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Petrelli F, Dottorini L, De Stefani A, Vavassori I, Luciani A. Localized prostate cancer in older patients: Radical prostatectomy or radiotherapy versus observation. J Geriatr Oncol 2024:101792. [PMID: 38802294 DOI: 10.1016/j.jgo.2024.101792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 04/17/2024] [Accepted: 05/03/2024] [Indexed: 05/29/2024]
Abstract
INTRODUCTION This study evaluates the effects of radical prostatectomy (RP) or irradiation on overall survival (OS) and prostate cancer-specific mortality (PCSM) in older patients with localized prostate cancer (PC). MATERIALS AND METHODS We conducted a comprehensive literature review across PubMed, EMBASE, and the Cochrane Library from inception up to December 2023 to identify studies comparing the outcomes of surgery or radiotherapy (RT) versus observation in patients aged 65 and older with localized PC. We pooled hazard ratios (HRs) for OS and PCSM using random-effects models. RESULTS Thirteen studies involving 284,066 patients were analyzed. Three were large randomized trials (RCTs) and 10 were retrospective studies. Overall survival with surgery was greater in observational studies (HR = 0.52, 95% confidence interval [CI] 0.47-0.59; P < 0.001) than in RCTs (HR = 0.84, 95%CI 0.72-0.98; P = 0.03). Data on PCSM from seven studies also indicated a significant benefit for RP in RCTs (HR = 0.47; 95% CI: 0.3-0.73; P < 0.001) and observational studies (HR = 0.41, 95%CI 0.27-0.62; P < 0.001). Both analyses presented high heterogeneity (I2 = 90%, P < 0.001 and I2 = 65%, P = 0.01). An analysis of patients receiving RT indicated a significant, albeit smaller, OS (n = 7 studies) and PCSM (n = 5 studies) advantage (HR = 0.69; 95% CI: 0.59-0.79; P < 0.001; and HR = 0.60; 95% CI 0.44-0.82; P = 0.001) compared to observation (1 RCT and 8 observational studies). DISCUSSION The evidence suggests that patients with PC might consider opting for surgery as the main treatment option or, alternatively, for RT, as an alternative to observation, based on their individual medical history, life expectancy, and preferences.
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Affiliation(s)
- Fausto Petrelli
- Medical Oncology Unit, ASST Bergamo Orest, Treviglio, BG, Italy.
| | | | | | | | - Andrea Luciani
- Medical Oncology Unit, ASST Bergamo Orest, Treviglio, BG, Italy
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2
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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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The Geriatric G8 Score Is Associated with Survival Outcomes in Older Patients with Advanced Prostate Cancer in the ADHERE Prospective Study of the Meet-URO Network. Curr Oncol 2022; 29:7745-7753. [PMID: 36290889 PMCID: PMC9600362 DOI: 10.3390/curroncol29100612] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/11/2022] [Accepted: 10/11/2022] [Indexed: 11/07/2022] Open
Abstract
Introduction: Androgen receptor pathway inhibitors (ARPIs) have been increasingly offered to older patients with prostate cancer (PC). However, prognostic factors relevant to their outcome with ARPIs are still little investigated. Methods and Materials: The Meet-URO network ADHERE was a prospective multicentre observational cohort study evaluating and monitoring adherence to ARPIs metastatic castrate-resistant PC (mCRPC) patients aged ≥70. Cox regression univariable and multivariable analyses for radiographic progression-free (rPFS) and overall survival (OS) were performed. Unsupervised median values and literature-based thresholds where available were used as cut-offs for quantitative variables. Results: Overall, 234 patients were enrolled with a median age of 78 years (73-82); 86 were treated with abiraterone (ABI) and 148 with enzalutamide (ENZ). With a median follow-up of 15.4 months (mo.), the median rPFS was 26.0 mo. (95% CI, 22.8-29.3) and OS 48.8 mo. (95% CI, 36.8-60.8). At the MVA, independent prognostic factors for both worse rPFS and OS were Geriatric G8 assessment ≤ 14 (p < 0.001 and p = 0.004) and PSA decline ≥50% (p < 0.001 for both); time to castration resistance ≥ 31 mo. and setting of treatment (i.e., post-ABI/ENZ) for rPFS only (p < 0.001 and p = 0.01, respectively); age ≥78 years for OS only (p = 0.008). Conclusions: Baseline G8 screening is recommended for mCRPC patients aged ≥70 to optimise ARPIs in vulnerable individuals, including early introduction of palliative care.
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Banna GL, Cantale O, Haydock MM, Battisti NML, Bambury K, Musolino N, O' Carroll E, Maltese G, Garetto L, Addeo A, Gomes F. International Survey on Frailty Assessment in Patients with Cancer. Oncologist 2022; 27:e796-e803. [PMID: 35905085 PMCID: PMC9526491 DOI: 10.1093/oncolo/oyac133] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/17/2022] [Indexed: 11/24/2022] Open
Abstract
Background Frailty negatively affects the outcomes of patients with cancer, and its assessment might vary widely in the real world. The objective of this study was to explore awareness and use of frailty screening tools among the ONCOassist healthcare professionals (HCPs) users. Materials and Methods We sent 2 emails with a cross-sectional 15-item survey in a 3-week interval between April and May 2021. Differences in the awareness and use of tools according to respondents’ continents, country income, and job types were investigated. Results Seven hundred thirty-seven HCPs from 91 countries (81% physicians, 13% nurses, and 5% other HCPs) completed the survey. Three hundred and eighty-five (52%) reported assessing all or the majority of their patients; 518 (70%) at baseline and before starting a new treatment. Three hundred and four (43%) HCPs were aware of performance status (PS) scores only, 309 (42%) age/frailty/comorbidity (AFC) screening, and 102 (14%) chemotoxicity predictive tools. Five hundred and thirty-seven (73%) reported using tools; 423 (57%) just PS, 237 (32%) AFC, and 60 (8%) chemotoxicity ones. Reasons for tools non-use (485 responders) were awareness (70%), time constraints (28%), and uselessness (2%). There were significant differences in awareness and use of screening tools among different continents, country income, job types, and medical specialties (P < .001 for all comparisons). Conclusion Among selected oncology HCPs, there is still a worldwide lack of knowledge and usage of frailty screening tools, which may differ according to their geography, country income, and education. Targeted initiatives to raise awareness and education are needed to implement frailty assessment in managing patients with cancer.
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Affiliation(s)
- Giuseppe Luigi Banna
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy.,Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Ornella Cantale
- Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy
| | | | - Nicolò Matteo Luca Battisti
- Breast Unit-The Royal Marsden NHS Foundation Trust & Breast Cancer Research Division, The Institute of Cancer Research, London, UK
| | | | | | | | - Giuseppe Maltese
- Epsom and St Helier University Hospitals, Surrey, UK.,King's College London, London, UK
| | - Lucia Garetto
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | | | - Fabio Gomes
- The Christie NHS Foundation Trust, Manchester, UK
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Wu SY, Effendi FF, Canales RE, Huang CC. The Latest Data Specifically Focused on Long-Term Oncologic Prognostication for Very Old Adults with Acute Vulnerable Localized Prostate Cancer: A Nationwide Cohort Study. J Clin Med 2022; 11:jcm11123451. [PMID: 35743522 PMCID: PMC9225393 DOI: 10.3390/jcm11123451] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 12/10/2022] Open
Abstract
Purpose: Few studies have evaluated the prime treatment choice for men older than 80 years with acute vulnerable localized prostate cancer (AV-LPC). Clinicians have been deeply troubled by this near end-of-life medical choice for a very specific group of patients. We compared the oncological prognostication of very old patients with AV-LPC after they underwent either radical prostatectomy (RP) or massive-dose intensity-modulated radiotherapy (IMRT) coupled with long-term androgen deprivation therapy (ADT) over a long-term investigation. Methods: In this nationwide cohort study, we used the Taiwan Cancer Registry Database and retrieved information related to patients (aged ≥ 80 years) with AV-LPC who underwent standard RP (the RP group) or massive-dose IMRT + long-term ADT (at least 72 Gy and ADT use ≥18 months; the IMRT + ADT group). After potential confounders were controlled for using propensity score matching (PSM), we utilized the Cox proportional hazards regression to evaluate the oncologic prognostication. Results: The IMRT + ADT group had a significantly higher adjusted hazard ratio (aHR) for all-cause mortality (aHR, 2.00; 95% confidence interval [CI], 1.41−2.87) than the RP group. Analysis of the secondary outcomes revealed that compared with the RP group, the aHRs of biochemical failure, locoregional recurrence, and distant metastasis in the IMRT + ADT group were 1.77 (95% CI: 1.36−2.11, p < 0.0001), 1.12 (95% CI: 1.04−1.33, p < 0.0001), and 1.15 (95% CI: 1.06−1.71, p = 0.0311), respectively. Conclusion: RP provides more favorable oncological prognostication than IMRT in very old adults with AV-LPC.
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Affiliation(s)
- Szu-Yuan Wu
- Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung 413, Taiwan;
- Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 265, Taiwan
- Division of Radiation Oncology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 265, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung 413, Taiwan
- Cancer Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 265, Taiwan
- Graduate Institute of Business Administration, Fu Jen Catholic University, Taipei 242, Taiwan
- Centers for Regional Anesthesia and Pain Medicine, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei 110, Taiwan
| | - Fransisca Fortunata Effendi
- School of Health Care Administration, Department of Health Care Administration, College of Management, Taipei Medical University, Taipei 110, Taiwan; (F.F.E.); (R.E.C.)
- PT Inertia Utama, Dexa Group, Jl. Boulevard Bintaro Jaya, Pondok Jaya, Pondok Aren, South Tangerang 15117, Indonesia
| | - Ricardo E. Canales
- School of Health Care Administration, Department of Health Care Administration, College of Management, Taipei Medical University, Taipei 110, Taiwan; (F.F.E.); (R.E.C.)
- Collegiate of Doctors in Honduras, Colegio Médico de Honduras (CMH), CA 6 Boulevard Fuerzas Armadas, Tegucigalpa 11101, Honduras
| | - Chung-Chien Huang
- Biotech and Healthcare Management, School of Health Care Administration, College of Management, Taipei Medical University, Taipei 110, Taiwan
- Department of Medical Quality, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei 110, Taiwan
- Department of Long-Term Care & School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei 110, Taiwan
- Department & School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei 110, Taiwan
- Correspondence:
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Wu SY, Effendi FF, Peng JY, Huang CC. Long-Term Medical Resource Consumption of Radical Prostatectomy vs. Intensity-Modulated Radiotherapy for Old Patients With Prostate Cancer: A Nationwide Population-Based Cohort Study. Front Med (Lausanne) 2022; 9:843709. [PMID: 35592854 PMCID: PMC9113182 DOI: 10.3389/fmed.2022.843709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 04/14/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose Few studies have compared the long-term medical resource consumption between radical prostatectomy (RP) and intensity-modulated radiation therapy (IMRT) among old (≥80 years) patients with localized prostate cancer (LPC), particularly in those at high risk of prostate adenocarcinoma. Patients and Methods The propensity score matching was conducted to investigate the medical expenditure of two therapeutic modalities (RP and IMRT) in elderly patients with high-risk LPC (HR-LPC). The generalized linear mixed and logistic regression models were employed to evaluate the number of postdischarge visits and medical reimbursement for urinary diseases or complications and the number of hospitalizations for treatment-related complications over 5 years after treatment, respectively. Results Significant differences were observed in the median or mean urology clinic visit numbers across the two therapeutic modalities from the first until fifth year post treatment (p < 0.0001). After adjustment for covariates, the mean difference [95% confidence interval (CI)] of urology clinic visit numbers between RP and IMRT was 13.07 (10.45-15.49, P < 0.0001), 7.47 (8.01-14.92, P < 0.0001), 8.24 (4.59-9.90, P < 0.0001), 6.63 (3.55-11.70, P < 0.0001), and 5.02 (1.12-8.73, P < 0.0001) for the first, second, third, fourth, and fifth years, respectively. In the logistic regression multivariate model with adjustment for covariates [therapy type, age, diagnosis year, income, hospital area, hospital level (academic or nonacademic), clinical and pathological T-stage, grade (Gleason score), pretreatment PSA level (ng/ml), and D'Amico risk classification], the adjusted odds ratio (95% CI) of IMRT was 2.10 (1.37-2.56, P = 0.0013), 1.55 (1.08-2.21, P = 0.0151), 1.35 (1.08-2.21, P = 0.0084), 1.24 (1.07-2.21, P = 0.0071), and 1.09 (1.02-1.81, P = 0.0379) for the first, second, third, fourth, and fifth years, respectively, compared with those of RP. The mean difference (95% CI) of total medical claims amounts of RP and IMRT between the RP and IMRT + ADT groups was 2,69,823 New Taiwan Dollars (NTD) (247,676-291,970, P < 0.0001), 40,803 NTD (17,379-54,228, P < 0.0001), 36,202 NTD (24,375-68,029, P < 0.0001), 26,708 NTD (11,179-54,595, P = 0.0321), and 12,173 NTD (17,140-41,487, P = 0.0187) for the first, second, third, fourth, and fifth years, respectively. Conclusion The long-term medical resource consumption was higher in old men with HR-LPC undergoing IMRT than in those undergoing RP.
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Affiliation(s)
- Szu-Yuan Wu
- Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan.,Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan.,Division of Radiation Oncology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan.,Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan.,Cancer Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan.,Graduate Institute of Business Administration, Fu Jen Catholic University, Taipei, Taiwan.,Centers for Regional Anesthesia and Pain Medicine, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Fransisca Fortunata Effendi
- Master Program in School of Health Care Administration, Department of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan.,PT Inertia Utama, Dexa Group, South Tangerang, Indonesia
| | - Jhao Yang Peng
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, New Taipei City, Taiwan.,Roche Diagnostics Ltd., New Taipei City, Taiwan
| | - Chung-Chien Huang
- International Ph.D. Program in Biotech and Healthcare Management, School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan.,Department of Medical Quality, Taipei Municipal Wan Fang Hospital-Managed by Taipei Medical University, Taipei, Taiwan
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Abstract
Cancer is predominantly a disease of aging, and older adults represent the majority of cancer diagnoses and deaths. Older adults with cancer differ significantly from younger patients, leading to important distinctions in cancer treatment planning and decision-making. As a consequence, the field of geriatric oncology has blossomed and evolved over recent decades, as the need to bring personalized cancer care to older adults has been increasingly recognized and a focus of study. The geriatric assessment (GA) has become the cornerstone of geriatric oncology research, and the past year has yielded promising results regarding the implementation of GA into routine cancer treatment decisions and outcomes for older adults. In this article, we provide an overview of the field of geriatric oncology and highlight recent breakthroughs with the use of GA in cancer care. Further work is needed to continue to provide personalized, evidence-based care for each older adult with cancer.
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Dharmarajan KV, Presley CJ, Wyld L. Care Disparities Across the Health Care Continuum for Older Adults: Lessons From Multidisciplinary Perspectives. Am Soc Clin Oncol Educ Book 2021; 41:1-10. [PMID: 33956492 DOI: 10.1200/edbk_319841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Older adults comprise a considerable proportion of patients with cancer in the world. Across multiple cancer types, cancer treatment outcomes among older age groups are often inferior to those among younger adults. Cancer care for older individuals is complicated by the need to adapt treatment to baseline health, fitness, and frailty, all of which vary widely within this age group. Rates of social deprivation and socioeconomic disparities are also higher in older adults, with many living on reduced incomes, further compounding health inequality. It is important to recognize and avoid undertreatment and overtreatment of cancer in this age group; however, simply addressing this problem by mandating standard treatment of all would lead to harms resulting from treatment toxicity and futility. However, there is little high-quality evidence on which to base these decisions, because older adults are poorly represented in clinical trials. Clinicians must recognize that simple extrapolation of outcomes from younger age cohorts may not be appropriate because of variance in disease stage and biology, variation in fitness and treatment tolerance, and reduced life expectancy. Older patients may also have different life goals and priorities, with a greater focus on quality of life and less on length of life at any cost. Health care professionals struggle with treatment of older adults with cancer, with high rates of variability in practice between and within countries. This suggests that better national and international recommendations that more fully address the needs of this special patient population are required and that primary research focused on the older age group is urgently required to inform these guidelines.
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Affiliation(s)
- Kavita V Dharmarajan
- Department of Radiation Oncology, Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Carolyn J Presley
- Division of Medical Oncology, Department of Internal Medicine, James Cancer Hospital & Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Lynda Wyld
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, United Kingdom.,Doncaster and Bassetlaw Teaching Hospitals, National Health Service Foundation Trust, Doncaster, United Kingdom
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9
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McKenzie GAG, Bullock AF, Greenley SL, Lind MJ, Johnson MJ, Pearson M. Implementation of geriatric assessment in oncology settings: A systematic realist review. J Geriatr Oncol 2020; 12:22-33. [PMID: 32680826 DOI: 10.1016/j.jgo.2020.07.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/04/2020] [Accepted: 07/06/2020] [Indexed: 12/20/2022]
Abstract
Older adults with cancer are more likely to have worse clinical outcomes than their younger counterparts, and shared decision-making can be difficult, due to both complexity from adverse ageing and under-representation in clinical trials. Geriatric assessment (GA) has been increasingly recognised as a predictive and prehabilitative tool for older adults with cancer. However, GA has been notoriously difficult to implement in oncological settings due to workforce, economic, logistical, and practical barriers. We aimed to review the heterogenous literature on implementation of GA in oncology settings to understand the different implementation context configurations of GA and the mechanisms they trigger to enable successful implementation. A systematic realist review was undertaken in two stages: i) systematic searches with structured data extraction combined with iterative key stakeholder consultations to develop programme theories for implementing GA in oncology settings; ii) synthesis to refine programme theories. Medline, Embase, PsycInfo, Cochrane Library, CINAHL, Web of Science, Scopus, ASSIA, Epistemonikos, JBI Database of Systematic Reviews and Implementation Reports, DARE and Health Technology Assessment were searched. Four programme theories were developed from 53 included articles and 20 key stakeholder consultations addressing the major barriers of GA implementation in oncology practice: time (leveraging non-specialists), funding (creating favourable health economics), practicalities (establishing the use of GA in cancer care), and managing limited resources. We demonstrate that a whole system approach is required to improve the implementation of GA in cancer settings. This review will help inform policy decisions regarding implementation of GA and provide a basis for further implementation research.
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Affiliation(s)
- Gordon A G McKenzie
- Wolfson Palliative Care Research Centre, Hull York Medical School, Allam Medical Building, University of Hull, Hull HU6 7RX, United Kingdom.
| | - Alex F Bullock
- Wolfson Palliative Care Research Centre, Hull York Medical School, Allam Medical Building, University of Hull, Hull HU6 7RX, United Kingdom
| | - Sarah L Greenley
- Wolfson Palliative Care Research Centre, Hull York Medical School, Allam Medical Building, University of Hull, Hull HU6 7RX, United Kingdom
| | - Michael J Lind
- Wolfson Palliative Care Research Centre, Hull York Medical School, Allam Medical Building, University of Hull, Hull HU6 7RX, United Kingdom
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, Allam Medical Building, University of Hull, Hull HU6 7RX, United Kingdom
| | - Mark Pearson
- Wolfson Palliative Care Research Centre, Hull York Medical School, Allam Medical Building, University of Hull, Hull HU6 7RX, United Kingdom
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10
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Holmes A, Kelly BD, Perera M, Eapen RS, Bolton DM, Lawrentschuk N. A systematic scoping review of multidisciplinary cancer team and decision-making in the management of men with advanced prostate cancer. World J Urol 2020; 39:297-306. [PMID: 32500304 DOI: 10.1007/s00345-020-03265-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/16/2020] [Indexed: 02/07/2023] Open
Abstract
PURPOSE The early diagnosis of prostate cancer and subsequent access to the treatment options helps to achieve optimal cancer outcomes. As the treatment options for patients with advanced prostate cancer continues to evolve, patients need to access a multidisciplinary team (MDT) meeting to receive best-practice care. METHODS In this paper a MEDLINE review was performed to assess clinical decision making in the context of MDT discussions for patients with advanced prostate cancer. RESULTS From 441 returned articles and abstracts, 50 articles were assessed for eligibility and 16 articles included for analysis. Sixteen articles were identified, 9 of the 16 articles used quantitative methodology including three retrospective analysis of clinical registry data, patient medical records and/or MDT meeting notes and three cross-sectional surveys. Other study designs included one observation study and one study using a combination of qualitative and quantitative methodologies and one mini-review. There were also four editorials included in the review and two consensus statements. CONCLUSION This paper highlights the important role the inter-disciplinary MDT has on shared decision making for men with advanced prostate cancer. The application of MDT care is a rapidly growing trend in uro-oncology and an efficient MDT service requires further research to assess its efficiency so that it may expand through all aspect of uro-oncology.
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Affiliation(s)
- A Holmes
- Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - B D Kelly
- Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - M Perera
- Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - R S Eapen
- Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, VIC, Australia.,Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - D M Bolton
- Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - N Lawrentschuk
- Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, VIC, Australia. .,Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia. .,EJ Whitten Prostate Cancer Research Centre at Epworth Healthcare, Melbourne, Australia. .,Department of Urology, Royal Melbourne Hospital, Melbourne, Australia.
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