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Bibas BJ, Minamoto H, Cardoso PFG, Cremonese MR, Pêgo-Fernandes PM, Terra RM. Brazilian airway surgery survey indicates low overall numbers and need for improved teaching skills. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivad177. [PMID: 37950507 PMCID: PMC10858343 DOI: 10.1093/icvts/ivad177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 10/30/2023] [Accepted: 11/06/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVES The Brazilian Society of Thoracic Surgeons conducted an online survey to determine the number of surgeons that perform adult and paediatric airway surgery and to understand the practice patterns along the country. METHODS Active members were electronically invited to complete the questionnaire through the REDCapR platform. Invitations were sent from January to April 2020. The survey encompassed 40 questions that explored 4 different topics in the assessment of tracheal diseases: (i) surgeon's demography; (ii) institutional profile, (iii) education and training in laryngo-tracheal surgery and (iv) preoperative and postoperative evaluation. RESULTS Eighty-nine percentage of the responders declared to perform tracheal surgery with a median of 5 tracheal resection procedures per year [interquartile range (IQR) 3-12]. Interaction with other specialties occurs in 37.3% of cases. Access to technology and devices is highly variable across the country. Resident training in airway surgery consists in traditional lectures in 97% of the cases. Training in animals (15.2%), cadavers (12.1%) and simulators (6.1%) are rare. Preoperatory evaluation encompasses flexible bronchoscopy (97.8%) and/or computed tomography (CT) scan of the airways (90.6%). Swallowing (20.1%) and voice (14.4%) disorders are rarely evaluated. Eighty-nine percentage of the surgeons consider bronchoscopy to be the preoperatory gold-standard exam, followed by CT scan (38.8%) and CT-3D reconstruction (37.4%). CONCLUSIONS Brazilian surgeons refer that airway resection and reconstruction are part of their current practice, but the total number of procedures per surgeon per year is low. Access to high-end technology and equipment is heterogenous. Training offered to residents in most academic institutions relies on traditional lectures.
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Affiliation(s)
- Benoit Jacques Bibas
- Disciplina de Cirurgia Torácica, Instituto do Coração (Incor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- Hospital Municipal Vila Santa Catarina Dr. Gilson de Cássia Marques de Carvalho; Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Helio Minamoto
- Disciplina de Cirurgia Torácica, Instituto do Coração (Incor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Paulo Francisco G Cardoso
- Disciplina de Cirurgia Torácica, Instituto do Coração (Incor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Mariana Rodrigues Cremonese
- Disciplina de Cirurgia Torácica, Instituto do Coração (Incor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- Hospital Municipal Vila Santa Catarina Dr. Gilson de Cássia Marques de Carvalho; Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Paulo Manuel Pêgo-Fernandes
- Disciplina de Cirurgia Torácica, Instituto do Coração (Incor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Ricardo Mingarini Terra
- Disciplina de Cirurgia Torácica, Instituto do Coração (Incor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
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Niyibizi BA, Muhizi E, Rangira D, Ndoli DA, Nzeyimana IN, Muvunyi J, Irakoze M, Kazindu M, Rugamba A, Uwimana K, Cao Y, Rugengamanzi E, de Dieu Kwizera J, Manirakiza AVC, Rubagumya F. Multidisciplinary approach to cancer care in Rwanda: the role of tumour board meetings. Ecancermedicalscience 2023; 17:1515. [PMID: 37113712 PMCID: PMC10129399 DOI: 10.3332/ecancer.2022.1515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Indexed: 04/29/2023] Open
Abstract
Introduction Cancer treatment is complex and necessitates a multidisciplinary approach. Tumour Board Meetings (TBMs) provide a multidisciplinary platform for health care providers to communicate about treatment plans for patients. TBMs improve patient care, treatment outcomes and, ultimately, patient satisfaction by facilitating information exchange and regular communication among all parties involved in a patient's treatment. This study describes the current status of case conference meetings in Rwanda including their structure, process and outcomes. Methods The study included four hospitals providing cancer care in Rwanda. Data gathered included patients' diagnosis, number of attendance and pre-TBM treatment plan, as well as changes made during TBMs, including diagnostic and management plan changes. Results From 128 meetings that took place at the time of the study, Rwanda Military Hospital hosted 45 (35%) meetings, King Faisal Hospital had 32 (25%), Butare University Teaching Hospital (CHUB) had 32 (25%) and Kigali University Teaching Hospital (CHUK) had 19 (15%). In all hospitals, General Surgery 69 (29%) was the leading speciality in presenting cases. The top three most presented disease site were head and neck 58 (24%), gastrointestinal 28 (16%) and cervix 28 (12%). Most (85% (202/239)) presented cases sought inputs from TBMs on management plan. On average, two oncologists, two general surgeons, one pathologist and one radiologist attended each meeting. Conclusion TBMs in Rwanda are increasingly getting recognised by clinicians. To influence the quality of cancer care provided to Rwandans, it is crucial to build on this enthusiasm and enhance TBMs conduct and efficiency.
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Affiliation(s)
| | - Eulade Muhizi
- Rwanda Cancer Relief, Kigali, Rwanda
- Department of Gynecology, Munini District Hospital, Nyabihu, Rwanda
| | - Daniella Rangira
- Rwanda Cancer Relief, Kigali, Rwanda
- Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto M5T 3M7, Canada
| | - Diane A Ndoli
- Rwanda Cancer Relief, Kigali, Rwanda
- Department of Oncology, Rwanda Military Hospital, Kigali, Rwanda
| | | | - Jackson Muvunyi
- Department of Oncology, Rwanda Military Hospital, Kigali, Rwanda
| | - Magnifique Irakoze
- Department of Gynecology, Kigali University Teaching Hospital, Kigali, Rwanda
| | - Madeleine Kazindu
- Rwanda Cancer Relief, Kigali, Rwanda
- School of Medicine, College of Medical and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Alex Rugamba
- Rwanda Cancer Relief, Kigali, Rwanda
- Department of Internal Medicine, Ruhango Provincial Hospital, Ruhango, Rwanda
| | - Khadidja Uwimana
- Rwanda Cancer Relief, Kigali, Rwanda
- School of Medicine, College of Medical and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Yuanzhen Cao
- Department of Internal Medicine, Dartmouth–Hitchcock Medical Center, Lebanon, NH 03766, USA
| | - Eulade Rugengamanzi
- Rwanda Cancer Relief, Kigali, Rwanda
- Department of Oncology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Jean de Dieu Kwizera
- Rwanda Cancer Relief, Kigali, Rwanda
- Department of Internal Medicine, Gisenyi Hospital, Rubavu, Gisenyi, Rwanda
| | - Achille VC Manirakiza
- Rwanda Cancer Relief, Kigali, Rwanda
- Unit of Oncology, Department of Internal Medicine, King Faisal Hospital, Kigali, Rwanda
| | - Fidel Rubagumya
- Rwanda Cancer Relief, Kigali, Rwanda
- Department of Oncology, Rwanda Military Hospital, Kigali, Rwanda
- School of Medicine, College of Medical and Health Sciences, University of Rwanda, Kigali, Rwanda
- Unit of Oncology, Department of Internal Medicine, King Faisal Hospital, Kigali, Rwanda
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Edney LC, Gray J, Karnon J. A scoping review of the economics of multidisciplinary teams in oncology care. J Cancer Policy 2020. [DOI: 10.1016/j.jcpo.2020.100257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Berardi R, Morgese F, Rinaldi S, Torniai M, Mentrasti G, Scortichini L, Giampieri R. Benefits and Limitations of a Multidisciplinary Approach in Cancer Patient Management. Cancer Manag Res 2020; 12:9363-9374. [PMID: 33061625 PMCID: PMC7533227 DOI: 10.2147/cmar.s220976] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 05/26/2020] [Indexed: 12/17/2022] Open
Abstract
Over the years, a growing body of literature has confirmed as beneficial the implementation of a multidisciplinary approach in the so-often-intricate scenario of cancer patients' management. Together with the consolidation of tumor-board experience in clinical practice, certain aspects have emerged as controversial and a source of current debate. In this systematic literature review, we focused our attention on the impact of multidisciplinary tumor boards, assessing benefits and limitations as a result of the dissemination of such approaches. On the bright side, adherence to clinical guidelines, treatment outcomes, and overall improvement in decision-making processes have been recognized as advantages. On the other side, our analysis highlights a few limitations that should be taken into account to optimize cancer patients' management. Of note, some issues, such as costs, legal responsibility, geographic barriers, and treatment delays, have yet to be resolved. In order partly to address this matter, software platforms and novel methods of computational analysis may provide the needed support. Therefore, the aim of our analysis was to describe the multidisciplinary approach in cancer care in terms of adherence to clinical guidelines, treatment outcomes, and overall improvement in decision-making processes through a systematic review of the literature.
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Affiliation(s)
- Rossana Berardi
- Clinica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - Francesca Morgese
- Clinica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - Silvia Rinaldi
- Clinica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - Mariangela Torniai
- Clinica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - Giulia Mentrasti
- Clinica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - Laura Scortichini
- Clinica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - Riccardo Giampieri
- Clinica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
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Kallianos KG, Muhoozi BN, Gottschalk A, Yom SS, Chan JW, Henry TS, Elicker BM, Ordovas KG, Naeger DM. Dedicated Diagnostic Radiology/Radiation Oncology Rounds: Added Value Beyond Traditional Tumor Boards. Curr Probl Diagn Radiol 2020; 49:248-253. [DOI: 10.1067/j.cpradiol.2019.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/15/2019] [Accepted: 05/07/2019] [Indexed: 11/22/2022]
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6
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Thalanayar Muthukrishnan P, Ratnam M, Nguyen MT, Le M, Gunzler D, Bruno D, Infeld M. Pre-diagnosis Multidisciplinary Tumor Board and Time to Staging in Lung Cancer: The Case Western MetroHealth Experience. Cureus 2020; 12:e6595. [PMID: 32064177 PMCID: PMC7003723 DOI: 10.7759/cureus.6595] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Introduction National guidelines support the discussion of cancer patients by multidisciplinary tumor boards (MTB). We researched whether early pre-diagnosis multidisciplinary tumor board discussions are associated with shorter times to staging in lung cancer. Methods We reviewed our institution’s lung cancer and MTB registries to retrospectively study if an early discussion at pre-diagnostic MTB (pd-MTB) influenced the timeliness of diagnostic evaluation. Over 14 months, 161 consecutive patients with a diagnosis of lung cancer were included. Fifty-five patients were presented at pd-MTB while 106 (controls) patients were not. The primary outcome was the difference in the time interval from suspicious imaging (Ix) to completion of staging (Sx). Outcomes were adjusted for key confounders with a multiple regression analysis. Results For stages I, II, and III lung cancer, where time to therapy matters, early discussion of patients with nodules suspicious for malignancy at pd-MTB was associated with no time delays when compared to patients who were not discussed in pd-MTB. The mean time intervals for imaging to staging (with standard deviations) are 65 days in controls (sd = 42.67) and 75 days (sd = 58.27) in tumor board cases (p=0.39). Adjusting for confounders with a multiple regression analysis among all stages revealed a similar lack of difference in time intervals to diagnosis, staging, and therapy. Conclusion Our stage I-III lung cancer cases (pd-MTB) completed staging in a timely manner, similar to controls (no pd-MTB). The severity of illness at presentation and the availability of diagnostic services and others likely influence the results. Our manuscript shares important numerical data on timelines during cancer diagnosis and treatment. Using this data, prospective registries examining the process workflow may help standardize cancer quality goals and maximize referrals from primary-care/specialty providers. The key findings in our study create a paradigm for future studies to create and achieve “door-to-balloon” time targets for lung cancer care (akin to cardiac care) across different styles of tumor boards.
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Affiliation(s)
| | - Maya Ratnam
- Medicine, Case Western Reserve University School of Medicine / Metrohealth Medical Center, Cleveland, USA
| | - Minh-Tri Nguyen
- Medicine, Case Western Reserve University School of Medicine / Metrohealth Medical Center, Cleveland, USA
| | - Michael Le
- Medicine, Case Western Reserve University School of Medicine / Metrohealth Medical Center, Cleveland, USA
| | - Douglas Gunzler
- Epidemiology and Public Health, Center for Health Care Research and Policy, Metrohealth Medical Center, Cleveland, USA
| | - Debora Bruno
- Oncology, Case Western Reserve University School of Medicine / University Hospitals Medical Center, Cleveland, USA
| | - Michael Infeld
- Pulmonary and Critical Care Medicine, Case Western Reserve University School of Medicine / Metrohealth Medical Center, Cleveland, USA
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Osarogiagbon RU. Overcoming the Implementation Gap in Multidisciplinary Oncology Care Programs. J Oncol Pract 2018; 12:888-891. [PMID: 27531378 DOI: 10.1200/jop.2016.014688] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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8
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Chiew KL, Sundaresan P, Jalaludin B, Vinod SK. A narrative synthesis of the quality of cancer care and development of an integrated conceptual framework. Eur J Cancer Care (Engl) 2018; 27:e12881. [PMID: 30028054 DOI: 10.1111/ecc.12881] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 04/17/2018] [Accepted: 05/31/2018] [Indexed: 12/11/2022]
Abstract
The general paradigms that exist to guide measures in quality of care do not sufficiently deal with the changing needs of cancer management. The aim of this study was to review the literature regarding the quality of cancer care and develop a conceptual framework relevant to current practice. A textual narrative review of the literature was conducted by searching electronic databases from the last 10 years. Articles were then screened and included if they were both relevant to the management of cancer and standards in quality of care. Thematic analysis of the included articles was performed. Eighty-three articles were included and 12 domains identified and integrated with current models to develop a conceptual framework. These included: healthcare delivery system; timeliness; access; appropriateness of care; multidisciplinary and coordinated care; patient experience; technical aspects; safety; patient-centred outcomes; disease-specific outcomes; innovation and improvement and value. We propose a conceptual framework for the quality of cancer care based on relevant and current oncology practice. This presents a more practical and comprehensive approach than general models, and can be used by healthcare providers, managers and policy makers to guide and identify the need for metrics for quality improvements.
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Affiliation(s)
- Kim-Lin Chiew
- Radiation Oncology, Sydney West Cancer Network, Crown Princess Mary Cancer Centre, Sydney, New South Wales, Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
| | - Puma Sundaresan
- Radiation Oncology, Sydney West Cancer Network, Crown Princess Mary Cancer Centre, Sydney, New South Wales, Australia.,Sydney Medical School, Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Bin Jalaludin
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia.,Epidemiology, Healthy People and Places Unit, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Shalini K Vinod
- South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,Radiation Oncology, Liverpool Cancer Therapy Centre, South Western Sydney Local Health District Cancer Services, Sydney, New South Wales, Australia
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The dutch national clinical audit for lung cancer: A tool to improve clinical practice? An analysis of unforeseen ipsilateral mediastinal lymph node involvement in the Dutch Lung Surgery Audit (DLSA). Eur J Surg Oncol 2018; 44:830-834. [DOI: 10.1016/j.ejso.2017.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 10/16/2017] [Accepted: 12/05/2017] [Indexed: 12/26/2022] Open
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Bossi P, Alfieri S. The Benefit of a Multidisciplinary Approach to the Patient Treated with (Chemo) Radiation for Head and Neck Cancer. Curr Treat Options Oncol 2017; 17:53. [PMID: 27520784 DOI: 10.1007/s11864-016-0431-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OPINION STATEMENT In the past two decades, multidisciplinary care has emerged as new way to manage cancer given the need to gather together specific areas of expertise and to discuss the variety of treatment approaches available for each patient. Of all the cancer subtypes, head and neck cancer might be considered one of the most valid areas, from an oncological point of view, for a multidisciplinary approach to be applied. Head and Neck Cancer is a complex disease area due to its varied histology and subsites, its numerous feasible treatments, its multiple typical comorbidities, and its treatment-induced toxicities whose management requires the simultaneous involvement of several professionals as part of the same health care team. However, the benefits of a multidisciplinary team approach in this particular area have not yet been properly documented in terms of survival outcomes. Moreover, there are some concerns and the limitations of a multidisciplinary team approach for Head and Neck Cancer patients are still open to question: cost-efficiency, the implications from a medical law perspective, the level of expertise required and the timing of each intervention (fixed or as required; before, during or after oncological treatment), and the role of the leader with other interested specialists to optimize all multidisciplinary care mechanisms.
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Affiliation(s)
- Paolo Bossi
- Head and Neck Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milano, Italy.
| | - Salvatore Alfieri
- Head and Neck Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milano, Italy
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11
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Brauer DG, Strand MS, Sanford DE, Kushnir VM, Lim KH, Mullady DK, Tan BR, Wang-Gillam A, Morton AE, Ruzinova MB, Parikh PJ, Narra VR, Fowler KJ, Doyle MB, Chapman WC, Strasberg SS, Hawkins WG, Fields RC. Utility of a multidisciplinary tumor board in the management of pancreatic and upper gastrointestinal diseases: an observational study. HPB (Oxford) 2017; 19:133-139. [PMID: 27916436 PMCID: PMC5477647 DOI: 10.1016/j.hpb.2016.11.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 08/08/2016] [Accepted: 11/11/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND & OBJECTIVES Multidisciplinary tumor boards (MDTBs) are frequently employed in cancer centers but their value has been debated. We reviewed the decision-making process and resource utilization of our MDTB to assess its utility in the management of pancreatic and upper gastrointestinal tract conditions. METHODS A prospectively-collected database was reviewed over a 12-month period. The primary outcome was change in management plan as a result of case discussion. Secondary outcomes included resources required to hold MDTB, survival, and adherence to treatment guidelines. RESULTS Four hundred seventy cases were reviewed. MDTB resulted in a change in the proposed plan of management in 101 of 402 evaluable cases (25.1%). New plans favored obtaining additional diagnostic workup. No recorded variables were associated with a change in plan. For newly-diagnosed cases of pancreatic ductal adenocarcinoma (n = 33), survival time was not impacted by MDTB (p = .154) and adherence to National Comprehensive Cancer Network guidelines was 100%. The estimated cost of physician time per case reviewed was $190. CONCLUSIONS Our MDTB influences treatment decisions in a sizeable number of cases with excellent adherence to national guidelines. However, this requires significant time expenditure and may not impact outcomes. Regular assessments of the effectiveness of MDTBs should be undertaken.
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Affiliation(s)
- David G Brauer
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center at Washington University School of Medicine, Saint Louis, MO, USA
| | - Matthew S Strand
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center at Washington University School of Medicine, Saint Louis, MO, USA
| | - Dominic E Sanford
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center at Washington University School of Medicine, Saint Louis, MO, USA
| | - Vladimir M Kushnir
- Department of Medicine, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center at Washington University School of Medicine, Saint Louis, MO, USA
| | - Kian-Huat Lim
- Department of Medicine, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center at Washington University School of Medicine, Saint Louis, MO, USA
| | - Daniel K Mullady
- Department of Medicine, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center at Washington University School of Medicine, Saint Louis, MO, USA
| | - Benjamin R Tan
- Department of Medicine, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center at Washington University School of Medicine, Saint Louis, MO, USA
| | - Andrea Wang-Gillam
- Department of Medicine, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center at Washington University School of Medicine, Saint Louis, MO, USA
| | - Ashley E Morton
- Department of Medicine, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center at Washington University School of Medicine, Saint Louis, MO, USA
| | - Marianna B Ruzinova
- Department of Pathology and Immunology, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center at Washington University School of Medicine, Saint Louis, MO, USA
| | - Parag J Parikh
- Department of Radiation Oncology, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center at Washington University School of Medicine, Saint Louis, MO, USA
| | - Vamsi R Narra
- Mallinckrodt Institute of Radiology, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center at Washington University School of Medicine, Saint Louis, MO, USA
| | - Kathryn J Fowler
- Mallinckrodt Institute of Radiology, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center at Washington University School of Medicine, Saint Louis, MO, USA
| | - Majella B Doyle
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center at Washington University School of Medicine, Saint Louis, MO, USA
| | - William C Chapman
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center at Washington University School of Medicine, Saint Louis, MO, USA
| | - Steven S Strasberg
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center at Washington University School of Medicine, Saint Louis, MO, USA
| | - William G Hawkins
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center at Washington University School of Medicine, Saint Louis, MO, USA
| | - Ryan C Fields
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center at Washington University School of Medicine, Saint Louis, MO, USA.
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Fabre E, Rivera C, Mordant P, Gibault L, Dujon A, Foucault C, Le Pimpec-Barthes F, Riquet M. Evolution of induction chemotherapy for non-small cell lung cancer over the last 30 years: A surgical appraisal. Thorac Cancer 2015; 6:731-40. [PMID: 26557911 PMCID: PMC4632925 DOI: 10.1111/1759-7714.12250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 02/16/2015] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Induction chemotherapy (ICT) is supposed to reduce the risk of micrometastatic progression and improve resectability of non-small cell lung cancer (NSCLC). However, best indications for ICT strategy remain unclear in published meta-analyses. Based on this observation, an evaluation of daily practice is of importance. Therefore, we reviewed indications and efficacy time trends in our 30-year series. METHODS A database including all patients with NSCLC who underwent surgical resection in two French centers from 1980 to 2009 (n = 5563) was prospectively set and retrospectively reviewed. The indications, clinical and pathologic response rates, and overall survival of ICT patients (n = 732) were analyzed during three successive time-periods: P1 from 1980 to 1989, P2 from 1990 to 1999, and P3 from 2000 to 2009. RESULTS The proportion of patients who benefited from ICT increased over time, from 2.8% (n = 35) in P1 to 12.5% (n = 274) in P2, and 20.2% (n = 423) in P3. Indications evolved over time with more N2 patients (n = 211; 49.8%) and less initially unresectable patients (n = 72; 17%) in P3. The clinical response rate between P1 and P2 increased. Five and 10-year survival rates of ICT patients were 35.2% and 21.5%, respectively. In multivariate analysis, time-period, age, type of resection, histology, and pathologic response to chemotherapy were significant prognostic factors. CONCLUSIONS Our report on the off-trial use of induction therapy during the last 30 years demonstrates an increased use of ICT, a progressive focus on N2 disease, and improved response rates.
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Affiliation(s)
- Elizabeth Fabre
- Department of Medical Oncology, Georges Pompidou European Hospital, University Descartes Paris, France
| | - Caroline Rivera
- Department of General Thoracic Surgery, Georges Pompidou European Hospital, University Descartes Paris, France
| | - Pierre Mordant
- Department of General Thoracic Surgery, Georges Pompidou European Hospital, University Descartes Paris, France
| | - Laure Gibault
- Department of Pathology, Georges Pompidou European Hospital, University Descartes Paris, France
| | - Antoine Dujon
- Department of Thoracic Surgery, Cedar Surgical Centre Bois Guillaume, France
| | - Christophe Foucault
- Department of General Thoracic Surgery, Georges Pompidou European Hospital, University Descartes Paris, France
| | - Françoise Le Pimpec-Barthes
- Department of General Thoracic Surgery, Georges Pompidou European Hospital, University Descartes Paris, France
| | - Marc Riquet
- Department of General Thoracic Surgery, Georges Pompidou European Hospital, University Descartes Paris, France
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Huber J, Ihrig A, Winkler E, Brechtel A, Friederich HC, Herzog W, Frank M, Grüllich C, Hallscheidt P, Zeier M, Pahernik S, Hohenfellner M. Interdisciplinary counseling service for renal malignancies: a patient-centered approach to raise guideline adherence. Urol Oncol 2014; 33:23.e1-23.e7. [PMID: 25465195 DOI: 10.1016/j.urolonc.2014.10.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 10/17/2014] [Accepted: 10/27/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Tumor boards have become an integral part of high-quality cancer care, but in general, patients are not directly involved. To overcome this weakness, we established an interdisciplinary counseling service for renal malignancies where 4 specialists talked to the patient at once. We evaluated this approach from the patients' and physicians' perspective. MATERIALS AND METHODS For 3 months, we assessed organizational and clinical data. Within a standardized telephone interview lasting for 14 ± 8 minutes, we explored the patients' view 1 week after counseling. A focus group contributed the physicians' perspective. Costs and revenues were calculated from the hospital's perspective. RESULTS We included 52 consecutive patients aged 62 ± 10 years. Patients' initiative for a "second opinion" triggered 37% of all appointments. Patients had localized (52%) and systemic (48%) disease presenting with primary diagnosis (48%), relapse (27%), or under continuous therapy (25%). The treatment strategy was changed significantly in 16 of 30 (53%) patients reporting a specific external opinion. The most frequent changes in recommendation were nephron-sparing surgery instead of radical nephrectomy in 8 cases and divergent judgments on restaging causing changes in systemic treatment in 6 cases. We successfully interviewed 43 of 52 patients. Overall, patients rated the consultation as very positive and only 1 patient (2%) was dissatisfied. Patients rated the quality of interpersonal interaction as very positive and said they would recommend the consultation service to others. Disease state was not associated with ratings. Physicians expressed a very positive opinion, highlighting the patients' benefit and very constructive case discussions. Nevertheless, they report remarkable efforts concerning time investment and effective coordination of medical experts. We estimated a deficit of 39 Euro per patient given the German health care system. There might be relevant secondary positive economic effects for the hospital such as recommendations from one patient to another leading to acquisition of additional patients. CONCLUSIONS Patient involvement in multidisciplinary tumor boards is feasible and well regarded by patients and physicians likewise. By stimulating interdisciplinary collaboration, the interdisciplinary counseling service improves patient satisfaction and clinical decision making. The interdisciplinary counseling service corrected half of the external treatment plans for better guideline adherence. These positive effects come at the price of higher resource utilization. (www.germanctr.de, number DRKS00003279).
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Affiliation(s)
- Johannes Huber
- Department of Urology, University of Heidelberg, Heidelberg, Germany.
| | - Andreas Ihrig
- Department of General Internal Medicine and Psychosomatic, University of Heidelberg, Heidelberg, Germany.
| | - Eva Winkler
- Department of Medical Oncology, National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany
| | - Anette Brechtel
- Department of General Internal Medicine and Psychosomatic, University of Heidelberg, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatic, University of Heidelberg, Heidelberg, Germany
| | - Wolfgang Herzog
- Department of General Internal Medicine and Psychosomatic, University of Heidelberg, Heidelberg, Germany
| | - Martin Frank
- Center for Health Economics Research Hannover, Leibniz University Hannover, Hannover, Germany
| | - Carsten Grüllich
- Department of Medical Oncology, National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany
| | - Peter Hallscheidt
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany
| | - Martin Zeier
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Sascha Pahernik
- Department of Urology, University of Heidelberg, Heidelberg, Germany
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Mordant P, Fabre É, Gibault L, Arame A, Pricopi C, Dujon A, Le Pimpec-Barthes F, Riquet M. [Impact of induction therapies on pathology and outcome after surgical resection of non-small lung cancer: a 30-year experience of 859 patients]. REVUE DE PNEUMOLOGIE CLINIQUE 2014; 70:9-15. [PMID: 24566030 DOI: 10.1016/j.pneumo.2013.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 12/19/2013] [Accepted: 12/19/2013] [Indexed: 06/03/2023]
Abstract
UNLABELLED The management of localized non-small cell lung cancer (NSCLC) has been modified over the last decades, with induction therapies being increasingly recommended as a prerequisite to surgical resection. However, the relative impact of chemo- and chemoradiotherapy on tumours' pathology and patients' survival is still discussed. METHODS We set a retrospective study including every patient who underwent surgical resection for NSCLC in 2 French centres from 1980 to 2009. We then compared the tumours' pathology and patients' survival according to the use of induction chemotherapy (group 1) or induction chemoradiotherapy (group 2). RESULTS There were 733 patients in group 1 and 126 patients in group 2. In group 1, 669 patients (91%) had platinum-based chemotherapy, for 2 to 3 cycles in 564 cases (77%). In group 2, chemoradiotheray was concomitant in 68 patients (54%), and sequential in 58 patients (46%). As compared with group 1, group 2 was characterized by younger age (mean 59.8±9.5 vs 56.4±9.6, respectively, P<.001), a higher rate of tumours deemed unresectable before induction treatment (25% vs 44%, P<.001), and a higher proportion of T4 (25% vs 44%, P<.001) or N2 diseases (56% vs 69%, P=.005). The type of resection, postoperative complications, and postoperative mortality were not significantly different between groups. On final pathologic report, as compared with group 1, there were more N0 and N1 disease in group 2 (N0: 43% vs 58%, P=.002; N1: 22% vs 10%, P=.002) while the rate of N2 disease was comparable (34% vs 32%, P=ns). The median, 5-, and 10-year survivals were 28 months, 35%, and 21% for group 1, and 29 months, 36%, and 23% for group 2, respectively (P=ns). CONCLUSION As compared with induction chemotherapy, induction chemoradiotherapy was performed in more advanced NSCLC, and resulted in better downstaging, similar postoperative course, and comparable long-term outcome after surgical resection.
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Affiliation(s)
- P Mordant
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Descartes, 20, rue Leblanc, 75015 Paris, France
| | - É Fabre
- Service d'oncologie médicale, hôpital européen Georges-Pompidou, université Descartes, 20, rue Leblanc, 75015 Paris, France
| | - L Gibault
- Service d'anatomopathologie, hôpital européen Georges-Pompidou, université Descartes, 20, rue Leblanc, 75015 Paris, France
| | - A Arame
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Descartes, 20, rue Leblanc, 75015 Paris, France
| | - C Pricopi
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Descartes, 20, rue Leblanc, 75015 Paris, France
| | - A Dujon
- Service de chirurgie thoracique, centre médico-chirurgical du Cèdre, 76230 Bois-Guillaume, France
| | - F Le Pimpec-Barthes
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Descartes, 20, rue Leblanc, 75015 Paris, France
| | - M Riquet
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Descartes, 20, rue Leblanc, 75015 Paris, France.
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