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Silva JR, Riechelmann RSP, Vizzacchi BA, Molina P, Jesus VHFDE, Coimbra FJF, Alves FAS, Camargo TDEB, Vicente GA, Santos DRD, Andrade VPDE, Carvalho GBDE. Clinical outcomes of patients with pancreatic tumors discussed in Tumor Board. Rev Col Bras Cir 2022; 49:e20223150. [PMID: 35588533 PMCID: PMC10578838 DOI: 10.1590/0100-6991e-20223150en] [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: 08/11/2021] [Accepted: 12/08/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE the recommendations of the decisions made by the Tumor Board (TB) should be followed to identify barriers that may interfere with the execution of the previously decided, best care for the patient. The aim of this study is to assess whether the TB conduct decision was performed in patients with pancreatic tumors, their life status 90 days after the TB decision, and to analyze the reasons why the conduct was not performed. METHODS we conducted a retrospective study with patients with pancreas tumors, evaluated between 2017 and 2019. We collected data on epidemiological status, whether the TB procedure was performed, the reason for not performing it, life status 90 days after the TB decision, and how many times each patient was discussed at a meeting. We compared categorical variables using the chi square test, numerical variables were presented as means and standard deviation. RESULTS we studied 111 session cases, in 95 patients, 86 (90.5%) diagnosed with cancer. After 90 days of TB, 83 patients (87.37%) remained alive, 9 had (9.47%) died, and 3 (3.16%) were lost to follow-up. The TB decision was not observed in 12 (10.8%) cases and the reasons were: 25% (3) for loss of follow-up, 8.33% (1) for patient refusal, and 66.67% (8) due to clinical worsening. The cases of patients with metastases had a lower rate of TB conduct compliance (p=0.006). CONCLUSIONS the TB conduct was performed in most cases and the most evident reason for non-compliance with the conducts is the patient's clinical worsening.
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SILVA JULIANARIBEIRO, RIECHELMANN RACHELSIMÕESPIMENTA, VIZZACCHI BÁRBARAALANA, MOLINA PATRICIA, JESUS VICTORHUGOFONSECADE, COIMBRA FELIPEJOSEFERNANDEZ, ALVES FULVIOAPARECIDOSANTOS, CAMARGO THAMIRESDEBRITO, VICENTE GABRIELAAGUIAR, SANTOS DENNYSRIBEIRODOS, ANDRADE VICTORPIANADE, CARVALHO GENIVALBARBOSADE. Desfechos clínicos dos pacientes com tumores de pâncreas discutidos em Tumor Board. Rev Col Bras Cir 2022. [DOI: 10.1590/0100-6991e-20223150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: as recomendações das decisões em Tumor Board (TB) deveriam ser acompanhadas para identificar barreiras que possam interferir na execução do melhor cuidado para o paciente decidido previamente. O objetivo do estudo é avaliar se a decisão de conduta em TB foi realizada em pacientes com tumores pancreáticos, o status de vida 90 dias após TB e analisar os motivos pelos quais a conduta não foi realizada. Métodos: estudo retrospectivo com pacientes com tumores de pâncreas, avaliados entre 2017 a 2019. Dados epidemiológicos, se a conduta de TB foi realizada, o motivo da não realização, o status de vida em 90 dias após decisão de TB e quantas vezes cada paciente foi discutido em reunião foram coletados. As variáveis categóricas foram comparadas pelo teste de qui-quadrado; variáveis numéricas foram apresentadas como médias e desvio padrão. Resultados: 111 casos, 95 pacientes, 86 (90,5%) com diagnóstico de câncer. Após 90 dias de TB, 83 pacientes (87,37%) permaneceram vivos, 9 pacientes (9,47%) faleceram e 3 (3,16%) perderam o seguimento. A conduta do TB não foi realizada em 12 (10,8%) dos casos e os motivos foram: 25% (3) por perda de seguimento, 8,33% (1) por recusa do paciente e 66,67% (8) devido à piora clínica. Os casos de pacientes com metástases tiveram menor execução de conduta de TB (p=0,006). Conclusões: a conduta do TB é realizada na maior parte dos casos e o motivo mais evidente para o não cumprimento das condutas é a piora clínica do paciente.
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Chen W, Dong H, Wang G, Chen J, Wang W. Effect of the duration of the capecitabine regimen following colon cancer surgery in an elderly population: a retrospective cohort study. World J Surg Oncol 2021; 19:238. [PMID: 34380513 PMCID: PMC8359119 DOI: 10.1186/s12957-021-02348-6] [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] [Received: 04/07/2021] [Accepted: 07/28/2021] [Indexed: 12/16/2022] Open
Abstract
Background Only 50–70% of elderly colon cancer patients could complete the recommended 6 months of postoperative chemotherapy. It is unknown whether a shorter duration of postoperative capecitabine-alone chemotherapy would compromise survival. We thus conducted this study to analyze the association between postoperative chemotherapy duration of a capecitabine-alone regimen and cancer-specific survival (CSS) and disease-free survival (DFS) of surgery-treated elderly colon cancer patients. Methods We performed a retrospective cohort study of surgically treated stage III and high-risk stage II colon cancer patients aged ≥ 70 treated at two medical centers. Cox proportional hazard regression models were utilized to calculate crude and adjusted hazard ratios (HRs). The nonlinear relationship between postoperative chemotherapy duration and survival was analyzed through restricted cubic spline regression analysis, and the threshold effect was calculated by the two-piecewise Cox proportional hazard model. Results A total of 1217 surgery-treated colon cancer patients between August 1, 2013, and September 1, 2019, were reviewed, and 257 stage III and high-risk stage II patients aged ≥ 70 were enrolled. Postoperative chemotherapy with capecitabine was administered to 114 patients, and 143 patients only received surgery. As the duration of chemotherapy increased by 1 week, the risk of cancer-specific death was reduced by 11% (HR = 0.89, 95% confidence interval (CI) 0.82–0.96), and the risk of recurrence was reduced by 10% (HR = 0.90, 0.82–0.96). Nonlinearity exploration suggested a threshold effect of capecitabine duration on CSS in stage III disease. The HR for death was 0.79 (95% CI, 0.68–0.92) with duration ≤ 16 weeks and 1.34 (95% CI, 0.91–1.97) with duration > 16 weeks. Conclusions The postoperative capecitabine duration was significantly associated with a decrease in death risk and recurrence risk in elderly colon cancer patients. However, the threshold effect of capecitabine duration on survival suggests that short-term chemotherapy may improve survival in elderly stage III colon cancer patients.
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Affiliation(s)
- Weiwei Chen
- Department of Clinical Medicine, Guizhou Medical University, Guiyang, China.,Department of Abdominal Oncology, Guizhou Province Cancer Hospital, Guiyang, China
| | - Hongmin Dong
- Department of Abdominal Oncology, Guizhou Province Cancer Hospital, Guiyang, China.,Department of Oncology, Affiliated Hospital of Guizhou Medical University, No. 1 Beijing West Road, Guiyang, Guizhou, 550001, China
| | - Gang Wang
- Department of Abdominal Oncology, Guizhou Province Cancer Hospital, Guiyang, China.,Department of Oncology, Affiliated Hospital of Guizhou Medical University, No. 1 Beijing West Road, Guiyang, Guizhou, 550001, China
| | - Juan Chen
- Department of Clinical Medicine, Guizhou Medical University, Guiyang, China.,Department of Abdominal Oncology, Guizhou Province Cancer Hospital, Guiyang, China
| | - Wenling Wang
- Department of Abdominal Oncology, Guizhou Province Cancer Hospital, Guiyang, China. .,Department of Oncology, Affiliated Hospital of Guizhou Medical University, No. 1 Beijing West Road, Guiyang, Guizhou, 550001, China.
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BUßMEYER F, Kneifel F, Eichelmann AK, Palmes D, Hummel R, Lindner K. Effects of therapy modifications during the last decade on the outcome of patients undergoing esophagectomy for esophageal cancer. Minerva Surg 2021; 76:235-244. [PMID: 33855371 DOI: 10.23736/s2724-5691.21.08393-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND During the last decade, numerous therapeutic regimes were assessed to improve the outcome of patients with esophageal carcinoma. We analyzed the impact of therapy alterations, including the establishment of a standardized clinical pathway and the introduction of an interdisciplinary tumor conference on the outcome of patients undergoing esophagectomy because of esophageal cancer. METHODS Three hundred one patients were included (204 adenocarcinoma and 97 squamous cell carcinoma) who underwent an esophagectomy between 2006 and 2015. Patients were divided into 3 groups: interval A (2006-2008), interval B (2009-2011) and interval C (2012-2015) and evaluated separately focusing on therapy management and patients' outcome. RESULTS Over the time periods, the incidence of tumor entity of adenocarcinoma increased from 61% to 76.2% (P=0.059). Patients with an initial tumor stage uT1 increased significantly from 4% to 15.9% over the intervals (P=0.002), while positive nodal involvement remained comparable (P=0.237). Patients in the later interval suffered from greater physical impairments preoperatively, represented by a significantly increased American Society Anesthesiologists (ASA) score (P=0.023) and a reduced Karnofsky Index (P<0.001). The tumor conference was accompanied by an increasing implementation of neoadjuvant therapy (27.1% vs. 42.2%, P=0.097). After establishing the clinical pathway 30-day mortality decreased (P=0.67). Grad III anastomotic leakage decreased significantly from 6.5% to 2% (P=0.01). However, gastrointestinal (P=0.007), pulmonary complications (P<0.001) including pneumonia (P<0.001) increased. Over the past ten years both overall survival and relapse-free survival prolonged (P=0.056 and P=0.063, respectively). CONCLUSIONS Patients' collective suffering from esophageal cancer has changed over the last decade. Continuous further developments of the therapy regimes are needed to meet the requirements of reducing perioperative mortality and extending survival time.
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Affiliation(s)
- Florian BUßMEYER
- Department of General and Visceral Surgery, Muenster University Hospital, Muenster, Germany
| | - Felicia Kneifel
- Department of General and Visceral Surgery, Muenster University Hospital, Muenster, Germany
| | - Ann-Kathrin Eichelmann
- Department of General and Visceral Surgery, Muenster University Hospital, Muenster, Germany
| | - Daniel Palmes
- Department of General and Visceral Surgery, Muenster University Hospital, Muenster, Germany
| | - Richard Hummel
- Department of Surgery, Campus Lübeck, University Hospital of Schleswig-Holstein, Lübeck, Germany
| | - Kirsten Lindner
- Department of Surgery, Campus Lübeck, University Hospital of Schleswig-Holstein, Lübeck, Germany -
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Gödde K, Siegerink B, Fügemann H, Keune D, Sander S, Schneider A, Müller-Nordhorn J, Holmberg C, Rieckmann N, Frost N, Keilholz U, Goerling U. Can routine register data be used to identify vulnerable lung cancer patients of suboptimal care in a German comprehensive cancer centre? Eur J Cancer Care (Engl) 2021; 30:e13398. [PMID: 33452721 DOI: 10.1111/ecc.13398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 10/01/2020] [Accepted: 11/20/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Several patient factors have been described to influence access to optimal cancer care like socioeconomic factors or place of residence. In this study, we investigate whether data routinely collected in a clinical cancer registry can be used to identify populations of lung cancer patients with increased risk of not receiving optimal cancer care. METHODS We analysed data of 837 lung cancer patients extracted from the clinical cancer registry of a German university hospital. We compared patient populations by two indicators of optimal care, namely implementation of tumour board meeting recommendations as well as the timeliness of care. RESULTS There was a high rate of implementation of tumour board meeting recommendations of 94.4%. Reasons for non-implementation were mainly a patient's own wish or a worsening of the health situation. Of all patient parameters, only tumour stage was associated with the two optimal care indicators. CONCLUSION Using routine data from a clinical cancer registry, we were not able to identify patient populations at risk of not getting optimal care and the implementation of guideline-conform care appeared to be very high in this setting. However, limitations were the ambiguity of optimal care indicators and availability of parameters predictive for patients' vulnerability.
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Affiliation(s)
- Kathrin Gödde
- Institute of Public Health, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Bob Siegerink
- Center for Stroke Research (CSB), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Hella Fügemann
- Institute of Public Health, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Institute of Social Medicine and Epidemiology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Dietmar Keune
- Charité Comprehensive Cancer Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Steffen Sander
- Charité Comprehensive Cancer Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Alice Schneider
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jacqueline Müller-Nordhorn
- Institute of Public Health, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Bayerisches Krebsregister, Erlangen, Germany
| | - Christine Holmberg
- Institute of Public Health, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Institute of Social Medicine and Epidemiology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany.,Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Potsdam, Germany
| | - Nina Rieckmann
- Institute of Public Health, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Nikolaj Frost
- Department of Infectious Diseases and Pulmonary Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ulrich Keilholz
- Charité Comprehensive Cancer Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ute Goerling
- Charité Comprehensive Cancer Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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A systematic scoping review of determinants of multidisciplinary cancer team access and decision-making in the management of older patients diagnosed with colorectal cancer. J Geriatr Oncol 2020; 11:909-916. [DOI: 10.1016/j.jgo.2019.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 08/06/2019] [Accepted: 11/04/2019] [Indexed: 12/24/2022]
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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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Stairmand J, Signal L, Sarfati D, Jackson C, Batten L, Holdaway M, Cunningham C. Consideration of comorbidity in treatment decision making in multidisciplinary cancer team meetings: a systematic review. Ann Oncol 2015; 26:1325-32. [PMID: 25605751 DOI: 10.1093/annonc/mdv025] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Accepted: 12/17/2014] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Comorbidity is very common among patients with cancer. Multidisciplinary team meetings (MDTs) are increasingly the context within which cancer treatment decisions are made internationally. Little is known about how comorbidity is considered, or impacts decisions, in MDTs. METHODS A systematic literature review was conducted to evaluate previous evidence on consideration, and impact, of comorbidity in cancer MDT treatment decision making. Twenty-one original studies were included. RESULTS Lack of information on comorbidity in MDTs impedes the ability of MDT members to make treatment recommendations, and for those recommendations to be implemented among patients with comorbidity. Where treatment is different from that recommended due to comorbidity, it is more conservative, despite evidence that such treatment may be tolerated and effective. MDT members are likely to be unaware of the extent to which issues such as comorbidity are ignored. CONCLUSIONS MDTs should systematically consider treatment of patients with comorbidity. Further research is needed to assist clinicians to undertake MDT decision making that appropriately addresses comorbidity. If this were to occur, it would likely contribute to improved outcomes for cancer patients with comorbidities.
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Affiliation(s)
- J Stairmand
- Cancer Control and Screening Research Group, University of Otago, Wellington
| | - L Signal
- Cancer Control and Screening Research Group, University of Otago, Wellington
| | - D Sarfati
- Cancer Control and Screening Research Group, University of Otago, Wellington
| | - C Jackson
- Department of Medicine, University of Otago, Dunedin
| | - L Batten
- Research Centre for Māori Health and Development, Massey University, Palmerston North, New Zealand
| | - M Holdaway
- Research Centre for Māori Health and Development, Massey University, Palmerston North, New Zealand
| | - C Cunningham
- Research Centre for Māori Health and Development, Massey University, Palmerston North, New Zealand
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Guillerme F, Clavier JB, Nehme-Schuster H, Leroy V, Heitz D, Schumacher C, Abdelghani MB, Brigand C, Kurtz JE, Noël G. Age impacts the pattern of care for elderly patients with rectal cancer. Int J Colorectal Dis 2014; 29:157-63. [PMID: 24127011 DOI: 10.1007/s00384-013-1778-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/27/2013] [Indexed: 02/04/2023]
Abstract
PURPOSE This study analyzed the current approaches for rectal cancer treatment in elderly patients. METHODS We retrospectively studied 240 rectal cancer patients who had undergone radiotherapy from 2000 to 2008. The ages of the patients ranged from 65 and 75 years (group A, n = 127) and older than 75 years (group B, n = 113). The distribution of the Charlson comorbidity index was similar between the two groups, but the ECOG performance status (PS) differed between the groups (66 % of the patients of group A were PS 0, and 40 % were PS 0 in group B (p < 0.0001)). The tumor stages were comparable between groups. RESULTS The median age of the patients was 74.3 years (range 65-90.6). Treatment was discussed during a multidisciplinary cancer team meeting before treatment for 55 % of the cases in group A and 73 % of the cases in group B (p < 0.001), and treatment proposals were in accordance with guidelines in 96 % of the cases in group A and 76 % of the cases in group B (p < 0.001). Group B patients received slightly less concurrent chemotherapy (35 vs. 30 % for group A; p = 0.54), more hypofractionated radiotherapy (41 vs. 54 % for group A; p = 0.064), less surgery (92 vs. 80 % for group A; p = 0.014), and less adjuvant chemotherapy (34 vs. 10 % for group A; p < 0.001). Finally, 80 % of the patients in group A and 60 % of the patients in group B received treatment in accordance with guidelines (p = 0.007) and in the logistic regression model. Non-metastatic patients who were aged below 75 years were predicted for conformal management (HR = 0.323; 95 % CI = 0.152-0.684) irrespective of their performance status, comorbidity, or disease stage. CONCLUSIONS Treatment proposals and administered therapy differed according to age.
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Affiliation(s)
- Florence Guillerme
- Center de lutte contre le cancer Paul Strauss, 3, rue de la porte de l'hôpital, 67065, Strasbourg cedex, France
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Bianchi V, Spitale A, Ortelli L, Mazzucchelli L, Bordoni A. Quality indicators of clinical cancer care (QC3) in colorectal cancer. BMJ Open 2013; 3:bmjopen-2013-002818. [PMID: 23869102 PMCID: PMC3717445 DOI: 10.1136/bmjopen-2013-002818] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Assessing the quality of cancer care (QoCC) has become increasingly important to providers, regulators and purchasers of care worldwide. The aim of this study was to develop evidence-based quality indicators (QIs) for colorectal cancer (CRC) to be applied in a population-based setting. DESIGN A comprehensive evidence-based literature search was performed to identify the initial list of QIs, which were then selected and developed using a two-step-modified Delphi process involving two multidisciplinary expert panels with expertise in CRC care, quality of care and epidemiology. SETTING The QIs of the clinical cancer care (QC3) population-based project, which involves all the public and private hospitals and clinics present on the territory of Canton Ticino (South Switzerland). PARTICIPANTS Ticino Cancer Registry, The Colorectal Cancer Working Group (CRC-WG) and the external academic Advisory Board (AB). MAIN OUTCOME MEASURES Set of QIs which encompass the whole diagnostic-treatment process of CRC. RESULTS Of the 149 QIs that emerged from 181 sources of literature, 104 were selected during the in-person meeting of CRC-WG. During the Delphi process, CRC-WG shortened the list to 89 QI. AB finally validated 27 QIs according to the phase of care: diagnosis (N=6), pathology (N=3), treatment (N=16) and outcome (N=2). CONCLUSIONS Using the validated Delphi methodology, including a literature review of the evidence and integration of expert opinions from local clinicians and international experts, we were able to develop a list of QIs to assess QoCC for CRC. This will hopefully guarantee feasibility of data retrieval, as well as acceptance and translation of QIs into the daily clinical practice to improve QoCC. Moreover, evidence-based selected QIs allow one to assess immediate changes and improvements in the diagnostic-therapeutic process that could be translated into a short-term benefit for patients with a possible gain both in overall and disease-free survival.
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Affiliation(s)
- Valentina Bianchi
- Cantonal Institute of Pathology, Ticino Cancer Registry, Locarno, Switzerland
| | - Alessandra Spitale
- Cantonal Institute of Pathology, Ticino Cancer Registry, Locarno, Switzerland
| | - Laura Ortelli
- Cantonal Institute of Pathology, Ticino Cancer Registry, Locarno, Switzerland
| | - Luca Mazzucchelli
- Cantonal Institute of Pathology, Clinical Pathology, Locarno, Switzerland
| | - Andrea Bordoni
- Cantonal Institute of Pathology, Ticino Cancer Registry, Locarno, Switzerland
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Fitzgerald TL, Biswas T, O’Brien K, Zervos EE, Wong JH. Neoadjuvant Radiotherapy for Rectal Cancer: Adherence to Evidence-Based Guidelines in Clinical Practice. World J Surg 2012; 37:639-45. [DOI: 10.1007/s00268-012-1862-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Croke JM, El-Sayed S. Multidisciplinary management of cancer patients: chasing a shadow or real value? An overview of the literature. ACTA ACUST UNITED AC 2012; 19:e232-8. [PMID: 22876151 DOI: 10.3747/co.19.944] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE Multidisciplinary cancer conferences (mccs) are designed to optimize patient outcomes. It appears intuitive that mccs are essential to clinical decision-making and patient management; however, it is unclear whether that belief is supported by evidence. Our objectives were to assess the currently published literature addressing the impact of mccs on clinical decision-making and patient outcomes. METHODS Ovid medline was searched from 1950 to June 2010 using these keywords: "multidisciplinary/interdisciplinary/clinical meeting$/conference$/round$/team$," "decision making," "neoplasms$/cancer$/oncology/tumo(u)r conference$/board$/meeting$," "multidisciplinary/interdisciplinary cancer conference$/meeting$." All trials, guidelines, metaanalyses, reviews, and prospective and retrospective studies were included. RESULTS The keywords retrieved 595 abstracts, and 30 manuscripts were obtained. Most of the studies assessed the impact of mccs on clinical decision-making rather than on patient outcomes. CONCLUSIONS Available evidence supports the belief that mccs significantly influence clinical decision-making and treatment recommendations. In contrast, scant evidence suggests that mccs improve patient outcomes. Unfortunately, the current literature is substantially heterogeneous and therefore does not allow for firm conclusions.
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Affiliation(s)
- J M Croke
- Division of Radiation Oncology, The Ottawa Hospital Cancer Centre, Ottawa, ON
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