1
|
Stirling RG, Harrison A, Huang J, Lee V, Taverner J, Barnes H. Multidisciplinary meeting review in nonsmall cell lung cancer: a systematic review and meta-analysis. Eur Respir Rev 2024; 33:230157. [PMID: 38719736 PMCID: PMC11078104 DOI: 10.1183/16000617.0157-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 02/23/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Lung cancer diagnosis, staging and treatment may be enhanced by multidisciplinary participation and presentation in multidisciplinary meetings (MDM). We performed a systematic review and meta-analysis to explore literature evidence of clinical impacts of MDM exposure. METHODS A study protocol was registered (PROSPERO identifier CRD42021258069). Randomised controlled trials and observational cohort studies including adults with nonsmall cell lung cancer and who underwent MDM review, compared to no MDM, were included. MEDLINE, CENTRAL, Embase and ClinicalTrials.gov were searched on 31 May 2021. Studies were screened and extracted by two reviewers. Outcomes included time to diagnosis and treatment, histological confirmation, receipt of treatments, clinical trial participation, survival and quality of life. Risk of bias was assessed using the ROBINS-I (Risk of Bias in Non-randomised Studies - of Interventions) tool. RESULTS 2947 citations were identified, and 20 studies were included. MDM presentation significantly increased histological confirmation of diagnosis (OR 3.01, 95% CI 2.30-3.95; p<0.00001) and availability of clinical staging (OR 2.55, 95% CI 1.43-4.56; p=0.002). MDM presentation significantly increased likelihood of receipt of surgery (OR 2.01, 95% CI 1.29-3.12; p=0.002) and reduced the likelihood of receiving no active treatment (OR 0.32, 95% CI 0.21-0.50; p=0.01). MDM presentation was protective of both 1-year survival (OR 3.23, 95% CI 2.85-3.68; p<0.00001) and overall survival (hazard ratio 0.63, 95% CI 0.55-0.72; p<0.00001). DISCUSSION MDM presentation was associated with increased likelihood of histological confirmation of diagnosis, documentation of clinical staging and receipt of surgery. Overall and 1-year survival was better in those presented to an MDM, although there was some clinical heterogeneity in participants and interventions delivered. Further research is required to determine the optimal method of MDM presentation, and address barriers to presentation.
Collapse
Affiliation(s)
- Rob G Stirling
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Amelia Harrison
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Australia
| | - Joanna Huang
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Australia
| | - Vera Lee
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - John Taverner
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Australia
| | - Hayley Barnes
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| |
Collapse
|
2
|
Huang RS, Mihalache A, Nafees A, Hasan A, Ye XY, Liu Z, Leighl NB, Raman S. The impact of multidisciplinary cancer conferences on overall survival: a meta-analysis. J Natl Cancer Inst 2024; 116:356-369. [PMID: 38123515 DOI: 10.1093/jnci/djad268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/11/2023] [Accepted: 12/16/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Multidisciplinary cancer conferences consist of regular meetings between diverse specialists working together to share clinical decision making in cancer care. The aim of this study was to systematically review and meta-analyze the effect of multidisciplinary cancer conference intervention on the overall survival of patients with cancer. METHODS A systematic literature search was conducted on Ovid MEDLINE, EMBASE, and the Cochrane Controlled Register of Trials for studies published up to July 2023. Studies reporting on the impact of multidisciplinary cancer conferences on patient overall survival were included. A standard random-effects model with the inverse variance-weighted approach was used to estimate the pooled hazard ratio of mortality (multidisciplinary cancer conference vs non-multidisciplinary cancer conference) across studies, and the heterogeneity was assessed by I2. Publication bias was examined using funnel plots and the Egger test. RESULTS A total of 134 287 patients with cancer from 59 studies were included in our analysis, with 48 467 managed by multidisciplinary cancer conferences and 85 820 in the control arm. Across all cancer types, patients managed by multidisciplinary cancer conferences had an increased overall survival compared with control patients (hazard ratio = 0.67, 95% confidence interval = 0.62 to 0.71, I2 = 84%). Median survival time was 30.2 months in the multidisciplinary cancer conference group and 19.0 months in the control group. In subgroup analysis, a positive effect of the multidisciplinary cancer conference intervention on overall survival was found in breast, colorectal, esophageal, hematologic, hepatocellular, lung, pancreatic, and head and neck cancer. CONCLUSIONS Overall, our meta-analysis found a significant positive effect of multidisciplinary cancer conferences compared with controls. Further studies are needed to establish nuanced guidelines when optimizing multidisciplinary cancer conference integration for treating diverse patient populations.
Collapse
Affiliation(s)
- Ryan S Huang
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Andrew Mihalache
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Asad Hasan
- University of British Columbia, Vancouver, BC, Canada
| | - Xiang Y Ye
- Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Zhihui Liu
- Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Natasha B Leighl
- Department of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Srinivas Raman
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
3
|
de Oliveira TB, Fontes DMN, Montella TC, Lewgoy J, Dutra C, Miola TM. The Best Supportive Care in Stage III Non-Small-Cell Lung Cancer. Curr Oncol 2023; 31:183-202. [PMID: 38248097 PMCID: PMC10814676 DOI: 10.3390/curroncol31010012] [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: 11/15/2023] [Accepted: 11/27/2023] [Indexed: 01/23/2024] Open
Abstract
Lung cancer is a major cause of cancer deaths worldwide. Non-small-cell lung cancer (NSCLC) represents most lung cancer cases, and approximately one-third of patients present with stage III disease at diagnosis. As multiple treatment plans can be adopted for these patients depending on tumor size and nodal staging, stage III NSCLC management is challenging. Over the past decades, multidisciplinary teams (MDTs) have been implemented in healthcare services to coordinate actions among the different health care professionals involved in cancer care. The aim of this review was to discuss real-world evidence of the impact of MDTs on stage III NSCLC management, survival, and quality of life. Here, we performed a literature review to investigate the role of nutrition and navigational nursing in NSCLC care and the influence of MDTs in the choice of treatment plans, including immunotherapy consolidation, and in the management of chemotherapy and radiotherapy-related adverse events. We also performed a mapping review to identify gaps in the implementation of cancer care MDTs in healthcare services around the world.
Collapse
Affiliation(s)
| | | | | | - Jairo Lewgoy
- Medical Oncology Department, Hospital Mãe de Deus, Porto Alegre 90880-481, Brazil;
| | - Carolina Dutra
- Medical Oncology Department, Clínica Soma, Florianópolis 88020-210, Brazil;
| | | |
Collapse
|
4
|
Pangarsa EA, Rizky D, Tandarto K, Setiawan B, Santosa D, Hadiyanto JN, Kyana S, Suharti C. The effect of multidisciplinary team on survival rates of women with breast cancer: a systematic review and meta-analysis. Ann Med Surg (Lond) 2023; 85:2940-2948. [PMID: 37363480 PMCID: PMC10289736 DOI: 10.1097/ms9.0000000000000914] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/14/2023] [Indexed: 06/28/2023] Open
Abstract
Breast cancer is quite frequent all around the world. This disease was responsible for an estimated 2.1 million malignancies in 2022, making it the seventh-highest cause of cancer deaths globally. A multidisciplinary team (MDT) care policy was developed in the United Kingdom (UK) in 1995 to enhance the quality of care for cancer patients. The purpose of this systematic review and meta-analysis study is to assess the effects of MDT on breast cancer survival rates. Methods This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020. Systematic search was conducted in several international databases including Google Scholar, PubMed, EBSCOhost, and Proquest from 2012 to 2022. The authors used RevMan 5.4 to do the meta-analysis of the pooled hazard ratio. Newcastle-Ottawa Scale to measure the risk of bias. Newcastle-Ottawa Scale evaluated participant selection, comparability, and reporting of results using eight subscale items. Egger's test funnel plot was used to assess the potential publication bias for this study. Results A total of 1187 studies were identified from research database. The authors found a total of six studies from six different countries (China, the UK, Taiwan, Australia, Africa, and France) included for this study. Based on the meta-analysis of the pooled hazard ratio of the included studies, the authors found that the overall effect size of the study was 0.80 (CI 95%: 0.73-0.88). Conclusions Breast cancer patients who participated in well-organized MDT discussions had a greater survival rate than those who did not.
Collapse
Affiliation(s)
- Eko A. Pangarsa
- Hematology Medical Oncology Division, Department of Internal Medicine, Faculty of Medicine, Diponegoro University/Dr. Kariadi General Hospital Semarang, Indonesia
| | - Daniel Rizky
- Hematology Medical Oncology Division, Department of Internal Medicine, Faculty of Medicine, Diponegoro University/Dr. Kariadi General Hospital Semarang, Indonesia
| | - Kevin Tandarto
- Hematology Medical Oncology Division, Department of Internal Medicine, Faculty of Medicine, Diponegoro University/Dr. Kariadi General Hospital Semarang, Indonesia
| | - Budi Setiawan
- Hematology Medical Oncology Division, Department of Internal Medicine, Faculty of Medicine, Diponegoro University/Dr. Kariadi General Hospital Semarang, Indonesia
| | - Damai Santosa
- Hematology Medical Oncology Division, Department of Internal Medicine, Faculty of Medicine, Diponegoro University/Dr. Kariadi General Hospital Semarang, Indonesia
| | - Jessica N. Hadiyanto
- Department of Internal Medicine, Dr. Kariadi General Hospital/Faculty of Medicine, Diponegoro University, Indonesia
| | - Salma Kyana
- Department of Internal Medicine, Dr. Kariadi General Hospital/Faculty of Medicine, Diponegoro University, Indonesia
| | - Catharina Suharti
- Hematology Medical Oncology Division, Department of Internal Medicine, Faculty of Medicine, Diponegoro University/Dr. Kariadi General Hospital Semarang, Indonesia
| |
Collapse
|
5
|
Blum TG, Morgan RL, Durieux V, Chorostowska-Wynimko J, Baldwin DR, Boyd J, Faivre-Finn C, Galateau-Salle F, Gamarra F, Grigoriu B, Hardavella G, Hauptmann M, Jakobsen E, Jovanovic D, Knaut P, Massard G, McPhelim J, Meert AP, Milroy R, Muhr R, Mutti L, Paesmans M, Powell P, Putora PM, Rawlinson J, Rich AL, Rigau D, de Ruysscher D, Sculier JP, Schepereel A, Subotic D, Van Schil P, Tonia T, Williams C, Berghmans T. European Respiratory Society guideline on various aspects of quality in lung cancer care. Eur Respir J 2023; 61:13993003.03201-2021. [PMID: 36396145 DOI: 10.1183/13993003.03201-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 09/23/2022] [Indexed: 11/18/2022]
Abstract
This European Respiratory Society guideline is dedicated to the provision of good quality recommendations in lung cancer care. All the clinical recommendations contained were based on a comprehensive systematic review and evidence syntheses based on eight PICO (Patients, Intervention, Comparison, Outcomes) questions. The evidence was appraised in compliance with the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Evidence profiles and the GRADE Evidence to Decision frameworks were used to summarise results and to make the decision-making process transparent. A multidisciplinary Task Force panel of lung cancer experts formulated and consented the clinical recommendations following thorough discussions of the systematic review results. In particular, we have made recommendations relating to the following quality improvement measures deemed applicable to routine lung cancer care: 1) avoidance of delay in the diagnostic and therapeutic period, 2) integration of multidisciplinary teams and multidisciplinary consultations, 3) implementation of and adherence to lung cancer guidelines, 4) benefit of higher institutional/individual volume and advanced specialisation in lung cancer surgery and other procedures, 5) need for pathological confirmation of lesions in patients with pulmonary lesions and suspected lung cancer, and histological subtyping and molecular characterisation for actionable targets or response to treatment of confirmed lung cancers, 6) added value of early integration of palliative care teams or specialists, 7) advantage of integrating specific quality improvement measures, and 8) benefit of using patient decision tools. These recommendations should be reconsidered and updated, as appropriate, as new evidence becomes available.
Collapse
Affiliation(s)
- Torsten Gerriet Blum
- Department of Pneumology, Lungenklinik Heckeshorn, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - Rebecca L Morgan
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Valérie Durieux
- Bibliothèque des Sciences de la Santé, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Joanna Chorostowska-Wynimko
- Department of Genetics and Clinical Immunology, National Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - David R Baldwin
- Department of Respiratory Medicine, Nottingham University Hospitals, Nottingham, UK
| | | | - Corinne Faivre-Finn
- Division of Cancer Sciences, University of Manchester and The Christie NHS Foundation Trust, Manchester, UK
| | | | | | - Bogdan Grigoriu
- Intensive Care and Oncological Emergencies and Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Georgia Hardavella
- Department of Respiratory Medicine, King's College Hospital London, London, UK
- Department of Respiratory Medicine and Allergy, King's College London, London, UK
| | - Michael Hauptmann
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Neuruppin, Germany
| | - Erik Jakobsen
- Department of Thoracic Surgery, Odense University Hospital, Odense, Denmark
| | | | - Paul Knaut
- Department of Pneumology, Lungenklinik Heckeshorn, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - Gilbert Massard
- Faculty of Science, Technology and Medicine, University of Luxembourg and Department of Thoracic Surgery, Hôpitaux Robert Schuman, Luxembourg, Luxembourg
| | - John McPhelim
- Lung Cancer Nurse Specialist, Hairmyres Hospital, NHS Lanarkshire, East Kilbride, UK
| | - Anne-Pascale Meert
- Intensive Care and Oncological Emergencies and Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Robert Milroy
- Scottish Lung Cancer Forum, Glasgow Royal Infirmary, Glasgow, UK
| | - Riccardo Muhr
- Department of Pneumology, Lungenklinik Heckeshorn, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - Luciano Mutti
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
- SHRO/Temple University, Philadelphia, PA, USA
| | - Marianne Paesmans
- Data Centre, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | | | - Paul Martin Putora
- Departments of Radiation Oncology, Kantonsspital St Gallen, St Gallen and University of Bern, Bern, Switzerland
| | | | - Anna L Rich
- Department of Respiratory Medicine, Nottingham University Hospitals, Nottingham, UK
| | - David Rigau
- Iberoamerican Cochrane Center, Barcelona, Spain
| | - Dirk de Ruysscher
- Maastricht University Medical Center, Department of Radiation Oncology (Maastro Clinic), GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands
- Erasmus Medical Center, Department of Radiation Oncology, Rotterdam, The Netherlands
| | - Jean-Paul Sculier
- Intensive Care and Oncological Emergencies and Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Arnaud Schepereel
- Pulmonary and Thoracic Oncology, Université de Lille, Inserm, CHU Lille, Lille, France
| | - Dragan Subotic
- Clinic for Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Paul Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | | - Thierry Berghmans
- Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Brussels, Belgium
| |
Collapse
|
6
|
Di Pilla A, Cozzolino MR, Mannocci A, Carini E, Spina F, Castrini F, Grieco A, Messina R, Damiani G, Specchia ML. The Impact of Tumor Boards on Breast Cancer Care: Evidence from a Systematic Literature Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14990. [PMID: 36429708 PMCID: PMC9690234 DOI: 10.3390/ijerph192214990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/03/2022] [Accepted: 11/08/2022] [Indexed: 06/16/2023]
Abstract
Breast cancer is the most common malignancy in women, with a complex clinical path that involves several professionals and that requires a multidisciplinary approach. However, the effectiveness of breast cancer multidisciplinary care and the processes that contribute to its effectiveness have not yet been firmly determined. This study aims to evaluate the impact of multidisciplinary tumor boards on breast cancer care outcomes. A systematic literature review was carried out through Scopus, Web of Science and Pubmed databases. The search was restricted to articles assessing the impact of MTB implementation on breast cancer care. Fourteen studies were included in the review. The most analyzed outcomes were diagnosis, therapy and survival. Four out of four studies showed that, with implementation of an MTB, there was a change in diagnosis, and all reported changes in the treatment plan after MTB implementation. A pooled analysis of three studies reporting results on the outcome "mortality" showed a statistically significant 14% reduction in mortality relative risk for patients enrolled versus not enrolled in an MTB. This study shows that MTB implementation is a valuable approach to deliver appropriate and effective care to patients affected by breast cancer and to improve their outcomes.
Collapse
Affiliation(s)
- Andrea Di Pilla
- Clinical Governance Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | | | - Alice Mannocci
- Faculty of Economics, Università “Universitas Mercatorum”, Piazza Mattei 10, 00186 Rome, Italy
| | | | - Federica Spina
- Department of Maternal, Children and Adult Medical and Surgical Sciences, Università degli Studi di Modena e Reggio Emilia, 41121 Modena, Italy
| | - Francesco Castrini
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Albino Grieco
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Rosaria Messina
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Gianfranco Damiani
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
- Women, Children and Public Health Sciences Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Maria Lucia Specchia
- Clinical Governance Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| |
Collapse
|
7
|
Milana F, Famularo S, Luberto A, Rimassa L, Scorsetti M, Comito T, Pressiani T, Franzese C, Poretti D, Di Tommaso L, Personeni N, Rodari M, Pedicini V, Donadon M, Torzilli G. Multidisciplinary Tumor Board in the Management of Patients with Colorectal Liver Metastases: A Single-Center Review of 847 Patients. Cancers (Basel) 2022; 14:3952. [PMID: 36010944 PMCID: PMC9405848 DOI: 10.3390/cancers14163952] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/12/2022] [Accepted: 08/13/2022] [Indexed: 11/17/2022] Open
Abstract
There is still debate over how reviewing oncological histories and addressing appropriate therapies in multidisciplinary team (MDT) discussions may affect patients’ overall survival (OS). The aim of this study was to describe MDT outcomes for a single cancer center’s patients affected by colorectal liver metastases (CRLMs). From 2010 to 2020, a total of 847 patients with CRLMs were discussed at our weekly MDT meeting. Patients’ characteristics and MDT decisions were analyzed in two groups: patients receiving systemic therapy (ST) versus patients receiving locoregional treatment (LRT). Propensity-score matching (PSM) was run to reduce the risk of selection bias. The median time from MDT indication to treatment was 27 (IQR 13−51) days. The median OS was 30 (95%CI = 27−34) months. After PSM, OS for patients undergoing LRT was 51 (95%CI = 36−64) months compared with 15 (95%CI = 13−20) months for ST patients (p < 0.0001). In this large retrospective study, the MDT discussions were useful in providing the patients with all available locoregional options.
Collapse
Affiliation(s)
- Flavio Milana
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Hepatobiliary and General Surgery, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Simone Famularo
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Hepatobiliary and General Surgery, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Antonio Luberto
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Hepatobiliary and General Surgery, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Lorenza Rimassa
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Humanitas Cancer Center, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Marta Scorsetti
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Tiziana Comito
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Tiziana Pressiani
- Humanitas Cancer Center, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Ciro Franzese
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Dario Poretti
- Department of Radiology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Luca Di Tommaso
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Pathology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Nicola Personeni
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Humanitas Cancer Center, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Marcello Rodari
- Department of Nuclear Medicine, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Vittorio Pedicini
- Department of Radiology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Matteo Donadon
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Hepatobiliary and General Surgery, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Guido Torzilli
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Hepatobiliary and General Surgery, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| |
Collapse
|
8
|
Chen CI, Chuang FC, Li HJ, Chen YC, Chen HP, Liu KW, Su YC, Chen JH, Lee HM. The impact of a multispecialty operative team on colorectal cancer surgery: A retrospective study from a would-be medical center in Taiwan. Medicine (Baltimore) 2022; 101:e29863. [PMID: 35945804 PMCID: PMC9351883 DOI: 10.1097/md.0000000000029863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Some studies showed that when distant metastasis or locally advanced tumors were observed, the participation of 2 or more operating surgeons (combined surgery) in the operation could improve the prognosis of patients. The multispecialty operative team would perform combined surgery in colon cancer patients with some complications since 2015. The goal of this study is to confirm performing combined surgery would improve the outcomes of colon cancer patients. A retrospective observational study was conducted, which involved all colon cancer patients between November 2015 and December 2019 at one would-be medical center. Patients were divided into 3 cohorts: those with complicated cases and had combined surgery (C_2S), those with complicated cases and had surgery performed by a single surgeon (C_1S), and those with uncomplicated cases and had surgery performed by a single surgeon (NC_1S). Overall survival and disease-free survival were compared among the 3 groups. A total of 296 colon cancer patients during the study period. Among them, 35 were C_2S, 87 were C_1S, and 174 were NC_1S. Patients in the NC_1S group had significantly higher 12-, 24-, and 36-month OS rates compared to those in the C_1S group (P < .01). In contrast, there was no significant difference in overall survival among patients in the NC_1S and C_2S group (P =.15). The quality of surgery must be impact the prognosis, especially in the individual who was complicated case, the survival in patients who had surgery performed by multispecialty operative team would be improved.
Collapse
Affiliation(s)
- Chih-I Chen
- Division of Colon and Rectal Surgery, Department of Surgery, E-Da Hospital, Kaohsiung, Taiwan
- Division of General Medicine Surgery, Department of Surgery, E-Da Hospital, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- Department of Information Engineering, I-Shou University, Kaohsiung, Taiwan
- School of Chinese Medicine for Post Baccalaureate, I-Shou University, Kaohsiung, Taiwan
| | - Fu-Cheng Chuang
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- Department of Radiation Oncology, E-Da Hospital, Kaohsiung, Taiwan
| | - Hung-Ju Li
- Division of Hematology-Oncology, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Yu-Chi Chen
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- Department of Urology, E-Da Cancer Hospital, Kaohsiung, Taiwan
| | - Hsin-Pao Chen
- Division of Colon and Rectal Surgery, Department of Surgery, E-Da Hospital, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Kuang-Wen Liu
- Division of Colon and Rectal Surgery, Department of Surgery, E-Da Hospital, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Yu-Chieh Su
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- Division of Hematology-Oncology, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Jian-Han Chen
- School of Chinese Medicine for Post Baccalaureate, I-Shou University, Kaohsiung, Taiwan
- Bariatric and Metabolic International Surgery Center, E-Da Hospital, Kaohsiung, Taiwan
- Division of General Surgery, Department of Surgery, E-Da Hospital, Kaohsiung, Taiwan
| | - Hui-Ming Lee
- Division of General Surgery, Department of Surgery, E-Da Hospital, Kaohsiung, Taiwan
- *Correspondence: Hui-Ming Lee, MD, E-Da Hospital, Kaohsiung, Taiwan (e-mail: )
| |
Collapse
|
9
|
Evaluation of Ibrutinib Cardiotoxicity By Comparative Use of Speckle-Tracking Technique and Biomarkers. Am J Ther 2022; 29:e50-e55. [PMID: 34994349 DOI: 10.1097/mjt.0000000000001463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Ibrutinib, a relatively new antineoplastic agent, has multiple cardiovascular effects that are still insufficiently known and evaluated, including subclinical myocardial damage. STUDY QUESTION The present study aims to assess the role of the myocardial strain, alone and in combination with cardiac biomarkers, in the early detection of ibrutinib-induced cardiotoxicity. STUDY DESIGN We included 31 outpatients with normal left ventricular ejection fraction (LVEF) on ibrutinib, in a tertiary University Hospital between 2019 and 2020, and evaluated them at inclusion and after 3 months. MEASURES AND OUTCOMES Data on myocardial strain, cardiac biomarkers [high-sensitive troponin T (hs TnT) and N-terminal probrain natriuretic peptide (NT-proBNP)], and ambulatory electrocardiographic monitoring were collected. RESULTS Myocardial deformation decreased significantly (P < 0.001) at later evaluation and hs TnT and NT-proBNP increased significantly (P = 0.019 and P = 0.03, respectively). The increase in hs TnT correlated with the increase in the left ventricle global longitudinal strain (LVGLS); in other words, it correlated with the decrease in myocardial deformation. No association was found between LVGLS increase and the increase in NT-proBNP. LVGLS modification was not significantly influenced by age, anemia, or arrhythmia burden quantified by 24-hour Holter monitoring (P = 0.747, P = 0.072, respectively; P = 0.812). LVEF did not change significantly during follow-up. CONCLUSIONS In patients on ibrutinib, evaluation of myocardial strain is useful in identifying early cardiac drug toxicity, surpassing the sensitivity and specificity limits of LVEF. In these patients, concomitant assessment of hs TnT increases the predictive power for subclinical myocardial involvement.
Collapse
|
10
|
Lin T, Pham J, Paul E, Conron M, Wright G, Ball D, Mitchell P, Atkin N, Brand M, Zalcberg J, Stirling RG. Impacts of lung cancer multidisciplinary meeting presentation: Drivers and outcomes from a population registry retrospective cohort study. Lung Cancer 2021; 163:69-76. [PMID: 34923204 DOI: 10.1016/j.lungcan.2021.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 11/29/2021] [Accepted: 12/07/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Multidisciplinary Meetings (MDM) are recommended in routine lung cancer care, however its broader impacts demand further evaluation. We assessed the drivers and impacts of MDM presentation in the Victorian Lung Cancer Registry (VLCR). METHODS We examined the effect of MDM presentation on receipt of treatment and survival in VLCR patients diagnosed between 2011 and 2020. We compared patient characteristics, drivers of MDM discussion and survival between the two groups. RESULTS Of 9,628 patients, 5,900 (61.3%) were discussed at MDM, 3,728 (38.7%) were not. In the non-MDM group, a lower proportion received surgery (22.1% vs. 31.2%), radiotherapy (34.2% vs. 44.4%) and chemotherapy (44.7% vs. 49.0%). Patients were less likely to be discussed if ≥80 years (OR 0.73, p < 0.001), of ECOG performance status (PS) 4 (OR 0.23, p < 0.001), clinical stage IV (OR 0.34, p < 0.001) or referred from regional (OR 0.52, p < 0.001) or private hospital (OR 0.18, p < 0.001). MDM-presented patients had better median survival (1.70 vs 0.75 years, p < 0.001) and lower adjusted mortality risk (HR 0.75; 0.71-0.80, p < 0.001), a protective effect consistent across all hospital types. Undocumented PS, histopathology and clinical stage were associated with lower likelihood of MDM discussion and worse mortality. CONCLUSIONS In the VLCR, being male, ≥80 years, of poorer PS, advanced clinical stage and poor clinical characterisation significantly disadvantaged patients in relation to MDM discussion. MDM-discussed patients were more likely to undergo treatment and had a 25% lower risk of mortality. This study supports the use of MDMs in lung cancer and identifies areas of inequity to be addressed.
Collapse
Affiliation(s)
- Tiffany Lin
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Australia
| | - Jonathan Pham
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Australia
| | - Eldho Paul
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Matthew Conron
- Department of Respiratory Medicine, St Vincent's Hospital, Melbourne, Australia
| | - Gavin Wright
- Victorian Comprehensive Cancer Centre, Melbourne, Australia
| | - David Ball
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Paul Mitchell
- Olivia Newton-John Cancer and Wellness Centre, Melbourne, Australia
| | - Nicola Atkin
- Parkville Integrated Palliative Care Service, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Margaret Brand
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - John Zalcberg
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Robert G Stirling
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Australia; Department of Medicine, Monash University, Melbourne, Australia.
| |
Collapse
|
11
|
Wihl J, Rosell L, Frederiksen K, Kinhult S, Lindell G, Nilbert M. Contributions to Multidisciplinary Team Meetings in Cancer Care: Predictors of Complete Case Information and Comprehensive Case Discussions. J Multidiscip Healthc 2021; 14:2445-2452. [PMID: 34511928 PMCID: PMC8426643 DOI: 10.2147/jmdh.s309162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/20/2021] [Indexed: 12/24/2022] Open
Abstract
Purpose Multidisciplinary team (MDT) meetings integrate complex information and base recommendations for clinical management on interdisciplinary and multiprofessional decision-making. To support high-quality decision-making and define key performance indicators, we aimed to determine completeness of case information and contributions to MDT case discussions in cancer care. Methods In a prospective observational study design, based on three MDTs, we applied the Metric for Observation of Decision-Making (MODe) tool to assess the quality of case presentation and team members’ contributions to case discussions. The MDTs handled patients with brain tumors, soft tissue sarcomas and hepatobiliary cancers. The results were correlated to patient and team characteristics and to MDT leadership skills. Results Data were collected from 349 case discussions during 32 MDT meetings. Information on radiology received the highest scores, followed by case history and information on histopathology. Patient-related information was less frequently mentioned and generally received low scores. Contributions to the case discussions were predominantly by the chair, surgeons, and oncologists with limited contributions from nurses. Leadership skills showed a positive correlation with case presentations scores and failure to reach a treatment recommendation correlated with lower case discussion scores. Conclusion Considerable resources are spent on MDT meetings in cancer care, which motivate initiatives to ensure high-quality and efficient decision-making processes. We identify unbalanced contributions from team members during MDT meetings, demonstrate limited provision of patient-related information and show that leadership skills may positively influence the quality of the case presentations. We suggest that MDTs should consider and develop these aspects to ensure high-quality MDT-based case management and decision-making.
Collapse
Affiliation(s)
- Jessica Wihl
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden.,Regional Cancer Centre South, Region Skåne, Lund, Sweden.,Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Linn Rosell
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden.,Regional Cancer Centre South, Region Skåne, Lund, Sweden
| | | | - Sara Kinhult
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden.,Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Gert Lindell
- Department of Surgery, Skåne University Hospital, Lund, Sweden
| | - Mef Nilbert
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden.,Danish Cancer Society Research Centre, Copenhagen, Denmark.,Clinical Research Centre, Hvidovre University Hospital and Copenhagen University, Copenhagen, Denmark
| |
Collapse
|
12
|
Khiat S, Pibarot M, Roux J, Bottin P, Saïas J, Rives N, Courbiere B. Challenging cases in oncofertility: insights from a national specialized e-meeting for fertility preservation specialists. J Assist Reprod Genet 2021; 38:2445-2453. [PMID: 34291419 PMCID: PMC8294278 DOI: 10.1007/s10815-021-02275-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 07/07/2021] [Indexed: 12/04/2022] Open
Abstract
Purpose To determine the use of a new specialized E-Meeting for Complex Cases in Oncofertility by fertility preservation specialists (FPSs) Material and methods We present 3 years of activity of the E-Meeting for Complex Cases in Oncofertility, a new tool created in September 2016 which allows national oncofertility experts to share viewpoints about challenging cases for which they do not have experience or sufficient data in order to provide them an emergency advice within 48 h. Second, a survey was conducted to evaluate the use of this e-meeting for participating FPSs. Results One hundred and four experts have joined the e-meeting since its set-up, and 109 challenging cases have been submitted. The mean age of the patients was 22.4 ± 8.9 years, and 87.0% were female. Each submitted case received on average of 1.8 ± 1.1 different strategies for FP and the opinions of 7.1 ± 3.4 experts. Among the FPSs who submitted cases, seeking opinions from other FPSs allowed them to confirm their care plan (N = 49, 84.4%), to offer different options to their patients (N = 34, 58.6%), and to compare their practices with those of other specialists (N = 23, 39.6%). All respondents reported a self-perceived improvement in their practice of oncologic FP (n = 80, 100.0%). Conclusion Specific attention should be paid to challenging cases for which the experiences of only a few individuals exist. Enhancing communication between FPSs through oncofertility networks, pooling experiences, and collecting the most complex cases is required to improve the management of these patients. Supplementary Information The online version contains supplementary material available at 10.1007/s10815-021-02275-1.
Collapse
Affiliation(s)
- Samuel Khiat
- Pôle Femmes-Parents-Enfants, Centre Clinico-biologique AMP-CECOS, Plateforme Cancer et Fertilité ONCOPACA-Corse, Assistance-Publique des Hôpitaux de Marseille (AP-HM), La Conception, 147 bd Baille, 13005, Marseille, France
| | - Michele Pibarot
- Regional Network of Cancerology ONCOPACA-Corse, hôpitaux Sud, 270, Boulevard Sainte-Marguerite, 13009, Marseille, France
| | - Jennifer Roux
- Regional Network of Cancerology ONCOPACA-Corse, hôpitaux Sud, 270, Boulevard Sainte-Marguerite, 13009, Marseille, France
| | - Pauline Bottin
- Pôle Femmes-Parents-Enfants, Centre Clinico-biologique AMP-CECOS, Plateforme Cancer et Fertilité ONCOPACA-Corse, Assistance-Publique des Hôpitaux de Marseille (AP-HM), La Conception, 147 bd Baille, 13005, Marseille, France
| | - Jacqueline Saïas
- Pôle Femmes-Parents-Enfants, Centre Clinico-biologique AMP-CECOS, Plateforme Cancer et Fertilité ONCOPACA-Corse, Assistance-Publique des Hôpitaux de Marseille (AP-HM), La Conception, 147 bd Baille, 13005, Marseille, France
| | - Nathalie Rives
- Biology of Reproduction-CECOS Laboratory, UNIROUEN, EA 4308 "Gametogenesis and Gamete Quality", Rouen University Hospital, Normandie Univ, 76031, Rouen, France
| | - Blandine Courbiere
- Pôle Femmes-Parents-Enfants, Centre Clinico-biologique AMP-CECOS, Plateforme Cancer et Fertilité ONCOPACA-Corse, Assistance-Publique des Hôpitaux de Marseille (AP-HM), La Conception, 147 bd Baille, 13005, Marseille, France. .,CNRS, IRD, Avignon Université, IMBE, Aix Marseille Univ, 13397, Marseille, France.
| |
Collapse
|
13
|
Improved Overall Survival of Colorectal Cancer under Multidisciplinary Team: A Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5541613. [PMID: 33997003 PMCID: PMC8110396 DOI: 10.1155/2021/5541613] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 04/23/2021] [Indexed: 01/09/2023]
Abstract
Purpose The purpose of the current meta-analysis was to evaluate whether multidisciplinary team improved overall survival of colorectal cancer. Methods PubMed, EMBASE, and Cochrane Library database were searched from inception to October 25, 2020. The hazard ratio (HR) and 95% confidence (CI) of overall survival (OS) were calculated. Results A total of 11 studies with 30814 patients were included in this meta-analysis. After pooling the HRs, the MDT group was associated with better OS compared with the non-MDT group (HR = 0.81, 95% CI 0.69-0.94, p = 0.005). In subgroup analysis of stage IV colorectal cancer, the MDT group was associated with better OS as well (HR = 0.73, 95% CI 0.59-0.90, p = 0.004). However, in terms of postoperative mortality, no significant difference was found between MDT and non-MDT groups (OR = 0.84, 95% CI 0.44-1.61, p = 0.60). Conclusion MDT could improve OS of colorectal cancer patients.
Collapse
|
14
|
Zhang Y, Lou Y, Wang J, Yu C, Shen W. Research Status and Molecular Mechanism of the Traditional Chinese Medicine and Antitumor Therapy Combined Strategy Based on Tumor Microenvironment. Front Immunol 2021; 11:609705. [PMID: 33552068 PMCID: PMC7859437 DOI: 10.3389/fimmu.2020.609705] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/03/2020] [Indexed: 12/13/2022] Open
Abstract
Treatment of malignant tumors encompasses multidisciplinary comprehensive diagnosis and treatment and reasonable combination and arrangement of multidisciplinary treatment, which is not a simple superimposition of multiple treatment methods, but a comprehensive consideration of the characteristics and specific conditions of the patients and the tumor. The mechanism of tumor elimination by restoring the body's immune ability is consistent with the concept of "nourishing positive accumulation and eliminating cancer by itself" in traditional Chinese medicine (TCM). The formation and dynamic changes in the tumor microenvironment (TME) involve many different types of cells and multiple signaling pathways. Those changes are similar to the multitarget and bidirectional regulation of immunity by TCM. Discussing the relationship and mutual influence of TCM and antitumor therapy on the TME is a current research hotspot. TCM has been applied in the treatment of more than 70% of cancer patients in China. Data have shown that TCM can significantly enhance the sensitivity to chemotherapeutic drugs, enhance tumor-suppressing effects, and significantly improve cancer-related fatigue, bone marrow suppression, and other adverse reactions. TCM treatments include the application of Chinese medicine monomers, extracts, classic traditional compound prescriptions, listed compound drugs, self-made compound prescriptions, as well as acupuncture and moxibustion. Studies have shown that the TCM functional mechanism related to the positive regulation of cytotoxic T cells, natural killer cells, dendritic cells, and interleukin-12, while negatively regulating of regulatory T cells, tumor-associated macrophages, myeloid-derived suppressive cells, PD-1/PD-L1, and other immune regulatory factors. However, the application of TCM in cancer therapy needs further study and confirmation. This article summarizes the existing research on the molecular mechanism of TCM regulation of the TME and provides a theoretical basis for further screening of the predominant population. Moreover, it predicts the effects of the combination of TCM and antitumor therapy and proposes further developments in clinical practice to optimize the combined strategy.
Collapse
Affiliation(s)
- Yang Zhang
- Department of Internal Medicine, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Yanni Lou
- Oncology Department of Integrated Traditional Chinese and Western Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Jingbin Wang
- Department of Spleen and Stomach Disease, Chinese Medicine Shenzhen Hospital, Guangzhou University, Shenzhen, China
| | - Cunguo Yu
- Department of Chinese Medicine, Qinhuangdao Haigang Hospital, Qinhuangdao, China
| | - Wenjuan Shen
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, China
| |
Collapse
|
15
|
Alizadehasl A, Amin A, Maleki M, Noohi F, Ghavamzadeh A, Farrashi M. Cardio-oncology discipline: focus on the necessities in developing countries. ESC Heart Fail 2020; 7:2175-2183. [PMID: 32602665 PMCID: PMC7524122 DOI: 10.1002/ehf2.12838] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/17/2020] [Accepted: 05/29/2020] [Indexed: 01/04/2023] Open
Abstract
Cardiovascular diseases constitute one of the main aetiologies of mortality among patients with cancer. Population ageing and cancer survival rate improvements have resulted in the coexistence of cardiovascular diseases and malignancies in an increasing number of patients. With the diversity in treatments and the introduction of new drug lines, multiple mechanisms of cardiovascular injury have been recognized in these patients. Cardio-oncology is an emerging entity introduced to provide a proper solution to the several challenges encountered in the management of patients with cancer and cardiac involvement. This review will assess the logical grounds for establishing a cardio-oncology unit, describe the main objectives and the detailed responsibilities in such systems, and outline the target population. Furthermore, the importance of research and appropriate data collection will be highlighted. Lastly, the special considerations and modifications required for setting up such centres in the developing countries are discussed.
Collapse
Affiliation(s)
- Azin Alizadehasl
- Cardio‐Oncology Research Center, Rajaie Cardiovascular Medical and Research CenterIran University of Medical SciencesTehranIran
| | - Ahmad Amin
- Rajaie Cardiovascular Medical and Research CenterIran University of Medical SciencesTehranIran
| | - Majid Maleki
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research CenterIran University of Medical SciencesTehranIran
| | - Feridoun Noohi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research CenterIran University of Medical SciencesTehranIran
| | - Ardeshir Ghavamzadeh
- Hematology, Oncology, and SCT Research CenterTehran University of Medical SciencesTehranIran
| | - Melody Farrashi
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research CenterIran University of Medical SciencesTehranIran
| |
Collapse
|
16
|
Largey G, Briggs P, Davies H, Underhill C, Ross C, Harvey K, Blum R, Parker C, Guthrie C, Parente P, Trevorah B, Torres J, Mott C, Lancaster C, Brand M, Earnest A, Pellegrini B, Reed M, Zalcberg J, Stirling R. Victorian Lung Cancer Service Redesign Project: impacts of a quality improvement collaborative on timeliness and management in lung cancer. Intern Med J 2020; 51:2061-2068. [PMID: 32896957 DOI: 10.1111/imj.15043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 08/26/2020] [Accepted: 08/31/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Lung cancer management is characterised by a high disease burden, poor survival and substantial variation in management and outcomes. Service redesign provides opportunities for quality improvement (QI) and this improvement may be leveraged across multiple sites using QI collaboration. AIM This initiative targeted Quality Improvement (QI) in lung cancer management, engaging a QI collaborative using service redesign methodologies in five Victorian hospitals. QI targets included timeliness from referral and diagnosis to treatment, multi-disciplinary meeting (MDM) presentation and supportive care screening. Redesign strategies targeted process sustainability through enhanced team capability. METHODS This study engaged a prospective quality improvement cohort design targeting newly diagnosed tissue confirmed lung cancer with 6-month pre-intervention period and 6-month redesign implementation period, between September 2016 and August 2017, evaluated using Interrupted Time Series Analysis. Hospital sites included three regional and two metropolitan hospitals in Victoria. QI redesign targeted time intervals from referral to first specialist appointment (FSA), referral to diagnosis, diagnosis to first treatment (any intent), MDM documented in medical records and Supportive Care Screening Tool documented in medical records. RESULTS There was a marked reduction in referral to FSA interval across all sites, with median (interquartile range) falling from 6 (0-15) to 4 (1-10) days, and proportion seen by a specialist within 14 days increased from 74.3% to 84.2%. The interval between diagnosis and treatment was not substantively changed in the 6-month implementation period. The proportion of subjects with documented presentation to the MDM increased from 61% to 67%. The proportion for which Supportive Care Screening documentation remained low at 26.3% post-intervention. CONCLUSIONS Data-driven redesign initiatives enable identification and analysis of clinical practice variation and may be utilised to enhance timeliness of cancer care and improve local data service capabilities.
Collapse
Affiliation(s)
- Geraldine Largey
- Southern Melbourne Integrated Cancer Services, Melbourne, Victoria, Australia
| | - Peter Briggs
- Southern Melbourne Integrated Cancer Services, Melbourne, Victoria, Australia
| | - Heather Davies
- Southern Melbourne Integrated Cancer Services, Melbourne, Victoria, Australia
| | - Craig Underhill
- Department of Border Medical Oncology, Albury Wodonga Health, Wodonga, Victoria, Australia
| | - Cara Ross
- Department of Border Medical Oncology, Albury Wodonga Health, Wodonga, Victoria, Australia
| | - Kellie Harvey
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, Australia
| | - Robert Blum
- Department of Medical Oncology, Bendigo Health Care Group, Bendigo, Victoria, Australia
| | - Carol Parker
- Department of Medical Oncology, Bendigo Health Care Group, Bendigo, Victoria, Australia
| | - Christal Guthrie
- Department of Medical Oncology, Bendigo Health Care Group, Bendigo, Victoria, Australia
| | - Phillip Parente
- Department of Medical Oncology, Eastern Health, Melbourne, Victoria, Australia
| | - Brooke Trevorah
- Department of Medical Oncology, Eastern Health, Melbourne, Victoria, Australia
| | - Javier Torres
- Department of Medical Oncology, Goulbourn Valley Health, Shepparton, Victoria, Australia
| | - Carole Mott
- Department of Medical Oncology, Goulbourn Valley Health, Shepparton, Victoria, Australia
| | - Cheryl Lancaster
- Department of Medical Oncology, Goulbourn Valley Health, Shepparton, Victoria, Australia
| | - Margaret Brand
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Arul Earnest
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Breanna Pellegrini
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Marita Reed
- Department of Health and Human Services, Quality and Cancer Outcomes, Melbourne, Victoria, Australia
| | - John Zalcberg
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rob Stirling
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, Australia.,Department of Medicine, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
17
|
Heinke MY, Vinod SK. A review on the impact of lung cancer multidisciplinary care on patient outcomes. Transl Lung Cancer Res 2020; 9:1639-1653. [PMID: 32953538 PMCID: PMC7481642 DOI: 10.21037/tlcr.2019.11.03] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
International guidelines recommend a multidisciplinary approach to the management of lung cancer due to the complexity of both patients and their disease and the multiple treatment options available. This care can be provided through patient discussion at multidisciplinary meetings where relevant medical and allied health staff formulate a consensus management plan taking all factors into consideration. This model can be extended further to include multidisciplinary clinics where the patient is present for assessment and discussion. However, conducting regular multidisciplinary meetings or clinics has significant time, resource and financial costs and therefore, it is important to assess the impact of multidisciplinary care. We aimed to review published evidence, from 2000 to 2019, to evaluate the impact of multidisciplinary care on lung cancer outcomes. There were 29 studies found, 11 evaluating multidisciplinary clinics, 14 studying multidisciplinary meetings and four where the model of care was not defined. There was only one randomised trial and three prospective studies, the remainder being retrospective studies. Despite limitations in trial design and confounding factors, overall, multidisciplinary care in lung cancer was associated with improvements in patient outcomes, in particular improved survival for all stages of lung cancer. Lung cancer patients managed in a multidisciplinary setting were more likely to receive active treatment and had improved utilisation of all treatment modalities: surgery, radiotherapy and chemotherapy. In addition, the treatment recommendations were more likely to be consistent with lung cancer management guidelines. These improved outcomes support the recommendations for a multidisciplinary approach to lung cancer care.
Collapse
Affiliation(s)
- Monique Y Heinke
- Liverpool and Macarthur Cancer Therapy Centre, Liverpool, NSW, Australia
| | - Shalini K Vinod
- Liverpool and Macarthur Cancer Therapy Centre, Liverpool, NSW, Australia.,South Western Sydney Clinical School, University of New South Wales, NSW, Australia
| |
Collapse
|
18
|
Yang X, Huang J, Zhu X, Shen K, Zhu J, Chen X. Compliance with multidisciplinary team recommendations and disease outcomes in early breast cancer patients: An analysis of 4501 consecutive patients. Breast 2020; 52:135-145. [PMID: 32512360 PMCID: PMC7375553 DOI: 10.1016/j.breast.2020.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/20/2020] [Accepted: 05/23/2020] [Indexed: 12/24/2022] Open
Abstract
Background Multidisciplinary team (MDT) discussions are widely held to facilitate the diagnosis and treatment of breast cancer, but patient compliance with the MDT recommendations and the impact of compliance on disease outcome are uncertain. Methods We conducted a retrospective review of data from a prospective database of breast cancer patients treated at Shanghai Ruijin Hospital between April 2013 and August 2018. MDT discussions were held for all patients before they started adjuvant therapy. The patients were classified into compliant and non-compliant groups according to whether they received the MDT-recommended regimens. We also analyzed which clinicopathological factors were associated with compliance and prognosis. Results Of 4501 breast cancer patients, 3681 (81.8%) and 820 (18.2%) were included in the compliant and non-compliant groups, respectively. Age >70 years (P < 0.001), invasive ductal carcinoma (P < 0.001), and histological grade III (P = 0.011) were independently associated with higher risk of non-compliance, whereas Ki-67 labeling index ≥14% and history of benign breast disease were independently associated with compliance. Disease-free survival (hazard ratio [HR] 1.813, 95% confidence interval [CI] 1.367–2.405, P < 0.001) and overall survival (HR 2.478, 95% CI 1.431–4.291, P < 0.001) were worse in the non-compliant group. Conclusions Several clinicopathological factors were associated with non-compliance with MDT recommendations for early breast cancer patients. Non-compliance was associated with worse disease outcome. A large consecutive breast cancer cohort with MDT-based treatment recommendation. Factors identified associated with non-compliance with MDT recommendations. A significantly better survival in patients compliant with MDT recommendation.
Collapse
Affiliation(s)
- Xingxia Yang
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Breast, Jiaxing University Affiliated Women and Children Hospital, Jiaxing, Zhejiang, China
| | - Jiahui Huang
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoping Zhu
- Department of Breast, Jiaxing University Affiliated Women and Children Hospital, Jiaxing, Zhejiang, China
| | - Kunwei Shen
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Juanying Zhu
- Department of Breast, Jiaxing University Affiliated Women and Children Hospital, Jiaxing, Zhejiang, China.
| | - Xiaosong Chen
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| |
Collapse
|
19
|
Samarasinghe A, Chan A, Hastrich D, Martin R, Gan A, Abdulaziz F, Latham M, Zissiadis Y, Taylor M, Willsher P. Compliance with multidisciplinary team meeting management recommendations. Asia Pac J Clin Oncol 2019; 15:337-342. [PMID: 31507069 DOI: 10.1111/ajco.13240] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 08/07/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The objective of this study was to evaluate patient compliance with management recommendations given by a breast cancer multidisciplinary team (MDT), assess for reasons for noncompliance, and perform an exploratory assessment on breast cancer outcomes in noncompliant patients. MATERIALS AND METHODS A retrospective analysis of prospectively collected data was undertaken for patients selected by their primary clinician to be discussed at the MDT of Breast Cancer Research Centre-WA in Perth between 1st March 2011 and the 28th February 2016. The primary objective was the rate of compliance with MDT management recommendations. Secondary objectives included factors associated with noncompliance, rate of clinical trial uptake, and impact of treatment noncompliance on breast cancer events in a subgroup of early breast cancer (EBC) patients. RESULTS AND CONCLUSION A total of 2614 MDT management recommendations were made for 925 patients. Overall, 92% were compliant with all recommendations given. Clinical trial recruitment was successful in 84.1%. The reasons given for treatment noncompliance were fear of toxicity, choosing an alternative treatment, and treatment inconvenience. In a subset of 337 EBC patients, there was a significantly higher rate of contralateral breast cancer, distant recurrence, and breast cancer-specific death, P = .0016, in those who were noncompliant. Our study demonstrates a high rate of MDT treatment recommendation compliance and clinical trial recruitment. In a subgroup of EBC patients, noncompliance was associated with significantly worse outcomes. Attention to educating patients to minimize their fear of treatment toxicity and ensuring their understanding of evidence-based treatment may lead to lower rates of noncompliance.
Collapse
Affiliation(s)
- Amali Samarasinghe
- Medical, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Arlene Chan
- Medical Oncology, Breast Cancer Research Centre-WA, Nedlands, Western Australia, Australia
| | - Diana Hastrich
- Breast Surgery, Mount Hospital, Perth, Western Australia, Australia
| | - Richard Martin
- Breast Surgery, Mount Hospital, Perth, Western Australia, Australia
| | - Albert Gan
- Medcial Oncology, Mount Hospital, Perth, Western Australia, Australia
| | - Farah Abdulaziz
- Breast Surgery, St John of God Hospital, Subiaco, Western Australia, Australia
| | - Margaret Latham
- Radiation Oncology, Genesis Cancer Care, Wembley, Western Australia, Australia
| | - Yvonne Zissiadis
- Radiation Oncology, Genesis Cancer Care, Wembley, Western Australia, Australia
| | - Mandy Taylor
- Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Peter Willsher
- Breast Surgery, Breast Cancer Research Centre-WA, Nedlands, Western Australia, Australia
| |
Collapse
|
20
|
Dickhoff C, Dahele M. The multidisciplinary lung cancer team meeting: increasing evidence that it should be considered a medical intervention in its own right. J Thorac Dis 2019; 11:S311-S314. [PMID: 30997206 DOI: 10.21037/jtd.2019.01.14] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Chris Dickhoff
- Department of Surgery, Amsterdam UMC, Cancer Center Amsterdam, Amsterdam, The Netherlands.,Department of Cardiothoracic Surgery, Amsterdam UMC, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Max Dahele
- Department of Radiation Oncology, Amsterdam UMC, Cancer Center Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
21
|
Dasgupta P, Baade PD, Youlden DR, Garvey G, Aitken JF, Wallington I, Chynoweth J, Zorbas H, Youl PH. Variations in outcomes by residential location for women with breast cancer: a systematic review. BMJ Open 2018; 8:e019050. [PMID: 29706597 PMCID: PMC5935167 DOI: 10.1136/bmjopen-2017-019050] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To systematically assess the evidence for variations in outcomes at each step along the breast cancer continuum of care for Australian women by residential location. DESIGN Systematic review. METHODS Systematic searches of peer-reviewed articles in English published from 1 January 1990 to 24 November 2017 using PubMed, EMBASE, CINAHL and Informit databases. Inclusion criteria were: population was adult female patients with breast cancer; Australian setting; outcome measure was survival, patient or tumour characteristics, screening rates or frequencies, clinical management, patterns of initial care or post-treatment follow-up with analysis by residential location or studies involving non-metropolitan women only. Included studies were critically appraised using a modified Newcastle-Ottawa Scale. RESULTS Seventy-four quantitative studies met the inclusion criteria. Around 59% were considered high quality, 34% moderate and 7% low. No eligible studies examining treatment choices or post-treatment follow-up were identified. Non-metropolitan women consistently had poorer survival, with most of this differential being attributed to more advanced disease at diagnosis, treatment-related factors and socioeconomic disadvantage. Compared with metropolitan women, non-metropolitan women were more likely to live in disadvantaged areas and had differing clinical management and patterns of care. However, findings regarding geographical variations in tumour characteristics or diagnostic outcomes were inconsistent. CONCLUSIONS A general pattern of poorer survival and variations in clinical management for Australian female patients with breast cancer from non-metropolitan areas was evident. However, the wide variability in data sources, measures, study quality, time periods and geographical classification made direct comparisons across studies challenging. The review highlighted the need to promote standardisation of geographical classifications and increased comparability of data systems. It also identified key gaps in the existing literature including a lack of studies on advanced breast cancer, geographical variations in treatment choices from the perspective of patients and post-treatment follow-up.
Collapse
Affiliation(s)
- Paramita Dasgupta
- Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia
| | - Peter D Baade
- Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia
- None, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Mathematical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Danny R Youlden
- Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia
| | - Gail Garvey
- Menzies School of Health Research, Brisbane, Queensland, Australia
| | - Joanne F Aitken
- Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- Institute for Resilient Regions, University of Southern Queensland, Toowoomba, Queensland, Australia
| | | | | | - Helen Zorbas
- Cancer Australia, Sydney, New South Wales, Australia
| | - Philippa H Youl
- Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia
- None, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| |
Collapse
|