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Zgardau A, Hathi K, Fowler J, Mullowney T, Price A, Husein M, Graham ME, Dzioba A, Madou E, Strychowsky JE. Carbon Footprint Reduction Associated With Multidisciplinary Pediatric Airway Clinics: A Program Evaluation Study. OTO Open 2024; 8:e167. [PMID: 38974174 PMCID: PMC11222738 DOI: 10.1002/oto2.167] [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: 05/17/2024] [Accepted: 06/15/2024] [Indexed: 07/09/2024] Open
Abstract
Objective Health care is a significant contributor to the climate crisis. Multidisciplinary clinics (MDC) may reduce carbon emissions by combining multiple appointments into one. This is the first program evaluation study to quantify the carbon footprint associated with multidisciplinary pediatric airway clinics. Study Design Retrospective. Setting Children's Hospital at London Health Sciences Center, London, Canada. Methods Pediatric airway MDC allows patients to see otolaryngology and respirology in one appointment. The carbon and financial savings (Canadian Dollars) of all patients attending the MDC from January 1, 2018 to December 31, 2022 were calculated. Patient postal codes and institutional parking rates were inputted into the CASCADES carbon accounting tool. Total distance was divided into unsustainable (vehicles) and sustainable (transit, walking, cycling) transportation to calculate carbon emissions. Travel costs included cost/kilometer for vehicles (maintenance, license/registration, insurance, fuel) and costs/ride for transit. Results A total of 560 MDC appointments for 300 patients saved 77,785 km. Total carbon emissions saved from travel averted was 16.21 tonnes. The total carbon emissions saved, minus public transit, was 15.60 tonnes. Using the Natural Resources Canada Greenhouse Gas Equivalencies Calculator, 16.21 tonnes are approximately equivalent to 5 passenger vehicles, 6906 L of gasoline, 3.8 homes' energy, and 10.8 homes' electricity use for one year, 36.6 barrels of oil consumed, and 675 propane cylinders. Travel costs of $28,891.83 (no parking), $30,519.40 ($4 minimum parking fee), or $33,774.55 ($12 maximum parking fee) were saved. Conclusion MDC effectively reduced carbon emissions and offered patients financial savings. Similar models can be adapted across institutions to help mitigate climate change.
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Affiliation(s)
- Alina Zgardau
- Schulich School of Medicine and DentistryWestern UniversityLondonOntarioCanada
| | - Kalpesh Hathi
- Division of Otolaryngology–Head and Neck Surgery, Department of SurgeryDalhousie UniversityHalifaxNova ScotiaCanada
| | - James Fowler
- Department of Otolaryngology–Head and Neck SurgeryWestern UniversityLondonOntarioCanada
| | - Tara Mullowney
- Department of Pediatrics, Division of RespirologyWestern UniversityLondonOntarioCanada
| | - April Price
- Department of Pediatrics, Division of RespirologyWestern UniversityLondonOntarioCanada
| | - Murad Husein
- Department of Otolaryngology–Head and Neck SurgeryWestern UniversityLondonOntarioCanada
| | - M. Elise Graham
- Department of Otolaryngology–Head and Neck SurgeryWestern UniversityLondonOntarioCanada
| | - Agnieszka Dzioba
- Department of Otolaryngology–Head and Neck SurgeryWestern UniversityLondonOntarioCanada
| | - Edward Madou
- Department of Otolaryngology–Head and Neck SurgeryWestern UniversityLondonOntarioCanada
| | - Julie E. Strychowsky
- Department of Otolaryngology–Head and Neck SurgeryWestern UniversityLondonOntarioCanada
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Lee S, Crowell KT, Zerillo JA. Models and Outcomes of Multidisciplinary Clinics in Colorectal Cancer. J Clin Med 2024; 13:3815. [PMID: 38999381 PMCID: PMC11242721 DOI: 10.3390/jcm13133815] [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: 04/24/2024] [Revised: 06/02/2024] [Accepted: 06/24/2024] [Indexed: 07/14/2024] Open
Abstract
Multidisciplinary clinics (MDCs) represent a potential platform through which high-quality, patient-centered care grounded in interdisciplinary expertise may be delivered for patients with colorectal cancer (CRC). This is increasingly important with the rapidly emerging diagnostic and treatment modalities as well as differential sequences of therapies available. MDCs have been reported to improve various outcomes across numerous non-colorectal cancers; however, data specific to the use of MDCs in CRC are more limited. In this report, we provide a narrative review of the different models of CRC MDCs in the literature and their associations with cancer care outcomes. We found significant heterogeneity in MDC operational logistics as well as reported outcomes across different practice settings. Further research is needed to better understand how MDCs may be optimally structured to meet the unique needs of patients with CRC and how they may affect CRC outcomes.
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Affiliation(s)
- Seohyuk Lee
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Kristen T Crowell
- Division of Colon and Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
- Harvard Medical School, Harvard University, Boston, MA 02115, USA
| | - Jessica A Zerillo
- Harvard Medical School, Harvard University, Boston, MA 02115, USA
- Division of Medical Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
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Kennedy A, Zmijewski PV, Bahl D, Banerjee R, Buczek E, Fazendin J, Chen H, Lindeman B. Can a Multidisciplinary Endocrine Clinic be Beneficial for Patients and Surgeons? Am Surg 2023; 89:5501-5504. [PMID: 36796451 DOI: 10.1177/00031348231157870] [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] [Indexed: 02/18/2023]
Abstract
BACKGROUND Multidisciplinary clinics are expected to improve patient care by enhancing efficiency for both patients and care providers. We hypothesized that while these clinics are an efficient use of time for patients, they can limit a surgeon's productivity. METHODS A retrospective review was performed for patients evaluated in a Multidisciplinary Endocrine Tumor Clinic (MDETC) and Multidisciplinary Thyroid Cancer Clinic (MDTCC) from 2018 to 2021. Time from evaluation to surgery and prevalence of surgery were evaluated. Patients were compared to those evaluated in a surgeon-only endocrine surgery clinic (ESC) from 2017 to 2021. Chi-square and t-tests were used to test significance. RESULTS Patients referred to the ESC underwent surgery more often than those referred to either multidisciplinary clinic (ESC 79.5%, MDETC 24.6%, MDTCC 7%; P < .001) but had a significantly longer delay between appointment and operation (ESC 19.9 days, MDETC 3.3 days, MDTCC 16.4 days; P < .001). Patients had a longer wait from referral to appointment for the MDCs (ESC 22.6 days, MDETC: 44.5, MDTCC 33; P < .05). There was no significant difference in miles traveled by patients to any clinic. CONCLUSION Multidisciplinary clinics can provide fewer appointments and faster time to surgery for patients but may lead to longer wait time from referral to appointment and fewer overall surgeries than endocrine surgeon-only clinics.
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Affiliation(s)
- Alexis Kennedy
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Polina V Zmijewski
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Deepti Bahl
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Ronadip Banerjee
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Erin Buczek
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Jessica Fazendin
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Herbert Chen
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Brenessa Lindeman
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
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A multi-modal study examining long-term bowel, urinary, and sexual function after rectal cancer surgery. Am J Surg 2022; 224:562-568. [DOI: 10.1016/j.amjsurg.2022.02.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 02/16/2022] [Indexed: 11/19/2022]
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5
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Multidisciplinary Approach to Older Adults with Hematologic Malignancies-a Paradigm Shift. Curr Hematol Malig Rep 2022; 17:31-38. [PMID: 35028826 PMCID: PMC8757625 DOI: 10.1007/s11899-021-00646-0] [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] [Accepted: 07/14/2021] [Indexed: 11/04/2022]
Abstract
Hematologic malignancies are most likely to present in the seventh and eighth decades of life. Continued population growth will lead to increasing numbers of older adults with hematologic malignancies. Oncology care for older adults is complex and must account for the effect of aging on disease biology and treatment tolerance. Multidisciplinary oncology care has been utilized in solid tumor oncology for decades, initially driven by the need for multi-modality treatment. In this review, we make the case for multidisciplinary oncogeriatric care for older adults with hematologic malignancies in order to best navigate the intersection of aging and blood cancer.
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Aghedo BO, Svoboda S, Holmes L, Man L, Wu Y, Linder J, D'Adamo C, Mavanur A, Poehler K, Codling D, Wolf JH. Telehealth Adaptation for Multidisciplinary Colorectal Cancer Clinic During the COVID-19 Pandemic. Cureus 2021; 13:e17848. [PMID: 34660054 PMCID: PMC8502002 DOI: 10.7759/cureus.17848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2021] [Indexed: 02/07/2023] Open
Abstract
Background The study objectives were to transition in-person colorectal cancer multidisciplinary clinic (MDC) to a telehealth MDC (tele-MDC) format and to assess early outcomes. Methods A colorectal tele-MDC was devised, in which patients used remote-access technology while supervised by a clinician. The team consisted of surgeons, medical oncologists, radiation oncologists, radiologists, and pathologists. Outcomes were assessed with patient and provider surveys, using a 5-point Likert scale (higher = more favorable). Results A total of 18 patients participated in the tele-MDC. Surveyed patients (n=18) and physicians (n=19) were satisfied with the quality of care (mean Likert = 4.93, 4.53, respectively), and low standard deviations (range 0-1.03) across all questions reflected homogeneity in satisfaction with the metrics surveyed. Conclusions This pilot study demonstrates that a functional colorectal cancer tele-MDC is a feasible alternative to in-person MDC during the coronavirus disease 2019 (COVID-19) pandemic, with the potential for a high degree of patient and physician satisfaction.
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Affiliation(s)
- Blessing O Aghedo
- Surgery, Sinai Hospital of Baltimore, Baltimore, USA.,Surgery, American University of Barbados, School of Medicine, Saint Michael, BRB
| | - Shane Svoboda
- Surgery, Sinai Hospital of Baltimore, Baltimore, USA
| | - Leslie Holmes
- Radiation Oncology, Sinai Hospital of Baltimore, Baltimore, USA
| | - Lillian Man
- Oncology, Sinai Hospital of Baltimore, Baltimore, USA
| | - Yin Wu
- Oncology, Sinai Hospital of Baltimore, Baltimore, USA
| | - Jeanette Linder
- Radiation Oncology, Sinai Hospital of Baltimore, Baltimore, USA
| | - Christopher D'Adamo
- Family and Community Medicine, University of Maryland Medical Center, Baltimore, USA.,Surgery, Sinai Hospital of Baltimore, Baltimore, USA
| | - Arun Mavanur
- Surgery, Sinai Hospital of Baltimore, Baltimore, USA.,Surgery, Johns Hopkins, Baltimore, USA
| | | | | | - Joshua H Wolf
- Surgery, Sinai Hospital of Baltimore, Baltimore, USA.,Surgery, George Washington University School of Medicine and Health Sciences, Baltimore, USA
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Eddington HS, McLeod M, Trickey AW, Barreto N, Maturen K, Morris AM. Patient-reported distress and age-related stress biomarkers among colorectal cancer patients. Cancer Med 2021; 10:3604-3612. [PMID: 33932256 PMCID: PMC8178484 DOI: 10.1002/cam4.3914] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 03/03/2021] [Accepted: 04/01/2021] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE Distress among cancer patients has been broadly accepted as an important indicator of well-being but has not been well studied. We investigated patient characteristics associated with high distress levels as well as correlations among measures of patient-reported distress and "objective" stress-related biomarkers among colorectal cancer patients. METHODS In total, 238 patients with colon or rectal cancer completed surveys including the Distress Thermometer, Problem List, and the Hospital Anxiety and Depression Scale. We abstracted demographic and clinical information from patient charts and determined salivary cortisol level and imaging-based sarcopenia. We evaluated associations between patient characteristics (demographics, clinical factors, and psychosocial and physical measures) and three outcomes (patient-reported distress, cortisol, and sarcopenia) with Spearman's rank correlations and multivariable linear regression. The potential moderating effect of age was separately investigated by including an interaction term in the regression models. RESULTS Patient-reported distress was associated with gender (median: women 5.0, men 3.0, p < 0.001), partnered status (single 5.0, partnered 4.0, p = 0.018), and cancer type (rectal 5.0, colon 4.0, p = 0.026); these effects varied with patient age. Cortisol level was associated with "emotional problems" (ρ = 0.34, p = 0.030), anxiety (ρ = 0.46, p = 0.006), and depression (ρ = 0.54, p = 0.001) among younger patients. We found no significant associations between patient-reported distress, salivary cortisol, and sarcopenia. CONCLUSIONS We found that young, single patients reported high levels of distress compared to other patient groups. Salivary cortisol may have limited value as a cancer-related stress biomarker among younger patients, based on association with some psychosocial measures. Stress biomarkers may not be more clinically useful than patient-reported measures in assessing distress among colorectal cancer patients.
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Affiliation(s)
- Hyrum S. Eddington
- S‐SPIRE CenterDepartment of SurgeryStanford UniversityStanfordCaliforniaUSA
| | - Megan McLeod
- University of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Amber W. Trickey
- S‐SPIRE CenterDepartment of SurgeryStanford UniversityStanfordCaliforniaUSA
| | - Nicolas Barreto
- S‐SPIRE CenterDepartment of SurgeryStanford UniversityStanfordCaliforniaUSA
| | - Katherine Maturen
- Department of RadiologyUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Arden M. Morris
- S‐SPIRE CenterDepartment of SurgeryStanford UniversityStanfordCaliforniaUSA
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