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Efstathiou JA, Morgans AK, Bland CS, Shore ND. Novel hormone therapy and coordination of care in high-risk biochemically recurrent prostate cancer. Cancer Treat Rev 2024; 122:102630. [PMID: 38035646 DOI: 10.1016/j.ctrv.2023.102630] [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: 05/30/2023] [Accepted: 09/25/2023] [Indexed: 12/02/2023]
Abstract
Biochemical recurrence (BCR) occurs in 20-50% of patients with prostate cancer (PCa) undergoing primary definitive treatment. Patients with high-risk BCR have an increased risk of metastatic progression and subsequent PCa-specific mortality, and thus could benefit from treatment intensification. Given the increasing complexity of diagnostic and therapeutic modalities, multidisciplinary care (MDC) can play a crucial role in the individualized management of this patient population. This review explores the role for MDC when evaluating the clinical evidence for the evolving definition of high-risk BCR and the emerging therapeutic strategies, especially with novel hormone therapies (NHTs), for patients with either high-risk BCR or oligometastatic PCa. Clinical studies have used different characteristics to define high-risk BCR and there is no consensus regarding the definition of high-risk BCR nor for management strategies. Next-generation imaging and multigene panels offer potential enhanced patient identification and precision-based decision-making, respectively. Treatment intensification with NHTs, either alone or combined with radiotherapy or metastasis-directed therapy, has been promising in clinical trials in patients with high-risk BCR or oligometastases. As novel risk-stratification and treatment options as well as evidence-based literature evolve, it is important to involve a multidisciplinary team to identify patients with high-risk features at an earlier stage, and make informed decisions on the treatments that could optimize their care and long-term outcomes. Nevertheless, MDC data are scarce in the BCR or oligometastatic setting. Efforts to integrate MDC into the standard management of this patient population are needed, and will likely improve outcomes across this heterogeneous PCa patient population.
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Affiliation(s)
- Jason A Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
| | - Alicia K Morgans
- Dana-Farber Cancer Institute, 850 Brookline Ave, Dana 09-930, Boston, MA 02215, USA.
| | - Christopher S Bland
- US Oncology Medical Affairs, Pfizer Inc., 66 Hudson Boulevard, Hudson Yards, Manhattan, New York, NY 10001, USA.
| | - Neal D Shore
- Carolina Urologic Research Center, GenesisCare US, 823 82nd Pkwy, Myrtle Beach, SC, USA.
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2
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Hendrickx JJ, Mennega T, Uppelschoten JM, Leemans CR. Changes in multidisciplinary team decisions in a high volume head and neck oncological center following those made in its preferred partner. Front Oncol 2023; 13:1205224. [PMID: 37727212 PMCID: PMC10505803 DOI: 10.3389/fonc.2023.1205224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/24/2023] [Indexed: 09/21/2023] Open
Abstract
Objective Head and neck cancer care is highly complex, and multidisciplinary team meetings (MDTs) are vital for improved outcomes. In the Netherlands, head and neck cancer care is practiced in eight high-volume head and neck oncologic centers (HNOC) and six affiliated hospitals preferred partner (PP) centers. Patients treated in the PP are presented and discussed in the HNOC. To evaluate the importance of these mandatory and decisive steps in decision making, we have assessed the changes in treatment. Materials and methods Retrospective evaluation of head and neck cancer patients referred between January 2011 and October 2018 for a MDT evaluation to the HNOC was conducted. The differences in MDT recommendation were classified with regards to major and minor changes. Results Management recommendation(MR) changed after 113 of 515 MDT discussions within the PP (487 patients; 22%), of which 86 cases (16%) were major changes. In 67 cases (59.3%), escalation of management was recommended, while in 43 cases (38.1%) de-escalation was recommended. Conclusion There was a high rate of change of MRs, when comparing the PP recommendations with the HNOC recommendations. Since patient and tumor characteristics seem unable to predict these changes, we recommend all patients be seen for a clinical presentation, revision of diagnostics, and MDT discussion in a high volume HNOC.
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Affiliation(s)
- Jan-Jaap Hendrickx
- Department of Otolaryngology-Head and Neck Surgery, Amsterdam University Medical Center-location VUmc, Amsterdam, Netherlands
| | - Tommy Mennega
- Department of Otolaryngology-Head and Neck Surgery, Amsterdam University Medical Center-location VUmc, Amsterdam, Netherlands
| | | | - C. René Leemans
- Department of Otolaryngology-Head and Neck Surgery, Amsterdam University Medical Center-location VUmc, Amsterdam, Netherlands
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3
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Wihl J, Falini V, Borg S, Stahl O, Jiborn T, Ohlsson B, Nilbert M. Implementation of the measure of case discussion complexity to guide selection of prostate cancer patients for multidisciplinary team meetings. Cancer Med 2023; 12:15149-15158. [PMID: 37255390 PMCID: PMC10417062 DOI: 10.1002/cam4.6189] [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: 05/23/2022] [Revised: 04/24/2023] [Accepted: 05/21/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Multidisciplinary team meetings (MDTMs) provide an integrated team approach to ensure individualized and evidence-based treatment recommendations and best expert advice in cancer care. A growing number of patients and more complex treatment options challenge MDTM resources and evoke needs for case prioritization. In this process, decision aids could provide streamlining and standardize evaluation of case complexity. We applied the recently developed Measure of Case Discussion Complexity, MeDiC, instrument with the aim to validate its performance in another healthcare setting and diagnostic area as a means to provide cases for full MDTM discussions. METHODS The 26-item MeDiC instrument evaluates case complexity and was applied to 364 men with newly diagnosed prostate cancer in Sweden. MeDiC scores were generated from individual-level health data and were correlated with clinicopathological parameters, healthcare setting, and the observed clinical case selection for MDTMs. RESULTS Application of the MeDiC instrument was feasible with rapid scoring based on available clinical data. Patients with high-risk prostate cancers had significantly higher MeDiC scores than patients with low or intermediate-risk cancers. In the total study, population affected lymph nodes and metastatic disease significantly influenced MDTM referral, whereas comorbidities and age did not predict MDTM referral. When individual patient MeDiC scores were compared to the clinical MDTM case selection, advanced stage, T3/T4 tumors, involved lymph nodes, presence of metastases and significant physical comorbidity were identified as key MDTM predictive factors. CONCLUSIONS Application of the MeDiC instrument in prostate cancer may be used to streamline case selection for MDTMs in cancer care and may complement clinical case selection.
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Affiliation(s)
- Jessica Wihl
- Department of Clinical Sciences, Division of Oncology and PathologyLund UniversityLundSweden
- Regional Cancer Centre South, Region SkåneLundSweden
- Department of Hematology, Oncology and Radiation PhysicsSkåne University HospitalLundSweden
| | - Victor Falini
- Regional Cancer Centre South, Region SkåneLundSweden
| | - Sixten Borg
- Regional Cancer Centre South, Region SkåneLundSweden
- Health Economics Unit, Department of Clinical Sciences in MalmöLund UniversityLundSweden
| | - Olof Stahl
- Department of Clinical Sciences, Division of Oncology and PathologyLund UniversityLundSweden
- Regional Cancer Centre South, Region SkåneLundSweden
- Department of Hematology, Oncology and Radiation PhysicsSkåne University HospitalLundSweden
| | - Thomas Jiborn
- Regional Cancer Centre South, Region SkåneLundSweden
- Department of UrologySkåne University HospitalMalmöSweden
| | - Bjorn Ohlsson
- Regional Cancer Centre South, Region SkåneLundSweden
| | - Mef Nilbert
- Department of Clinical Sciences, Division of Oncology and PathologyLund UniversityLundSweden
- Department of Hematology, Oncology and Radiation PhysicsSkåne University HospitalLundSweden
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4
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Naessens C, Laloze J, Leobon S, Gauthier T, Lacorre A, Monteil J, Venat L, Deluche E. Physician compliance with multidisciplinary tumor board recommendations for managing gynecological cancers. Future Oncol 2023; 19:897-908. [PMID: 37232140 DOI: 10.2217/fon-2022-1183] [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: 05/27/2023] Open
Abstract
Aims: Evaluation of compliance with gynecological multidisciplinary tumor board (MTB) recommendations and its impact. Patients & methods: All patient records discussed in our MTB from 2018 to 2020 were analyzed. Results: We analyzed 437 MTB recommendations concerning 166 patients. Each patient was discussed an average of 2.6 (1.0-4.2) times. Of the 789 decisions, the decision was not followed 102 times (12.9%), corresponding to 85 MTB meetings (19.5%). Of these, 72 recommendations concerned therapeutic changes (70.5%), and 30 concerned non-therapeutic changes (29.5%). Of these 85 MTB decisions, 60 (71%) led to a new MTB submission. Noncompliance with MTB decisions decreased the overall survival (46 vs 138 months; p = 0.003). Conclusion: Improving compliance with MTB decisions is crucial to enhance patient outcomes.
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Affiliation(s)
- Clara Naessens
- Radiation Therapy Department, Limoges University Hospital, Limoges, 87000, France
| | - Jerome Laloze
- Reconstructive Surgery Department, Limoges University Hospital, Limoges, 87000, France
| | - Sophie Leobon
- Medical Oncology Department, Limoges University Hospital, Limoges, 87000, France
| | - Tristan Gauthier
- Gynecological Department, Limoges University Hospital, Limoges, 87000, France
| | - Aymeline Lacorre
- Gynecological Department, Limoges University Hospital, Limoges, 87000, France
| | - Jacques Monteil
- Nuclear Medicine Department, Limoges University Hospital, Limoges, 87000, France
| | - Laurence Venat
- Medical Oncology Department, Limoges University Hospital, Limoges, 87000, France
| | - Elise Deluche
- Medical Oncology Department, Limoges University Hospital, Limoges, 87000, France
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5
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Bandini M, Ahmed M, Basile G, Watkin N, Master V, Zhu Y, Prakash G, Rodriguez A, Ssebakumba MK, Leni R, Cirulli GO, Ayres B, Compitello R, Pederzoli F, Joshi PM, Kulkarni SB, Montorsi F, Sonpavde G, Necchi A, Spiess PE. A global approach to improving penile cancer care. Nat Rev Urol 2022; 19:231-239. [PMID: 34937881 PMCID: PMC8693593 DOI: 10.1038/s41585-021-00557-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2021] [Indexed: 02/06/2023]
Abstract
Rare tumours such as penile carcinoma have been largely neglected by the urology scientific community in favour of more common - and, therefore, more easily fundable - diseases. Nevertheless, penile cancer represents a rising burden for health-care systems around the world, because a lack of widespread expertise, ineffective centralization of care and absence of research funds have hampered our ability to improve the global care of these patients. Moreover, a dichotomy has arisen in the field of penile cancer, further impeding care: the countries that are mainly supporting research on this topic through the development of epidemiological studies and design of clinical trials are not the countries that have the highest prevalence of the disease. This situation means that randomized controlled trials in developed countries often do not meet the minimum accrual and are intended to close before reaching their end points, whereas trials are almost completely absent in those areas with the highest disease prevalence and probability of successful recruitment, such as Africa, South America and South Asia. The scientific and organizational inaction that arises owing to this mismatch translates into a burdensome cost for our patients. A global effort to gather experts and pull together scientific data from around the world may be the best way to boost clinical research, to change clinical practice and, ultimately, to improve care for patients and their families.
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Affiliation(s)
- Marco Bandini
- Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy.
| | - Mohamed Ahmed
- grid.66875.3a0000 0004 0459 167XDepartment of Urology, Mayo Clinic, Rochester, MN USA
| | - Giuseppe Basile
- grid.15496.3f0000 0001 0439 0892Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Nicholas Watkin
- grid.451349.eSt George’s University Hospitals, NHS Foundation Trust, London, UK
| | - Viraj Master
- grid.189967.80000 0001 0941 6502Emory University School of Medicine, Department of Urology, Atlanta, GA USA
| | - Yao Zhu
- grid.452404.30000 0004 1808 0942Fudan University Shanghai Cancer Center, Shanghai, China
| | - Gagan Prakash
- grid.450257.10000 0004 1775 9822Department of Urosurgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Alejandro Rodriguez
- grid.416016.40000 0004 0456 3003Urology Associates of Rochester, Rochester General Hospital, Rochester, NY USA
| | | | - Riccardo Leni
- grid.15496.3f0000 0001 0439 0892Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Giuseppe Ottone Cirulli
- grid.15496.3f0000 0001 0439 0892Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Ben Ayres
- grid.451349.eSt George’s University Hospitals, NHS Foundation Trust, London, UK
| | - Rachel Compitello
- grid.468198.a0000 0000 9891 5233Moffitt Cancer Center and Research Institute, Tampa, FL USA
| | - Filippo Pederzoli
- grid.15496.3f0000 0001 0439 0892Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Pankaj M. Joshi
- grid.512719.9Kulkarni Reconstructive Urology Center, Pune, India
| | | | - Francesco Montorsi
- grid.15496.3f0000 0001 0439 0892Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Guru Sonpavde
- grid.38142.3c000000041936754XDana Farber Cancer Institute, Harvard Medical School, Boston, MA USA
| | - Andrea Necchi
- grid.15496.3f0000 0001 0439 0892Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Philippe E. Spiess
- grid.468198.a0000 0000 9891 5233Moffitt Cancer Center and Research Institute, Tampa, FL USA
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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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Zhu S, Chen J, Ni Y, Zhang H, Liu Z, Shen P, Sun G, Liang J, Zhang X, Wang Z, Wei Q, Li X, Chen N, Li Z, Wang X, Shen Y, Yao J, Huang R, Liu J, Cai D, Zeng H. Dynamic multidisciplinary team discussions can improve the prognosis of metastatic castration-resistant prostate cancer patients. Prostate 2021; 81:721-727. [PMID: 34028061 PMCID: PMC8362088 DOI: 10.1002/pros.24167] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/18/2021] [Accepted: 05/07/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Multidisciplinary team (MDT) management is a popular treatment paradigm in managing cancer patients, which provides fully-discussed, interdisciplinary treatment recommendations for patients. However, there has been a lack of data on its actual impact on the overall survival (OS) of metastatic castration-resistant prostate cancer (mCRPC) patients. mCRPC is the end stage of prostate cancer, facing a treatment dilemma of overwhelming options; therefore, we hypothesize dynamic MDT discussions can be helpful in comprehensively managing these patients. METHODS We retrospectively collected 422 mCRPC patients' clinical information from 2013 to 2020 from our institute. Patients can voluntarily choose whether to enroll in the dynamic MDT group, which includes discussions at CRPC diagnosis and subsequent disease progression. All patients were followed up regularly, and OS from CRPC diagnosis to death was set as the endpoint of this study. RESULTS Participating in MDT discussions is a favorable independent indicator of longer overall survival (median OS: MDT (+): 39.7 months; MDT (-): 27.0 months, hazard ratio: 0.549, p = .001). Moreover, this survival benefit of MDT remained in subgroups with first-line therapy [median OS: MDT (+): not reached; MDT (-): 27.0 months, p = .001) and with multi-line therapy until the end of follow-up (median OS: MDT (+): 36.7 months; MDT (-): 25.6 months, p = .044). CONCLUSION Therefore, regular MDT discussions are valuable in the management of mCRPC patients. Clinicians are encouraged to tailor MDT discussions dynamically to provide mCRPC patients with a better and more individualized treatment plan and more prolonged survival. Take-home messages ● The MDT model is defined as dynamic MDT discussions at the time of mCRPC diagnosis and each time they progressed later on throughout the disease management. ● Prostate cancer MDT usually includes specialists in urologic oncology, pathology, chemotherapy, radiotherapy, ultrasound, imaging and nuclear medicine. ● MDT model can benefit mCRPC patients in terms of overall survival.
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Affiliation(s)
- Sha Zhu
- Department of Urology, West China HospitalSichuan UniversityChengduSichuanChina
| | - Junru Chen
- Department of Urology, West China HospitalSichuan UniversityChengduSichuanChina
| | - Yuchao Ni
- Department of Urology, West China HospitalSichuan UniversityChengduSichuanChina
| | - Haoran Zhang
- Department of Urology, West China HospitalSichuan UniversityChengduSichuanChina
| | - Zhenhua Liu
- Department of Urology, West China HospitalSichuan UniversityChengduSichuanChina
| | - Pengfei Shen
- Department of Urology, West China HospitalSichuan UniversityChengduSichuanChina
| | - Guangxi Sun
- Department of Urology, West China HospitalSichuan UniversityChengduSichuanChina
| | - Jiayu Liang
- Department of Urology, West China HospitalSichuan UniversityChengduSichuanChina
| | - Xingming Zhang
- Department of Urology, West China HospitalSichuan UniversityChengduSichuanChina
| | - Zhipeng Wang
- Department of Urology, West China HospitalSichuan UniversityChengduSichuanChina
| | - Qiang Wei
- Department of Urology, West China HospitalSichuan UniversityChengduSichuanChina
| | - Xiang Li
- Department of Urology, West China HospitalSichuan UniversityChengduSichuanChina
| | - Ni Chen
- Department of Pathology, West China HospitalSichuan UniversityChengduSichuanChina
| | - Zhiping Li
- Department of Oncology, West China HospitalSichuan UniversityChengduSichuanChina
| | - Xin Wang
- Department of Oncology, West China HospitalSichuan UniversityChengduSichuanChina
| | - Yali Shen
- Department of Oncology, West China HospitalSichuan UniversityChengduSichuanChina
| | - Jin Yao
- Department of Radiology, West China HospitalSichuan UniversityChengduSichuanChina
| | - Rui Huang
- Department of Nuclear Medicine, West China HospitalSichuan UniversityChengduSichuanChina
| | - Jiyan Liu
- Department of Biotherapy, West China HospitalSichuan UniversityChengduSichuanChina
| | - Diming Cai
- Department of Medical Ultrasound, West China HospitalSichuan UniversityChengduSichuanChina
| | - Hao Zeng
- Department of Urology, West China HospitalSichuan UniversityChengduSichuanChina
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8
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Kelley S, Beck AC, Weigel RJ, Howe JR, Sugg SL, Lal G. Influence of endocrine multidisciplinary tumor board on patient management and treatment decision making. Am J Surg 2021; 223:76-80. [PMID: 34303521 DOI: 10.1016/j.amjsurg.2021.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/15/2021] [Accepted: 07/16/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Multidisciplinary Tumor Boards (MDT) are used to obtain input regarding cancer management. This study assessed the impact of our institutional Endocrine MDT. METHODS MDT notes on patients with thyroid cancer treated during 2012-2018 were abstracted retrospectively from the electronic medical record. Management change (MC) was prospectively collected by the MDT coordinator. Biannual evaluations reviewed the impact of the MDT as observed by attendees. RESULTS MC was recommended in 47 (15%) of 286 presentations, with additional imaging being the most frequent (43%). Presentation of recurrences were more likely to result in MC (24% vs. 13% initial, p = 0.03). Overall, 98% of attendees found the conference exceeded educational expectations. About 24% reported intending to use a more evidence/guideline-based approach after attending and this trend increased over time (p = 0.002). CONCLUSION MDT presentations led to a higher rate of MC particularly in recurrent TC patients and increased evidenced-based practice for attendees.
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Affiliation(s)
- Sarah Kelley
- University of Iowa Hospitals and Clinics, Department of Internal Medicine, 200 Hawkins Dr, Iowa City, IA, 52242, USA
| | - Anna C Beck
- University of Iowa Hospitals and Clinics, Department of Surgery, 200 Hawkins Dr, Iowa City, IA, 52242, USA
| | - Ronald J Weigel
- University of Iowa Hospitals and Clinics, Department of Surgery, 200 Hawkins Dr, Iowa City, IA, 52242, USA
| | - James R Howe
- University of Iowa Hospitals and Clinics, Department of Surgery, 200 Hawkins Dr, Iowa City, IA, 52242, USA
| | - Sonia L Sugg
- University of Iowa Hospitals and Clinics, Department of Surgery, 200 Hawkins Dr, Iowa City, IA, 52242, USA
| | - Geeta Lal
- University of Iowa Hospitals and Clinics, Department of Surgery, 200 Hawkins Dr, Iowa City, IA, 52242, USA.
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9
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Petrella F, Radice D, Guarize J, Piperno G, Rampinelli C, de Marinis F, Spaggiari L. The Impact of Multidisciplinary Team Meetings on Patient Management in Oncologic Thoracic Surgery: A Single-Center Experience. Cancers (Basel) 2021; 13:E228. [PMID: 33435181 PMCID: PMC7827504 DOI: 10.3390/cancers13020228] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/05/2021] [Accepted: 01/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND the aim of this paper is to quantify multidisciplinary team meeting (MDT) impact on the decisional clinical pathway of thoracic cancer patients, assessing the modification rate of the initial out-patient evaluation. METHODS the impact of MDT was classified as follows: confirmation: same conclusions as out-patient hypothesis; modification: change of out-patient hypothesis; implementation: definition of a clear clinical track/conclusion for patients that did not receive any clinical hypothesis; further exams required: the findings that emerged in the MDT meeting require further exams. RESULTS one thousand consecutive patients evaluated at MDT meetings were enrolled. Clinical settings of patients were: early stage lung cancer (17.4%); locally advanced lung cancer (27.4%); stage IV lung cancer (9.8%); mesothelioma (1%); metastases to the lung from other primary tumors (4%); histologically proven or suspected recurrence from previous lung cancer (15%); solitary pulmonary nodule (19.2%); mediastinal tumors (3.4%); other settings (2.8%). CONCLUSIONS MDT meetings impact patient management in oncologic thoracic surgery by modifying the out-patient clinical hypothesis in 10.6% of cases; the clinical settings with the highest decisional modification rates are "solitary pulmonary nodule" and "proven or suspected recurrence" with modification rates of 14.6% and 13.3%, respectively.
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Affiliation(s)
- Francesco Petrella
- Department of Thoracic Surgery, IRCCS European Institute of Oncology, 20141 Milan, Italy; (J.G.); or (L.S.)
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, 20141 Milan, Italy
| | - Davide Radice
- Department of Biostatistcs, IRCCS European Institute of Oncology, 20141 Milan, Italy;
| | - Juliana Guarize
- Department of Thoracic Surgery, IRCCS European Institute of Oncology, 20141 Milan, Italy; (J.G.); or (L.S.)
| | - Gaia Piperno
- Department of Radiotherapy, IRCCS European Institute of Oncology, 20141 Milan, Italy;
| | - Cristiano Rampinelli
- Department of Radiology, IRCCS European Institute of Oncology, 20141 Milan, Italy;
| | - Filippo de Marinis
- Department of Thoracic Oncology, IRCCS European Institute of Oncology, 20141 Milan, Italy;
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, IRCCS European Institute of Oncology, 20141 Milan, Italy; (J.G.); or (L.S.)
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, 20141 Milan, Italy
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10
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Gil M, Guerra J, Andrade V, Medeiros M, Guimarães T, Bernardino R, Falcão G, Calais da Silva F, Campos Pinheiro L. The impact of multidisciplinary team conferences in urologic cancer in a tertiary hospital. Int Urol Nephrol 2020; 53:41-47. [PMID: 32816157 DOI: 10.1007/s11255-020-02608-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/10/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE Multidisciplinary team (MDT) conferences are currently the standard of care in cancer patients' management. Despite evidence supporting benefits to the majority of malignancies, a paucity of data exists examining the impact in urinary and male genital cancers. This study aims to evaluate the impact of MDT conferences in urologic cancer practice. METHODS Clinical plans discussed in urologic MDT conferences in Centro Hospitalar Universitário de Lisboa Central between January 2019 and December 2019 were retrospectively analysed. Clinical plans were categorized as accepted, changed, rejected (cases that had to be re-presented to the MDT because of insufficient staging or administrative issues) or no plan. MDT conferences' impact was assessed according to type of consultation, referral medical specialty and primary tumour type. RESULTS 710 clinical plans were discussed at the MDT conferences. 61.8% were accepted, 10.6% were changed, 16.5% were rejected and 11.1% of cases referred to MDT discussion had no defined clinical plan. First consultations had a higher rate of accepted clinical plans (63.4%) versus subsequent consultations (56.4%). Referrals by the urology specialty had the highest rate of acceptances (64.3%). On the stratification by primary tumour site, testicular cancer had the highest acceptance rate (70.3%), whereas bladder cancer had the lowest (47.8%). CONCLUSIONS MDT conferences had an important impact in the management of 38.2% of cases. Therefore, all patients with urologic malignancies should be referred to MDT review to ensure optimal clinical care.
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Affiliation(s)
- Miguel Gil
- Urology Department, Centro Hospitalar Universitário de Lisboa Central, EPE, Rua José António Serrano, 1150-199, Lisbon, Portugal.
| | - João Guerra
- Urology Department, Centro Hospitalar Universitário de Lisboa Central, EPE, Rua José António Serrano, 1150-199, Lisbon, Portugal
| | - Vanessa Andrade
- Urology Department, Centro Hospitalar Universitário de Lisboa Central, EPE, Rua José António Serrano, 1150-199, Lisbon, Portugal
| | - Mariana Medeiros
- Urology Department, Centro Hospitalar Universitário de Lisboa Central, EPE, Rua José António Serrano, 1150-199, Lisbon, Portugal
| | - Thiago Guimarães
- Urology Department, Centro Hospitalar Universitário de Lisboa Central, EPE, Rua José António Serrano, 1150-199, Lisbon, Portugal
| | - Rui Bernardino
- Urology Department, Centro Hospitalar Universitário de Lisboa Central, EPE, Rua José António Serrano, 1150-199, Lisbon, Portugal
| | - Gil Falcão
- Urology Department, Centro Hospitalar Universitário de Lisboa Central, EPE, Rua José António Serrano, 1150-199, Lisbon, Portugal
| | - Fernando Calais da Silva
- Urology Department, Centro Hospitalar Universitário de Lisboa Central, EPE, Rua José António Serrano, 1150-199, Lisbon, Portugal
| | - Luís Campos Pinheiro
- Urology Department, Centro Hospitalar Universitário de Lisboa Central, EPE, Rua José António Serrano, 1150-199, Lisbon, Portugal
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Maeng CH, Ahn HK, Oh SY, Lim S, Kim BS, Kim DY. Practice patterns of multidisciplinary team meetings in Korean cancer care and patient satisfaction with this approach. Korean J Intern Med 2020; 35:205-214. [PMID: 31795023 PMCID: PMC6960038 DOI: 10.3904/kjim.2019.189] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 07/31/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND/AIMS The multidisciplinary team (MDT) approach is a cornerstone of clinical oncology. This study investigated the current state of MDT care, including patient satisfaction, in Korea. METHODS We obtained the annual number of cancer patients who have received MDT care since 2014 from the registry of the Health Insurance Review and Assessment Service (HIRA). In addition, patients who received MDT care from August 2014 to May 2017 at four university hospitals were further characterized, and patient satisfaction was measured prospectively using a patient-reported questionnaire. RESULTS The total number of patients who received MDT care increased from 2014 to 2016 (2,113 to 9,998 patients, respectively) in the HIRA Cohort. The type of cancer that most often required MDT was breast cancer (23.8%), followed by colorectal cancer (19.1%). In the Representative Cohort (n = 1,032), MDT was requested by the surgeon more than half the time (55.7%). The main focus of MDT was decision making for further treatment planning (99.0%). The number of doctors participating in the MDT was usually five (70.0%). After initiating an MDT approach, the treatment plan changed for 17.4% of patients. Among these patients, 359 completed a prospective satisfaction survey regarding their MDT care. The overall satisfaction with the MDT approach was very high, with an average score of 9.6 out of 10 points. CONCLUSION The application of MDT care is a rapidly growing trend in clinical oncology, and shows high patient satisfaction. Further research is needed to determine which types of cancer patients could benefit most from MDT, and to enable MDT care to operate more efficiently so that it may expand successfully throughout Korea.
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Affiliation(s)
- Chi Hoon Maeng
- Department of Medical Oncology and Hematology, Kyung Hee University Hospital, Seoul, Korea
| | - Hee Kyung Ahn
- Department of Oncology, Gachon University Gil Medical Center, Incheon, Korea
| | - Sung Yong Oh
- Department of Hematology-Oncology, Dong-A University College of Medicine, Busan, Korea
| | - Seungtaek Lim
- Department of Internal Medicine, Wonju Severance Christian Hospital, Wonju, Korea
| | - Bong-Seog Kim
- Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Korea
| | - Do Yeun Kim
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
- Correspondence to Do Yeun Kim, M.D. Department of Internal Medicine, Dongguk University Ilsan Hospital, 27 Dongguk-ro, Ilsandong-gu, Goyang 10326, Korea Tel: +82-31-961-7143 Fax: +82-31-961-7141 E-mail:
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De Luca S, Fiori C, Tucci M, Poggio M, Allis S, Bollito E, Solitro F, Passera R, Buttigliero C, Porpiglia F. Prostate cancer management at an Italian tertiary referral center: does multidisciplinary team meeting influence diagnostic and therapeutic decision-making process? A snapshot of the everyday clinical practice. MINERVA UROL NEFROL 2019; 71:576-582. [DOI: 10.23736/s0393-2249.19.03231-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Scarberry K, Ponsky L, Cherullo E, Larchian W, Bodner D, Cooney M, Ellis R, Maclennan G, Johnson B, Tabayoyong W, Abouassaly R. Evaluating the impact of the genitourinary multidisciplinary tumour board: Should every cancer patient be discussed as standard of care? Can Urol Assoc J 2018; 12:E403-E408. [PMID: 29787374 DOI: 10.5489/cuaj.5150] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION We sought to prospectively evaluate the effectiveness of the multidisciplinary tumour board (MTB) on altering treatment plans for genitourinary (GU) cancer patients. METHODS All GU cancer patients seen at our tertiary care hospital are discussed at MTB. We prospectively collected data on adult patients discussed over a continuous, 20-month period. Physicians completed a survey prior to MTB to document their opinion on the likelihood of change in their patient's treatment plan. Logistic regression was used to asses for factors associated with a change by the MTB, including patient age or sex, malignancy type, the predicted treatment plan, and the provider's years of experience or fellowship training. RESULTS A total of 321 cancer patients were included. Patients were primarily male (84.4%) with a median age of 67 (range 20-92) years old. Prostate (38.9%), bladder (31.8%), and kidney cancer (19.6%) were the most common malignancies discussed. A change in management plan following MTB was observed in 57 (17.8%) patients. The physician predicted a likely change in six (10.5%) of these patients. Multivariate logistic regression did not determine physician prediction to be associated with treatment plan change, and the only significant variable identified was a plan to discuss multiple treatment options with a patient (odds ratio 2.46; 95% confidence interval 1.09-9.54). CONCLUSIONS Routine discussion of all urologic oncology cases at MTB led to a change in treatment plan in 17.8% of patients. Physicians cannot reliably predict which patients have their treatment plan altered. Selectively choosing patients to be presented likely undervalues the impact of a multidisciplinary approach to care.
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Affiliation(s)
- Kyle Scarberry
- Urology Institute, University Hospitals Cleveland Medical Center.,Case Western Reserve University School of Medicine
| | - Lee Ponsky
- Urology Institute, University Hospitals Cleveland Medical Center.,Case Western Reserve University School of Medicine
| | - Edward Cherullo
- Urology Institute, University Hospitals Cleveland Medical Center.,Case Western Reserve University School of Medicine
| | - William Larchian
- Urology Institute, University Hospitals Cleveland Medical Center.,Case Western Reserve University School of Medicine
| | - Donald Bodner
- Urology Institute, University Hospitals Cleveland Medical Center.,Case Western Reserve University School of Medicine
| | - Matthew Cooney
- Case Western Reserve University School of Medicine.,Division of Hematology/Oncology, University Hospitals Cleveland Medical Center
| | - Rodney Ellis
- Case Western Reserve University School of Medicine.,Department of Radiation Oncology, University Hospitals Cleveland Medical Center
| | - Gregory Maclennan
- Case Western Reserve University School of Medicine.,Department of Pathology, University Hospitals Cleveland Medical Center; Cleveland, OH, United States
| | - Ben Johnson
- Urology Institute, University Hospitals Cleveland Medical Center.,Case Western Reserve University School of Medicine
| | - William Tabayoyong
- Urology Institute, University Hospitals Cleveland Medical Center.,Case Western Reserve University School of Medicine
| | - Robert Abouassaly
- Urology Institute, University Hospitals Cleveland Medical Center.,Case Western Reserve University School of Medicine
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Soukup T, Lamb BW, Arora S, Darzi A, Sevdalis N, Green JS. Successful strategies in implementing a multidisciplinary team working in the care of patients with cancer: an overview and synthesis of the available literature. J Multidiscip Healthc 2018; 11:49-61. [PMID: 29403284 PMCID: PMC5783021 DOI: 10.2147/jmdh.s117945] [Citation(s) in RCA: 175] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
In many health care systems globally, cancer care is driven by multidisciplinary cancer teams (MDTs). A large number of studies in the past few years and across different literature have been performed to better understand how these teams work and how they manage patient care. The aim of our literature review is to synthesize current scientific and clinical understanding on cancer MDTs and their organization; this, in turn, should provide an up-to-date summary of the current knowledge that those planning or leading cancer services can use as a guide for service implementation or improvement. We describe the characteristics of an effective MDT and factors that influence how these teams work. A range of factors pertaining to teamwork, availability of patient information, leadership, team and meeting management, and workload can affect how well MDTs are implemented within patient care. We also review how to assess and improve these teams. We present a range of instruments designed to be used with cancer MDTs - including observational tools, self-assessments, and checklists. We conclude with a practical outline of what appears to be the best practices to implement (Dos) and practices to avoid (Don'ts) when setting up MDT-driven cancer care.
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Affiliation(s)
- Tayana Soukup
- Health Service and Population Research Department, Centre for Implementation Science, King's College London, London, UK
| | - Benjamin W Lamb
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Sonal Arora
- Department of Surgery and Cancer, Center for Patient Safety and Service Quality, Imperial College London
| | - Ara Darzi
- Department of Surgery and Cancer, Center for Patient Safety and Service Quality, Imperial College London
| | - Nick Sevdalis
- Health Service and Population Research Department, Centre for Implementation Science, King's College London, London, UK
| | - James Sa Green
- Whipps Cross University Hospital, Barts Health NHS Trust.,Faculty of Health and Social Care, London South Bank University, London, UK
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Kinnear N, Smith R, Hennessey DB, Bolton D, Sengupta S. Implementation rates of uro-oncology multidisciplinary meeting decisions. BJU Int 2017; 120 Suppl 3:15-20. [DOI: 10.1111/bju.13892] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Ned Kinnear
- Department of Urology; Austin Health; Heidelberg Vic. Australia
| | - Riley Smith
- Department of Urology; Austin Health; Heidelberg Vic. Australia
| | | | - Damien Bolton
- Department of Urology; Austin Health; Heidelberg Vic. Australia
- Department of Surgery; University of Melbourne; Heidelberg Vic. Australia
| | - Shomik Sengupta
- Department of Urology; Austin Health; Heidelberg Vic. Australia
- Department of Surgery; University of Melbourne; Heidelberg Vic. Australia
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The impact of multidisciplinary team meetings on patient assessment, management and outcomes in oncology settings: A systematic review of the literature. Cancer Treat Rev 2015; 42:56-72. [PMID: 26643552 DOI: 10.1016/j.ctrv.2015.11.007] [Citation(s) in RCA: 385] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 11/13/2015] [Accepted: 11/19/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Conducting regular multidisciplinary team (MDT) meetings requires significant investment of time and finances. It is thus important to assess the empirical benefits of such practice. A systematic review was conducted to evaluate the literature regarding the impact of MDT meetings on patient assessment, management and outcomes in oncology settings. METHODS Relevant studies were identified by searching OVID MEDLINE, PsycINFO, and EMBASE databases from 1995 to April 2015, using the keywords: multidisciplinary team meeting* OR multidisciplinary discussion* OR multidisciplinary conference* OR case review meeting* OR multidisciplinary care forum* OR multidisciplinary tumour board* OR case conference* OR case discussion* AND oncology OR cancer. Studies were included if they assessed measurable outcomes, and used a comparison group and/or a pre- and post-test design. RESULTS Twenty-seven articles met inclusion criteria. There was limited evidence for improved survival outcomes of patients discussed at MDT meetings. Between 4% and 45% of patients discussed at MDT meetings experienced changes in diagnostic reports following the meeting. Patients discussed at MDT meetings were more likely to receive more accurate and complete pre-operative staging, and neo-adjuvant/adjuvant treatment. Quality of studies was affected by selection bias and the use of historical cohorts impacted study quality. CONCLUSIONS MDT meetings impact upon patient assessment and management practices. However, there was little evidence indicating that MDT meetings resulted in improvements in clinical outcomes. Future research should assess the impact of MDT meetings on patient satisfaction and quality of life, as well as, rates of cross-referral between disciplines.
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Rao K, Manya K, Azad A, Lawrentschuk N, Bolton D, Davis ID, Sengupta S. Uro-oncology multidisciplinary meetings at an Australian tertiary referral centre - impact on clinical decision-making and implications for patient inclusion. BJU Int 2014; 114 Suppl 1:50-4. [DOI: 10.1111/bju.12764] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Kenny Rao
- Department of Urology; Austin Health; Melbourne VIC Australia
| | - Kiran Manya
- Department of Urology; Austin Health; Melbourne VIC Australia
| | - Arun Azad
- Joint Austin-Ludwig Oncology Unit; Austin Health; Melbourne VIC Australia
| | - Nathan Lawrentschuk
- Department of Urology; Austin Health; Melbourne VIC Australia
- Austin Department of Surgery; University of Melbourne; Melbourne VIC Australia
- Ludwig Institute for Cancer Research; Austin Hospital; Melbourne VIC Australia
| | - Damien Bolton
- Department of Urology; Austin Health; Melbourne VIC Australia
- Austin Department of Surgery; University of Melbourne; Melbourne VIC Australia
| | - Ian D. Davis
- Joint Austin-Ludwig Oncology Unit; Austin Health; Melbourne VIC Australia
- Eastern Health Clinical School; Monash University; Melbourne VIC Australia
| | - Shomik Sengupta
- Department of Urology; Austin Health; Melbourne VIC Australia
- Austin Department of Surgery; University of Melbourne; Melbourne VIC Australia
- Ludwig Institute for Cancer Research; Austin Hospital; Melbourne VIC Australia
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Brunner M, Gore SM, Read RL, Alexander A, Mehta A, Elliot M, Milross C, Boyer M, Clark JR. Head and neck multidisciplinary team meetings: Effect on patient management. Head Neck 2014; 37:1046-50. [PMID: 24710807 DOI: 10.1002/hed.23709] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 01/30/2014] [Accepted: 04/04/2014] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The purpose of this study was for us to present our findings on the prospectively audited impact of head and neck multidisciplinary team meetings on patient management. METHODS We collected clinical data, the pre-multidisciplinary team meeting treatment plan, the post-multidisciplinary team meeting treatment plans, and follow-up data from all patients discussed at a weekly multidisciplinary team meeting and we recorded the changes in management. RESULTS One hundred seventy-two patients were discussed in 39 meetings. In 52 patients (30%), changes in management were documented of which 20 (67%) were major. Changes were statistically more likely when the referring physician was a medical or radiation oncologist, when the initial treatment plan did not include surgery, and when the histology was neither mucosal squamous cell cancer nor a skin malignancy. Compliance to the multidisciplinary team meeting treatment recommendation was 84% for all patients and 70% for patients with changes in their treatment recommendation. CONCLUSION Head and neck multidisciplinary team meetings changed management in almost a third of the cases.
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Affiliation(s)
- Markus Brunner
- Sydney Head and Neck Cancer Institute, The Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Sydney, Australia
- Department of Otolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Sinclair M Gore
- Sydney Head and Neck Cancer Institute, The Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Sydney, Australia
| | - Rebecca L Read
- Sydney Head and Neck Cancer Institute, The Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Sydney, Australia
| | - Ashlin Alexander
- Sydney Head and Neck Cancer Institute, The Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Sydney, Australia
| | - Ankur Mehta
- Sydney Head and Neck Cancer Institute, The Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Sydney, Australia
| | - Michael Elliot
- Sydney Head and Neck Cancer Institute, The Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Sydney, Australia
| | - Chris Milross
- Sydney Head and Neck Cancer Institute, The Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Sydney, Australia
| | - Michael Boyer
- Sydney Head and Neck Cancer Institute, The Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Sydney, Australia
| | - Jonathan R Clark
- Sydney Head and Neck Cancer Institute, The Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Sydney, Australia
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Ryan J, Faragher I. Not all patients need to be discussed in a colorectal cancer MDT meeting. Colorectal Dis 2014; 16:520-6. [PMID: 24617857 DOI: 10.1111/codi.12581] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 12/09/2013] [Indexed: 02/08/2023]
Abstract
AIM It is recommended that patients with cancer should be managed in the context of a multidisciplinary team (MDT). Alternatively, proponents of the standard model of care propose that the well-informed treating doctor is able to make the appropriate plan for each patient, making the need for a MDT meeting redundant. We compared the management plans made within a colorectal cancer MDT with routine care. METHOD Consecutive cases presenting to the colorectal MDT were prospectively assessed. Before the meeting management plans were made, based on routine care pathways. These were compared with plans made at the MDT meeting and discrepancies recorded. The number of patients who generated beneficial discussion was recorded. RESULTS There were 261 discussions regarding the care of 197 patients. In the 203 cases where the pathways were relevant, patient management was consistent with the pathway in 94% of the cases discussed. Discussion of routine cases of colon cancer rarely changed management (3.4%). Conversely, management changed after MDT discussion in 50% of complex cases (the preoperative management of rectal cancer, recurrence, metastatic disease and malignant polyps). The postoperative discussion of pathology findings rarely generated beneficial discussion. CONCLUSION Discussion of routine cases of colon cancer in our MDT rarely changed management, but it did change the decisions regarding complex cases or in patients with unusual pathology. We propose a two-tiered approach to the MDT where all patients are listed for a MDT meeting but only patients with complex pathology are discussed in detail.
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Affiliation(s)
- J Ryan
- Department of Surgery, Colorectal Unit, Western Health, Melbourne, Victoria, Australia
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Monn MF, Gellhaus PT, Masterson TA, Patel AA, Tann M, Cregar DM, Boris RS. R.E.N.A.L. Nephrometry scoring: how well correlated are urologist, radiologist, and collaborator scores? J Endourol 2014; 28:1006-10. [PMID: 24708445 DOI: 10.1089/end.2014.0166] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
PURPOSE R.E.N.A.L. Nephrometry Score (NS) is an imaging-based (CT/MRI) scoring system commonly used by urologists to standardize the reporting of renal masses by enabling quantification of anatomical characteristics. We sought to examine the inter-rater correlation of NS between urologists, radiologists, and tumor-board collaborators. METHODS We identified adult patients undergoing partial or radical nephrectomy over 10 years (n=2450). Patients with autosomal dominant polycystic kidney disease (ADPKD), metastatic disease, masses >10 cm, and studies in which the study urologists or radiologists partook in patient care were excluded. Preoperative imaging was evaluated and patients with multiphasic CT available were included. Scans were provided to the reviewers to evaluate with a R.E.N.A.L. nephrometry questionnaire. Results were analyzed using kappa correlation coefficients. RESULTS One hundred twenty patients met inclusion criteria with mean age of 59.5 years. The majority of cases were partial nephrectomies (72%). Eighty-five percent of the tumors were malignant, with 26% having high-grade histology. The mean (standard deviation) overall NS was 6.8 (1.9) with fair correlation among reviewers (κ=0.222). Collaborators had the highest inter-rater correlation, ranging from 0.41 to 0.84 for NS component scores, compared with 0.42-0.85 for radiologists and 0.36-0.86 for urologists. "R" scores were best correlated (κ>0.8). NS correlation ranged between 0.16 and 0.31 for the groups while the NS complexity category correlation ranged between 0.50 and 0.61. CONCLUSIONS Despite being naive to NS, inter-radiologist scoring patterns were better correlated than inter-urologist. The urologist and radiologist collaborating in tumor board showed the highest agreement, suggesting that a multidisciplinary approach in the characterization of renal masses may provide benefit to patient management.
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Affiliation(s)
- M Francesca Monn
- 1 Department of Urology, Indiana University School of Medicine , Indianapolis, Indiana
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[Multidisciplinary meetings dedicated to bone metastases: a historical perspective and rationale]. Bull Cancer 2014; 100:1135-9. [PMID: 24165281 DOI: 10.1684/bdc.2013.1851] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Bone metastases of solid tumors have a strong impact on patient's autonomy and vital outcome. Drugs specifically targeting bone remodeling as well as local treatment (radiotherapy, osteoplasty, surgery) make the management of bone metastasis a multidisciplinary process. Multidisciplinary teams (MDTs) dedicated to bone metastasis aim at providing the diagnosis of certainty, defining treatment indications and monitoring follow-up. The MDTs are the place for innovation in imaging and treatments of bone metastases.
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Golusiński W, Sówka M, Uczułka R, Golusińska E, Kardach H, Wegner A, Pazdrowski J. Rola zespołu interdyscyplinarnego w diagnostyce i leczeniu chorych z nowotworami krtani i gardła dolnego. Otolaryngol Pol 2013; 67:198-203. [DOI: 10.1016/j.otpol.2013.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 03/22/2013] [Accepted: 03/27/2013] [Indexed: 11/26/2022]
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Les décisions des RCP sont-elles conformes au référentiel utilisé ? Expérience d’un centre de référence universitaire pour le cancer du sein. ACTA ACUST UNITED AC 2013; 41:164-7. [DOI: 10.1016/j.gyobfe.2013.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 01/22/2013] [Indexed: 11/23/2022]
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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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Decision-making in oncology: a selected literature review and some recommendations for the future. Curr Opin Oncol 2012; 24:381-90. [PMID: 22572724 DOI: 10.1097/cco.0b013e328354b2f6] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Decision-making in oncology is associated with uncertainty and potential decisional conflict. The purpose of this paper is to review strategies suggested to improve treatment decision-making, discuss their limits and describe recommendations that have been made to improve the decision-making process. RECENT FINDINGS To improve the decision-making process, uncertainty reduction, shared decision-making and multidisciplinary teamwork have been initially proposed. Due to their limits, alternative approaches such as uncertainty management, collaborative decision-making and collaborative multidisciplinary teamwork have been recommended. Uncertainty management considers uncertainty as a multilevel concept. It may be achieved through collaborative decision-making and collaborative multidisciplinary teamwork. Collaborative decision-making is an in-depth personalized iterative assessment of patient medical, psychological and social status. It promotes the patient's proactive role as a key stakeholder of decision-making and the physician's proactive role as a key support to patient decision-making. Collaborative multidisciplinary teamwork promotes an optimal environment for collaborative decision-making in which patients are key stakeholders and all relevant healthcare professionals are actively involved. These approaches require developing interventions for patients, and trainings for physicians and multidisciplinary teams. SUMMARY On the basis of these recent approaches, we propose a 'three-step model of multidisciplinary collaborative treatment decision-making' in oncology. This model should be tested for its validity.
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[Multidisciplinary team meetings in cancerology: setting priorities for improvement]. Bull Cancer 2011; 98:989-98. [PMID: 21908262 DOI: 10.1684/bdc.2011.1428] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Resulting medical decision from a multidisciplinary team (MDT) meeting has to be accurate regarding to various patient criteria and relevant specialists participation. The target is to optimize treatment or management options for patients taking into account patients' benefit. The aim of our study was to examine quality criteria of MDT meeting processes, implementation of the MDT decision, and the follow-up of national or regional clinical guidelines. The results lead us to discuss about care management in cancer. Ten various medical specialities of MDT meetings were studied. Relevant multidisciplinarity varied between MDT meetings specialities and was effective between 55 and 100%. Implementation of the decisions that arise from MDT meetings was 86.3%. The most frequent grounds of non-application were patient refusal and new or previous unknown clinical data. The percentage of MDT meetings decisions following national or regional recommendations was 74%. The main reason of not following was the complexity of clinical patient circumstances. Participation in MDT meetings is more and more time-consuming related to enforce the completeness referred to the Plan Cancer (National recommendations). Leading to completeness raises questions about medical time employment and meaning of the MDT meeting for standard clinical cases. The priority seems to enforce multidisciplinarity rather than reach completeness.
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Abdulrahman GO. The effect of multidisciplinary team care on cancer management. Pan Afr Med J 2011; 9:20. [PMID: 22355430 PMCID: PMC3215542 DOI: 10.4314/pamj.v9i1.71195] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Accepted: 06/11/2011] [Indexed: 12/11/2022] Open
Abstract
Over the past 15 years, the multidisciplinary team management of many medical conditions especially cancers has increasingly taken a prominent role in patient management in many hospitals and medical centres in the developed countries. In the United Kingdom, it began to gain prominence following the Calman-Heine report in 1995 which suggested that each Cancer Unit in a hospital should have in place arrangements for non-surgical oncological input into services, with a role for a non-surgical oncologist. The report further suggested that a lead clinician with a well established interest in cancer care should be appointed to organise and coordinate the whole range of cancer services provided within the Cancer Unit. Many people have argued that the multidisciplinary team management of patients has resulted in better care and improved survival. However, there are barriers to the optimal effectiveness of the multidisciplinary team. This paper aims to review various studies on the effectiveness of the multidisciplinary team in the management of cancer patients and also discuss some of the barriers to the multidisciplinary team.
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Affiliation(s)
- Ganiy Opeyemi Abdulrahman
- Cardiff University of Wales College of Medicine, School of Medicine Registry, Cardiff University, UK
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Lamb BW, Brown KF, Nagpal K, Vincent C, Green JSA, Sevdalis N. Quality of care management decisions by multidisciplinary cancer teams: a systematic review. Ann Surg Oncol 2011; 18:2116-25. [PMID: 21442345 DOI: 10.1245/s10434-011-1675-6] [Citation(s) in RCA: 304] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Indexed: 02/06/2023]
Abstract
BACKGROUND Factors that affect the quality of clinical decisions of multidisciplinary cancer teams (MDTs) are not well understood. We reviewed and synthesised the evidence on clinical, social and technological factors that affect the quality of MDT clinical decision-making. METHODS Electronic databases were searched in May 2009. Eligible studies reported original data, quantitative or qualitative. Data were extracted and tabulated by two blinded reviewers, and study quality formally evaluated. RESULTS Thirty-seven studies were included. Study quality was low to medium. Studies assessed quality of care decisions via the effect of MDTs on care management. MDTs changed cancer management by individual physicians in 2-52% of cases. Failure to reach a decision at MDT discussion was found in 27-52% of cases. Decisions could not be implemented in 1-16% of cases. Team decisions are made by physicians, using clinical information. Nursing personnel do not have an active role, and patient preferences are not discussed. Time pressure, excessive caseload, low attendance, poor teamworking and lack of leadership lead to lack of information and deterioration of decision-making. Telemedicine is increasingly used in developed countries, with no detriment to quality of MDT decisions. CONCLUSIONS Team/social factors affect management decisions by cancer MDTs. Inclusion of time to prepare for MDTs into team-members' job plans, making team and leadership skills training available to team-members, and systematic input from nursing personnel would address some of the current shortcomings. These improvements ought to be considered at national policy level, with the ultimate aim of improving cancer care.
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Affiliation(s)
- Benjamin W Lamb
- Department of Surgery and Cancer, Imperial College London, London, UK.
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Gardinal-Galera I, Bulai Livideanu C, Lamant L, Viraben R, Meyer N, Mazereeuw-Hautier J, Maza A, Prey S, Nespoulous M, Paul C. Joint clinical and pathological review meetings improve patient care: a prospective evaluation in dermatology. J Eur Acad Dermatol Venereol 2010; 25:928-32. [PMID: 21054572 DOI: 10.1111/j.1468-3083.2010.03883.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Joint clinical and pathological review meeting exists in most academic dermatology departments. OBJECTIVE The primary objective of the study was to assess the impact of the joint clinical and pathological review meeting in dermatology on patient care. METHODS Prospective descriptive study over 6 months (May to October 2008) on all clinical cases of dermatology reviewed at the joint clinical and pathological review meeting in our University Hospital. RESULTS A total of 139 cases were reviewed during the 6-month period. In 97 cases (69.8%), the joint clinical and pathological review meeting had a positive impact on final diagnosis and/or on patient management. For 27 cases, a consensus diagnosis different from the initial proposal was established. In 21 cases, the joint clinical and pathological review meeting led to additional investigations or therapeutic proposals. The impact of the joint clinical and pathological review meeting was highest for inflammatory skin diseases. CONCLUSIONS The joint clinical and pathological review meeting is a useful procedure to improve diagnostic accuracy in difficult cases.
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Affiliation(s)
- I Gardinal-Galera
- Department of Dermatology, Paul-Sabatier University, Larrey University Hospital, Toulouse, France
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Descotes JL, Guillem P, Bondil P, Colombel M, Chabloz C. Évaluation des réunions de concertation pluridisciplinaire (RCP) en cancérologie dans la région Rhône-Alpes : une enquête de terrain. Prog Urol 2010; 20:651-6. [DOI: 10.1016/j.purol.2010.03.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2009] [Revised: 02/24/2010] [Accepted: 03/14/2010] [Indexed: 10/19/2022]
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Communication in and clinician satisfaction with multidisciplinary team meetings in neuro-oncology. J Clin Neurosci 2010; 17:1130-5. [DOI: 10.1016/j.jocn.2010.03.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Revised: 03/04/2010] [Accepted: 03/07/2010] [Indexed: 11/16/2022]
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Abstract
Decisions in surgical oncology are increasingly being made by multi-disciplinary teams (MDTs). Although MDTs have been widely accepted as the preferred model for cancer service delivery, the process of decision making has not been well described and there is little evidence pointing to the ideal structure of an MDT. Performance in surgery has been shown to depend on non-technical skills, such as decision making, as well as patient factors and the technical skills of the healthcare team. Application of this systems approach to MDT working allows the identification of factors that affect the quality of decision making for cancer patients. In this article we review the literature on decision making in surgical oncology and by drawing from the systems approach to surgical performance we provide a framework for understanding the process of decision making in MDTs. Technical factors that affect decision making include the information about patients, robust ICT and video-conferencing equipment, a minimum dataset with expert review of radiological and pathological information, implementation and recording of the MDTs decision. Non-technical factors with an impact on decision making include attendance of team members at meetings, leadership, teamwork, open discussion, consensus on decisions and communication with patients and primary care. Optimising these factors will strengthen the decision making process and raise the quality of care for cancer patients.
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Affiliation(s)
- B Lamb
- Department of Surgery and Cancer, Imperial College London, UK.
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Sooriakumaran P, Dick JA, Thompson AC, Morley R. The central urology multidisciplinary team - is it time to change the referral criteria? An audit of practice in a district general hospital in London. Ann R Coll Surg Engl 2009; 91:700-2. [PMID: 19785943 DOI: 10.1308/003588409x12486167521190] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION All cancer patients are discussed in multidisciplinary team meetings (MDTs). Certain patients are referred to the Central MDT based on specific national criteria. We wanted to see whether the Central MDT aided in the decision-making process above that of the Local MDT alone. PATIENTS AND METHODS All MDT forms (local and central) for 2007 were retrospectively reviewed. RESULTS A total of 217 patients were reviewed at the Local MDT. Of these 217 cases, 102 (47.0%) cases were referred to the Central MDT and 15 of the 102 (14.7%) cases were awaiting investigations at the time of the Local MDT and were, therefore, excluded. For the prostate cancer cases (n = 67), the Central MDT did not change outright the Local MDT decision in any case, but in 6 of 67 (9.0%), advised/excluded patients from clinical trials. For bladder cancer cases (n = 19), 4 of 19 (21.0%) patients had their management changed by the Central MDT. The one kidney cancer case had its Local MDT decision changed by the Central MDT. CONCLUSIONS This audit suggests that the Central MDT plays a useful role in the decision-making process for bladder and kidney cancers, and helps determine eligibility for clinical trials in metastatic prostate cancer patients. Its value over the Local MDT alone in the decision-making process for non-metastatic prostate cancer is questionable.
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Wright FC, Lookhong N, Urbach D, Davis D, McLeod RS, Gagliardi AR. Multidisciplinary Cancer Conferences: Identifying Opportunities to Promote Implementation. Ann Surg Oncol 2009; 16:2731-7. [DOI: 10.1245/s10434-009-0639-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2009] [Revised: 04/28/2009] [Accepted: 04/29/2009] [Indexed: 11/18/2022]
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Kurpad R, Kim W, Rathmell WK, Godley P, Whang Y, Fielding J, Smith L, Pettiford A, Schultz H, Nielsen M, Wallen EM, Pruthi RS. A multidisciplinary approach to the management of urologic malignancies: does it influence diagnostic and treatment decisions? Urol Oncol 2009; 29:378-82. [PMID: 19576797 DOI: 10.1016/j.urolonc.2009.04.008] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2009] [Revised: 04/07/2009] [Accepted: 04/07/2009] [Indexed: 12/11/2022]
Abstract
OBJECTIVE It is recognized that multidisciplinary teams may improve management decisions for patients with malignancies. We prospectively studied the effect of such a multidisciplinary approach on the diagnosis and treatment decisions of patients newly presenting with urologic malignancies. METHODS Two hundred sixty-nine consecutive new patients presenting to our institution with an outside diagnosis of a urologic malignancy for diagnostic or treatment considerations (2007-2008). All cases were reviewed and discussed at a tumor board with all members of the different subspecialties present. Reevaluation of the outside diagnostic and treatment plan was undertaken. Based on this team review and approach, patients were classified based on changes in diagnosis and/or treatment. RESULTS Cohort was comprised of patients with the diagnosis of cancer of the prostate (34%), bladder (23%), kidney (35%), testicle (5%), and other (1%). Only 35% of patients had no changes in diagnosis or treatment, 38% had a change in diagnosis or treatment, 10% required further analysis (i.e., "other"), and 17% were N/A. Changes in diagnosis were most common in bladder (23%) and renal (17%) cancers. Changes in treatment were most common in bladder cancer (44%), followed by kidney (36%), testicular (29%), then prostate (22%) cancers. A stage effect on diagnostic and treatment considerations was also noted, especially for bladder cancer. CONCLUSIONS A multidisciplinary team approach affects the diagnostic and management decisions in a significant number patients with a newly diagnosed urologic malignancy, and thereby seems to have a clinical impact for many of our patients with urologic cancers.
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Affiliation(s)
- Raj Kurpad
- Division of Urologic Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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Evans AC, Zorbas HM, Keaney MA, Sidhom MA, Goodwin HE, Peterson JC. Medicolegal implications of a multidisciplinary approach to cancer care: consensus recommendations from a national workshop. Med J Aust 2008; 188:401-4. [DOI: 10.5694/j.1326-5377.2008.tb01684.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2007] [Accepted: 11/14/2007] [Indexed: 11/17/2022]
Affiliation(s)
| | | | | | - Mark A Sidhom
- Cancer Therapy Centre, Liverpool Hospital, Sydney, NSW
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