| | - Carolin Siech
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Max-Johann Sturm
- Department of Radiotherapy and Radiation Oncology, University Hospital Jena, Jena, Germany
| | - Sabrina Sulzer
- Department of Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center Göttingen, Göttingen, Germany
| | - Kathrin Heinrich
- Medical Clinic and Polyclinic III, University Hospital Munich, LMU Munich, Munich, Germany
| | - Arndt Stahler
- Charité University Medicine, Medical Clinic m. S. Hematology, Oncology and Tumor Immunology, Berlin, Germany
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Prouse G, Robaldo A, van den Berg JC, Ettorre L, Mongelli F, Giovannacci L. Impact of Multidisciplinary Team Meetings on Decision Making in Vascular Surgery: A Prospective Observational Study. Eur J Vasc Endovasc Surg 2023; 66:130-135. [PMID: 36972815 DOI: 10.1016/j.ejvs.2023.03.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 02/20/2023] [Accepted: 03/21/2023] [Indexed: 03/28/2023]
Abstract
OBJECTIVE This cohort study aimed to prospectively determine the impact of multidisciplinary team meetings (MDTs) on treatment plans in vascular patients. METHODS The weekly MDT at the institution consisted of a structured discussion of vascular cases in the presence of at least one representative of each specialty from vascular surgery, angiology, and interventional radiology. Participants were asked to examine the cases entered on the digital MDT platform and to fill in forms with a detailed open text treatment recommendation for each patient. Individual recommendations were compared with the final MDT decision, which was based on a shared decision after discussion of clinical and radiological data. The primary endpoint was the agreement rate. The rate of decision implementation was determined to verify the adherence to MDT recommendations. RESULTS Four hundred consecutive case discussions in 367 patients between November 2019 and March 2021 were included, excluding patients needing urgent treatment, yielding MDT discussion in 88.5% of carotid artery cases, 83% of aorto-iliac cases, and 51.7% of peripheral arterial cases, which included 56.9% of the chronic limb threatening ischaemia cases. The overall average agreement rate was 71% ± 41%. Analysis according to the specialty of the attending physician showed agreement rates of 82% ± 30% for senior vascular surgeons, 62% ± 44% for junior vascular surgeons, 71% ± 43% for interventional radiologists, 58% ± 50% for angiologists (p < .001), and 75% ± 38% considering only senior practitioners. The inter-rater agreement, resulted in kappa coefficients of 0.60 - 0.68 for senior vascular surgeons, 0.29 - 0.31 for junior vascular surgeons, 0.39 - 0.52 for interventional radiologists, and 0.25 for angiologists. The MDT treatment decision was implemented in 353 (96.2%) cases. CONCLUSION The impact of MDT discussion on treatment recommendations and the adherence to MDT recommendations were significant and in line with results reported from other specialties.
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Affiliation(s)
- Giorgio Prouse
- Service of Vascular Surgery, Ospedale Regionale di Lugano, Centro Vascolare Ticino, EOC, Lugano, Switzerland.
| | - Alessandro Robaldo
- Service of Vascular Surgery, Ospedale Regionale di Lugano, Centro Vascolare Ticino, EOC, Lugano, Switzerland
| | - Jos C van den Berg
- Service of Interventional Radiology, Ospedale Regionale di Lugano, Centro Vascolare Ticino, EOC, Lugano, Switzerland; Inselspital Bern, Universitätsinstitut für Diagnostische, Interventionelle und Pädiatrische Radiologie, Bern, Switzerland
| | - Ludovica Ettorre
- Service of Vascular Surgery, Ospedale Regionale di Lugano, Centro Vascolare Ticino, EOC, Lugano, Switzerland
| | - Francesco Mongelli
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, EOC, Bellinzona, Switzerland; Faculty of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland
| | - Luca Giovannacci
- Service of Vascular Surgery, Ospedale Regionale di Lugano, Centro Vascolare Ticino, EOC, Lugano, Switzerland
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Plotkin A, Olkhov-Mitsel E, Gagliardi AR. The Impact of the Pathologist in Multidisciplinary Cancer Conferences on Patient Care. Am J Clin Pathol 2023; 159:352-357. [PMID: 36749312 DOI: 10.1093/ajcp/aqac164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 11/30/2022] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVES Multidisciplinary cancer conferences (MCCs) are important tools in the treatment of patients with complex health issues, helping clinicians achieve optimal outcomes in oncological practice. To explore the role of pathologists at MCCs, we conducted a review of prior research on this topic. METHODS We conducted a scoping review by searching MEDLINE, EMBASE, and the Cochrane Library for English-language qualitative, quantitative, or multiple/mixed methods studies on the role and impact of pathologists on MCCs. We used Microsoft Excel to extract data. RESULTS Of 76 research results, we included only 3 studies that involved review of cancer cases by pathologists for MCCs. All 3 studies showed that expert pathology review improved the accuracy of diagnosis and refined disease staging, leading to changes in the management of melanoma, breast cancer, and gynecologic cancer. No studies explored the barriers to pathologists participating in MCCs or the strategies or interventions employed to promote or support pathologist involvement. CONCLUSIONS We identified a paucity of studies on the role of pathologists in MCCs. Given the positive impact of MCCs involving pathologists on the accuracy of diagnosis and optimization of treatment, future research is warranted to further establish the role and impact of pathologists in MCCs and how to promote or support pathologists' involvement.
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Affiliation(s)
- Anna Plotkin
- Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
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9
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Majumdar D, Reynolds Kueny C, Anderson M. Impact of Merging Into a Comprehensive Cancer Center on Health Care Teams and Subsequent Team-Member and Patient Experiences. JCO Oncol Pract 2023; 19:e78-e91. [PMID: 36240476 DOI: 10.1200/op.22.00280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
PURPOSE Comprehensive health care centers are increasingly popular as they offer inclusive health care services under one roof. Often, these centers are formed by merging previously separate clinics. However, there is a lack of systematic guidance on the interprofessional, and interteam and intrateam dynamics that may develop during such an organizational change process. Using team process literature, we identify a possible model to explain how merging into a comprehensive cancer center (CCC) might influence health care teams and their subsequent outcomes, including patient experience. METHODS We used a mixed-method research design. Qualitative data were collected via semistructured interviews from 20 health care professionals employed at a recently merged CCC. During the time frame the interviews were collected, quantitative data were collected from 50 patients receiving treatment at the cancer center through anonymous paper-pencil surveys. Qualitative interviews were analyzed using thematic analysis, on the basis of the input-process-output team dynamics framework. Descriptive statistics were calculated for patient experience data. Trends between data collections were identified. RESULTS On the basis of our qualitative analysis, we provide an input-process-output framework that documents positive and negative aspects of interteam and intrateam dynamics associated with the merger process. Additionally, a number of connections were found between health care professional perceptions and quality patient experiences (eg, merger impacts on interteam and patient communication). CONCLUSION Our findings and model may assist in future merging efforts. Future CCCs may use the proposed framework to better understand and visualize their postmerger progress, in particular from the aspects of interprofessional, and interteam and intrateam dynamics.
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10
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Milana F, Famularo S, Luberto A, Rimassa L, Scorsetti M, Comito T, Pressiani T, Franzese C, Poretti D, Di Tommaso L, Personeni N, Rodari M, Pedicini V, Donadon M, Torzilli G. Multidisciplinary Tumor Board in the Management of Patients with Colorectal Liver Metastases: A Single-Center Review of 847 Patients. Cancers (Basel) 2022; 14:3952. [PMID: 36010944 PMCID: PMC9405848 DOI: 10.3390/cancers14163952] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/12/2022] [Accepted: 08/13/2022] [Indexed: 11/17/2022] Open
Abstract
There is still debate over how reviewing oncological histories and addressing appropriate therapies in multidisciplinary team (MDT) discussions may affect patients’ overall survival (OS). The aim of this study was to describe MDT outcomes for a single cancer center’s patients affected by colorectal liver metastases (CRLMs). From 2010 to 2020, a total of 847 patients with CRLMs were discussed at our weekly MDT meeting. Patients’ characteristics and MDT decisions were analyzed in two groups: patients receiving systemic therapy (ST) versus patients receiving locoregional treatment (LRT). Propensity-score matching (PSM) was run to reduce the risk of selection bias. The median time from MDT indication to treatment was 27 (IQR 13−51) days. The median OS was 30 (95%CI = 27−34) months. After PSM, OS for patients undergoing LRT was 51 (95%CI = 36−64) months compared with 15 (95%CI = 13−20) months for ST patients (p < 0.0001). In this large retrospective study, the MDT discussions were useful in providing the patients with all available locoregional options.
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Affiliation(s)
- Flavio Milana
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Hepatobiliary and General Surgery, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Simone Famularo
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Hepatobiliary and General Surgery, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Antonio Luberto
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Hepatobiliary and General Surgery, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Lorenza Rimassa
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Humanitas Cancer Center, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Marta Scorsetti
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Tiziana Comito
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Tiziana Pressiani
- Humanitas Cancer Center, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Ciro Franzese
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Dario Poretti
- Department of Radiology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Luca Di Tommaso
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Pathology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Nicola Personeni
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Humanitas Cancer Center, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Marcello Rodari
- Department of Nuclear Medicine, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Vittorio Pedicini
- Department of Radiology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Matteo Donadon
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Hepatobiliary and General Surgery, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Guido Torzilli
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Hepatobiliary and General Surgery, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
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11
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Tizianel I, Caccese M, Torresan F, Lombardi G, Evangelista L, Crimì F, Sepulcri M, Iacobone M, Padovan M, Galuppini F, Zagonel V, Scaroni C, Ceccato F. The Overall Survival and Progression-Free Survival in Patients with Advanced Adrenocortical Cancer Is Increased after the Multidisciplinary Team Evaluation. Cancers (Basel) 2022; 14:cancers14163904. [PMID: 36010898 PMCID: PMC9406070 DOI: 10.3390/cancers14163904] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/18/2022] [Accepted: 08/09/2022] [Indexed: 11/16/2022] Open
Abstract
We aimed to evaluate the role of adrenal multidisciplinary team evaluation (MTE) in affecting the overall survival (OS) and progression-free survival (PFS) in patients with adrenocortical carcinoma (ACC). We included in a retrospective monocentric study 47 patients with ACC. We divided our cohort into group 1 (without adrenal-MTE discussion, ACC diagnosis from 2004 to 2012, n = 14) and group 2 (diagnosis and beginning of treatments after 2013, all discussed in the adrenal MTE, n = 33). OS was defined by the survival between the first and the last visit, while PFS as the time from the first visit to the progression of the disease. Kaplan−Meier curves were used to compare OS and PFS between Group 1 and Group 2. Group 1stages III−IV (n = 10) presented a shorter median OS than Group 2stages III−IV (25 patients, 4 vs. 31 months, p = 0.023). Likewise, the median PFS was lower in Group 1 as compared to Group 2 (2.9 vs. 17.2 months, p < 0.001). The gain in PFS (6 months) was also confirmed in stage III-IV patients (2.9 vs. 8.7 months, respectively, for Group 1 and Group 2, p = 0.02). Group 1 presented a median PFS of 4 months, while the median PFS of Group 2 was 14.7 months (p = 0.128). In conclusion, we found a significant gain in terms of survival in patients after the MTE discussion in 2013. Therefore, ACC patients should be referred to a tertiary center, ideally from the time of diagnosis, to promptly apply all available treatments, according to the single patient’s clinical history and based on multidisciplinary management.
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Affiliation(s)
- Irene Tizianel
- Department of Medicine DIMED, University of Padova, 35128 Padua, Italy
- Endocrine Disease Unit, University-Hospital of Padova, 35128 Padua, Italy
| | - Mario Caccese
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy
| | - Francesca Torresan
- Endocrine Surgery Unit, Department of Surgical, Oncological and Gastroenterological Sciences (DiSCOG), University of Padova, 35128 Padua, Italy
| | - Giuseppe Lombardi
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy
| | - Laura Evangelista
- Department of Medicine DIMED, University of Padova, 35128 Padua, Italy
- Nuclear Medicine Unit, University-Hospital of Padova, 35128 Padua, Italy
| | - Filippo Crimì
- Department of Medicine DIMED, University of Padova, 35128 Padua, Italy
- Institute of Radiology, University-Hospital of Padova, 35128 Padua, Italy
| | - Matteo Sepulcri
- Department of Radiation Oncology, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy
| | - Maurizio Iacobone
- Endocrine Surgery Unit, Department of Surgical, Oncological and Gastroenterological Sciences (DiSCOG), University of Padova, 35128 Padua, Italy
| | - Marta Padovan
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy
| | - Francesca Galuppini
- Department of Medicine DIMED, University of Padova, 35128 Padua, Italy
- Pathology Unit, University-Hospital of Padova, 35128 Padua, Italy
| | - Vittorina Zagonel
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy
| | - Carla Scaroni
- Department of Medicine DIMED, University of Padova, 35128 Padua, Italy
- Endocrine Disease Unit, University-Hospital of Padova, 35128 Padua, Italy
| | - Filippo Ceccato
- Department of Medicine DIMED, University of Padova, 35128 Padua, Italy
- Endocrine Disease Unit, University-Hospital of Padova, 35128 Padua, Italy
- Correspondence:
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12
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Davis CH, Ho J, Stephenson R, August DA, Gee H, Weiner J, Alexander HR, Pitt HA, Berger AC. Virtual Tumor Board Increases Provider Attendance and Case Presentations. JCO Oncol Pract 2022; 18:e1603-e1610. [DOI: 10.1200/op.22.00158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE: Many cancer centers engage in multidisciplinary tumor board meetings to determine the optimal approach to complex cancer care. With the onset of the COVID-19 pandemic, many institutions changed the format of these meetings from in-person to virtual. The aim of this study was to determine if the change to a virtual meeting format had an impact on attendance and cases presented. METHODS: Tumor board records were analyzed to obtain attendance and case presentation information at a National Cancer Institute–designated Comprehensive Cancer Center. Twelve-month in-person tumor board data were compared with 12-month virtual tumor board data to assess for difference in attendance and case presentation patterns. RESULTS: Seven separate weekly tumor board meetings at the beginning of the study (breast, GI, gynecology, liver, lung, melanoma, and urology) were expanded to nine meetings on the virtual platform (+endocrine and pancreas). Overall attendance increased by 46% on the virtual platform compared with in-person meetings (4,030 virtual attendances v 2,753 in-person, P < .001). Increased attendance was present across all specialties on the virtual platform. In addition, the number of patient cases discussed increased from 2,127 in in-person meeting to 2,656 on the virtual platform (a 20% increase, P < .001). CONCLUSION: A significant increase was observed in overall tumor board attendance and in case presentations per meeting, requiring the expansion of additional weekly meetings. Furthermore, in a major cancer center with multiple community affiliates, virtual tumor boards may encourage increased participation from remote sites with the benefit of obtaining expert specialist advice as compared with geographically challenging in-person meetings.
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Affiliation(s)
- Catherine H. Davis
- Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
- Rutgers Robert Wood Johnson University Medical School, New Brunswick, NJ
| | - Jason Ho
- Rutgers Robert Wood Johnson University Medical School, New Brunswick, NJ
| | - Ryan Stephenson
- Rutgers Robert Wood Johnson University Medical School, New Brunswick, NJ
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - David A. August
- Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
- Rutgers Robert Wood Johnson University Medical School, New Brunswick, NJ
| | - Heather Gee
- Rutgers Robert Wood Johnson University Medical School, New Brunswick, NJ
| | - Joseph Weiner
- Rutgers Robert Wood Johnson University Medical School, New Brunswick, NJ
- Division of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - H. Richard Alexander
- Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
- Rutgers Robert Wood Johnson University Medical School, New Brunswick, NJ
| | - Henry A. Pitt
- Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
- Rutgers Robert Wood Johnson University Medical School, New Brunswick, NJ
| | - Adam C. Berger
- Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
- Rutgers Robert Wood Johnson University Medical School, New Brunswick, NJ
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13
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Soukup T, Lamb BW, Morbi A, Shah NJ, Bali A, Asher V, Gandamihardja T, Giordano P, Darzi A, Sevdalis N, Green JSA. Cancer multidisciplinary team meetings: impact of logistical challenges on communication and decision-making. BJS Open 2022; 6:6677491. [PMID: 36029030 PMCID: PMC9418925 DOI: 10.1093/bjsopen/zrac093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/14/2022] [Accepted: 06/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background Multidisciplinary teams (MDTs) are widely used in cancer care. Recent research points to logistical challenges impeding MDT decision-making and dissatisfaction among members. This study sought to identify different types of logistical issues and how they impacted team processes. Methods This was a secondary analysis of a cross-sectional observational study. Three cancer MDTs (breast, colorectal, and gynaecological) were recruited from UK hospitals. Validated observational instruments were used to measure decision-making (Metrics of Observational Decision-making, MDT-MODe), communication (Bales' Interaction Process Analysis, Bales' IPA), and case complexity (Measure of Case Discussion Complexity, MeDiC), including logistical challenges (Measure of Case Discussion Complexity, MeDiC), across 822 case discussions from 30 videoed meetings. Descriptive analysis and paired samples t tests were used to identify and compare frequency of different types of logistical challenges, along with partial correlations, controlling for clinical complexity of cases, to understand how such issues related to the MDT decision-making and communication. Results A significantly higher frequency of administrative and process issues (affecting 30 per cent of cases) was seen compared with the frequency of equipment issues (affecting 5 per cent of cases; P < 0.001) and the frequency of the attendance issues (affecting 16 per cent of cases; P < 0.001). The frequency of the attendance issues was significantly higher than the frequency of equipment issues (P < 0.001). Partial correlation analysis revealed that administrative and process issues, including attendance, were negatively correlated with quality of information (r = −0.15, P < 0.001; r = −0.11, P < 0.001), and equipment issues with the quality of contribution to meeting discussion (r = −0.14, P < 0.001). More questioning and answering by MDT members was evident with the administrative and process issues (r = 0.21, P < 0.001; r = 0.19, P < 0.001). Some differences were observed in teams' socioemotional reactions to the administrative and process issues with the gynaecological MDT showing positive correlation with positive socioemotional reactions (r = 0.20, P < 0.001), and the breast cancer MDT with negative socioemotional reactions (r = 0.17, P < 0.001). Conclusion Administrative and process issues were the most frequent logistical challenges for the studied teams. Where diagnostic results were unavailable, and inadequate patient details provided, the quality of decision-making was reduced.
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Affiliation(s)
- Tayana Soukup
- Centre for Implementation Science, Health Service & Population Research Department, King's College London , London , UK
| | - Benjamin W Lamb
- Department of Urology, Cambridge University Hospital NHS Trust , London , UK
| | - Abigail Morbi
- Department of Surgery and Cancer, Imperial College London , London , UK
| | - Nisha J Shah
- HeLEX Centre, University of Oxford , Oxford , UK
| | | | | | | | - Pasquale Giordano
- Whipps Cross University Hospital, Barts Health NHS Trust , London , UK
| | - Ara Darzi
- Department of Surgery and Cancer, Imperial College London , London , UK
| | - Nick Sevdalis
- Centre for Implementation Science, Health Service & Population Research Department, King's College London , London , UK
| | - James S A Green
- Whipps Cross University Hospital, Barts Health NHS Trust , London , UK
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14
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Brown GTF, Bekker HL, Young AL. Quality and efficacy of Multidisciplinary Team (MDT) quality assessment tools and discussion checklists: a systematic review. BMC Cancer 2022; 22:286. [PMID: 35300636 PMCID: PMC8928609 DOI: 10.1186/s12885-022-09369-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 02/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background MDT discussion is the gold standard for cancer care in the UK. With the incidence of cancer on the rise, demand for MDT discussion is increasing. The need for efficiency, whilst maintaining high standards, is therefore clear. Paper-based MDT quality assessment tools and discussion checklists may represent a practical method of monitoring and improving MDT practice. This reviews aims to describe and appraise these tools, as well as consider their value to quality improvement. Methods Medline, EMBASE and PsycInfo were searched using pre-defined terms. The PRISMA model was followed throughout. Studies were included if they described the development of a relevant tool, or if an element of the methodology further informed tool quality assessment. To investigate efficacy, studies using a tool as a method of quality improvement in MDT practice were also included. Study quality was appraised using the COSMIN risk of bias checklist or the Newcastle-Ottawa scale, depending on study type. Results The search returned 7930 results. 18 studies were included. In total 7 tools were identified. Overall, methodological quality in tool development was adequate to very good for assessed aspects of validity and reliability. Clinician feedback was positive. In one study, the introduction of a discussion checklist improved MDT ability to reach a decision from 82.2 to 92.7%. Improvement was also noted in the quality of information presented and the quality of teamwork. Conclusions Several tools for assessment and guidance of MDTs are available. Although limited, current evidence indicates sufficient rigour in their development and their potential for quality improvement. Trial registration PROSPERO ID: CRD42021234326. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09369-8.
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Affiliation(s)
- George T F Brown
- Department of Pancreatic Surgery, St James's University Hospital, Leeds, UK
| | - Hilary L Bekker
- Leeds Unit of Complex Intervention Development, School of Medicine, University of Leeds, Leeds, UK.,Research Centre for Patient Involvement, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Alastair L Young
- Department of Pancreatic Surgery, St James's University Hospital, Leeds, UK.
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15
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Guilabert M, Prades J, Borras JM, Maestu I, Guerra JA, Fumadó L, Mira JJ. A Web-Based Self-assessment Model for Evaluating Multidisciplinary Cancer Teams in Spain: Development and Validation Pilot Study. J Med Internet Res 2022; 24:e29063. [PMID: 35266870 PMCID: PMC8949680 DOI: 10.2196/29063] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 08/02/2021] [Accepted: 08/12/2021] [Indexed: 11/17/2022] Open
Abstract
Background Tumor boards constitute the main consensus and clinical decision–making body of multidisciplinary teams (MDTs) in cancer care. With the increasing clinical complexity of treatment options (eg, targeted therapies, multimodal treatments) and the progressive incorporation of new areas of intervention (eg, survivorship care), tumor boards are now required to play a central role in all cancer processes. However, although frameworks are in place to evaluate MDT quality, only few web-based tools are available for this purpose; indeed, no web-based MDT evaluation tools have been developed for or adapted to the Spanish National Health System. Objective The first aim of this study was to develop a web-based self-assessment model (Autoevaluación de Equipos Multidisciplinares de Atención al Cáncer [AEMAC]) for evaluating multidisciplinary cancer teams in Spain and the second aim was to validate this tool by testing its metric properties, acceptability, and usability. Methods We designed and validated the AEMAC program in 3 stages. In the first stage (research), we reviewed the available scientific evidence and performed a qualitative case study of good practice in multidisciplinary care within the Spanish National Health System (n=4 centers and 28 health care professionals). The results were used to define the thematic areas and quality criteria for the self-evaluation model, which were then discussed and validated by a group of experts. The second stage (development) involved the technological development of a web app that would be accessible from any mobile device. In the third stage (piloting and validation), we conducted 4 pilot tests (n=15 tumor boards, 243 professionals) and used the results to analyze the acceptability and usefulness of the tool. Results We designed a self-assessment model based on 5 thematic areas encompassing a total of 25 quality components, which users rated on a 3-option development scale. The evaluation process, which was managed entirely from the web app, consisted of individual self-assessment, group prioritization, and creation of an improvement plan. Cronbach alpha (.86), McDonald’s omega (0.88), and various fit indices (comparative fit index between 0.95 and 1 and goodness-of-fit index between 0.97 and 0.99 for all 5 aspects) confirmed internal consistency. The mean rating for overall satisfaction with the tool and for consistency between the content of the tool and the reality of tumor boards was 7.6 out of 10. Conclusions The results obtained during the period of research and piloting of the AEMAC program showed that it has an appropriate structure and metric properties and could therefore be implemented in a real context and generalized to other hospitals. As a virtual tool, it helps to measure the key aspects of MDT quality, such as effectiveness of collaboration and communication, leadership, and the organizational environment.
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Affiliation(s)
| | - Joan Prades
- Department of Health, Catalonian Cancer Strategy, Barcelona, Spain.,Department of Clinical Sciences, University of Barcelona, Instituto de Investigación Biomédica de Bellvitge, Barcelona, Spain
| | - Josep M Borras
- Department of Health, Catalonian Cancer Strategy, Barcelona, Spain.,Department of Clinical Sciences, University of Barcelona, Instituto de Investigación Biomédica de Bellvitge, Barcelona, Spain
| | - Inmaculada Maestu
- Medical Oncology Service, Doctor Peset University Hospital, Valencia, Spain
| | - Juan Antonio Guerra
- Department of Hematology and Oncology, Fuenlabrada University Hospital, Fuenlabrada, Spain
| | - Lluís Fumadó
- Urological Cancer Functional Unit, Hospital del Mar-Parc de Salut Mar-IMIM, Barcelona, Spain
| | - José Joaquin Mira
- Health Psychology Department, Miguel Hernandez University, Elche, Spain.,Atenea Research Group, Foundation for the Promotion of Health and Biomedical Research, Sant Joan d'Alacant, Spain.,Alicante-Sant Joan Health Department, Alicante, Spain
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- see Authors' Contributions,
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16
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Tran TH, de Boer J, Gyorki DE, Krishnasamy M. Optimising the quality of multidisciplinary team meetings: A narrative review. Cancer Med 2022; 11:1965-1971. [PMID: 35257515 PMCID: PMC9089217 DOI: 10.1002/cam4.4432] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 10/28/2021] [Accepted: 10/29/2021] [Indexed: 11/08/2022] Open
Abstract
Background Understanding of factors that contribute to implementation of effective cancer multidisciplinary team meetings (MDMs) is still limited. Published literature on the effect of teamwork function, leadership roles, decision‐making processes and structural components on the quality of MDMs was reviewed and synthesised. Methods In this paper, a MEDLINE review (September 2020) was performed to assess clinical decision‐making in the context of MDM discussions. Results Twenty‐nine eligible studies were included. Six studies addressed the infrastructural aspects of MDMs. Nine studies used either qualitative or mixed method approach to develop and validate observational tools to assess the quality of MDMs. Seven studies used qualitative approaches to explore the opinions of MDM members on factors that impact on the effectiveness of MDMs. Five studies used validated observational tools to observe and assess the effectiveness of MDMs. One prospective study explored the relationship between quality of information presented at MDMs and ability of MDM members to make clinical decisions. The final study prospectively tested the ability of a multicomponent intervention to improve decision‐making processes within MDMs. Conclusions A broad range of factors including teamwork, leadership, case complexity, decision‐making processes and availability of patient information were identified to impact the quality of MDMs. Evidence currently available largely focuses on the development of tools to identify factors in need of improvement to optimise MDMs. Robust research is required to identify the factors that are demonstrated to enhance MDM quality which can then aid the standardisation of how MDMs are conducted.
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Affiliation(s)
- Thanh Hai Tran
- University of Melbourne, Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Jasper de Boer
- Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia
| | - David E Gyorki
- Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.,Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Meinir Krishnasamy
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia.,Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
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17
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Current Surgical Management Strategies for Colorectal Cancer Liver Metastases. Cancers (Basel) 2022; 14:cancers14041063. [PMID: 35205811 PMCID: PMC8870224 DOI: 10.3390/cancers14041063] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/15/2022] [Accepted: 02/18/2022] [Indexed: 12/14/2022] Open
Abstract
Simple Summary Colorectal cancer is one of the most common cancer diagnoses in the world. At least half of patients diagnosed with colorectal cancer will develop metastatic disease, with most being identified in the liver. Surgical resection of colorectal liver metastases (CRLM) is potentially curative. Surgical resection of CRLM, however, remains underutilized despite the continued expansion of operative strategies available. This is likely due to differing views on resectability. Resectability is a surgical assessment, and the classification of CRLM as unresectable should only be made by an experienced hepatobiliary surgeon. Obtaining a surgical evaluation at the time of liver metastasis discovery may help mitigate the challenge of assessing resectability and the determination of potential operative time windows within current multimodal management strategies. The aim of this review is to help facilitate discussions surrounding resectability as well as the timing and sequencing of both surgical and non-surgical therapies. Abstract Colorectal cancer is the third most common cancer diagnosis in the world, and the second most common cause of cancer-related deaths. Despite significant progress in management strategies for colorectal cancer over the last several decades, metastatic disease remains difficult to treat and is often considered incurable. However, for patients with colorectal liver metastases (CRLM), surgical resection offers the best opportunity for survival, can be curative, and remains the gold standard. Unfortunately, surgical treatment options are underutilized. Misperceptions regarding resectable and unresectable CRLM likely play a role in this. The assessment of factors that impact resectability status like medical fitness, technical considerations, and disease biology can be difficult, necessitating careful multidisciplinary input and discussion. The identification of ideal operative time windows that align with the multimodal management of these patients can also be perplexing. For all patients with CRLM it may therefore be advantageous to obtain surgical evaluation at the time of discovering liver metastases to mitigate these challenges and minimize the risk of undertreatment. In this review we summarize current surgical management strategies for CRLM and discuss factors to be considered when determining resectability.
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18
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Nic Giolla Easpaig B, Tran Y, Winata T, Lamprell K, Fajardo Pulido D, Arnolda G, Delaney GP, Liauw W, Smith K, Avery S, Rigg K, Westbrook J, Olver I, Currow D, Karnon J, Ward RL, Braithwaite J. The complexities, coordination, culture and capacities that characterise the delivery of oncology services in the common areas of ambulatory settings. BMC Health Serv Res 2022; 22:190. [PMID: 35151314 PMCID: PMC8841048 DOI: 10.1186/s12913-022-07593-3] [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: 06/07/2021] [Accepted: 02/02/2022] [Indexed: 11/16/2022] Open
Abstract
Background Relatively little is understood about real-world provision of oncology care in ambulatory outpatient clinics (OPCs). This study aimed to: 1) develop an understanding of behaviours and practices inherent in the delivery of cancer services in OPC common areas by characterising the organisation and implementation of this care; and 2) identify barriers to, and facilitators of, the delivery of this care in OPC common areas. Methods A purpose-designed ethnographic study was employed in four public hospital OPCs. Informal field scoping activities were followed by in-situ observations, key informant interviews and document review. A view of OPCs as complex adaptive systems was used as a scaffold for the data collection and interpretation, with the intent of understanding ‘work as done’. Data were analysed using an adapted “Qualitative Rapid Appraisal, Rigorous Analysis” approach. Results Field observations were conducted over 135 h, interviews over 6.5 h and documents were reviewed. Analysis found six themes. Staff working in OPCs see themselves as part of small local teams and as part of a broader multidisciplinary care team. Professional role boundaries could be unclear in practice, as duties expanded to meet demand or to stop patients “falling through the cracks.” Formal care processes in OPCs were supported by relationships, social capital and informal, but invaluable, institutional expertise. Features of the clinic layout, such as the proximity of departments, affected professional interactions. Staff were aware of inter- and intra-service communication difficulties and employed strategies to minimise negative impacts on patients. We found that complexity, coordination, culture and capacity underpin the themes that characterise this care provision. Conclusions The study advances understanding of how multidisciplinary care is delivered in ambulatory settings and the factors which promote or inhibit effective care practice. Time pressures, communication challenges and competing priorities can pose barriers to care delivery. OPC care is facilitated by: self-organisation of participants; professional acumen; institutional knowledge; social ties and relationships between and within professional groups; and commitment to patient-centred care. An understanding of the realities of ‘work-as-done’ may help OPCs to sustain high-quality care in the face of escalating service demand.
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Creating a Multidisciplinary Clinic. Urol Oncol 2022. [DOI: 10.1007/978-3-030-89891-5_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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20
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The Effectiveness of e-Health Interventions on Caregiver Burden, Depression, and Quality of Life in Informal Caregivers of Patients with cancer: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Int J Nurs Stud 2022; 127:104179. [DOI: 10.1016/j.ijnurstu.2022.104179] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 01/07/2022] [Accepted: 01/11/2022] [Indexed: 01/19/2023]
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The Effects of Multidisciplinary Team Meetings on Clinical Practice for Colorectal, Lung, Prostate and Breast Cancer: A Systematic Review. Cancers (Basel) 2021; 13:cancers13164159. [PMID: 34439312 PMCID: PMC8394238 DOI: 10.3390/cancers13164159] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/29/2021] [Accepted: 08/16/2021] [Indexed: 02/06/2023] Open
Abstract
Simple Summary Multidisciplinary team meetings have increasingly been implemented in cancer care worldwide to ensure timely, accurate and evidence-based diagnosis, and treatment plans. Nowadays, multidisciplinary team meetings are generally considered indispensable. However, they are considered time-consuming and expensive, while the effects of multidisciplinary team meetings are not yet fully understood. The aim of this systematic review is to update and summarize the literature and create an overview of the existing knowledge. Cancer types such as colorectal, lung, prostate and breast cancer with rapidly increasing incidence rates will inevitably impact the workload of clinicians. Understanding the effects of the widely implemented multidisciplinary team meetings in oncology care is fundamental in order to optimize care pathways and allocate resources in the rapidly diversifying landscape of cancer therapies. Abstract Objective: The aim of our systematic review is to identify the effects of multidisciplinary team meetings (MDTM) for lung, breast, colorectal and prostate cancer. Methods: Our systematic review, performed following PRISMA guidelines, included studies examining the impact of MDTMs on treatment decisions, patient and process outcomes. Electronic databases PUBMED, EMBASE, Cochrane Library and Web of Science were searched for articles published between 2000 and 2020. Risk of bias and level of evidence were assessed using the ROBINS-I tool and GRADE scale. Results: 41 of 13,246 articles were selected, evaluating colorectal (21), lung (10), prostate (6) and breast (4) cancer. Results showed that management plans were changed in 1.6–58% of cases after MDTMs. Studies reported a significant impact of MDTMs on surgery type, and a reduction of overall performed surgery after MDTM. Results also suggest that CT and MRI imaging significantly increased after MDTM implementation. Survival rate increased significantly with MDTM discussions according to twelve studies, yet three studies did not show significant differences. Conclusions: Despite heterogeneous data, MDTMs showed a significant impact on management plans, process outcomes and patient outcomes. To further explore the impact of MDTMs on the quality of healthcare, high-quality research is needed.
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22
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Rascon J, Salasevicius L, Rutkauskiene G, Bien E, Vincerzevskiene I. The impact of incomplete registration on survival rate of children with very rare tumors. Sci Rep 2021; 11:14066. [PMID: 34234275 PMCID: PMC8263601 DOI: 10.1038/s41598-021-93670-2] [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: 12/19/2020] [Accepted: 06/23/2021] [Indexed: 11/23/2022] Open
Abstract
Pediatric very rare tumors (VRTs) represent a heterogeneous subset of childhood cancers, with reliable survival estimates depending dramatically on each (un)registered case. The current study aimed to evaluate the number of VRTs among Lithuanian children, to assess the impact of the registration status on survival rates and to track changes in treatment outcomes over the 16-year study period. We performed a population-based retrospective study across children below 18 years old diagnosed with VRTs in Lithuania between the years 2000 and 2015. The identified cases were cross-checked with the Lithuanian Cancer Registry—a population-based epidemiology cancer registry—for the fact of registration and survival status. The overall survival was calculated in relation to the registration status and treatment period. Thirty-seven children with VRTs were identified within the defined time frame. Six of them (16.2%) were not reported to the Lithuanian Cancer Registry at diagnosis. The probability of overall survival at 5 years (OS5y) differed significantly between the registered (n = 31) and unregistered (n = 6) cohorts: 51.6% versus 100%, respectively (p = 0.049). A 5-year survival estimate for children diagnosed with a VRT at the age of 0–14 years differed by 10 percentage points according to the registration completeness: 52.1% calculated for the entire cohort versus 42.1% for registered patients only. The OS5y has not improved over the analyzed period: 61.1% in 2000–2007 versus 57.9% in 2008–2015 (p = 0.805). The survival continued to decline beyond 5 years post-diagnosis due to late cancer-related adverse events: 59.5% of patients were alive at 5 years as compared to 44.3% at 10 years. The OS5y of children affected by VRT was lower than in more common childhood cancers. The survival rate of the unregistered patients may lead to misinterpretation of treatment outcomes. Meticulous registration of VRTs is crucial for correct evaluation of treatment outcomes, especially across small countries with few cases.
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Affiliation(s)
- Jelena Rascon
- Center for Pediatric Oncology and Hematology, Vilnius University Hospital Santaros Klinikos, Santariškių 4, 08406, Vilnius, Lithuania. .,Faculty of Medicine, Vilnius University, M. K. Čiurlionio 21/27, 03101, Vilnius, Lithuania.
| | - Lukas Salasevicius
- Faculty of Medicine, Vilnius University, M. K. Čiurlionio 21/27, 03101, Vilnius, Lithuania
| | - Giedre Rutkauskiene
- Lithuanian University of Health Sciences, A. Mickevičiaus 9, 44307, Kaunas, Lithuania
| | - Ewa Bien
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdansk, 7 Debinki Street; 80-211, Gdansk, Poland
| | - Ieva Vincerzevskiene
- National Cancer Institute, Cancer Registry, Santariškių 1, 08660, Vilnius, Lithuania
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23
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Voltan G, Boscaro M, Armanini D, Scaroni C, Ceccato F. A multidisciplinary approach to the management of adrenal incidentaloma. Expert Rev Endocrinol Metab 2021; 16:201-212. [PMID: 34240680 DOI: 10.1080/17446651.2021.1948327] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 06/23/2021] [Indexed: 01/15/2023]
Abstract
An adrenal incidentaloma (AI) is an adrenal neoplasm incidentally discovered during an imaging unrelated to suspected adrenal disease. The aim of the present review is to offer practical guidance on the multidisciplinary approach of AIs.Areas covered:The prevalence of AI is high in the aging population (up to 5-8%); however, hormonally active or malignant conditions are rare. After the discovery of an AI, it is suggested to assess in parallel if the mass is potentially malignant and functionally active. The answer to the former question is mainly based on medical history (extra-adrenal malignancies, new-onset of signs or symptoms) and imaging (conventional radiology and/or nuclear medicine). The answer to the latter question is a complete endocrine evaluation of both cortical (glucocorticoids, mineralocorticoids) and medullary (catecholamines) secretion.Expert opinion:A multidisciplinary discussion is suggested for patients with adrenal disease, after the exclusion of nonfunctioning benign cortical adenoma, in order to plan a close and tailored follow-up for the suspected malignant or functioning forms. Surgery is advised for patients with malignant disease (adrenocortical cancer) or with clinically relevant secreting neoplasm (primary aldosteronism, Cushing's syndrome, and pheochromocytoma).
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Affiliation(s)
- Giacomo Voltan
- Endocrinology, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Marco Boscaro
- Endocrinology, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Decio Armanini
- Endocrinology, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Carla Scaroni
- Endocrinology, Department of Medicine DIMED, University of Padova, Padova, Italy
- Endocrine Disease Unit, University-Hospital of Padova, Padova, Italy
| | - Filippo Ceccato
- Endocrinology, Department of Medicine DIMED, University of Padova, Padova, Italy
- Endocrine Disease Unit, University-Hospital of Padova, Padova, Italy
- Department of Neuroscience DNS, University of Padova, Padova, Italy
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24
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Huang YC, Kung PT, Ho SY, Tyan YS, Chiu LT, Tsai WC. Effect of multidisciplinary team care on survival of oesophageal cancer patients: a retrospective nationwide cohort study. Sci Rep 2021; 11:13243. [PMID: 34168186 PMCID: PMC8225808 DOI: 10.1038/s41598-021-92618-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/14/2021] [Indexed: 12/24/2022] Open
Abstract
Oesophageal cancer is the sixth leading cause of cancer death worldwide. This nationwide study analyses the survival results of oesophageal cancer under multidisciplinary team (MDT) care. We enrolled oesophageal cancer patients diagnosed between 2010 and 2015 with follow-up for at least 1 year. This study performed propensity score matching with a ratio of 1:1 between MDT participants and non-MDT participants. We performed conditional Cox proportional hazards model to research relative risk of survival and associated factors of survival. The adjusted survival curves were plotted. 8184 newly diagnosed oesophageal cancer patients were included. The favourable survival factors include participant status of MDT, gender, monthly salary, urbanization level, other catastrophic illness, stage of cancer, treatment methods, and service volume of physicians (P < 0.05). MDT participants showed lower risk of death (HR = 0.73; 95% CI 0.67–0.79). Further stratification analysis revealed that the incorporation of an MDT reduced the death risk of patients with stages 2, 3, and 4 cancer, with the greatest reduction observed in patients with stage 3 cancer (HR = 0.72; 95% CI 0.67–0.79). The risk of death was lower for oesophageal cancer patients who enrolled in MDT care.
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Affiliation(s)
- Yuan-Chun Huang
- Department of Health Services Administration, China Medical University, No. 100, Sec. 1, Jingmao Road, Taichung, 404060, Taiwan.,Department of Medical Imaging, Changhua Christian Hospital, Changhua, Taiwan.,School of Medical Imaging and Radiological Sciences, School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan.,Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan
| | - Pei-Tseng Kung
- Department of Healthcare Administration, Asia University, Taichung, Taiwan.,Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Shang-Yun Ho
- Department of Medical Imaging, Changhua Christian Hospital, Changhua, Taiwan
| | - Yeu-Sheng Tyan
- School of Medical Imaging and Radiological Sciences, School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Li-Ting Chiu
- Department of Health Services Administration, China Medical University, No. 100, Sec. 1, Jingmao Road, Taichung, 404060, Taiwan
| | - Wen-Chen Tsai
- Department of Health Services Administration, China Medical University, No. 100, Sec. 1, Jingmao Road, Taichung, 404060, Taiwan.
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25
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Fehervari M, Hamrang-Yousefi S, Fadel MG, Mills SC, Warren OJ, Tekkis PP, Kontovounisios C. A systematic review of colorectal multidisciplinary team meetings: an international comparison. BJS Open 2021; 5:6278497. [PMID: 34013317 PMCID: PMC8134530 DOI: 10.1093/bjsopen/zrab044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 04/11/2021] [Indexed: 01/31/2023] Open
Abstract
Background Colorectal multidisciplinary teams (CR MDTs) were introduced to enhance the cancer care pathway and allow for early investigation and treatment of cancer. However, there are no ‘gold standards’ set for this process. The aim of this study was to review the literature systematically and provide a qualitative analysis on the principles, organization, structure and output of CR MDTs internationally. Methods Literature on the role of CR MDTs published between January 1999 and March 2020 in the UK, USA and continental Europe was evaluated. Historical background, structure, core members, education, frequency, patient-selection criteria, quality assurance, clinical output and outcomes were extracted from data from the UK, USA and continental Europe. Results Forty-eight studies were identified that specifically met the inclusion criteria. The majority of hospitals held CR MDTs at least fortnightly in the UK and Europe by 2002 and 2005 respectively. In the USA, monthly MDTs became a mandatory element of cancer programmes by 2013. In the UK, USA and in several European countries, the lead of the MDT meeting is a surgeon and core members include the oncologist, specialist nurse, histopathologist, radiologist and gastroenterologist. There were differences observed in patient-selection criteria, in the use of information technology, MDT databases and quality assurance internationally. Conclusion CR MDTs are essential in improving the patient care pathway and should express clear recommendations for each patient. However, a form of quality assurance should be implemented across all MDTs.
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Affiliation(s)
- M Fehervari
- Department of Surgery and Cancer, Imperial College, London, UK.,Department of Colorectal Surgery, Chelsea and Westminster Hospital, London, UK
| | | | - M G Fadel
- Department of Colorectal Surgery, Chelsea and Westminster Hospital, London, UK
| | - S C Mills
- Department of Surgery and Cancer, Imperial College, London, UK.,Department of Colorectal Surgery, Chelsea and Westminster Hospital, London, UK
| | - O J Warren
- Department of Surgery and Cancer, Imperial College, London, UK.,Department of Colorectal Surgery, Chelsea and Westminster Hospital, London, UK
| | - P P Tekkis
- Department of Surgery and Cancer, Imperial College, London, UK.,Department of Colorectal Surgery, Chelsea and Westminster Hospital, London, UK.,Department of Colorectal Surgery, Royal Marsden Hospital, London, UK
| | - C Kontovounisios
- Department of Surgery and Cancer, Imperial College, London, UK.,Department of Colorectal Surgery, Chelsea and Westminster Hospital, London, UK.,Department of Colorectal Surgery, Royal Marsden Hospital, London, UK
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26
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Díez JJ, Galofré JC. Thyroid Cancer Patients' View of Clinician Professionalism and Multidisciplinary Approach to Their Management. J Multidiscip Healthc 2021; 14:1053-1061. [PMID: 33994791 PMCID: PMC8114825 DOI: 10.2147/jmdh.s309953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 04/13/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The objective of this study was to query thyroid cancer patients about 1) both the characteristics of the healthcare facilities where they were treated and the healthcare professionals that provided that treatment, as well as 2) the multidisciplinary approach used in the treatment process. METHODS Using a web-based survey, patients were asked to give their opinion of the healthcare centers, the professionalism of their team of specialists, and the thyroid cancer multidisciplinary teams (MDT). RESULTS For the 485 patients that responded, the most highly rated aspect of healthcare centers was the reduced waiting time between diagnosis and surgical intervention, an opinion expressed by 62.7% of patients. The most appreciated aspect of professionalism was the kindness shown toward patients by healthcare staff (66.6%). About 44.3% of patients were aware of the existence of thyroid cancer MDT. Most of respondents (82.7%) agreed that patients' opinions should be considered by their physicians when making treatment decisions. CONCLUSION We conclude that most patients with thyroid cancer appreciate therapeutic efficacy and kindness, and almost all are clearly in favor of using a multidisciplinary approach to their disease. Since such patients often demand to participate in the decision-making process, multidisciplinary teams should make every effort to share information with, and to integrate the opinion of, patients in the management of their thyroid disease.
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Affiliation(s)
- Juan J Díez
- Department of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
- Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana (IDIPHISA), Madrid, Spain
- Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- Thyroid Task Force from the Sociedad Española de Endocrinología y Nutrición (SEEN), Madrid, Spain
| | - Juan C Galofré
- Thyroid Task Force from the Sociedad Española de Endocrinología y Nutrición (SEEN), Madrid, Spain
- Department of Endocrinology, Clínica Universidad de Navarra, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
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27
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Luijten JCHBM, Haagsman VC, Luyer MDP, Vissers PAJ, Nederend J, Huysentruyt C, Creemers GJ, Curvers W, van der Sangen M, Heesakkers FBM, Schrauwen RWM, Jürgens MC, Buster EHCJ, Vincent J, Kneppelhout JK, Verhoeven RHA, Nieuwenhuijzen GAP. Implementation of a regional video multidisciplinary team meeting is associated with an improved prognosis for patients with oesophageal cancer A mixed methods approach. Eur J Surg Oncol 2021; 47:3088-3096. [PMID: 33926781 DOI: 10.1016/j.ejso.2021.04.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/15/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Studies have shown that multidisciplinary team meetings (MDTM) improve diagnostic work-up and treatment-decisions. This study aims to evaluate the influence of implementing a regional-video-Upper-GI-MDTM (uMDTM) for oesophageal cancer (OC) on the number of patients discussed, treatment-decisions, perspectives of involved clinicians and overall survival (OS) in the Eindhoven Upper-GI Network consisting of 1 resection hospital and 5 referring hospitals. METHODS Between 2012 and 2018, patients diagnosed with OC within this region, were selected from the Netherlands Cancer Registry(n = 1119). From 2014, an uMDTM was gradually implemented and a mixed-method quantitative and qualitative design was used to analyse changes. Quantitative outcomes were described before and after implementation of the uMDTM. Clinicians were interviewed to assess their perspectives regarding the uMDTM. RESULTS After participation in the uMDTM more patients were discussed in an MDTM (80%-89%,p < 0.0001) and involvement of a resection centre during the uMDTM increased (43%-82%,p < 0.0001). The proportion of patients diagnosed with potentially curable OC (cT1-4a-x, any cN, cM0) remained stable (59%-61%, p = 0.452). Endoscopic or surgical resections were performed more often (28%-34%,p = 0.034) and the use of best supportive care decreased (21%-15%,p = 0.018). In the qualitative part an improved knowledge, collaboration and discussion was perceived due to implementation of the uMDTM. Three-year OS for all OC patients increased after the implementation of the uMDTM (24%-30%,p = 0.025). CONCLUSIONS Implementation of a regional Upper-GI MDTM was associated with an increase in patients discussed with a resection centre, more curative resections and a better OS. It remains to be elucidated which factors in the clinical pathway explain this observed improved survival.
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Affiliation(s)
- Josianne C H B M Luijten
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands
| | - Vera C Haagsman
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands
| | - Misha D P Luyer
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Pauline A J Vissers
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands
| | - Joost Nederend
- Department of Radiology, Catharina Hospital, Eindhoven, the Netherlands
| | | | | | - Wouter Curvers
- Department of Gastroenterology, Catharina Hospital, Eindhoven, the Netherlands
| | | | | | - Ruud W M Schrauwen
- Department of Gastroenterology, Bernhoven Hospital, Uden, the Netherlands
| | | | - Erik H C J Buster
- Department of Gastroenterology, Maxima Medical Centre, Veldhoven, the Netherlands
| | - Jeroen Vincent
- Department of Oncology, Elkerliek Hospital, Helmond, the Netherlands
| | | | - Rob H A Verhoeven
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands; Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
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Shepherd C, Cookson M, Shore N. The Growth of Integrated Care Models in Urology. Urol Clin North Am 2021; 48:223-232. [PMID: 33795056 DOI: 10.1016/j.ucl.2020.12.002] [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: 10/21/2022]
Abstract
With heightened awareness of health care outcomes and efficiencies and reimbursement-based metrics, it is ever more important that urologists consider the effects of integrated care models on physicians/staff/clinics fulfillment and patient outcomes, and whether and how to optimally implement these models within their unique practice settings. Despite growing evidence that integrating care improves outcomes, uncertainty persists regarding which approach is most efficient and achievable in terms of specialty considerations and financial resources. In this article, we discuss strategies for integrating urologic care and its impact on current and future health care delivery.
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Affiliation(s)
- Caitlin Shepherd
- University of Oklahoma, 920 Stanton L. Young Boulevard, WP 2140, Oklahoma City, OK 73104, USA.
| | - Michael Cookson
- Department of Urology, University of Oklahoma, 920 Stanton L. Young Boulevard, WP 2140, Oklahoma City, OK, USA
| | - Neal Shore
- CPI, Carolina Research Center, 823 82nd Parkway, Myrtle Beach, SC 29572, USA
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29
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Youl PH, Theile DE, Moore J, Harrington J, Philpot S. Outcomes following major resection for colorectal cancer in patients aged 65+ years: a population-based study in Queensland, Australia. ANZ J Surg 2021; 91:932-937. [PMID: 33590925 DOI: 10.1111/ans.16631] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/17/2021] [Accepted: 01/19/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The risk of developing colorectal cancer (CRC) increases with increasing age. As surgery is the primary treatment for CRC, our aim was to examine outcomes following major resection for CRC in a cohort of individuals aged ≥65 years. METHODS This population-based retrospective study included 18 339 patients aged ≥65 years diagnosed with CRC from 2007 to 2016. Multivariate logistic regression was used to examine factors associated with the likelihood of having major resection, 30-day mortality and laparoscopic surgical procedure. Cox proportional hazards was used to examine factors associated with risk of death at 2 years post-surgery. RESULTS Overall, 77.8% (n = 14 274) of patients had a major resection. Males and patients ≥75 years were significantly less likely to have a major resection (P < 0.001 and P < 0.001, respectively). Thirty-day mortality was 3.1% and 2-year overall survival was 78.7%. After adjustment, factors such as increasing age (≥75 years), ≥2 comorbidities, emergency admission, open surgical procedure and treatment in a public hospital were all independently and significantly associated with poorer outcomes. The likelihood a patient had a laparoscopic procedure was significantly lower for those from a disadvantaged area (P < 0.001), emergency admission (P < 0.001) as well as for those treated in a public versus private hospital (P < 0.001). CONCLUSIONS Post-operative mortality increased, and 2-year survival decreased after age 75 years. The finding of significantly lower rates of laparoscopic surgery for patients from disadvantaged areas and those treated in a public hospital requires further investigation.
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Affiliation(s)
- Philippa H Youl
- Cancer Alliance Queensland, Metro South Hospital and Health Service, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - David E Theile
- Cancer Alliance Queensland, Metro South Hospital and Health Service, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.,Translational Research Institute, University of Queensland, Brisbane, Australia
| | - Julie Moore
- Cancer Alliance Queensland, Metro South Hospital and Health Service, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - John Harrington
- Cancer Alliance Queensland, Metro South Hospital and Health Service, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Shoni Philpot
- Cancer Alliance Queensland, Metro South Hospital and Health Service, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
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30
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Algwaiz G, Salam Y, Bustami R, Ferwana M, Jazieh AR. Do Multidisciplinary Tumor Board Discussions Correlate With Increase in 5-Year Survival? A Meta-Analysis Study. GLOBAL JOURNAL ON QUALITY AND SAFETY IN HEALTHCARE 2021; 4:3-10. [PMID: 37260532 PMCID: PMC10229009 DOI: 10.36401/jqsh-20-23] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 10/20/2020] [Indexed: 06/02/2023]
Abstract
Introduction Due to the complex nature of cancer cases, it is imperative that the involved healthcare providers coordinate the patients care plan in union to reach the best possible outcome in the smoothest and fastest manner. This is what multidisciplinary tumor board (MTB) meetings strive to achieve. Conducting regular MTB meetings requires significant investment of time and finances. It is thus vital to assess the empirical benefits of such practice. Methods A meta-analysis was conducted to evaluate the literature regarding the impact of MTB meetings on patient 5-year survival. Relevant studies were identified by searching Ovid MEDLINE and Embase databases from January 1995 to July 2019. Studies were included if they assessed 5-year survival in cases discussed in MTB meetings and used a comparison group and/or a pretest and posttest design. Results Five articles met the study's inclusion criteria. Quality of studies was affected by selection bias and the use of historic cohorts. The results showed significantly improved 5-year survival in the MTB group compared with the non-MTB groups (odds ratio for 5-year death rate of 0.59, CI 0.45-0.78, p < 0.001). Conclusion This meta-analysis showed that cancer MTB meetings have a significant impact on patients' 5-year survival. This could be because of several reasons, such as less time to treatment initiation, better adherence to guidelines, higher numbers of investigational imaging, lesser surgical complications, and recurrence rates. Future prospective studies are needed to further delineate reasons for improvement of outcome to enhance the benefits of this approach.
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Affiliation(s)
- Ghada Algwaiz
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Yezan Salam
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Rami Bustami
- Department of Healthcare Management, Alfaisal University, Riyadh, Saudi Arabia
| | - Mazen Ferwana
- Department of Family Medicine, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdul Rahman Jazieh
- Department of Oncology, King Abdulaziz Medical City, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
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Biju K, Zhang GQ, Stem M, Sahyoun R, Safar B, Atallah C, Efron JE, Rajput A. Impact of Treatment Coordination on Overall Survival in Rectal Cancer. Clin Colorectal Cancer 2021; 20:187-196. [PMID: 33618972 DOI: 10.1016/j.clcc.2021.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 01/15/2021] [Accepted: 01/17/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Rectal cancer treatment is often multimodal, comprising of surgery, chemotherapy, and radiotherapy. However, the impact of coordination between these modalities is currently unknown. We aimed to assess whether delivery of nonsurgical therapy within same facility as surgery impacts survival in patients with rectal cancer. METHODS A patient cohort with rectal cancer stages II to IV who received multimodal treatment between 2004 and 2016 from National Cancer Database was retrospectively analyzed. Patients were categorized into three groups: (A) surgery + chemotherapy + radiotherapy at same facility (surgery + 2); (B) surgery + chemotherapy or radiotherapy at same facility (surgery + 1); or (C) only surgery at reporting facility (chemotherapy + radiotherapy elsewhere; surgery + 0). The primary outcome was 5-year overall survival (OS), analyzed using Kaplan-Meier curves, log-rank tests, and Cox proportional-hazards models. RESULTS A total of 44,716 patients (16,985 [37.98%] surgery + 2, 12,317 [27.54%] surgery + 1, and 15,414 [34.47%] surgery + 0) were included. In univariate analysis, we observed that surgery+2 patients had significantly greater 5-year OS compared to surgery + 1 or surgery + 0 patients (5-year OS: 63.46% vs 62.50% vs 61.41%, respectively; P= .002). We observed similar results in multivariable Cox proportional-hazards analysis, with surgery + 0 group demonstrating increased hazard of mortality when compared to surgery + 2 group (HR: 1.09; P< .001). These results held true after stratification by stage for stage II (HR 1.10; P= .022) and stage III (HR 1.12; P< .001) but not for stage IV (P= .474). CONCLUSION Greater degree of care coordination within the same facility is associated with greater OS in patients with stage II to III rectal cancer. This finding illustrates the importance of interdisciplinary collaboration in multimodal rectal cancer therapy.
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Affiliation(s)
- Kevin Biju
- Colorectal Research Unit, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - George Q Zhang
- Colorectal Research Unit, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Miloslawa Stem
- Colorectal Research Unit, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Rebecca Sahyoun
- Colorectal Research Unit, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Bashar Safar
- Colorectal Research Unit, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Chady Atallah
- Colorectal Research Unit, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jonathan E Efron
- Colorectal Research Unit, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ashwani Rajput
- Colorectal Research Unit, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
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Luijten JCHBM, Vissers PAJ, Lingsma H, van Leeuwen N, Rozema T, Siersema PD, Rosman C, van Laarhoven HWM, Lemmens VEP, Nieuwenhuijzen GAP, Verhoeven RHA. Changes in hospital variation in the probability of receiving treatment with curative intent for esophageal and gastric cancer. Cancer Epidemiol 2021; 71:101897. [PMID: 33484974 DOI: 10.1016/j.canep.2021.101897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 01/06/2021] [Accepted: 01/10/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Previous studies describe a large variation in the proportion of patients undergoing treatment with curative intent for esophageal (EC) and gastric cancer (GC). Since centralization of surgical care was initiated and more awareness regarding hospital practice variation was potentially present, we hypothesized that hospital practice variation for potentially curable EC and GC patients changed over time. METHODS Patients with potentially curable EC (n = 10,115) or GC (n = 3988) diagnosed between 2012-2017 were selected from the Netherlands Cancer Registry. Multilevel multivariable logistic regression was used to analyze the differences in the probability of treatment with curative intent between hospitals of diagnosis over time, comparing 2012-2014 with 2015-2017. Relative survival (RS) between hospitals with different probabilities of treatment with curative intent were compared. RESULTS The range of proportions of patients undergoing treatment with curative intent per hospital of diagnosis for EC was 45-95 % in 2012-2014 and 54-89 % in 2015-2017, and for GC 52-100 % and 45-100 %. The adjusted variation declined for EC with Odds Ratios ranging from 0.50 to 1.72 between centers in the first period to 0.70-1.44 in the second period (p < 0.001) and did not change for GC (Odds Ratios ranging from 0.78 to 1.23 to 0.82-1.23, (p = 1.00)). A higher probability of treatment with curative intent was associated with a better survival for both malignancies. CONCLUSION Although substantial variation between hospitals of diagnosis in the probability in receiving treatment with curative intent still exists for both malignancies, it has decreased for EC. A low probability of receiving curative treatment remained associated with worse survival.
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Affiliation(s)
- Josianne C H B M Luijten
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands
| | - Pauline A J Vissers
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands
| | - Hester Lingsma
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Nikki van Leeuwen
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Tom Rozema
- Department of Radiotherapy, Institute Verbeeten, Tilburg, the Netherlands
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Camiel Rosman
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Hanneke W M van Laarhoven
- Department of Medical Oncology, Cancer Centre Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Valery E P Lemmens
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands; Department of Public Health, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | | | - Rob H A Verhoeven
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands; Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands.
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Bond A, Conley T, Fiske J, Raymond V, Young A, Collins P, Dibb M, Smith P. Reducing 30-day post gastrostomy insertion mortality with a feeding issues multidisciplinary team meeting. Clin Nutr ESPEN 2020; 40:282-287. [DOI: 10.1016/j.clnesp.2020.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/03/2020] [Accepted: 09/06/2020] [Indexed: 12/24/2022]
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Heuser C, Diekmann A, Schellenberger B, Bohmeier B, Kuhn W, Karbach U, Ernstmann N, Ansmann L. Patient Participation in Multidisciplinary Tumor Conferences from the Providers' Perspective: Is It Feasible in Routine Cancer Care? J Multidiscip Healthc 2020; 13:1729-1739. [PMID: 33273821 PMCID: PMC7708776 DOI: 10.2147/jmdh.s283166] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 11/16/2020] [Indexed: 12/18/2022] Open
Abstract
Objective Recent studies from Germany show that a small amount of breast and gynecological cancer patients participate in multidisciplinary tumor conferences (MTCs) at some cancer centers. One reason for the variation by center might be the providers’ attitudes about and experiences with MTC patient participation (MTCpp), which has not been analyzed before. Therefore, it is the aim of this study to analyze the providers’ expected or experienced feasibility concerning MTCpp at breast and gynecological cancer centers in Germany. Methods This paper presents cross-sectional qualitative interview data from the PINTU study. From April to December 2018, n=30 health-care providers from n=6 breast and gynecological cancer centers in North-Rhine-Westphalia, Germany, were interviewed. One-half of the providers had no experience and the other half had experience with MTCpp. Inductive and deductive coding was performed in order to capture the feasibility aspects of participation. Results MTCpp seems not to be feasible in routine cancer care following providers’ expected barriers and negative experiences. However, MTCpp seems to be feasible for selected cancer patients following providers’ expected opportunities and positive experiences. Our results show that both provider groups report positive and negative experiences or expectations. Conclusion The mixed findings regarding expected or experienced feasibility of MTCpp provide first insights into differences concerning MTCpp between organizations. Our results suggest that the providers’ perceptions (expectations and experiences) influence the possibility for patients to participate in an MTC in a cancer center.
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Affiliation(s)
- Christian Heuser
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, Germany
| | - Annika Diekmann
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, Germany
| | - Barbara Schellenberger
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, Germany
| | - Barbara Bohmeier
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, Germany
| | - Walther Kuhn
- Gynecological Cancer Center Deggendorf, DONAUISAR Hospital, Deggendorf, Germany
| | - Ute Karbach
- Sociology in Rehabilitation, Faculty of Rehabilitation Sciences, Technical University Dortmund, Dortmund, Germany
| | - Nicole Ernstmann
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, Germany
| | - Lena Ansmann
- Division for Organizational Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
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Soukup T, Lamb BW, Morbi A, Shah NJ, Bali A, Asher V, Gandamihardja T, Giordano P, Darzi A, SA Green J, Sevdalis N. A multicentre cross-sectional observational study of cancer multidisciplinary teams: Analysis of team decision making. Cancer Med 2020; 9:7083-7099. [PMID: 32794351 PMCID: PMC7541152 DOI: 10.1002/cam4.3366] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/15/2020] [Accepted: 07/20/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Multidisciplinary teams (MDT) formulate expert informed treatment recommendations for people with cancer. We set out to examine how the factors proposed by the functional perspective of group decision making (DM), that is, interaction process, internal factors (factors emanating from within the group such as group size), external circumstances (factors coming from the outside of the team), and case-complexity affect the quality of MDT decision making. METHODS This was a cross-sectional observational study. Three cancer MDTs were recruited with 44 members overall and 30 of their weekly meetings filmed. Validated observational instruments were used to measure quality of DM, interactions, and complexity of 822 case discussions. RESULTS The full regression model with the variables proposed by the functional perspective was significant, R2 = 0.52, F(20, 801) = 43.47, P < .001, adjusted R2 = 0.51. Positive predictors of DM quality were asking questions (P = .001), providing answers (P = .001), team size (P = .007), gender balance (P = .003), and clinical complexity (P = .001), while negative socioemotional reactions (P = .007), gender imbalance (P = .003), logistical issues (P = .001), time-workload pressures (P = .002), and time spent in the meeting (P = .001) were negative predictors. Second half of the meetings also saw significant decrease in the DM quality (P = .001), interactions (P = .001), group size (P = .003), and clinical complexity (P = .001), and an increase in negative socioemotional reactions (P = .001) and time-workload pressures (P = .001). DISCUSSION To the best of our knowledge, this is the first study to attempt to assess the factors proposed by the functional perspective in cancer MDTs. One novel finding is the effect of sociocognitive factors on team DM quality, while another is the cognitive-catch 22 effect: while the case discussions are significantly simpler in the second half of the meeting, there is significantly less time left to discuss the remaining cases, further adding to the cognitive taxation in teams who are now rapidly attempting to close their time-workload gap. Implications are discussed in relation to quality and safety.
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Affiliation(s)
- Tayana Soukup
- Centre for Implementation ScienceKing’s College LondonUK
| | | | - Abigail Morbi
- Department of Surgery and CancerImperial College LondonLondonUK
| | | | | | | | | | | | - Ara Darzi
- Department of Surgery and CancerImperial College LondonLondonUK
| | - James SA Green
- Whipps Cross University HospitalBarts Health NHS TrustLondonUK
| | - Nick Sevdalis
- Centre for Implementation ScienceKing’s College LondonUK
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Kochovska S, Ferreira DH, Luckett T, Phillips JL, Currow DC. Earlier multidisciplinary palliative care intervention for people with lung cancer: a systematic review and meta-analysis. Transl Lung Cancer Res 2020; 9:1699-1709. [PMID: 32953543 PMCID: PMC7481603 DOI: 10.21037/tlcr.2019.12.18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Lung cancer is the most common cancer and leading cause of cancer mortality globally. Lung cancer is associated with significant morbidity, with symptoms often being poorly managed, causing significant symptom burden for both patients and their family caregivers. In people with life-limiting illnesses including advanced cancer, palliative care has been effective in improving symptom control, physical and mental wellbeing, quality of life, and survivorship; with benefits extending to caregivers while in the role and subsequently. Earlier integration of palliative care within oncology may be associated with improved patient outcomes, and has been supported by two Lancet commissions and national guidelines. The evidence for its effectiveness, however, has been mixed across the cancer spectrum. The aim of this review was to evaluate the current evidence for the effectiveness of early integrated palliative care in improving outcomes for people with lung cancer and their caregivers. Meta-analyses were performed where studies used the same measure. Otherwise, synthesis used a narrative approach. Similar to other types of advanced cancer, this review reveals mixed evidence for the effectiveness of early referral to palliative care and for the effectiveness of individual palliative interventions for people with lung cancer and their caregivers. Evidence that on-demand palliative care is equally, if not more effective than palliative care that is routinely provided, raises the question whether initiation and provision of palliative care as part of multidisciplinary lung cancer care ought to be guided by an early referral or need-based referral. Better understanding of what constitutes palliative care when delivered to people with lung cancer and their caregivers will help delineate the correlation with reported outcomes for these populations.
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Affiliation(s)
- Slavica Kochovska
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Diana H Ferreira
- Discipline Palliative and Supportive Services, Flinders University, Adelaide, SA, Australia
| | - Tim Luckett
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Jane L Phillips
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - David C Currow
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.,Wolfson Palliative Care Research Centre, University of Hull, Hull, UK
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Einführung eines interdisziplinären Tumorboards führt zur Verbesserung der Behandlungsergebnisse von Cholangio- und Gallenblasenkarzinomen. Chirurg 2020; 91:650-661. [DOI: 10.1007/s00104-019-01100-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Serra M, Li AQ, Cataliotti L, Cianchetti E, Corsi F, De Vita R, Fabiocchi L, Fortunato L, Friedman D, Klinger M, Marotti L, Murgo R, Ponti A, Roncella M, Del Turco MR, Rinaldi S, Surace A, Taffurelli M, Tinterri C, Tomatis M, Mano MP. Aesthetic results following breast cancer surgery: A prospective study on 6515 cases from ten Italian Senonetwork breast centers. Eur J Surg Oncol 2020; 46:1861-1866. [PMID: 32723610 DOI: 10.1016/j.ejso.2020.04.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 03/20/2020] [Accepted: 04/17/2020] [Indexed: 10/24/2022] Open
Abstract
Breast cancer treatment has deeply changed in the last decades, since clinical and oncological cure cannot be achieved without patient's satisfaction in term of aesthetic outcomes. Several methods have been proposed to objectively assess these results. However, Italian breast centers have not yet agreed on measurable, reproducible and validated aesthetic outcome indicators to monitor their performance. METHODS The study was designed and conducted by Senonetwork, a not-for-profit association of Italian breast centers. Ten breast centers were selected based on specific eligibility criteria. This multicentre observational prospective study recruited 6515 patients with diagnosis of in situ or invasive breast cancer who underwent breast surgery in the years 2013-2016. Thirteen indicators of aesthetic results and of related quality of care were analyzed. Data collection and analysis were conducted using a common study database. RESULTS On average, seven out of ten centers were able to collect data on the proposed indicators with a proportion of missing values < 25%. By expert consensus based on study results, some seven indicators have been defined as "mandatory" while the remaining six have been defined as "recommended" because they require further refinement before they can be proposed for monitoring aesthetic outcomes or because there are doubts on the feasibility of data collection. The minimum standard is reached for 5 of 13 indicators. This finding and the wide range between centers reveal that there is ample room for improvement. CONCLUSIONS From the present study useful measurable aesthetic parameters have emerged, leading to the definition of target objectives that breast centers can use for benchmarking and improvement of quality of care.
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Affiliation(s)
- M Serra
- UOC di Chirurgia Generale e Della Mammella Policlinico di Sant'Orsola, Università di Bologna, Bologna, Italy.
| | - A Quattrini Li
- Centro Senologico Azienda Ospedaliera Universitaria Pisana Ospedale Santa Chiara, Pisa, Italy
| | | | - E Cianchetti
- Breast Centre Asl 02 Abruzzo, P.O. G. Bernabeo Ortona, Chieti, Italy
| | - F Corsi
- Breast Unit, Surgery Department, ICS Maugeri S.p.A. SB, Pavia, Italy; Department of Biomedical and Clinical Sciences L. Sacco, University of Milan, Milan, Italy
| | - R De Vita
- Istituto Nazionale Dei Tumori di Roma "Regina Elena", Rome, Italy
| | - L Fabiocchi
- Centro Di Senologia Rimini - Sant'Arcangelo di Romagna, Rimini, Italy
| | - L Fortunato
- UOSD Centro di Senologia, Azienda Ospedaliera San Giovanni Addolorata, Rome, Italy
| | - D Friedman
- Policlinico San Martino di Genova. University of Genova, DISC Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, Genova, Italy
| | - M Klinger
- Breast Centre Humanitas - Istituto Clinico Humanitas - Humanitas Mirasole Spa, Rozzano, (Milan), Italy
| | - L Marotti
- European Society of Breast Cancer Specialists, Florence, Italy
| | - R Murgo
- Dipartimento di Oncoematologia/Unità Operativa Complessa di Chirurgia Senologica, IRCCS Ospedale Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - A Ponti
- CPO Piemonte - SSD Epidemiologia Screening - AOU Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - M Roncella
- Centro Senologico Azienda Ospedaliera Universitaria Pisana Ospedale Santa Chiara, Pisa, Italy
| | | | - S Rinaldi
- UOSVD di Chirurgia Senologica Ospedale San Paolo, Bari, Italy
| | - A Surace
- CPO Piemonte - SSD Epidemiologia Screening - AOU Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - M Taffurelli
- UOC di Chirurgia Generale e Della Mammella Policlinico di Sant'Orsola, Università di Bologna, Bologna, Italy
| | - C Tinterri
- Breast Centre Humanitas - Istituto Clinico Humanitas - Humanitas Mirasole Spa, Rozzano, (Milan), Italy
| | - M Tomatis
- CPO Piemonte - SSD Epidemiologia Screening - AOU Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - M P Mano
- CPO Piemonte - AOU Città Della Salute e Della Scienza di Torino and University of Turin, Turin, Italy
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Basso M, Corallo S, Calegari MA, Zurlo IV, Ardito F, Vellone M, Marchesani S, Orlandi A, Dadduzio V, Fucà G, Di Dio C, Mele C, Barbaro B, Strippoli A, Coppola A, Cassano A, Bria E, Barone CA, Giuliante F. The impact of multidisciplinary team management on outcome of hepatic resection in liver-limited colorectal metastases. Sci Rep 2020; 10:10871. [PMID: 32616782 PMCID: PMC7331814 DOI: 10.1038/s41598-020-67676-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 05/19/2020] [Indexed: 12/28/2022] Open
Abstract
Hepatic resection is the gold standard treatment for patients affected by liver-limited colorectal metastases. Reports addressing the impact of multidisciplinary team (MDT) evaluation on survival are controversial. The aim of this study was to evaluate the benefit of MDT management in these patients in our Institution experience. The objective of the analysis was to compare survivals of patients managed within our MDT (MDT cohort) to those of patients referred to surgery from other hospitals without MDT discussion (non-MDT cohort). Of the 523 patients, 229 were included in the MDT cohort and 294 in the non-MDT cohort. No difference between the two groups was found in terms of median overall survival (52.5 vs 53.6 months; HR 1.13; 95% CI, 0.88-1.45; p = 0.344). In the MDT cohort there was a higher number of metastases (4.5 vs 2.7; p < 0.0001). The median duration of chemotherapy was lower in MDT patients (8 vs 10 cycles; p < 0.001). Post-operative morbidity was lower in the MDT cohort (6.2 vs 21.5%; p < 0.001). One hundred and ninety-seven patients in each group were matched by propensity score and no significant difference was observed between the two groups in terms of OS and DFS. Our study does not demonstrate a survival benefit from MDT management, but it allows surgery to patients with a more advanced disease. MDT assessment reduces the median duration of chemotherapy and post-operative morbidities.
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Affiliation(s)
- Michele Basso
- Oncologia Medica, Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Salvatore Corallo
- Oncologia Medica, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Ina Valeria Zurlo
- Oncologia Medica, Università Cattolica del Sacro Cuore-IRCCS, Rome, Italy
| | - Francesco Ardito
- Chirurgia Epatobiliare, Università Cattolica del Sacro Cuore-IRCCS, Rome, Italy
| | - Maria Vellone
- Chirurgia Epatobiliare, Università Cattolica del Sacro Cuore-IRCCS, Rome, Italy
| | - Silvio Marchesani
- Oncologia Medica, Università Cattolica del Sacro Cuore-IRCCS, Rome, Italy
| | - Armando Orlandi
- Oncologia Medica, Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy
| | | | - Giovanni Fucà
- Oncologia Medica, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Carmela Di Dio
- Oncologia Medica, Università Cattolica del Sacro Cuore-IRCCS, Rome, Italy
| | - Caterina Mele
- Chirurgia Epatobiliare, Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Rome, Italy
| | - Brunella Barbaro
- Radiologia Diagnostica ed Interventistica Generale, Università Cattolica del Sacro Cuore - IRCCS, Rome, Italy
| | - Antonia Strippoli
- Oncologia Medica, Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Alessandro Coppola
- Chirurgia Epatobiliare, Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Rome, Italy
| | - Alessandra Cassano
- Oncologia Medica, Università Cattolica del Sacro Cuore-IRCCS, Rome, Italy
| | - Emilio Bria
- Oncologia Medica, Università Cattolica del Sacro Cuore-IRCCS, Rome, Italy
| | - Carlo Antonio Barone
- Oncologia Medica, Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy.
| | - Felice Giuliante
- Chirurgia Epatobiliare, Università Cattolica del Sacro Cuore-IRCCS, Rome, Italy
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Blank AT, Larson BM, Shaw S, Wakefield CJ, King T, Jones KB, Randall RL. National Comprehensive Cancer Network guidelines compliance of a sarcoma service: A retrospective review. World J Clin Oncol 2020; 11:389-396. [PMID: 32874952 PMCID: PMC7450813 DOI: 10.5306/wjco.v11.i6.389] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/09/2020] [Accepted: 05/20/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Clinical workup and treatment guidelines have been published by the National Comprehensive Cancer Network (NCCN) to ensure patients are treated uniformly and appropriately. This study sought to retrospectively review patients with a new diagnosis of sarcoma who were treated in a National Cancer Institute (NCI) designated center and determine compliance rates with guidelines for sarcoma.
AIM To evaluate our compliance of NCCN sarcoma guidelines at a major NCI designated center and to report instances of deviation that could be used for future studies to improve patient care.
METHODS Data was collected retrospectively as an internal review and quality assessment of 35 newly diagnosed and treated patients. Demographic data were recorded and information concerning whether patients had appropriate imaging, biopsy and management. Variables of interest were expressed as raw numbers and percentages.
RESULTS Primary site imaging was obtained in 100% of cases. Chest and full-body imaging were obtained in 97% and 100% of indicated cases, respectively. Tissue was obtained preoperatively in 97% of cases. Imaging was reviewed at multidisciplinary Treatment Planning Conference (TPC) in 97% of cases. Pathology was reviewed in 94% of cases in TPC. Both tumor, node, metastasis staging and plan of care were reviewed in 100% of cases in TPC. Treatment guidelines were followed in 94% of cases reviewed.
CONCLUSION This study evaluated the workup and treatment provided by a single NCI designated sarcoma service to a series of patients with pathologies defined with the NCCN sarcoma treatment guidelines. Although adherence to NCCN was reported to be very high future prospective studies are required to investigate whether NCCN guidelines impact patient outcomes.
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Affiliation(s)
- Alan T Blank
- Department of Orthopedic Surgery, Division of Oncology, Rush University Medical Center, Chicago, IL 60612, United States
| | - Brandon Michael Larson
- Department of Orthopedic Surgery, Division of Oncology, Rush University Medical Center, Chicago, IL 60612, United States
| | - Sara Shaw
- Department of Orthopedics, University of Utah, Salt Lake City, UT 84108, United States
| | - Connor J Wakefield
- Department of Orthopedic Surgery, Division of Oncology, Rush University Medical Center, Chicago, IL 60612, United States
| | - Tricia King
- Department of Orthopedics, University of Utah, Salt Lake City, UT 84108, United States
| | - Kevin B Jones
- Department of Orthopedics, University of Utah, Salt Lake City, UT 84108, United States
| | - R Lor Randall
- Department of Orthopedic Surgery, University of California-Davis Medical Center, Sacramento, CA 95817, United States
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Berlin NL, Offodile AC. Leveraging Implementation Science to Improve Delivery of Oncologic Reconstructive Surgery. Ann Surg Oncol 2020; 27:2117-2119. [PMID: 32281015 DOI: 10.1245/s10434-020-08465-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Indexed: 01/27/2023]
Affiliation(s)
- Nicholas L Berlin
- Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA.,National Clinician Scholars Program, University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
| | - Anaeze C Offodile
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA. .,Baker Institute for Public Policy, Rice University, Houston, TX, USA. .,Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Wales KE, Saxena A, Gray TG. Evidence for the urogynaecology multidisciplinary team meeting: evaluation from a secondary care perspective. Int Urogynecol J 2019; 31:1181-1189. [PMID: 31813032 DOI: 10.1007/s00192-019-04154-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/10/2019] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Urogynaecology multidisciplinary team (MDT) meetings to discuss management plans prior to invasive treatments for urinary incontinence have been recommended by guidelines in the UK since 2013. Evidence for MDT discussion in urogynaecology is lacking, with only two published studies. The aim of this study was to evaluate the cases discussed at a secondary care urogynaecology MDT meeting, to establish types of clinical problems discussed, assess the outcomes of the MDT meeting and compare this with existing evidence for MDT meetings in urogynaecology. METHODS A retrospective review of meeting minutes and all case notes for patients discussed at 12 MDT meetings over 13 months was carried out. Data collected included attendance from different staff groups, reasons for referral, outcome of discussions, and changes to management plans. RESULTS A total of 123 cases were discussed over 12 meetings, 7 members of staff attended each meeting on average. 63% of cases were referred for discussion of a primary problem. The majority of patients were referred for discussion of management of urinary incontinence prior to invasive procedures (57%). The agreed MDT plan corresponded with proposed management in 67% of cases, with changes to management plan in 31% of cases. CONCLUSION Refinements to management plans in this study highlight the importance of MDT input in urogynaecology care and mirror the findings of two previous studies. Evidence for improved outcomes and the cost-effectiveness of MDTs is lacking and is an area for future research. Expanded national guidance for urogynaecology MDTs is likely to require local and regional restructuring of these in the UK.
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Affiliation(s)
- Keren E Wales
- Sheffield Teaching Hospitals NHS Foundation Trust, c/o Tricia Kenyon, Level 4, Jessop Wing, Tree Root Walk, Sheffield, S10 2SF, UK.,The Rotherham Foundation NHS Trust, Rotherham, UK
| | | | - Thomas G Gray
- Sheffield Teaching Hospitals NHS Foundation Trust, c/o Tricia Kenyon, Level 4, Jessop Wing, Tree Root Walk, Sheffield, S10 2SF, UK.
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Nguyen EK, Yu H, Pond G, Shayegan B, Pinthus JH, Kapoor A, Mukherjee SD, Neville A, Lalani AKA, Hotte SJ, Corbett TB, Dayes IS, Lukka HR. Outcomes of trimodality bladder-sparing therapy for muscle-invasive bladder cancer. Can Urol Assoc J 2019; 14:122-129. [PMID: 31702551 DOI: 10.5489/cuaj.5945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Although radical cystectomy is considered the standard of care for muscle-invasive bladder cancer (MIBC), recent data has suggested comparable survival outcomes for bladder-sparing trimodality therapy (TMT). We conducted a retrospective, single-institution analysis of MIBC patients to evaluate the efficacy of TMT as an alternative, curative approach to surgical intervention. METHODS We conducted a retrospective analysis of MIBC patients assessed by a multidisciplinary team at the Juravinski Cancer Centre from 2010-2016. Patients underwent transurethral resection of bladder tumor (TURBT) followed by radiotherapy with or without concurrent chemotherapy. Patients could receive neoadjuvant treatment. Clinical data and response rates were summarized, and overall survival (OS) and disease-free survival (DFS) were estimated using the Kaplan-Meier method. RESULTS Our analytic cohort included 115 patients, of whom 53 underwent TMT and 62 underwent radiotherapy alone following TURBT. Median age at diagnosis was 79 years and median followup was 21 months. Complete response rates in those receiving TMT and radiation without chemotherapy were 84.4% and 66.7%, respectively. For TMT patients, three-year OS and DFS were 68.5% and 49.6%, respectively. Patients who received TMT had reduction in risk of mortality (hazard ratio [HR] 0.49; p=0.026) and disease recurrence (HR 0.55; p=0.017) compared to those who had radiation without chemotherapy. Overall, four patients had grade 3 or higher late toxicity. CONCLUSIONS In this single-institution analysis, TMT appears to be a safe and effective approach in the short-term management of MIBC in appropriately selected patients. Extended followup and analysis are necessary to validate these results.
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Affiliation(s)
- Eric K Nguyen
- Division of Radiation Oncology, McMaster University, Hamilton, ON, Canada
| | - Hang Yu
- Michael DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Gregory Pond
- Escarpment Cancer Research Institute, McMaster University, Hamilton, ON, Canada
| | - Bobby Shayegan
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Jehonathan H Pinthus
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Anil Kapoor
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Som D Mukherjee
- Division of Medical Oncology, McMaster University, Hamilton, ON, Canada
| | - Alan Neville
- Division of Medical Oncology, McMaster University, Hamilton, ON, Canada
| | - Aly-Khan A Lalani
- Division of Medical Oncology, McMaster University, Hamilton, ON, Canada
| | - Sebastien J Hotte
- Division of Medical Oncology, McMaster University, Hamilton, ON, Canada
| | - Thomas B Corbett
- Division of Radiation Oncology, McMaster University, Hamilton, ON, Canada
| | - Ian S Dayes
- Division of Radiation Oncology, McMaster University, Hamilton, ON, Canada
| | - Himanshu R Lukka
- Division of Radiation Oncology, McMaster University, Hamilton, ON, Canada
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Seuren LM, Stommel W, van Asselt D, Sir Ö, Stommel M, Schoon Y. Multidisciplinary meetings at the emergency department: A conversation-analytic study of decision-making. Soc Sci Med 2019; 242:112589. [PMID: 31629160 DOI: 10.1016/j.socscimed.2019.112589] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 10/01/2019] [Accepted: 10/03/2019] [Indexed: 12/13/2022]
Abstract
Multidisciplinary meetings (MDMs) have become an established part of many medical disciplines. Much research has been done to investigate the conditions under which they work best. This research, however, has been mostly retrospective and has had little consideration for the actual workings of MDMs. The aim of this study was to determine how Multidisciplinary Teams (MDTs) come to a shared decision and thus how they organize MDMs moment by moment. For this purpose we recorded twenty MDMs at the Department of Emergency Medicine (ED) of the Radboud University Medical Center in The Netherlands between November 2017 and June 2018. These meetings, contrary to those discussed in the literature, were scheduled ad-hoc as patients were seen at the ED and were conducted by small MDTs of between three and six participants, always involving a surgeon, a geriatrician, and an emergency physician. Using Conversation Analysis we found that despite the ad hoc nature of these meetings, teams collaboratively developed a structure that was grounded in everyday medical practice and reached a decision in on average slightly over 10 min. First they do a case presentation in which they share the patient's medical history and results of the physical examination and any medical tests. They subsequently agree on a differential diagnosis, and then develop a work plan. Finally, the decision is often formulated to invite confirmation and make it an interactionally shared decision. The benefit of having an MDM was evidenced by discussion of patients' frailty in particular: it was sometimes omitted during the case presentation, but then consistently requested by the geriatrician. And as we show, it was occasionally invoked as a definitive argument for deciding between surgical or conservative treatment. Our analysis suggests that MDMs can have added value in other disciplines where it is feasible to schedule meetings ad hoc.
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Affiliation(s)
- Lucas M Seuren
- Radboud University Medical Center, Department of Emergency Medicine, Geert Grooteplein Zuid 22, 6525 GA, Nijmegen, the Netherlands.
| | - Wyke Stommel
- Radboud University, Center for Language Studies, Erasmusplein 1, 6525 HT Nijmegen, the Netherlands
| | - Dieneke van Asselt
- Radboud University Medical Center, Department of Geriatrics, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
| | - Özcan Sir
- Radboud University Medical Center, Department of Emergency Medicine, Geert Grooteplein Zuid 22, 6525 GA, Nijmegen, the Netherlands
| | - Martijn Stommel
- Radboud University Medical Center, Department of Surgery, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
| | - Yvonne Schoon
- Radboud University Medical Center, Department of Emergency Medicine, Geert Grooteplein Zuid 22, 6525 GA, Nijmegen, the Netherlands; Radboud University Medical Center, Department of Geriatrics, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands; Radboud University Medical Center, Radboud Institute for Health Sciences, Geert Grooteplein Zuid 28, 6525 GA, Nijmegen, the Netherlands
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Quyyumi FF, Wright JD, Accordino MK, Buono D, Law CW, Hillyer GC, Neugut AI, Hershman DL. Factors Associated with Multidisciplinary Consultations in Patients with Early Stage Breast Cancer. Cancer Invest 2019; 37:233-241. [PMID: 31296072 DOI: 10.1080/07357907.2019.1624766] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Purpose: Multidisciplinary care (MDC) encourages multiple specialists to formulate a unified treatment plan. We sought to determine the frequency and predictors of MDC and assess the association between MDC and nationally-recognized quality metrics in patients with breast cancer. Methods: We used the surveillance, epidemiology, and end results-medicare dataset to evaluate patients diagnosed with stages I-III breast cancer who underwent breast-conserving surgery between 2002 and 2011 with follow-up to 2012. We defined MDC as a visit claim from a surgeon, radiation oncologist and medical oncologist within 12 months of diagnosis. We used multivariable regression analysis to determine the association between demographic and clinical variables and MDC, and to assess the association between MDC and three nationally-recognized quality indicators (adjuvant hormone therapy for hormone receptor-positive tumors, chemotherapy for hormone receptor-negative cancer, and radiation after lumpectomy). Results: Of the 61,039 patients in our initial cohort, 53,849 (88.2%) saw a medical oncologist, 46,521 (76.2%) saw a radiation oncologist, and 43,280 (70.9%) were evaluated by all three providers the first year after diagnosis. MDC use was higher in patients with the highest socioeconomic status compared with the lowest [odds ratio (OR) 1.74, 95% CI 1.63-1.86], in patients diagnosed in later years, and those with stage III disease compared to stage I [OR 1.29, 95% CI 1.19-1.41]. Patients older in age (≥80 vs. 65-69 years, OR 0.33, 95% CI 0.31-0.34), patients with more comorbidities, those who lived in a rural setting compared to urban (OR 0.61, 95% CI 0.57-0.64), and unmarried patients (OR 0.79, 95% CI 0.76-0.82) were less likely to see all three providers. In a multivariable analysis, MDC use was associated with increased likelihood of meeting each quality metric. Conclusion: Early stage breast cancer patients were evaluated by a surgeon, radiation oncologist and medical oncologist less than 75% of the time. Enhanced coordination of care and navigation programs may improve the quality of care delivered.
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Affiliation(s)
- Farah F Quyyumi
- a Department of Medicine, Columbia University College of Physicians and Surgeons , New York , New York , USA.,b Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons , New York , New York , USA
| | - Jason D Wright
- b Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons , New York , New York , USA.,c Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons , New York , New York , USA
| | - Melissa K Accordino
- a Department of Medicine, Columbia University College of Physicians and Surgeons , New York , New York , USA.,b Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons , New York , New York , USA
| | - Donna Buono
- d Department of Epidemiology, Mailman School of Public Health, Columbia University , New York , New York , USA
| | - Cynthia W Law
- d Department of Epidemiology, Mailman School of Public Health, Columbia University , New York , New York , USA
| | - Grace C Hillyer
- b Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons , New York , New York , USA.,d Department of Epidemiology, Mailman School of Public Health, Columbia University , New York , New York , USA
| | - Alfred I Neugut
- a Department of Medicine, Columbia University College of Physicians and Surgeons , New York , New York , USA.,b Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons , New York , New York , USA.,d Department of Epidemiology, Mailman School of Public Health, Columbia University , New York , New York , USA
| | - Dawn L Hershman
- a Department of Medicine, Columbia University College of Physicians and Surgeons , New York , New York , USA.,b Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons , New York , New York , USA.,d Department of Epidemiology, Mailman School of Public Health, Columbia University , New York , New York , USA
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Analysing Breast Cancer Multidisciplinary Patient Management: A Prospective Observational Evaluation of Team Clinical Decision-Making. World J Surg 2019; 43:559-566. [PMID: 30382292 PMCID: PMC6329729 DOI: 10.1007/s00268-018-4815-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background Multidisciplinary team (MDT)-driven cancer care is a mandatory UK national policy, widely used globally. However, few studies have examined how MDT members make decisions as a team. We report a single-centre prospective study on team working within breast cancer MDT. Methods This was a prospective observational study of 10 breast MDT meetings (MDM). Trained clinical observer scored quality of presented information and disciplinary contribution to case reviews in real time, using a validated tool, namely Metric for the Observation of Decision-Making. Data were analysed to evaluate quality of team working. Results Ten MDMs were observed (N = 346 patients). An average of 42 patients were discussed per MDM (range: 29–51) with an average 3 min 20 s (range: 31 s–9 min) dedicated to each patient. Management decision was made in 99% of cases. In terms of contribution to case reviews, breast care nurses scored significantly (p < 0.05) lower (M = 1.79, SD = 0.12) compared to other team members (e.g. surgeons, M = 4.65; oncologists, M = 3.07; pathologists, M = 4.51; radiologists, M = 3.21). Information on patient psychosocial aspects (M = 1.69, SD = 0.68), comorbidities (M = 1.36, SD = 0.39) and views on treatment options (M = 1.47, SD = 0.34) was also significantly (p < 0.05) less well represented compared to radiology (M = 3.62, SD = 0.77), pathology (M = 4.42, SD = 0.49) and patient history (M = 3.91, SD = 0.48). Conclusion MDT evaluation via direct observation in a meeting is feasible and reliable. We found consistent levels of quality of information coverage and contribution within the team, but certain aspects could be improved. Contribution to patient review resides predominantly with surgeons, while presented patient information is largely of biomedical nature. These findings can be fed to cancer MDTs to identify potential interventions for improvement.
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Soukup T, Gandamihardja TAK, McInerney S, Green JSA, Sevdalis N. Do multidisciplinary cancer care teams suffer decision-making fatigue: an observational, longitudinal team improvement study. BMJ Open 2019; 9:e027303. [PMID: 31138582 PMCID: PMC6549703 DOI: 10.1136/bmjopen-2018-027303] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 03/22/2019] [Accepted: 03/26/2019] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE The objective of this study was to examine effectiveness of codesigned quality-improving interventions with a multidisciplinary team (MDT) with high workload and prolonged meetings to ascertain: (1) presence and impact of decision-making (DM) fatigue on team performance in the weekly MDT meeting and (2) impact of a short meeting break as a countermeasure of DM fatigue. DESIGN AND INTERVENTIONS This is a longitudinal multiphase study with a codesigned intervention bundle assessed within team audit and feedback cycles. The interventions comprised short meeting breaks, as well as change of room layout and appointing a meeting chair. SETTING AND PARTICIPANTS A breast cancer MDT with 15 members was recruited between 2013 and 2015 from a teaching hospital of the London (UK) metropolitan area. MEASURES A validated observational tool (Metric for the Observation of Decision-making) was used by trained raters to assess quality of DM during 1335 patient reviews. The tool scores quality of information and team contributions to reviews by individual disciplines (Likert-based scores), which represent our two primary outcome measures. RESULTS Data were analysed using multivariate analysis of variance. DM fatigue was present in the MDT meetings: quality of information (M=16.36 to M=15.10) and contribution scores (M=27.67 to M=21.52) declined from first to second half of meetings at baseline. Of the improvement bundle, we found breaks reduced the effect of fatigue: following introduction of breaks (but not other interventions) information quality remained stable between first and second half of meetings (M=16.00 to M=15.94), and contributions to team DM improved overall (M=17.66 to M=19.85). CONCLUSION Quality of cancer team DM is affected by fatigue due to sequential case review over often prolonged periods of time. This detrimental effect can be reversed by introducing a break in the middle of the meeting. The study offers a methodology based on 'team audit and feedback' principle for codesigning interventions to improve teamwork in cancer care.
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Affiliation(s)
- Tayana Soukup
- Centre for Implementation Science, Health Services and Population Research Department, King’s College London, London, UK
| | | | - Sue McInerney
- Department of Cancer, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - James S A Green
- Department of Urology, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
| | - Nick Sevdalis
- Centre for Implementation Science, Health Services and Population Research Department, King’s College London, London, UK
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A web-based multidisciplinary team meeting visualisation system. Int J Comput Assist Radiol Surg 2019; 14:2221-2231. [PMID: 31115755 DOI: 10.1007/s11548-019-01999-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 05/14/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Multidisciplinary team meetings (MDTs) are the standard of care for safe, effective patient management in modern hospital-based clinical practice. Medical imaging data are often the central discussion points in many MDTs, and these data are typically visualised, by all participants, on a common large display. We propose a Web-based MDT visualisation system (WMDT-VS) to allow individual participants to view the data on their own personal computing devices with the potential to customise the imaging data, i.e. different view of the data to that of the common display, for their particular clinical perspective. METHODS We developed the WMDT-VS by leveraging the state-of-the-art Web technologies to support four MDT visualisation features: (1) 2D and 3D visualisations for multiple imaging modality data; (2) a variety of personal computing devices, e.g. smartphone, tablets, laptops and PCs, to access and navigate medical images individually and share the visualisations; (3) customised participant visualisations; and (4) the addition of extra local image data for visualisation and discussion. RESULTS We outlined these MDT visualisation features on two simulated MDT settings using different imaging data and usage scenarios. We measured compatibility and performances of various personal, consumer-level, computing devices. CONCLUSIONS Our WMDT-VS provides a more comprehensive visualisation experience for MDT participants.
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Multidisciplinary teams for the proper management of patients with genitourinary tumors: When topics set scientific societies’ agenda. TUMORI JOURNAL 2019; 105:161-167. [DOI: 10.1177/0300891618784789] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Introduction: The multidisciplinary management of oncologic patients is identified as the bottom line element of quality in tumor care. Methods: In 2015, 7 Italian scientific societies representing the specialists involved in the diagnosis and treatment of genitourinary tumors joined efforts in the Italian uro-oncologic multidisciplinary teams (MDTs) project. The aims were to promote the reorganization of genitourinary cancer care, switching to a multidisciplinary approach, reach a consensus on the core elements for the setup of MDTs in genitourinary oncology, and support health policy makers and managers in remodeling of the assistance and care of uro-oncologic patients on a national level. Results: The first activity was the setup of 5 working groups, given the task of exploring selected topics: general principles, organization of MDTs, minimal requirements, economic evaluation, and relations with authorities. The groups participated in the writing of a document that was approved by the scientific societies and published on their web sites. Moreover, a few items summarizing the extensive document were approved in the first MDT Consensus Conference held in Milan in December 2015. Conclusions: The experience of this initial phase led to the opening of the team to other professionals and societies, in line with a correct management of patients with genitourinary tumors, which need a multidisciplinary as well as a multiprofessional approach with emerging techniques and procedures, and with a new project work package on genitourinary paths of care and indicators.
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Townsend M, Kallogjeri D, Scott-Wittenborn N, Gerull K, Jansen S, Nussenbaum B. Multidisciplinary Clinic Management of Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg 2019; 143:1213-1219. [PMID: 29075744 DOI: 10.1001/jamaoto.2017.1855] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Melanie Townsend
- Department of Otolaryngology, Washington University in St Louis, St Louis, Missouri
| | - Dorina Kallogjeri
- Department of Otolaryngology, Washington University in St Louis, St Louis, Missouri
| | | | - Katherine Gerull
- Department of Otolaryngology, Washington University in St Louis, St Louis, Missouri
| | - Stacy Jansen
- Department of Otolaryngology, Washington University in St Louis, St Louis, Missouri
| | - Brian Nussenbaum
- Department of Otolaryngology, Washington University in St Louis, St Louis, Missouri
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