1
|
Salih A, Abdullh A, Baba H, Qaradaqhy A, Ali R, Mohammed R, Muhialdeen A, Dhahir H, Saeed Y, Kakamand F. Concurrent squamous cell carcinoma and non-hodgkin lymphoma: a rare case report and multidisciplinary approach. Case Reports Plast Surg Hand Surg 2024; 11:2381757. [PMID: 39045018 PMCID: PMC11265305 DOI: 10.1080/23320885.2024.2381757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 07/15/2024] [Indexed: 07/25/2024]
Abstract
Introduction Squamous cell carcinoma (SCC) is a skin malignancy typically treated with surgical resection. Non-Hodgkin lymphoma (NHL) is a group of lymphoid tissue malignancies treated with various strategies, including chemotherapy and radiotherapy. Case Presentation A 64-year-old male with prior SCC presented with a new scalp lesion. Examination revealed an elevated, irregular, non-tender lesion with mild yellow discoloration. Imaging showed a scalp lesion, cervical lymphadenopathies, and a well-defined mass. Ultrasonography uncovered lymph node involvement and splenomegaly. Fine needle aspiration, biopsy, and immune stains of the lymph node confirmed NHL. Wide local excision of the scalp lesion, reconstruction, and lymph node biopsies were performed, confirming SCC and NHL. The patient received radiotherapy and chemotherapy. Conclusion This unique rare case emphasizes the complex interplay of SCC and NHL, necessitating vigilant SCC patient follow-up.
Collapse
Affiliation(s)
- Abdulwahid Salih
- Smart Health Tower, Sulaymaniyah, Iraq
- College of Medicine, University of Sulaimani, Sulaymaniyah, Iraq
| | - Ari Abdullh
- Smart Health Tower, Sulaymaniyah, Iraq
- Department of Pathology, Sulaymaniyah Teaching Hospital, Sulaymaniyah, Iraq
| | - Hiwa Baba
- Smart Health Tower, Sulaymaniyah, Iraq
- Kscien Organization, Azadi Mall, Sulaymaniyah, Iraq
| | - Aras Qaradaqhy
- Smart Health Tower, Sulaymaniyah, Iraq
- Department of Radiology, Shorsh Teaching Hospital, Sulaymaniyah, Iraq
| | - Rebaz Ali
- Smart Health Tower, Sulaymaniyah, Iraq
- Hiwa Hospital, Sulaymaniyah, Iraq
| | - Rebaz Mohammed
- Smart Health Tower, Sulaymaniyah, Iraq
- Halabja Emergency Teaching Hospital, Halabja, Iraq
| | - Aso Muhialdeen
- Smart Health Tower, Sulaymaniyah, Iraq
- Kscien Organization, Azadi Mall, Sulaymaniyah, Iraq
| | | | | | - Fahmi Kakamand
- Smart Health Tower, Sulaymaniyah, Iraq
- College of Medicine, University of Sulaimani, Sulaymaniyah, Iraq
- Kscien Organization, Azadi Mall, Sulaymaniyah, Iraq
| |
Collapse
|
2
|
Li L, Yu J, Shen K, Chen X. The 21-Gene Recurrence Score Assay Improved Multidisciplinary Treatment Compliance in Hormone Receptor-Positive, Human Epidermal Growth Factor Receptor 2-Negative Breast Cancer Patients: An Analysis of 2,323 Patients. J Breast Cancer 2024; 27:163-175. [PMID: 38769684 PMCID: PMC11221206 DOI: 10.4048/jbc.2023.0248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/28/2024] [Accepted: 03/24/2024] [Indexed: 05/22/2024] Open
Abstract
PURPOSE The 21-gene recurrence score (RS) can guide adjuvant chemotherapy decisions in the multidisciplinary treatment (MDT) of patients with early breast cancer. This study aimed to evaluate the influence of the 21-gene RS assay on patient' compliance with MDT and its association with disease outcomes. METHODS Patients diagnosed with pN0-1, hormone receptor-positive, human epidermal growth factor receptor-2-negative breast cancer between January 2013 and June 2019 were enrolled. A logistic regression model was used to identify parameters associated with treatment adherence. Prognostic indicators were evaluated using the Cox proportional hazard models. RESULTS After the assay, patients were less likely to violate the treatment plan (14.9% vs. 23.1%, p < 0.001), and higher compliance rates were observed for chemotherapy (p = 0.042), radiotherapy (p = 0.012), and endocrine therapy (p < 0.001). Multivariable analysis demonstrated that the 21-gene RS assay (odds ratio [OR], 1.43; 95% confidence interval [CI], 1.09-1.88; p = 0.009) was independently associated with MDT compliance. Moreover, compliance with MDT was independently associated with better disease-free survival (hazard ratio, 0.43; 95% CI, 0.29-0.64; p < 0.001), regardless of the 21-gene RS assay (interaction p = 0.842). CONCLUSION The 21-gene RS assay improved the MDT compliance rate in patients with early breast cancer. Adherence to MDT is associated with a better prognosis.
Collapse
Affiliation(s)
- Liangqiang Li
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Breast Surgery, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, Fujian, China
| | - Jing Yu
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kunwei Shen
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaosong Chen
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| |
Collapse
|
3
|
Sugiyama A, Okumiya H, Fujimoto K, Utsunomiya K, Shimomura Y, Sanuki M, Kume K, Yano T, Kagawa R, Bando H. Integrated Electronic Health Record of Multidisciplinary Professionals Throughout the Cancer Care Pathway: A Pilot Study Exploring Patient-Centered Information in Breast Cancer Patients. J Multidiscip Healthc 2024; 17:2069-2081. [PMID: 38736534 PMCID: PMC11088412 DOI: 10.2147/jmdh.s455281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 04/20/2024] [Indexed: 05/14/2024] Open
Abstract
Purpose The aim of this pilot study was to first aggregate and then integrate the medical records of various healthcare professionals involved with breast cancer patients to reveal if and how patient-centered information is documented in multidisciplinary cancer care. Patients and Methods We aggregated 20 types of medical records from various healthcare professionals such as physicians, nurses and allied healthcare professionals (AHPs) throughout three breast cancer patients' care pathways in a department of breast surgery at a university hospital. Purposeful sampling was used, and three cases were examined. The number of integrated type of records was 14, 14, 17 in case 1, 2 and 3, respectively. We manually annotated and analyzed them exploratively using a thematic analysis. The tags were produced using both a deductive template approach and a data-driven inductive approach. All records were then given tags. We defined patient-centered information related tags and biomedical information related tags and then analyzed for if and how patient-centered information was documented. Results The number of patient-centered information related tags accounted for 30%, 30% and 20% of the total in case 1, 2 and 3, respectively. In all cases, patient-centered information was distributed across various medical records. The Progress Note written by doctors provided much of the patient-centered information, while other records contained information not described elsewhere in the Progress Notes. The records of nurses and AHPs included more patient-centered information than the doctors' notes. Each piece of patient-centered information was documented in fragments providing from each of the healthcare professionals' viewpoints. Conclusion The documented information throughout the breast cancer care pathway in the cases examined was dominated by biomedical information. However, our findings suggest that integrating fragmented patient-centered information from various healthcare professionals' medical records produces holistic patient-centered information from multiple perspectives and thus may facilitate an enhanced multidisciplinary patient-centered care.
Collapse
Affiliation(s)
- Atsuko Sugiyama
- R&D Planning Office, Canon Medical Systems Corporation, Otawara, Tochigi, Japan
- Research and Development Center, Canon Medical Systems Corporation, Otawara, Tochigi, Japan
- Graduate School of Biomedical Engineering, Tohoku University, Sendai, Miyagi, Japan
| | - Hayato Okumiya
- R&D Planning Office, Canon Medical Systems Corporation, Otawara, Tochigi, Japan
| | - Katsuhiko Fujimoto
- R&D Planning Office, Canon Medical Systems Corporation, Otawara, Tochigi, Japan
| | - Kazuki Utsunomiya
- R&D Planning Office, Canon Medical Systems Corporation, Otawara, Tochigi, Japan
| | - Yuka Shimomura
- Research and Development Center, Canon Medical Systems Corporation, Otawara, Tochigi, Japan
| | - Masaru Sanuki
- Laboratory of Mathematical Informatics in Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Keitaro Kume
- Laboratory of Mathematical Informatics in Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Takahiro Yano
- Laboratory of Mathematical Informatics in Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Rina Kagawa
- Department of Biomedical Informatics and Management, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Hiroko Bando
- Department of Breast-Thyroid-Endocrine Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| |
Collapse
|
4
|
Magnoni F, Tinterri C, Corso G, Curigliano G, Leonardi MC, Toesca A, Rocco N, Catalano F, Bianchi B, Lauria F, Caldarella P, Pagani G, Galimberti V, Veronesi P. The multicenter experience in the multidisciplinary Italian breast units: a review and update. Eur J Cancer Prev 2024; 33:185-191. [PMID: 37997909 DOI: 10.1097/cej.0000000000000853] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
A breast unit is a multidisciplinary center specialized in the management of women with breast diseases, including breast cancer (BC). It represents a care path, passing from screening activities to diagnostic investigations, from surgery to the definition of the therapeutic strategy, from psychophysical rehabilitation to long-term checks (follow-up), and up to genetic counseling. Since 2006, following a resolution issued by the European Parliament to urge member states to activate multidisciplinary breast centers by 2016, work has been underway throughout Italy to improve the management of women with BC. In Italy, the State-Regions agreement was signed on 18 December 2014, sanctioning the establishment of breast units. These centers must adhere to specific quality criteria and requirements. In 2020, the experts of the EUSOMA group (European Society of Breast Cancer Specialists), in their latest document published, expanded the requirements of the breast units. Furthermore, Senonetwork was founded in 2012 with the aim of allowing BC to be treated in breast units that comply with European requirements to ensure equal treatment opportunities for all Italian women. Indeed, the available data indicate that the BC patient has a greater chance of better treatment in the breast units with a multidisciplinary team, thus increasing the survival rate with a better quality of life, compared to those managed in nonspecialized structures. The present review is a perspective on the current Italian reality of breast units, updated with the available literature and the most recent epidemiological data from Senonetwork and AgeNaS.
Collapse
Affiliation(s)
- Francesca Magnoni
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
- European Cancer Prevention Organization (ECP), Milan, Italy
| | - Corrado Tinterri
- Breast Unit, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Giovanni Corso
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
- European Cancer Prevention Organization (ECP), Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Giuseppe Curigliano
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Division of Experimental Therapeutics, Division of Medical Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Antonio Toesca
- Division of Breast Surgical Oncology, Candiolo Cancer Institute FPO-IRCCS, Candiolo (To), Italy
| | - Nicola Rocco
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Francesca Catalano
- Multidisciplinary Breast Unit, Cannizzaro Hospital of Catania, Catania, Italy
| | - Beatrice Bianchi
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Federica Lauria
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Pietro Caldarella
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Gianmatteo Pagani
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Viviana Galimberti
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Paolo Veronesi
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| |
Collapse
|
5
|
Orlowski C, Lai J, Vereker M, Antill Y, Richardson G, White M, Gregory P, Kemp S, Morgan J, Ooi C, Senior J, David S. Impact of multidisciplinary team meetings on the management of patients with breast cancer in a large private healthcare facility. Asia Pac J Clin Oncol 2024; 20:285-291. [PMID: 36791022 DOI: 10.1111/ajco.13947] [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: 10/14/2021] [Revised: 09/26/2022] [Accepted: 01/29/2023] [Indexed: 02/16/2023]
Abstract
AIMS Multidisciplinary meetings (MDMs) play a crucial role in decision-making in breast cancer patient care. This study aimed to firstly assess the impact of breast cancer MDMs in decision-making for breast cancer patients and secondly to determine the concordance between MDM recommendations and implementation of clinical practice. METHODS Patient cases to be presented at the weekly breast cancer MDMs were identified and prospectively enrolled. Management plans were predicted by the treating surgeon with the pre-MDM management plans then compared to MDM recommendations. Changes in decision-making were assessed in the following domains: further surgery, systemic therapy (endocrine, chemotherapy or targeted), radiotherapy, enrolment in a clinical trial, further investigations, and referral to other specialists or services. Patient records were subsequently reviewed at 3 months post-MDM to assess the rate of implementation of MDM recommendations and any reasons for discordance. RESULTS Out of 50 cases, 66% (CI 53-79%; p < .005) experienced a change in management plan as a result of MDM discussion, with a total of 66 episodes of recorded change per decision-making domain affecting the following: further surgery (7.6%), endocrine therapy (4.5%), chemotherapy (19.7%), targeted therapy (4.5%), radiotherapy (18.2%), enrolment for a clinical trial (12.1%), additional investigations (22.7%), and further referrals (10.6%). MDM recommendations were implemented in 83.7% of cases. CONCLUSION The breast cancer MDMs were found to substantially impact on the management plans for breast cancer patients, with 83.7% of MDM recommendations being implemented into clinical practice. This study reinforces the importance of MDMs in the management of these patients, as well as highlighting the need for further investigating and addressing the potential barriers to the implementation of MDM recommendations.
Collapse
Affiliation(s)
| | - John Lai
- Cabrini Health, Melbourne, Victoria, Australia
- Epworth Freemasons Hospital, Melbourne, Victoria, Australia
| | - Melissa Vereker
- Cabrini Institute, Cabrini Health, Melbourne, Victoria, Australia
| | - Yoland Antill
- Cabrini Health, Melbourne, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Gary Richardson
- Cabrini Health, Melbourne, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | | | | | - Sarah Kemp
- Cabrini Health, Melbourne, Victoria, Australia
| | | | - Corinne Ooi
- Cabrini Health, Melbourne, Victoria, Australia
| | | | - Steven David
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| |
Collapse
|
6
|
Wells JB, Lewis SJ, Barron M, Trieu PD. Surgical and Radiology Trainees' Proficiency in Reading Mammograms: the Importance of Education for Cancer Localisation. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2024; 39:186-193. [PMID: 38100062 PMCID: PMC10994868 DOI: 10.1007/s13187-023-02393-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/03/2023] [Indexed: 04/05/2024]
Abstract
Medical imaging with mammography plays a very important role in screening and diagnosis of breast cancer, Australia's most common female cancer. The visualisation of cancers on mammograms often forms a diagnosis and guidance for radiologists and breast surgeons, and education platforms that provide real cases in a simulated testing environment have been shown to improve observer performance for radiologists. This study reports on the performance of surgical and radiology trainees in locating breast cancers. An enriched test set of 20 mammography cases (6 cancer and 14 cancer free) was created, and 18 surgical trainees and 32 radiology trainees reviewed the cases via the Breast Screen Reader Assessment Strategy (BREAST) platform and marked any lesions identifiable. Further analysis of performance with high- and low-density cases was undertaken, and standard metrics including sensitivity and specificity. Radiology trainees performed significantly better than surgical trainees in terms of specificity (0.72 vs. 0.35; P < 0.01). No significant differences were observed between the surgical and radiology trainees in sensitivity or lesion sensitivity. Mixed results were obtained with participants regarding breast density, with higher density cases generally having lower performance. The higher specificity of the radiology trainees compared to the surgical trainees likely represents less exposure to negative mammography cases. The use of high-fidelity simulated self-test environments like BREAST is able to benchmark, understand and build strategies for improving cancer education in a safe environment, including identifying challenging scenarios like breast density for enhanced training.
Collapse
Affiliation(s)
- J B Wells
- Discipline of Medical Imaging Sciences, Faculty of Medicine and Health, University of Sydney, D18 Susan Wakil Health Building, Western Avenue, Camperdown, NSW, 2006, Australia
| | - S J Lewis
- Discipline of Medical Imaging Sciences, Faculty of Medicine and Health, University of Sydney, D18 Susan Wakil Health Building, Western Avenue, Camperdown, NSW, 2006, Australia.
| | - M Barron
- Discipline of Medical Imaging Sciences, Faculty of Medicine and Health, University of Sydney, D18 Susan Wakil Health Building, Western Avenue, Camperdown, NSW, 2006, Australia
| | - P D Trieu
- Discipline of Medical Imaging Sciences, Faculty of Medicine and Health, University of Sydney, D18 Susan Wakil Health Building, Western Avenue, Camperdown, NSW, 2006, Australia
| |
Collapse
|
7
|
Capobianco AML, Gallucci G, Lapadula L, Dinardo G, La Torre G, Sisti N, Sisti LG. Impact of the Multidisciplinary Cancer Team on the Diagnostic and Therapeutic Care Pathway of Early Breast Cancer Patients and Perception of Team Members: The Experience of a Cancer Centre in Italy. Cancer Invest 2024; 42:12-20. [PMID: 38149612 DOI: 10.1080/07357907.2023.2300442] [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: 07/06/2021] [Accepted: 12/26/2023] [Indexed: 12/28/2023]
Abstract
Literature on the role of multidisciplinary team (MDT) in cancer is still controversial. We aimed to investigate MDT impact on a panel of indicators in breast cancer care in a single-center retrospective study performed in a Cancer Reference Center in Italy. We analysed the diagnostic and therapeutic care pathway (DTCP) of 266 early breast cancer patients managed by our MDT during 2019-2020. Process indicators reflecting the change of the diagnostic and therapeutic care pathways occurred after the MDT discussion were computed. Further, the performance of some quality care indicators in breast cancer care since the establishment of the MDT activity and the breast cancer MDT members' perceptions were also investigated. According to our study, the MDT approach improves breast cancer management by increasing the completion of staging and by encouraging neo-adjuvant treatment and an appropriate and faster surgery. In MDT members' perspective it also improves decision-making and training and creates a positive work environment. Globally, our study encourages MDT rollout in breast cancer care. However, to enhance the reliability and comparability of the results of studies investigating MDT effectiveness in clinical practice, shared guidelines on its operationalisation are strongly desirable.
Collapse
Affiliation(s)
- A M L Capobianco
- Multidisciplinary Oncology Unit, IRCCS CROB, Rionero in Vulture, Italy
| | - G Gallucci
- Cardio-oncology Unit, IRCCS CROB, Rionero in Vulture, Italy
| | - L Lapadula
- Radiotherapy Unit, IRCCS CROB, Rionero in Vulture, Italy
| | - G Dinardo
- Breast Radiology Unit, IRCCS CROB, Rionero in Vulture, Italy
| | - G La Torre
- Breast Surgery Unit, IRCCS CROB, Rionero in Vulture, Italy
| | - N Sisti
- Pharmacist and Pharmacovigilance Expert, Rome, Italy
| | - L G Sisti
- Center for Global Health Research and Studies, Università Cattolica del Sacro Cuore, Rome, Italy
- International Relations, Relation with Regions and Project Cycle Management Unit - National Institute for Health, Migration and Poverty (INMP), Rome, Italy
| |
Collapse
|
8
|
Dong X, Yu J, Nie L, Wu Y, Lu Y, Qin Y, Jin Y, Chen Y, Gu C, Gan L, Zhang N. Information Support Provided by Specialized Nurses via Mobile Healthcare App May Improve Treatment Adherence of Breast Cancer Patients: An Observational Study. Semin Oncol Nurs 2023; 39:151511. [PMID: 37880011 DOI: 10.1016/j.soncn.2023.151511] [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: 01/21/2023] [Revised: 08/02/2023] [Accepted: 09/14/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVES Mobile devices facilitate the healthcare management of breast cancer. Meanwhile, specialist nurses play an important role in disease management. We established a smartphone-based app that enables patients to raise questions to specialist nurses. We aimed to evaluate whether the information support provided by specialist nurses via smartphone app could improve the treatment adherence of breast cancer patients. DATA SOURCE Breast cancer patients who received surgery and registered for the app between March 2013 and April 2020 were included. Data related to the use of the app, the number of raised questions, and the specific content of each question were retrieved. Overall, 2675 patients were included, with 560 patients raising questions to specialist nurses via the app. Patients with higher educational levels, postmenopause status, and more advanced diseases were more likely to seek informational support via a smartphone app. The treatment adherence was 86.4%. Multivariate analysis demonstrated that raising questions was associated with better compliance. Regarding the distribution of questions, 78.8% of patients had questions about the treatment schedule and procedure, 65.9% of patients had questions during the adjuvant treatment, and only 19.6% of patients raised questions about follow-up and rehabilitation. After a median follow-up of 44 months, there was no survival difference between patients who raised questions and those who did not. CONCLUSION Seeking information support from specialist nurses was associated with better treatment adherence. The smartphone-based healthcare app enables specialist nurses to provide more conducive service for patients, and validation of this finding in further studies is warranted. IMPLICATIONS FOR NURSING PRACTICE Breast cancer patients were more interested in problems with treatment procedures and schedules. Those who asked questions had better treatment adherence. The smartphone-based app could not only provide patients with a platform to seek information support but also help specialist nurses understand the needs of patients.
Collapse
Affiliation(s)
- Xiaojing Dong
- Specialist nurse, Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Yu
- Physician, Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lijing Nie
- Specialist nurse, Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiying Wu
- Specialist nurse, Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Lu
- Specialist nurse, Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yanwen Qin
- Specialist nurse, Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yufei Jin
- Specialist nurse, Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yunyun Chen
- Specialist nurse, Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chengjia Gu
- Specialist nurse, Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lu Gan
- Specialist nurse, Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Nan Zhang
- Specialist nurse, Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Head nurse and supervisor, Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| |
Collapse
|
9
|
Michalopoulou E, Clauser P, Gilbert FJ, Pijnappel RM, Mann RM, Baltzer PAT, Chen Y, Fallenberg EM. A survey by the European Society of Breast Imaging on radiologists' preferences regarding quality assurance measures of image interpretation in screening and diagnostic mammography. Eur Radiol 2023; 33:8103-8111. [PMID: 37481690 PMCID: PMC10598074 DOI: 10.1007/s00330-023-09973-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
OBJECTIVES Quality assurance (QA) of image interpretation plays a key role in screening and diagnostic mammography, maintaining minimum standards and supporting continuous improvement in interpreting images. However, the QA structure across Europe shows considerable variation. The European Society of Breast Imaging (EUSOBI) conducted a survey among the members to collect information on radiologists' preferences regarding QA measures in mammography. MATERIALS AND METHODS An anonymous online survey consisting of 25 questions was distributed to all EUSOBI members and national breast radiology bodies in Europe. The questions were designed to collect demographic characteristics, information on responders' mammography workload and data about QA measures currently used in their country. Data was analysed using descriptive statistical analysis, the χ2 test, linear regression, and Durbin-Watson statistic test. RESULTS In total, 251 breast radiologists from 34 countries completed the survey. Most respondents were providing both screening and symptomatic services (137/251, 54.6%), working in an academic hospital (85/251, 33.9%) and reading 1000-4999 cases per year (109/251, 43.4%). More than half of them (133/251, 53%) had established QA measures in their workplace. Although less than one-third (71/251, 28.3%) had to participate in regular performance testing, the vast majority (190/251, 75.7%) agreed that a mandatory test would be helpful to improve their skills. CONCLUSION QA measures were in place for more than half of the respondents working in screening and diagnostic mammography to evaluate their breast imaging performance. Although there were substantial differences between countries, the importance of having QA in the workplace and implemented was widely acknowledged by radiologists. CLINICAL RELEVANCE STATEMENT Although several quality assurance (QA) measures of image interpretation are recommended by European bodies or national organisations, the QA in mammography is quite heterogenous between countries and reporting settings, and not always actively implemented across Europe. KEY POINTS The first survey that presents radiologists' preferences regarding QA measures of image interpretation in mammography. Quality assurance measures in the workplace are better-established for breast screening compared to diagnostic mammography. Radiologists consider that performance tests would help to improve their mammography interpretation skills.
Collapse
Affiliation(s)
- Eleni Michalopoulou
- University of Nottingham, School of Medicine, Clinical Sciences Building, City Hospital Campus, Hucknall Road, NG5 1PB, Nottingham, UK.
| | - Paola Clauser
- Department of Biomedical Imaging and Image-guided Therapy, Allgemeines Krankenhaus, Medical University of Vienna, 1090, Vienna, Austria
| | - Fiona J Gilbert
- Department of Radiology, Clinical School, Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Ruud M Pijnappel
- University Medical Centre Utrecht, Utrecht University, Heidelberglaan 100, 3584, Utrecht, CX, The Netherlands
- Dutch Expert Centre for Screening, Wijchenseweg 101, 6538, Nijmegen, SW, The Netherlands
| | - Ritse M Mann
- Department of Medical Imaging, Radboud University Medical Centre, 6525, Nijmegen, The Netherlands
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Pascal A T Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Allgemeines Krankenhaus, Medical University of Vienna, 1090, Vienna, Austria
| | - Yan Chen
- University of Nottingham, School of Medicine, Clinical Sciences Building, City Hospital Campus, Hucknall Road, NG5 1PB, Nottingham, UK
| | - Eva Maria Fallenberg
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, München, Germany
| |
Collapse
|
10
|
Suciu V, El Chamieh C, Soufan R, Mathieu MC, Balleyguier C, Delaloge S, Balogh Z, Scoazec JY, Chevret S, Vielh P. Real-World Diagnostic Accuracy of the On-Site Cytopathology Advance Report (OSCAR) Procedure Performed in a Multidisciplinary One-Stop Breast Clinic. Cancers (Basel) 2023; 15:4967. [PMID: 37894334 PMCID: PMC10605571 DOI: 10.3390/cancers15204967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 08/19/2023] [Accepted: 09/24/2023] [Indexed: 10/29/2023] Open
Abstract
Fine-needle aspiration (FNA) cytology has been widely used for the diagnosis of breast cancer lesions with the objective of differentiating benign from malignant masses. However, the occurrence of unsatisfactory samples and false-negative rates remains a matter of concern. Major improvements have been made thanks to the implementation of rapid on-site evaluation (ROSE) in multidisciplinary and integrated medical settings such as one-stop clinics (OSCs). In these settings, clinical and radiological examinations are combined with a morphological study performed by interventional pathologists. The aim of our study was to assess the diagnostic accuracy of the on-site cytopathology advance report (OSCAR) procedure on breast FNA cytologic samples in our breast OSC during the first three years (April 2004 till March 2007) of its implementation. To this goal, we retrospectively analyzed a series of 1820 breast masses (1740 patients) radiologically classified according to the American College of Radiology (ACR) BI-RADS lexicon (67.6% being either BI-RADS 4 or 5), sampled by FNA and immediately diagnosed by cytomorphology. The clinicoradiological, cytomorphological, and histological characteristics of all consecutive patients were retrieved from the hospital computerized medical records prospectively registered in the central information system. Histopathological analysis and ultrasound (US) follow-up (FU) were the reference diagnostic tests of the study design. In brief, we carried out either a histopathological verification or an 18-month US evaluation when a benign cytology was concordant with the components of the triple test. Overall, histology was available for 1138 masses, whereas 491 masses were analyzed at the 18-month US-FU. FNA specimens were morphologically nondiagnostic in 3.1%, false negatives were observed in 1.5%, and there was only one false positive (0.06%). The breast cancer prevalence was 62%. Diagnostic accuracy measures of the OSCAR procedure with their 95% confidence intervals (95% CI) were the following: sensitivity (Se) = 97.4% (96.19-98.31); specificity (Sp) = 94.98% (92.94-96.56); positive predictive value (PPV) = 96.80% (95.48-97.81); negative predictive value (NPV) = 95.91% (94.02-97.33); positive likelihood ratio (LR+) = 19.39 (13.75-27.32); negative predictive ratio (LR-) = 0.03 (0.02-0.04), and; accuracy = 96.45% (95.42-97.31). The respective positive likelihood ratio (LR+) for each of the four categories of cytopathological diagnoses (with their 95% CI) which are malignant, suspicious, benign, and nondiagnostic were 540 (76-3827); 2.69 (1.8-3.96); 0.03 (0.02-0.04); and 0.37 (0.2-0.66), respectively. In conclusion, our study demonstrates that the OSCAR procedure is a highly reliable diagnostic approach and a perfect test to select patients requiring core-needle biopsy (CNB) when performed by interventional cytopathologists in a multidisciplinary and integrated OSC setting. Besides drastically limiting the rate of nondiagnostic specimens and diagnostic turn-around time, OSCAR is an efficient and powerful first-line diagnostic approach for patient-centered care.
Collapse
Affiliation(s)
- Voichita Suciu
- Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, France
| | - Carolla El Chamieh
- Department of Biostatistics and Medical Information, INSERM UMR1153 ECSTRRA Team, Hôpital Saint Louis, AP-HP, 75010 Paris, France
| | - Ranya Soufan
- Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, France
| | | | | | - Suzette Delaloge
- Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, France
| | - Zsofia Balogh
- Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, France
| | | | - Sylvie Chevret
- Department of Biostatistics and Medical Information, INSERM UMR1153 ECSTRRA Team, Hôpital Saint Louis, AP-HP, 75010 Paris, France
| | - Philippe Vielh
- Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, France
- Medipath and American Hospital of Paris, 92200 Paris, France
| |
Collapse
|
11
|
Xu F, Ou D, Qi W, Wang S, Han Y, Cai G, Cao L, Xu C, Chen JY. Impact of multidisciplinary team on the pattern of care for brain metastasis from breast cancer. Front Oncol 2023; 13:1160802. [PMID: 37664027 PMCID: PMC10471195 DOI: 10.3389/fonc.2023.1160802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 07/18/2023] [Indexed: 09/05/2023] Open
Abstract
Purpose The aim of this study was to explore how a multidisciplinary team (MDT) affects patterns of local or systematic treatment. Methods We retrospectively reviewed the data of consecutive patients in the breast cancer with brain metastases (BCBM) database at our institution from January 2011 to April 2021. The patients were divided into an MDT group and a non-MDT group. Results A total of 208 patients were analyzed, including 104 each in the MDT and non-MDT groups. After MDT, 56 patients (53.8%) were found to have intracranial "diagnosis upgrade". In the matched population, patients in the MDT group recorded a higher proportion of meningeal metastases (14.4% vs. 4.8%, p = 0.02), symptomatic tumor progression (11.5% vs. 5.8%, p = 0.04), and an increased number of occurrences of brain metastases (BM) progression (p < 0.05). Attending MDT was an independent factor associated with ≥2 courses of intracranial radiotherapy (RT) [odds ratio (OR) 5.4, 95% confidence interval (CI): 2.7-10.9, p < 0.001], novel RT technique use (7.0, 95% CI 3.5-14.0, p < 0.001), and prospective clinical research (OR 5.7, 95% CI 2.4-13.4, p < 0.001). Conclusion Patients with complex conditions are often referred for MDT discussions. An MDT may improve the qualities of intracranial RT and systemic therapy, resulting in benefits of overall survival for BC patients after BM. This encourages the idea that treatment recommendations for patients with BMBC should be discussed within an MDT.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Jia-Yi Chen
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| |
Collapse
|
12
|
Lai-Kwon J, Dushyanthen S, Seignior D, Barrett M, Buisman-Pijlman F, Buntine A, Woodward-Kron R, McArthur G, Kok DL. Designing a wholly online, multidisciplinary Master of Cancer Sciences degree. BMC MEDICAL EDUCATION 2023; 23:544. [PMID: 37525150 PMCID: PMC10391849 DOI: 10.1186/s12909-023-04537-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/25/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Improving oncology-specific knowledge and skills of healthcare professionals is critical for improving the outcomes of people with cancer. Many current postgraduate education offerings may be inaccessible to busy professionals, contain minimal consumer input or do not focus on the multidisciplinary nature of cancer care. In response to these needs, a Master of Cancer Sciences degree was developed. Our aim is to describe the development of the Master of Cancer Sciences. METHODS We describe the development of the Master of Cancer Sciences, including its theoretical and its pedagogical underpinnings. RESULTS Our approach to curriculum design was guided by Kern's Six-Step Approach to Medical Curriculum and underpinned by the Seven Principles of Online Learning. These approaches were further underpinned by the Cognitive Theory of Multimedia Learning which informed our approach to audio and visual information design. The pedagogy is interactive, experiential, interprofessional and importantly, includes consumers as educators. In practice, learning activities include peer feedback, multidisciplinary team meeting simulations, group work and clinical role plays. The online environment was visually shaped through infographics, high-quality educational videos and gamification. CONCLUSION We have designed a Master of Cancer Sciences that is one of the first wholly online, cancer-specific Masters' programs. Its industry-led curriculum using evidence-based pedagogical choices utilises a range of novel digital formats and integrates the consumer perspective to provide a holistic overview of the field. Quantitative and qualitative evaluation of learning outcomes is ongoing.
Collapse
Affiliation(s)
- Julia Lai-Kwon
- Victorian Comprehensive Cancer Centre (VCCC) Alliance, Melbourne, Australia
- Department of Medical Education, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
- Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, 3000, Australia
| | - Sathana Dushyanthen
- Centre for Digital Transformation of Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - David Seignior
- Melbourne School of Professional and Continuing Education, University of Melbourne, Melbourne, Australia
| | - Michelle Barrett
- Victorian Comprehensive Cancer Centre (VCCC) Alliance, Melbourne, Australia
| | - Femke Buisman-Pijlman
- Melbourne School of Professional and Continuing Education, University of Melbourne, Melbourne, Australia
| | - Andrew Buntine
- Melbourne School of Professional and Continuing Education, University of Melbourne, Melbourne, Australia
| | - Robyn Woodward-Kron
- Department of Medical Education, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Grant McArthur
- Victorian Comprehensive Cancer Centre (VCCC) Alliance, Melbourne, Australia
- Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, 3000, Australia
- Department of Clinical Pathology, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia
| | - David L Kok
- Victorian Comprehensive Cancer Centre (VCCC) Alliance, Melbourne, Australia.
- Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, 3000, Australia.
- Department of Clinical Pathology, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia.
| |
Collapse
|
13
|
Ali SR, Dobbs TD, Jovic M, Hutchings HA, Whitaker IS. Improving the effectiveness of multidisciplinary team meetings on skin cancer: Analysis of the National Cancer Research UK survey responses. J Plast Reconstr Aesthet Surg 2023; 82:141-151. [PMID: 37167715 DOI: 10.1016/j.bjps.2023.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 09/05/2022] [Accepted: 01/29/2023] [Indexed: 03/30/2023]
Abstract
INTRODUCTION Skin cancer is the most common form of cancer in the UK, comprising at least 25% of all new cancer diagnoses. Many patients require referral to the local or specialist skin cancer multidisciplinary team (MDT) for ongoing management. However, national data have shown that Specialist Skin Cancer MDTs are costly and do not currently meet NICE standards for composition and quoracy. Innovative solutions to these problems are therefore warranted. METHODS We performed a secondary comparative analysis of 3563 quantitative responses to two Cancer Research UK commissioned surveys along with subanalysis of 282 skin cancer MDT respondents. RESULTS Good uniformity was observed amongst skin respondents in the belief that risk stratification and prioritization of complex cases were the most important factors compared to other cancer MDT members. The most important priorities for areas requiring change to MDT working deemed by the skin MDT were 1) imaging and pathology results ready for the meeting, 2) time to discuss patients in detail, 3) clear meeting owner in charge, and 4) clear agenda, in advance of the meeting. There was agreement (median Likert score 4) amongst skin MDT respondents that patients should be placed on protocolized treatment pathways. CONCLUSION The responses of skin MDT respondents analyzed in the current study support changes to meeting attendance, preparation, and protocolized streaming. In line with other studies, we support tumor-specific guidance for streamlining MDT discussions. We also encourage stakeholders to adopt an evidence-based approach to test, develop, and reassess changes in this herculean task.
Collapse
Affiliation(s)
- Stephen R Ali
- Reconstructive Surgery and Regenerative Medicine Research Centre (ReconRegen), Institute of Life Sciences, Swansea University Medical School, Swansea, UK; Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | - Thomas D Dobbs
- Reconstructive Surgery and Regenerative Medicine Research Centre (ReconRegen), Institute of Life Sciences, Swansea University Medical School, Swansea, UK; Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | - Matthew Jovic
- Reconstructive Surgery and Regenerative Medicine Research Centre (ReconRegen), Institute of Life Sciences, Swansea University Medical School, Swansea, UK
| | - Hayley A Hutchings
- Patient and Population Health and Informatics Research, Swansea University Medical School, Swansea, UK
| | - Iain S Whitaker
- Reconstructive Surgery and Regenerative Medicine Research Centre (ReconRegen), Institute of Life Sciences, Swansea University Medical School, Swansea, UK; Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK.
| |
Collapse
|
14
|
Kumar B, Prasad P, Singh R, Sahu RK, Singh A, Magani SJ, Hedau S. Role of identified proteins in the proteome profiles of CDK4/6 inhibitor-resistant breast cancer cell lines. Mol Omics 2023. [PMID: 36938944 DOI: 10.1039/d2mo00285j] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
Abemaciclib (Ab) and palbociclib (Pb) are CDK4/6 inhibitors used to cure advanced breast cancer (BC). However, acquired resistance is a major challenge. The molecular mechanisms and signature proteins of therapy resistance for Ab and Pb drugs need to be explored. Here we developed resistant cells for Ab and Pb drugs in MCF-7 cell lines and explored the mechanisms and signature proteins of therapy resistance in BC. Proteome profiling was performed using the label-free proteome-orbitrap-fusion-MS-MS technique. Gene ontology (GO)-terms, KEGG pathways and network analysis were performed for the proteome data. Drug-resistant cells showed increased drug tolerance, enhanced colony formation potential and an increased gap-healing tendency for the respective drug. Up-regulation of survival genes (BCL-2 and MCL-1) and down-regulation of apoptosis inducers were observed. Drug-resistance markers (MDR-1 and ABCG2 (BCRP)) along with ESR-1, CDK4, CDK6, and cyclin-D1 genes were up-regulated in resistant cells. A total of 237 and 239 proteins were found to be differentially expressed in the Ab and Pb-resistant cells, respectively. Down-regulated proteins induce apoptosis signalling and nucleotide metabolisms and restrict EGFR signalling; however, up-regulated proteins induce Erk, wnt-β-catenin, VEGFR-PI3K-AKT, glucose transportation, and hypoxia signalling pathways and regulate hydrogen peroxide signalling pathways. The panel of identified proteins associated with these pathways might have characteristics of molecular signature and new drug targets for overcoming drug resistance in breast cancer.
Collapse
Affiliation(s)
- Binayak Kumar
- Division of Molecular Oncology, ICMR-National Institute of Cancer Prevention and Research, I-7, Sector-39, Noida, Uttar Pradesh, 201301, India.
| | - Peeyush Prasad
- Department of Research, Sir Ganga Ram Hospital, 110060, New Delhi, India
| | - Ragini Singh
- Division of Molecular Oncology, ICMR-National Institute of Cancer Prevention and Research, I-7, Sector-39, Noida, Uttar Pradesh, 201301, India.
| | - Ram Krishna Sahu
- Division of Molecular Oncology, ICMR-National Institute of Cancer Prevention and Research, I-7, Sector-39, Noida, Uttar Pradesh, 201301, India.
| | - Ashutosh Singh
- Department of Life Sciences, Shiv Nadar University, NH-91, Tahsil-Dadri, Distt-Gautam Budhaa Nagar, Uttar Pradesh, 201314, India.
| | - Srikrishna Jayadev Magani
- Department of Life Sciences, Shiv Nadar University, NH-91, Tahsil-Dadri, Distt-Gautam Budhaa Nagar, Uttar Pradesh, 201314, India.
| | - Suresh Hedau
- Division of Molecular Oncology, ICMR-National Institute of Cancer Prevention and Research, I-7, Sector-39, Noida, Uttar Pradesh, 201301, India.
| |
Collapse
|
15
|
Karukivi J, Leino-Kilpi H, Kuokkanen L, Kuusisto H, Rautava P, Seppänen L, Sulosaari V, Stolt M. Association between work empowerment and interprofessional collaboration among health care professionals working in cancer care settings. J Interprof Care 2023; 37:21-28. [PMID: 34979858 DOI: 10.1080/13561820.2021.1997949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
This study aimed to analyze work-related empowerment and interprofessional collaboration and to identify possible associations among healthcare professionals working in cancer care settings. A cross-sectional survey design was employed in this study. Healthcare professionals (n = 175) in one Finnish Cancer Center participating in the care of patients with cancer at least on a monthly basis took part in the study. The data were collected with three instruments: Interprofessional Collaboration and Leadership, Performance of an Empowered Personnel (PEN), and Work-related Empowerment Promoting Factors (WEP). The data were analyzed with descriptive statistics, Pearson and Spearman's correlation coefficients and multivariate analysis using generalized liner models. Healthcare professionals rated their work empowerment as rather high. Performance of an Empowered Personnel (PEN) was perceived as high (mean 4.08, SD 0.47). Promoting factors for Work Empowerment (WEP) were also assessed as high (mean 3.98, SD 0.61). Interprofessional collaboration in the cancer care setting was perceived as moderate (mean 2.94, SD 0.36). Managerial position explained work empowerment based on multivariate analysis. Work empowerment and interprofessional collaboration had a strong correlation. The results can be used in the leadership and management of interprofessional collaboration and in developing new structures to support health professionals' work empowerment. In the future, work empowerment needs to be promoted by constructing solutions and practices that support interprofessional collaboration and thus improve the quality of cancer care.
Collapse
Affiliation(s)
- Johanna Karukivi
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Helena Leino-Kilpi
- Department of Nursing Science, University of Turku, Turku, Finland.,Turku University Hospital, Turku, Finland
| | - Liisa Kuokkanen
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Hannele Kuusisto
- Environmental and Energy Engineering, Turku University of Applied Sciences, Turku, Finland
| | - Päivi Rautava
- Public Health, University of Turku, Turku, Finland.,Clinical Research Centre, Turku University Hospital, Turku, Finland
| | - Laura Seppänen
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Virpi Sulosaari
- Department of Nursing Science, University of Turku, Turku, Finland.,Health and Well-being, Turku University of Applied Sciences, Turku, Finland
| | - Minna Stolt
- Department of Nursing Science, University of Turku, Turku, Finland.,Turku University Hospital, Turku, Finland
| |
Collapse
|
16
|
Licata L, Cosentini D, De Sanctis R, Iorfida M, Caremoli ER, Vingiani A, Simoncini EL, Pruneri G, Munzone E, Bianchini G, Zambelli A, Tondini C. Multigene signatures for early breast cancer in clinical practice: A report of the Lombardy genomic assays for breast cancer working group. Front Oncol 2023; 13:1081885. [PMID: 36950554 PMCID: PMC10025563 DOI: 10.3389/fonc.2023.1081885] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/15/2023] [Indexed: 03/08/2023] Open
Abstract
The increasing understanding of breast cancer biology has provided the basis for the development of multigene signatures aimed to improve the capability of clinicians to assess patients' prognostication and risk stratification. Incorporating these tools in clinical practice has profoundly impacted on the decision-making process for the adjuvant therapy of patients with ER+/HER2- early breast cancer and the results from prospective adjuvant trials have strengthened the clinical utility of multigene signatures in this setting. In July 2019, Lombardy was the first Region in Italy to reimburse genomic testing for patients with ER+/HER2- early breast cancer. Three years later, a group of investigators from six referral Cancer Centers in Lombardy convened to debate the use of multigene signatures in clinical practice and share their own experience with the tests after reimbursement. Here, we reviewed relevant data on the role of multigene signatures in tailoring adjuvant chemotherapy for patients with ER+/HER2- early breast cancer and discussed about the optimal use of these assays in current clinical practice. As the treatment landscape of early breast cancer evolves and novel questions about the possible additional applications of multigene assays arise, we also provide our viewpoint on the potential implementation of the assays in the evolving scenario ER+/HER2- early breast cancer treatment.
Collapse
Affiliation(s)
- Luca Licata
- Department of Medical Oncology, San Raffaele Hospital, Milan, Italy
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy
- *Correspondence: Luca Licata,
| | - Deborah Cosentini
- Medical Oncology Unit, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Rita De Sanctis
- Medical Oncology and Hematology Unit, IRCCS - Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Monica Iorfida
- Division of Medical Senology, IEO, European Institute of Oncology, Milan, Italy
| | | | - Andrea Vingiani
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Faculty of Medicine and Surgery, University of Milan, Milan, Italy
| | | | - Giancarlo Pruneri
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Faculty of Medicine and Surgery, University of Milan, Milan, Italy
| | - Elisabetta Munzone
- Division of Medical Senology, IEO, European Institute of Oncology, Milan, Italy
| | - Giampaolo Bianchini
- Department of Medical Oncology, San Raffaele Hospital, Milan, Italy
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Zambelli
- Medical Oncology and Hematology Unit, IRCCS - Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Carlo Tondini
- Oncology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| |
Collapse
|
17
|
Merker L, Conroy S, El-Wakeel H, Laurence N. Streamlining the Multi-Disciplinary Team Meeting: The Introduction of Robust Pre-Preparation Methods and Its Effect on the Length of Case Discussions. J Multidiscip Healthc 2023; 16:613-622. [PMID: 36910017 PMCID: PMC9993954 DOI: 10.2147/jmdh.s387174] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 12/15/2022] [Indexed: 03/06/2023] Open
Abstract
Introduction The multidisciplinary team (MDT) approach has long been considered the optimal way in which to deliver a high standard of care to patients with breast cancer. With a growing number of patients and ever-increasing complexity of cases, the strain on time and resource of the MDT is becoming increasingly evident. It is therefore essential that local hospital departments adapt their MDT processes to better streamline discussions and optimise efficiency. The Royal United Hospital in Bath is a district general hospital in the UK. Approximately 500 patients with cancers are treated annually, and the MDT discusses approximately 60 patients per week. Methods To improve our MDT meeting processes and increase productivity, we created a concise MDT template using Microsoft Access™: giving all clinicians the ability to add patients and information in real time. We also allocated weekly preparation time whereby a senior clinician ensured all patients were prepared prior to the meeting with results and potential outcomes prepopulated where possible. Results We recorded the time spent discussing patients during 6 MDT meetings before and after implementation of changes. Cases were classified by pathology category to determine if there were differences following the preparation changes. Overall, we significantly reduced our average MDT discussion time (p=0.02). We significantly reduced average discussion time in postoperative malignant cases (p<0.0006) and expected benign core biopsy cases (p<0.0047), allowing appropriate redistribution of time towards discussion of more complex cases, reflected by the significant increase in time spent discussing complex radiology cases (p<0.025). Conclusion We offer an effective method for improving the MDT meeting preparation and presentation by ensuring each patient is appropriately prepared prior to the meeting, and outcomes for those simple cases are already prepopulated. This creates additional time within the meeting to discuss more complex clinical cases while allowing all members of the team an opportunity to discuss all patients if needed.
Collapse
Affiliation(s)
- Louise Merker
- Department of Breast Surgery, Royal United Hospital, Bath, UK
| | - Soraya Conroy
- Department of Breast Surgery, Royal United Hospital, Bath, UK
| | | | - Nicola Laurence
- Department of Breast Surgery, Royal United Hospital, Bath, UK
| |
Collapse
|
18
|
Schellenberger B, Heuser C, Diekmann A, Ernstmann N, Schippers A, Geiser F, Schmidt‐Wolf IGH, Scholl I, Ansmann L. How shared is decision‐making in multidisciplinary tumour conferences with patient participation? An observational study. Health Expect 2022; 25:3297-3306. [DOI: 10.1111/hex.13638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/29/2022] [Accepted: 10/10/2022] [Indexed: 11/04/2022] Open
Affiliation(s)
- Barbara Schellenberger
- Department for Psychosomatic Medicine and Psychotherapy, Center for Health Communication and Health Services Research (CHSR) University Hospital Bonn Bonn Germany
- Center for Integrated Oncology (CIO) University Hospital Bonn Bonn Germany
| | - Christian Heuser
- Department for Psychosomatic Medicine and Psychotherapy, Center for Health Communication and Health Services Research (CHSR) University Hospital Bonn Bonn Germany
- Center for Integrated Oncology (CIO) University Hospital Bonn Bonn Germany
| | - Annika Diekmann
- Department for Psychosomatic Medicine and Psychotherapy, Center for Health Communication and Health Services Research (CHSR) University Hospital Bonn Bonn Germany
- Center for Integrated Oncology (CIO) University Hospital Bonn Bonn Germany
| | - Nicole Ernstmann
- Department for Psychosomatic Medicine and Psychotherapy, Center for Health Communication and Health Services Research (CHSR) University Hospital Bonn Bonn Germany
- Center for Integrated Oncology (CIO) University Hospital Bonn Bonn Germany
| | - Anna Schippers
- Department for Psychosomatic Medicine and Psychotherapy, Center for Health Communication and Health Services Research (CHSR) University Hospital Bonn Bonn Germany
- Center for Integrated Oncology (CIO) University Hospital Bonn Bonn Germany
| | - Franziska Geiser
- Center for Integrated Oncology (CIO) University Hospital Bonn Bonn Germany
- Department for Psychosomatic Medicine and Psychotherapy, Faculty of Medicine University Hospital Bonn Bonn Germany
| | - Ingo G. H. Schmidt‐Wolf
- Center for Integrated Oncology (CIO) University Hospital Bonn Bonn Germany
- Department of Integrated Oncology University Hospital Bonn Bonn Germany
| | - Isabelle Scholl
- Department of Medical Psychology University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Lena Ansmann
- Department of Health Services Research, School of Medicine and Health Sciences, Division for Organizational Health Services Research Carl von Ossietzky University Oldenburg Oldenburg Germany
| |
Collapse
|
19
|
Prades J, Coll-Ortega C, Dal Lago L, Goffin K, Javor E, Lombardo C, de Munter J, Ponce J, Regge D, Salazar R, Valentini V, Borras JM. Use of information and communication technologies (ICTs) in cancer multidisciplinary team meetings: an explorative study based on EU healthcare professionals. BMJ Open 2022; 12:e051181. [PMID: 36202578 PMCID: PMC9540836 DOI: 10.1136/bmjopen-2021-051181] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Multidisciplinary teams in cancer care are increasingly using information and communication technology (ICT), hospital health information system (HIS) functionalities and ICT-driven care components. We aimed to explore the use of these tools in multidisciplinary team meetings (MTMs) and to identify the critical challenges posed by their adoption based on the perspective of professionals representatives from European scientific societies. DESIGN This qualitative study used discussion of cases and focus group technique to generate data. Thematic analysis was applied. SETTING Healthcare professionals working in a multidisciplinary cancer care environment. PARTICIPANTS Selection of informants was carried out by European scientific societies in accordance with professionals' degree of experience in adopting the implementation of ICT and from different health systems. RESULTS Professionals representatives of 9 European scientific societies were involved. Up to 10 ICTs, HIS functionalities and care components are embedded in the informational and decision-making processes along three stages of MTMs. ICTs play a key role in opening MTMs to other institutions (eg, by means of molecular tumour boards) and information types (eg, patient-reported outcome measures), and in contributing to the internal efficiency of teams. While ICTs and care components have their own challenges, the information technology context is characterised by the massive generation of unstructured data, the lack of interoperability between systems from different hospitals and HIS that are conceived to store and classify information rather than to work with it. CONCLUSIONS The emergence of an MTM model that is better integrated in the wider health system context and incorporates inputs from patients and support systems make traditional meetings more dynamic and interconnected. Although these changes signal a second transition in the development process of multidisciplinary teams, they occur in a context marked by clear gaps between the information and management needs of MTMs and the adequacy of current HIS.
Collapse
Affiliation(s)
- Joan Prades
- Catalan Cancer Strategy, Department of Health, Barcelona, Spain
- University of Barcelona (UB & IDIBELL), Barcelona, Spain
| | | | - Lissandra Dal Lago
- Department of Medicine, Jules Bordet Institute & Université Libre de Bruxelles, 1 Rue Héger Bordet, 1000, Bruxelles, Belgium
- International Society of Geriatric Oncology (SIOG), Geneva, Switzerland
| | - Karolien Goffin
- University Hospital Leuven, KU Leuven, Leuven, Belgium
- European Association of Nuclear Medicine, Vienna, Austria
| | - Eugen Javor
- Pharmacy Department, General Hospital Bjelovar, Bjelovar, Croatia
- European Society of Oncology Pharmacy (ESOP), Hamburg, Germany
| | - Claudio Lombardo
- Organisation of European Cancer Institutes (OECI), Brussels, Belgium
- SOS Europe, Via B. Bosco 57/9A, 16121, Genova, Italy
| | - Johan de Munter
- Cancer Center, University Hospital Ghent, Gent, Belgium
- European Oncology Nursing Society, Brussels, Belgium
| | - Jordi Ponce
- Department of Gynaecology, Bellvitge University Hospital, Barcelona, Spain
- University of Barcelona (IDIBELL), Hospitalet de Llobregat, Spain
- European Society of Gynaecological Oncology (ESGO), Prague, Czechia
| | - Daniele Regge
- Department of Surgical Sciences, University of Turin, Turin, 10124, Italy
- Radiology Unit, Candiolo Cancer Institute, FPO-IRCCS, 10060 Candiolo, Italy
- European Society of Radiology (ESR), Vienna, Austria
| | - Ramón Salazar
- Institut Català d'Oncologia, Hospitalet de Llobregat, Spain
- Oncobell Program, Institut de Recerca Biomèdica de Bellvitge (IDIBELL), Hospitalet de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
- European Society of Medical Oncology (ESMO), Lugano, Switzerland
| | - Vincenzo Valentini
- Radiation Oncology and Hematology Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
- Università Cattolica S.Cuore- ROME (I), Rome, Italy
- European SocieTy for Radiotherapy & Oncology (ESTRO), Brussels, Belgium
| | - Josep M Borras
- Catalan Cancer Strategy, Department of Health, Barcelona, Spain
- Department of Clinical Sciences, University of Barcelona, Hospitalet, Barcelona, Spain
| |
Collapse
|
20
|
Sanna V, Fedele P, Deiana G, Alicicco MG, Ninniri C, Santoro AN, Pazzola A, Fancellu A. Edmonton Symptom Assessment Scale may reduce medical visits in patients undergoing chemotherapy for breast cancer. World J Clin Oncol 2022; 13:577-586. [PMID: 36157162 PMCID: PMC9346425 DOI: 10.5306/wjco.v13.i7.577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 06/05/2022] [Accepted: 06/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Adjuvant chemotherapy is recommended in high-risk breast cancer. However, no universally accepted guidelines exist on pre-chemotherapy assessment. In particular, the number and frequency of medical visits vary according to each institution’s policy. We hypothesised that the Edmonton Symptom Assessment Scale (ESAS) may have a favourable impact on the pre-treatment assessment in candidates for adjuvant chemotherapy.
AIM To investigate whether the ESAS can be used to safely reduce the number of medical visits in women with breast cancer undergoing adjuvant chemotherapy.
METHODS In a retrospectively prospective matched-pair analysis, 100 patients who completed the ESAS questionnaire before administration of adjuvant chemotherapy (ESAS Group) were compared with 100 patients who underwent chemotherapy according to the traditional modality, without ESAS (no-ESAS Group). Patients of the ESAS Group received additional visits before treatment if their ESAS score was > 3. The primary endpoint was the total number of medical visits during the entire duration of the chemotherapy period. The secondary endpoints were the occurrence of severe complications (grade 3-4) and the number of unplanned visits during the chemotherapy period.
RESULTS The study variables did not statistically differ between patients of the ESAS Group and no-ESAS Group (age P = 0.880; breast cancer stage P = 0.56; cancer histology P = 0.415; tumour size P = 0.258; lymph node status P = 0.883; immunohistochemical classification P = 0.754; type of surgery P = 0.157), except for premenopausal status (P = 0.015). The study variables did not statistically differ between patients of the ESAS Group and no-ESAS Group regarding age, cancer stage, histology, tumour size, lymph node status, immunohistochemical classification, and type of surgery. Unplanned visits during the entire duration of chemotherapy were 8 in the ESAS Group and 18 in the no-ESAS Group visits (P = 0.035). Grade 3-4 toxicity did not differ between the study groups (P = 0.652). Forty-eight patients of the ESAS Group received additional visits due to an ESAS score > 3. The mean number of medical visits was 4.38 ± 0.51 in the ESAS Group and 16.18 ± 1.82 in the no-ESAS group (P < 0.001). With multivariate analysis, women of the ESAS group were more likely to undergo additional visits for an ESAS score > 3 if they were aged 60 or older, received a mastectomy, or had tumour stage II/III.
CONCLUSION The ESAS score may safely reduce the number of medical visits in candidates for adjuvant chemotherapy for early breast cancer. Our results suggest that the ESAS score may be used for selecting a group of breast cancer patients for whom it is safe to reduce the number of medical visits in the setting of adjuvant chemotherapy. This may translate into several advantages, such as a more rational utilization of human resources and a possible reduction of coronavirus pandemic infection risk in oncologic patients.
Collapse
Affiliation(s)
- Valeria Sanna
- Unit of Medical Oncology, A.O.U. Sassari, Sassari 07100, Italy
| | - Palma Fedele
- Unit of Medical Oncology, Hospital “D. Camberlingio”, Francavilla Fontana 72100, Brindisi, Italy
| | - Giulia Deiana
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari 07100, Italy
| | | | - Chiara Ninniri
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari 07100, Italy
| | - Anna N Santoro
- Unit of Medical Oncology, Hospital “D. Camberlingio”, Francavilla Fontana 72100, Brindisi, Italy
| | - Antonio Pazzola
- Unit of Medical Oncology, A.O.U. Sassari, Sassari 07100, Italy
| | - Alessandro Fancellu
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari 07100, Italy
| |
Collapse
|
21
|
Henshall C, Dawson P, Rahman N, Ball H, Sundralingam A, Shahidi M, McKeown E, Park J, Walthall H, Davey Z. Understanding clinical decision-making in mesothelioma care: a mixed methods study. BMJ Open Respir Res 2022; 9:9/1/e001312. [PMID: 35840292 PMCID: PMC9295667 DOI: 10.1136/bmjresp-2022-001312] [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: 05/18/2022] [Accepted: 06/17/2022] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Malignant pleural mesothelioma is a rare, incurable cancer arising from previous asbestos exposure; patients have a poor prognosis, with a median survival rate of 8-14 months. Variation in mesothelioma clinical decision-making remains common with a lack of multidisciplinary knowledge sharing, leading to inconsistencies in treatment decisions. The study aimed to explore which factors impacted on clinicians' decision-making in mesothelioma care, with a view to optimising the mesothelioma care pathway. METHODS This mixed methods study consisted of documentary analysis of local and national guidelines, policies or documents pertaining to mesothelioma care pathways, secondary analysis of mesothelioma patient data, and interviews with clinicians attending lung cancer and/or mesothelioma-specific multidisciplinary team meetings. The study took place at three National Health Service trusts in England. Documentations relating to patients' treatment pathways were collated and reviewed qualitatively. Records of patients with mesothelioma were extracted from hospital patient records and data collected on diagnosis date, treatment, mortality rates, survival postdiagnosis, age and clinical care team. Data were statistically analysed. Interviews with clinicians explored influences on clinical decision-making, including challenges or barriers involved. Data were thematically analysed. The Strengthening the Reporting of Observational Studies in Epidemiology reporting checklist was used. RESULTS There were differences in the structure and delivery of mesothelioma treatment and care between trusts. Four main themes were identified: 'collaboration and communication', 'evidence base and knowledge', 'role of the clinician' and 'role of the patient'. Two cross-cutting themes relating to the role of the mesothelioma nurse specialist and the impact of COVID-19 were identified. DISCUSSION There is a need to review the structure of mesothelioma multidisciplinary team meetings to ensure patients are reviewed by clinicians with appropriate knowledge, expertise and understanding of how, why and when decisions should be made. There is a need for expert clinicians in mesothelioma care to promote an up-to-date evidence and knowledge base within the wider multidisciplinary team.
Collapse
Affiliation(s)
- Catherine Henshall
- Oxford School for Nursing and Midwifery, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK .,Oxford Health NHS Foundation Trust, Warneford Hospital, Warneford Lane, Oxford, UK
| | - Paul Dawson
- Oxford School for Nursing and Midwifery, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Najib Rahman
- Oxford Pleural Unit, Oxford Centre for Respiratory Medicine, Oxford University, Oxford, UK.,Oxford Respiratory Trials Unit, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Oxford Biomedical Research Centre, Oxford, UK
| | - Hannah Ball
- Cancer Nursing, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Anand Sundralingam
- Oxford Pleural Unit, Oxford Centre for Respiratory Medicine, Oxford University, Oxford, UK.,Oxford Respiratory Trials Unit, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Mitra Shahidi
- Respiratory Medicine, Buckinghamshire Healthcare NHS Trust, Amersham, UK
| | - Edward McKeown
- Respiratory Medicine, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - John Park
- Oxford Pleural Unit, Oxford Centre for Respiratory Medicine, Oxford University, Oxford, UK.,Oxford Respiratory Trials Unit, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Helen Walthall
- Nursing and Midwifery Research and Innovation, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Zoe Davey
- Oxford School for Nursing and Midwifery, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| |
Collapse
|
22
|
Schellenberger B, Heuser C, Diekmann A, Ansmann L, Krüger E, Schreiber L, Schnettler B, Geiser F, Schmidt-Wolf IGH, Ernstmann N. Questions and emotional expressions from patients and companions while participating in multidisciplinary tumor conferences in breast and gynecological cancer centers. PATIENT EDUCATION AND COUNSELING 2022; 105:2058-2066. [PMID: 34953619 DOI: 10.1016/j.pec.2021.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/18/2021] [Accepted: 12/15/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To investigate (a) how many questions and negative emotions (cues/concerns) breast and/or gynecologic cancer patients and companions express during their case discussion in multidisciplinary tumor conferences (MTCs), (b) with which topics the emotions are linked, and (c) which patient- and context-related characteristics determine patients' communicative behavior. METHODS This observational study included audio/video recordings of MTCs with patient participation in three breast and gynecological cancer centers. Using the Verona Coding Definitions of Emotional Sequences, patients' and companions' questions and negative emotions expressed were analyzed. Multiple regression analyses were used to determine associations between communicative behavior and patient- and context-related characteristics. RESULTS We identified 607 questions and 230 cues/concerns expressed by patients/companions in 82 case discussions in MTCs. The number of questions was significantly associated with the hospital. In case discussions with patients who had need for psychological support and who were accompanied, more questions were asked by patients/companions. CONCLUSION The results show that active patient participation does not depend only on patient characteristics, but also on the hospital setting. PRACTICE IMPLICATIONS If cancer centers want to enable patient participation in MTCs, they must define the role of the patient before. Subsequently, conditions must be created to enable this role expectation.
Collapse
Affiliation(s)
- Barbara Schellenberger
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Germany; Center for Integrated Oncology (CIO), University Hospital Bonn, Germany.
| | - Christian Heuser
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Germany; Center for Integrated Oncology (CIO), University Hospital Bonn, Germany
| | - Annika Diekmann
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Germany; Center for Integrated Oncology (CIO), University Hospital Bonn, Germany
| | - Lena Ansmann
- Division for Organizational Health Services Research, Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Germany
| | - Emily Krüger
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Germany; Center for Integrated Oncology (CIO), University Hospital Bonn, Germany
| | - Leonie Schreiber
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Germany; Center for Integrated Oncology (CIO), University Hospital Bonn, Germany
| | | | - Franziska Geiser
- Center for Integrated Oncology (CIO), University Hospital Bonn, Germany; Department for Psychosomatic Medicine and Psychotherapy, Faculty of Medicine, University Hospital Bonn, Germany
| | - Ingo G H Schmidt-Wolf
- Center for Integrated Oncology (CIO), University Hospital Bonn, Germany; Department of Integrated Oncology, University Hospital, Bonn, Germany
| | - Nicole Ernstmann
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Germany; Center for Integrated Oncology (CIO), University Hospital Bonn, Germany
| |
Collapse
|
23
|
Kurniasih DAA, Setiawati EP, Pradipta IS, Subarnas A. Interprofessional collaboration in the breast cancer unit: how do healthcare workers see it? BMC Womens Health 2022; 22:227. [PMID: 35698115 PMCID: PMC9195208 DOI: 10.1186/s12905-022-01818-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 06/02/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Interprofessional collaboration has an important role in health care for breast cancer patients who are undergoing treatment at the hospital. Interprofessional collaboration has been reported to provide significant benefits for patients. However, qualitative research on interprofessional collaboration in the breast cancer department is rarely done, therefore, a study was conducted to determine the perception of health practitioners about interprofessional collaboration in the breast care unit at a referral centre hospital in West Java, Indonesia. METHODS A qualitative study was carried out using in-depth interviews and focus group discussions (FGDs) with 15 healthcare personnel using total sampling. Participants were chosen among healthcare professionals who treat and in charge for outpatient breast cancer, but were not resident physicians. The FGD approach was used for nurses and pharmacists, and interviews were used for oncologists. The audio recordings of all interviews and FGDs were transcribed verbatim and evaluated using thematic analysis. RESULT The findings were categorized into two categories to obtain health care workers' perspectives on interprofessional collaboration: (1) impediment factors: personality, lack of leadership, seniority, healthcare workers with double positions, the need for a clinical meeting, hospital bureaucracy, national health insurance implementation, issues with patients, hospital infrastructure, and evaluation and synchronisation; (2) existing supportive elements: effective cooperation, effective communication, clear job description, interpersonal relationships, Standard Operational Procedure (SOP) for cancer therapy, legality for inter-discipline cancer team, professional responsibility, integrated clinical pathway, patient centred care, and comprehensive health services. CONCLUSIONS Interprofessional collaboration was seen positively by the respondents. However, there are several hurdles that must be overcome to apply interprofessional collaboration works effectively. The findings of this study can be used to build interprofessional collaborations targeted at enhancing quality health care in breast cancer units.
Collapse
Affiliation(s)
- Dea Anita Ariani Kurniasih
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Raya Bandung Sumedang Km. 21, Hegarmanah, Jatinangor, Kabupaten Sumedang, 45363, Jawa Barat, Indonesia.,Doctoral Program of Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, Indonesia.,Pharmacy Study Program, Akademi Farmasi YPF, Bandung, Indonesia
| | - Elsa Pudji Setiawati
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Sumedang, Indonesia
| | - Ivan Surya Pradipta
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Raya Bandung Sumedang Km. 21, Hegarmanah, Jatinangor, Kabupaten Sumedang, 45363, Jawa Barat, Indonesia.,Drug Utilization and Pharmacoepidemiology Research Group, Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Sumedang, Indonesia
| | - Anas Subarnas
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Raya Bandung Sumedang Km. 21, Hegarmanah, Jatinangor, Kabupaten Sumedang, 45363, Jawa Barat, Indonesia.
| |
Collapse
|
24
|
Bortot L, Targato G, Noto C, Giavarra M, Palmero L, Zara D, Bertoli E, Dri A, Andreetta C, Pascoletti G, Poletto E, Russo S, Seriau L, Mansutti M, Cedolini C, Basile D, Fasola G, Bonotto M, Minisini AM. Multidisciplinary Team Meeting Proposal and Final Therapeutic Choice in Early Breast Cancer: Is There an Agreement? Front Oncol 2022; 12:885992. [PMID: 35747814 PMCID: PMC9209643 DOI: 10.3389/fonc.2022.885992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/12/2022] [Indexed: 11/13/2022] Open
Abstract
Background A multidisciplinary team meeting (MDM) approach in breast cancer (BC) management is a standard of care. One of the roles of MDMs is to identify the best diagnostic and therapeutic strategies for patients (pts) with new diagnosis of early BC. The purpose of this study was to define whether there was an agreement between the planned program (i.e., MDMs-based decision) and that actually applied. In addition, the study explored factors associated with discordance. Methods We conducted a retrospective study of a consecutive series of 291 patients with new diagnosis of early BC, discussed at MDMs at the University Hospital of Udine (Italy), from January 2017 to June 2018. The association between clinico-biological factors and discordance between what was decided during the MDMs and what was consequently applied by the oncologist was explored through uni- and multivariate logistic regression analyses. Results The median age was 62 years (range 27–88 years). Among invasive early BC patients, the most frequent phenotype was luminal A (38%), followed by luminal B (33%), HER2-positive (12%), and triple-negative (5%). In situ carcinoma (DCIS) represented 12% of cases. The median time from MDM discussion to first oncologic examination was 2 weeks. The rate of discordance between MDM-based decision and final choice, during a face-to-face consultation with the oncologist, was 15.8% (46/291). The most frequent reason for changing the MDM-based program was clinical decision (87%). Follow-up was preferred to the chemotherapy (CT) proposed within the MDMs in 15% of cases, and to the endocrine therapy (ET) in 39% of cases (among these, 44.5% had a diagnosis of DCIS). Therapeutic change from sequential CT-ET to ET alone was chosen in 16/46 pts (35%): among these patients, seven had a luminal B disease and six had an HER2-positive disease. On univariate analysis, factors associated with discordance were values of Ki-67 14%–30% (OR 3.91; 95% CI 1.19–12.9), age >70 years (OR 2.44, 95% CI 1.28–4.63), housewife/retired status (OR 2.35, 95% CI 1.14–4.85), polypharmacy (OR 1.95; 95% CI 1.02–3.72), postmenopausal status (OR 4.15; 95% CI 1.58–10.9), and high Charlson Comorbidity Index (OR 1.31; 95% CI 1.09–1.57). The association with marital status, educational level, alcohol and smoke habits, presence of a caregiver, parity, grading, histotype and phenotype, and stage was not statistically significant. On multivariate analysis, only Ki-67 value maintained its statistical significance. Conclusion The results of our study could be useful for enhancing the role of MDMs in the clinical decision-making process in early BC.
Collapse
Affiliation(s)
- Lucia Bortot
- Department of Medicine (DAME), University of Udine, Udine, Italy
- Department of Medical Oncology, Academic Hospital of Udine, Udine, Italy
- *Correspondence: Lucia Bortot,
| | - Giada Targato
- Department of Medicine (DAME), University of Udine, Udine, Italy
- Department of Medical Oncology, Academic Hospital of Udine, Udine, Italy
| | - Claudia Noto
- Department of Medicine (DAME), University of Udine, Udine, Italy
- Department of Medical Oncology, Academic Hospital of Udine, Udine, Italy
| | - Marco Giavarra
- Department of Oncology, Ospedale Santo Spirito, Casale Monferrato, Italy
| | - Lorenza Palmero
- Department of Medicine (DAME), University of Udine, Udine, Italy
- Department of Medical Oncology, Aviano Oncology Reference Center, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Aviano, Italy
| | - Diego Zara
- Department of Medicine (DAME), University of Udine, Udine, Italy
- Department of Medical Oncology, Aviano Oncology Reference Center, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Aviano, Italy
| | - Elisa Bertoli
- Department of Medicine (DAME), University of Udine, Udine, Italy
- Department of Medical Oncology, Aviano Oncology Reference Center, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Aviano, Italy
| | - Arianna Dri
- Department of Medicine (DAME), University of Udine, Udine, Italy
- Department of Medical Oncology, Academic Hospital of Udine, Udine, Italy
| | - Claudia Andreetta
- Department of Medical Oncology, Academic Hospital of Udine, Udine, Italy
| | - Gaetano Pascoletti
- Department of Medical Oncology, Academic Hospital of Udine, Udine, Italy
| | - Elena Poletto
- Department of Medical Oncology, Academic Hospital of Udine, Udine, Italy
| | - Stefania Russo
- Department of Medical Oncology, Academic Hospital of Udine, Udine, Italy
| | - Luca Seriau
- Breast Surgery, Department of Medicine (DAME), University Hospital of Udine, Udine, Italy
| | - Mauro Mansutti
- Department of Medical Oncology, Academic Hospital of Udine, Udine, Italy
| | - Carla Cedolini
- Breast Surgery, Department of Medicine (DAME), University Hospital of Udine, Udine, Italy
| | - Debora Basile
- Department of Medical Oncology, San Giovanni di Dio Hospital, Crotone, Italy
| | - Gianpiero Fasola
- Department of Medical Oncology, Academic Hospital of Udine, Udine, Italy
| | - Marta Bonotto
- Department of Medical Oncology, Academic Hospital of Udine, Udine, Italy
| | | |
Collapse
|
25
|
Significance of thickening of the upper gastrointestinal tract on cross sectional imaging: Endoscopic correlation. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 48:2127-2131. [DOI: 10.1016/j.ejso.2022.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 04/29/2022] [Accepted: 05/27/2022] [Indexed: 11/23/2022]
|
26
|
Kondziołka J, Wilczyński S, Michalecki Ł. Potential Use of Novel Image and Signal Processing Methods to Develop a Quantitative Assessment of the Severity of Acute Radiation Dermatitis in Breast Cancer Radiotherapy. Clin Cosmet Investig Dermatol 2022; 15:725-733. [PMID: 35497689 PMCID: PMC9041143 DOI: 10.2147/ccid.s354320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/18/2022] [Indexed: 11/23/2022]
Abstract
More than 95% of patients who undergo radiotherapy report symptoms of radiation dermatitis, which is a side effect of this therapy. Erythema, edema, dry and moist desquamation intensify with each fraction of irradiation and can significantly reduce a patient's quality of life. Therefore, an effective skin care procedure is needed for skin that has been exposed to ionizing radiation in order to avoid unplanned treatment interruptions. The methods that are currently used to assess the severity of an acute radiation reaction are based on visual scales (RTOG, EORTC, NCI CTCAE, LENT-SOMA). Because the assessment is made subjectively, the results depend on the researchers, their experience and perceptiveness. Until now, several studies have been carried out to check the possibility of using an objective methods like hyperspectral imaging, thermal imaging, laser Doppler flowmetry, dielectric and electrochemical methods, reflection spectrophotometry and Courage-Khazaka Multi-skin instrument to radiation-induced dermatitis assessment. Unfortunately, due to various limitations that occurred in the research, none of these techniques was successfully implement as alternative for visual assessment. The continuous development of technology enables researchers to access new techniques that might constitute useful diagnostic and cognitive tools. Infrared thermal imaging, hyperspectral imaging and reflectance spectroscopy are examples of the visual techniques that have been used for many years in various fields of medicine, including dermatology and chronic wound or burn care. They provide information on the skin parameters, such as the temperature, concentration and distribution of chromophores (eg, hemoglobin and melanin), saturation or perfusion changes. The aim of this study is to review the available literature on the use of imaging methods in the clinical assessment of skin with lesions of various origins, evaluation of their suitability for the assessment of radiation reaction and consideration the possibility of creating a quantitative scale for assessing severity of acute radiation dermatitis.
Collapse
Affiliation(s)
- Joanna Kondziołka
- Department of Basic Biomedical Science, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, Katowice, Poland
| | - Sławomir Wilczyński
- Department of Basic Biomedical Science, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, Katowice, Poland
| | - Łukasz Michalecki
- University Clinical Center of the Medical University of Silesia, Katowice, Poland
| |
Collapse
|
27
|
Barrios C, Sánchez-Vanegas G, Villarreal-Garza C, Ossa A, Lombana MA, Monterrosa-Blanco A, Ferrigno AS, Castro CA. Barriers and facilitators to provide multidisciplinary care for breast cancer patients in five Latin American countries: A descriptive-interpretative qualitative study. LANCET REGIONAL HEALTH. AMERICAS 2022; 11:100254. [PMID: 36778924 PMCID: PMC9904076 DOI: 10.1016/j.lana.2022.100254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background Multidisciplinary care (MDC) remains a cornerstone for breast cancer management as it is associated with improved quality of care and patient outcomes. However, the adoption of MDC practice is heterogeneous and has been poorly explored in Latin America. The objective was to describe barriers and possible facilitators for providing MDC to breast cancer patients in five Latin American countries. Methods A panel of experts with an active clinical practice in Bolivia, Colombia, Ecuador, Mexico, and Uruguay was convened to identify barriers and facilitators to MDC. This study is a qualitative synthesis of a structured discussion regarding the state of MDC in the setting of breast cancer. Findings Experts recognized that most oncology practices in Latin America do not apply a multidisciplinary approach for breast cancer patients. Predominant barriers for MDC are fragmentation of health services, being understaffed, inadequate infrastructure, and geographic disparities. Access to MDC varies widely in the region, with significant heterogeneity documented within countries. MDC practice was described as being more common in the private sector in Ecuador and Uruguay, while it is more widely implemented in public institutions of Colombia and Bolivia. Interpretation Establishing quality MDC remains a challenge for oncology practices in Latin America. Addressing regional issues and identifying specific local needs is warranted to encourage the adoption of an effective multidisciplinary approach and, consequently, improve clinical outcomes. Active involvement of all stakeholders is required to build locally solutions and should involve institutions, health professionals, and patients. Funding Research was funded by Productos Roche S.A.
Collapse
Affiliation(s)
- Carlos Barrios
- Oncoclinicas Group, Oncology Research Center, Hospital São Lucas, PUCRS Latin-American Cooperative Oncology Group (LACOG), Rio Grande do Sul, RS, Brazil
| | - Guillermo Sánchez-Vanegas
- Soluciones Integrales Para la Investigación y la Educación en Salud – SIIES Consultores, Cr 45ª #106ª-20, Bogotá, Cundinamarca, Colombia,Fundación Universtiaria de Ciencias de la Salud-FUCS, Bogotá, Colombia.,Corresponding author.
| | - Cynthia Villarreal-Garza
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, San Pedro Garza García, Nuevo León, México
| | - Andrés Ossa
- Coordinator Breast Cancer Department Hospital General de Medellín, Medellín, Antioquia, Colombia
| | - Milton A. Lombana
- Scientific Medical Head at Comprehensive Cancer Center, Clinica de Occidente, Cali, Valle del Cauca, Colombia
| | - Angélica Monterrosa-Blanco
- Soluciones Integrales Para la Investigación y la Educación en Salud – SIIES Consultores, Cr 45ª #106ª-20, Bogotá, Cundinamarca, Colombia
| | - Ana S. Ferrigno
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, San Pedro Garza García, Nuevo León, México
| | - Carlos Alberto Castro
- Soluciones Integrales Para la Investigación y la Educación en Salud – SIIES Consultores, Cr 45ª #106ª-20, Bogotá, Cundinamarca, Colombia,Fundación Universtiaria de Ciencias de la Salud-FUCS, Bogotá, Colombia
| |
Collapse
|
28
|
Guilabert M, Prades J, Borras JM, Maestu I, Guerra JA, Fumadó L, Mira JJ. A Web-Based Self-assessment Model for Evaluating Multidisciplinary Cancer Teams in Spain: Development and Validation Pilot Study. J Med Internet Res 2022; 24:e29063. [PMID: 35266870 PMCID: PMC8949680 DOI: 10.2196/29063] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 08/02/2021] [Accepted: 08/12/2021] [Indexed: 11/17/2022] Open
Abstract
Background Tumor boards constitute the main consensus and clinical decision–making body of multidisciplinary teams (MDTs) in cancer care. With the increasing clinical complexity of treatment options (eg, targeted therapies, multimodal treatments) and the progressive incorporation of new areas of intervention (eg, survivorship care), tumor boards are now required to play a central role in all cancer processes. However, although frameworks are in place to evaluate MDT quality, only few web-based tools are available for this purpose; indeed, no web-based MDT evaluation tools have been developed for or adapted to the Spanish National Health System. Objective The first aim of this study was to develop a web-based self-assessment model (Autoevaluación de Equipos Multidisciplinares de Atención al Cáncer [AEMAC]) for evaluating multidisciplinary cancer teams in Spain and the second aim was to validate this tool by testing its metric properties, acceptability, and usability. Methods We designed and validated the AEMAC program in 3 stages. In the first stage (research), we reviewed the available scientific evidence and performed a qualitative case study of good practice in multidisciplinary care within the Spanish National Health System (n=4 centers and 28 health care professionals). The results were used to define the thematic areas and quality criteria for the self-evaluation model, which were then discussed and validated by a group of experts. The second stage (development) involved the technological development of a web app that would be accessible from any mobile device. In the third stage (piloting and validation), we conducted 4 pilot tests (n=15 tumor boards, 243 professionals) and used the results to analyze the acceptability and usefulness of the tool. Results We designed a self-assessment model based on 5 thematic areas encompassing a total of 25 quality components, which users rated on a 3-option development scale. The evaluation process, which was managed entirely from the web app, consisted of individual self-assessment, group prioritization, and creation of an improvement plan. Cronbach alpha (.86), McDonald’s omega (0.88), and various fit indices (comparative fit index between 0.95 and 1 and goodness-of-fit index between 0.97 and 0.99 for all 5 aspects) confirmed internal consistency. The mean rating for overall satisfaction with the tool and for consistency between the content of the tool and the reality of tumor boards was 7.6 out of 10. Conclusions The results obtained during the period of research and piloting of the AEMAC program showed that it has an appropriate structure and metric properties and could therefore be implemented in a real context and generalized to other hospitals. As a virtual tool, it helps to measure the key aspects of MDT quality, such as effectiveness of collaboration and communication, leadership, and the organizational environment.
Collapse
Affiliation(s)
| | - Joan Prades
- Department of Health, Catalonian Cancer Strategy, Barcelona, Spain.,Department of Clinical Sciences, University of Barcelona, Instituto de Investigación Biomédica de Bellvitge, Barcelona, Spain
| | - Josep M Borras
- Department of Health, Catalonian Cancer Strategy, Barcelona, Spain.,Department of Clinical Sciences, University of Barcelona, Instituto de Investigación Biomédica de Bellvitge, Barcelona, Spain
| | - Inmaculada Maestu
- Medical Oncology Service, Doctor Peset University Hospital, Valencia, Spain
| | - Juan Antonio Guerra
- Department of Hematology and Oncology, Fuenlabrada University Hospital, Fuenlabrada, Spain
| | - Lluís Fumadó
- Urological Cancer Functional Unit, Hospital del Mar-Parc de Salut Mar-IMIM, Barcelona, Spain
| | - José Joaquin Mira
- Health Psychology Department, Miguel Hernandez University, Elche, Spain.,Atenea Research Group, Foundation for the Promotion of Health and Biomedical Research, Sant Joan d'Alacant, Spain.,Alicante-Sant Joan Health Department, Alicante, Spain
| | -
- see Authors' Contributions,
| |
Collapse
|
29
|
Nic Giolla Easpaig B, Tran Y, Winata T, Lamprell K, Fajardo Pulido D, Arnolda G, Delaney GP, Liauw W, Smith K, Avery S, Rigg K, Westbrook J, Olver I, Currow D, Karnon J, Ward RL, Braithwaite J. The complexities, coordination, culture and capacities that characterise the delivery of oncology services in the common areas of ambulatory settings. BMC Health Serv Res 2022; 22:190. [PMID: 35151314 PMCID: PMC8841048 DOI: 10.1186/s12913-022-07593-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 02/02/2022] [Indexed: 11/16/2022] Open
Abstract
Background Relatively little is understood about real-world provision of oncology care in ambulatory outpatient clinics (OPCs). This study aimed to: 1) develop an understanding of behaviours and practices inherent in the delivery of cancer services in OPC common areas by characterising the organisation and implementation of this care; and 2) identify barriers to, and facilitators of, the delivery of this care in OPC common areas. Methods A purpose-designed ethnographic study was employed in four public hospital OPCs. Informal field scoping activities were followed by in-situ observations, key informant interviews and document review. A view of OPCs as complex adaptive systems was used as a scaffold for the data collection and interpretation, with the intent of understanding ‘work as done’. Data were analysed using an adapted “Qualitative Rapid Appraisal, Rigorous Analysis” approach. Results Field observations were conducted over 135 h, interviews over 6.5 h and documents were reviewed. Analysis found six themes. Staff working in OPCs see themselves as part of small local teams and as part of a broader multidisciplinary care team. Professional role boundaries could be unclear in practice, as duties expanded to meet demand or to stop patients “falling through the cracks.” Formal care processes in OPCs were supported by relationships, social capital and informal, but invaluable, institutional expertise. Features of the clinic layout, such as the proximity of departments, affected professional interactions. Staff were aware of inter- and intra-service communication difficulties and employed strategies to minimise negative impacts on patients. We found that complexity, coordination, culture and capacity underpin the themes that characterise this care provision. Conclusions The study advances understanding of how multidisciplinary care is delivered in ambulatory settings and the factors which promote or inhibit effective care practice. Time pressures, communication challenges and competing priorities can pose barriers to care delivery. OPC care is facilitated by: self-organisation of participants; professional acumen; institutional knowledge; social ties and relationships between and within professional groups; and commitment to patient-centred care. An understanding of the realities of ‘work-as-done’ may help OPCs to sustain high-quality care in the face of escalating service demand.
Collapse
|
30
|
Karadeniz Cakmak G. Innovative Standards in Oncoplastic Breast Conserving Surgery: From Radical Mastectomy to Extreme Oncoplasty. Breast Care (Basel) 2022; 16:559-573. [PMID: 35087359 DOI: 10.1159/000518992] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/11/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Oncoplastic breast conserving surgery (OBCS), which is the current procedure of choice for eligible BC patients, describes a philosophy that prioritizes oncologic and cosmetic outcomes. However, knowledge gaps regarding training, acceptance, and practice preclude standardization and make it difficult to design algorithmic guidelines to optimize individualized management in the era of precision medicine. SUMMARY The harmony between patient expectations and oncologic goals creates the state of the art of OBCS. Nevertheless, to achieve these goals, multidisciplinary approach is a must. Surgical decisions require a comprehensive evaluation including patient factors, tumor biology, genetics, technical considerations, and adjunct therapies. Moreover, the quality-of-life (QOL) issues should be considered as the highest level of priority with a shared decision making instituted on realistic discussions with the patient. KEY MESSAGES The standardization in OBCS should be initiated via defining a breast surgeon who should gain theorical and practical competence on techniques via national or international educational programs. The algorithmic patient assessment with appropriate documentation before and after surgery should be established. A simple and safe global lexicon should be designed regarding techniques to be proposed and quality metrics to be considered. Additionally, international multicenter prospective trials should be instituted to overcome knowledge gaps. It is evident that OBCS is the perfect union of science with art. Nevertheless, at the very end, the question is not the nature of the surgeon/artist who would be the extremist, the innovator, or the conservative, but the patient's satisfaction, prognosis, and QOL that conclude the cascade of state of the art of OBCS.
Collapse
|
31
|
Rendell VR, Ricker MM, Winslow ER. Deconstructing the Meaning of Multidisciplinary Cancer Care: A mixed-method study of patients and providers. ONCOLOGY ISSUES 2022; 37:52-64. [PMID: 36845883 PMCID: PMC9957188 DOI: 10.1080/10463356.2021.2008592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Victoria R Rendell
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisc
| | - Melissa M Ricker
- Department of Family Medicine and Community Health at the University of Wisconsin School of Medicine and Public Health, Madison, Wisc
| | - Emily R Winslow
- Georgetown University, Medstar Georgetown Transplant Institute, D.C
| |
Collapse
|
32
|
Chen SH, Chung WP, Huang YC, Kuo YL, Lee KT, Hsu HP, Loh ZJ, Tsai JH, Yang SR, Lee CH. Real-world utilization of the 21-gene assay in taiwanese female patients with early-stage breast cancer: Experience from a single institute. JOURNAL OF CANCER RESEARCH AND PRACTICE 2022. [DOI: 10.4103/2311-3006.355306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
33
|
He P, Sheng J, Qi J, Bai X, Li J, Wang F, Yuan Y, Zheng X. STAT3-induced NCK1 elevation promotes migration of triple-negative breast cancer cells via regulating ERK1/2 signaling. Mol Biol Rep 2021; 49:267-278. [PMID: 34846647 DOI: 10.1007/s11033-021-06868-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 10/21/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Noncatalytic region of tyrosine kinase 1 (NCK1) plays a key role in extracellular matrix degradation, which is required for the metastasis of triple-negative breast cancer (TNBC). However, the role NCK1 plays in the metastatic progression of TNBC is unknown. METHODS AND RESULTS Based on online databases, NCK1 was found to be highly expressed in TNBC as compared to normal breast-like subjects, which was also confirmed using TNBC cells and a tissue microarray. NCK1 expression gradually decreased with increased tumor stage. High NCK1 expression displayed a poor prognosis in lymph node-positive metastatic TNBC patients, but not in lymph node-negative patients. Using transwell assays and immunoblotting, we confirmed that NCK1 overexpression promoted, while NCK1 downregulation inhibited migration capabilities, as well as the expression of matrix metalloproteinases (MMP2/9), uridylyl phosphate adenosine, and plasminogen activator inhibitor-1 in TNBC cells. Mechanistically, NCK1 upregulation mediated the activation of MMP2/9 through ERK1/2 activity. Signal transducer and activator of transcription 3 (STAT3) was positively correlated with NCK1. STAT3 could directly bind to the promoter region of NCK1 to promote its expression and was accompanied by the elevation of MMP2/9 and ERK1/2 signaling, which were partially abolished by the knockdown of NCK1 in TNBC cells. CONCLUSIONS NCK1 may serve as a diagnostic and prognostic marker of metastatic TNBC. STAT3 upregulation promoted the expression of NCK1, which subsequently induced the migration and activity of MMPs in a ERK1/2 signaling-dependent manner in TNBC cells. NCK1 is a promising target for improving TNBC migration.
Collapse
Affiliation(s)
- Peina He
- Department of Medicine, Pingdingshan University, Chongwen Rd., Xincheng District, Pingdingshan, 467092, China
| | - Jianyun Sheng
- Department of Gynecotokology, Pingdingshan First People's Hospital, Pingdingshan, 410402, China
| | - Jinxu Qi
- Department of Medicine, Pingdingshan University, Chongwen Rd., Xincheng District, Pingdingshan, 467092, China
| | - Xianguang Bai
- Department of Medicine, Pingdingshan University, Chongwen Rd., Xincheng District, Pingdingshan, 467092, China
| | - Jiaxin Li
- Department of Medicine, Pingdingshan University, Chongwen Rd., Xincheng District, Pingdingshan, 467092, China
| | - Fubao Wang
- Department of Gynecotokology, Pingdingshan First People's Hospital, Pingdingshan, 410402, China
| | - Yamin Yuan
- Department of Medicine, Pingdingshan University, Chongwen Rd., Xincheng District, Pingdingshan, 467092, China
| | - Xinhua Zheng
- Department of Medicine, Pingdingshan University, Chongwen Rd., Xincheng District, Pingdingshan, 467092, China.
| |
Collapse
|
34
|
Yu J, Wu J, Huang O, Chen X, Shen K. A Smartphone-Based App to Improve Adjuvant Treatment Adherence to Multidisciplinary Decisions in Patients With Early-Stage Breast Cancer: Observational Study. J Med Internet Res 2021; 23:e27576. [PMID: 34528890 PMCID: PMC8485191 DOI: 10.2196/27576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/24/2021] [Accepted: 07/21/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Multidisciplinary treatment (MDT) and adjuvant therapy are associated with improved survival rates in breast cancer. However, nonadherence to MDT decisions is common in patients. We developed a smartphone-based app that can facilitate the full-course management of patients after surgery. OBJECTIVE This study aims to investigate the influence factors of treatment nonadherence and to determine whether this smartphone-based app can improve the compliance rate with MDTs. METHODS Patients who had received a diagnosis of invasive breast cancer and had undergone MDT between March 2013 and May 2019 were included. Patients were classified into 3 groups: Pre-App cohort (November 2017, before the launch of the app); App nonused, cohort (after November 2017 but not using the app); and App used cohort (after November 2017 and using the app). Univariate and multivariate analyses were performed to identify the factors related to MDT adherence. Compliance with specific adjuvant treatments, including chemotherapy, radiotherapy, endocrine therapy, and targeted therapy, was also evaluated. RESULTS A total of 4475 patients were included, with Pre-App, App nonused, and App used cohorts comprising 2966 (66.28%), 861 (19.24%), and 648 (14.48%) patients, respectively. Overall, 15.53% (695/4475) patients did not receive MDT recommendations; the noncompliance rate ranged from 27.4% (75/273) in 2013 to 8.8% (44/500) in 2019. Multivariate analysis demonstrated that app use was independently associated with adherence to adjuvant treatment. Compared with the patients in the Pre-App cohort, patients in the App used cohort were less likely to deviate from MDT recommendations (odds ratio [OR] 0.61, 95% CI 0.43-0.87; P=.007); no significant difference was found in the App nonused cohort (P=.77). Moreover, app use decreased the noncompliance rate for adjuvant chemotherapy (OR 0.41, 95% CI 0.27-0.65; P<.001) and radiotherapy (OR 0.49, 95% CI 0.25-0.96; P=.04), but not for anti-HER2 therapy (P=.76) or endocrine therapy (P=.39). CONCLUSIONS This smartphone-based app can increase MDT adherence in patients undergoing adjuvant therapy; this was more obvious for adjuvant chemotherapy and radiotherapy.
Collapse
Affiliation(s)
- Jing Yu
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiayi Wu
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ou Huang
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaosong Chen
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kunwei Shen
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
35
|
Nic Giolla Easpaig B, Tran Y, Winata T, Lamprell K, Fajardo Pulido D, Arnolda G, Delaney GP, Liauw W, Smith K, Avery S, Rigg K, Westbrook J, Olver I, Currow D, Girgis A, Karnon J, Ward RL, Braithwaite J. Providing outpatient cancer care for CALD patients: a qualitative study. BMC Res Notes 2021; 14:304. [PMID: 34372907 PMCID: PMC8350263 DOI: 10.1186/s13104-021-05724-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/30/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE There have been few descriptions of how outpatient cancer care is provided to patients from culturally and linguistically diverse (CALD) communities. As populations who experience disparities in cancer care access and outcomes, deeper understanding is needed to help identify those factors which can shape the receipt of multidisciplinary care in ambulatory settings. This paper reports on data collected and analysed as part of a multicentre characterisation of care in Australian public hospital cancer outpatient clinics (OPCs). RESULTS Analysis of data from our ethnographic study of four OPCs identified three themes: "Identifying CALD patient language-related needs"; "Capacity and resources to meet CALD patient needs", and "Making it work for CALD communities." The care team comprises not only clinicians but also families and non-clinical staff; OPCs serve as "touchpoints" facilitating access to a range of therapeutic services. The findings highlight the potential challenges oncology professionals negotiate in providing care to CALD communities and the ways in which clinicians adapt their practices, formulate strategies and use available resources to support care delivery.
Collapse
Affiliation(s)
- Bróna Nic Giolla Easpaig
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, NSW 2109 Australia
| | - Yvonne Tran
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, NSW 2109 Australia
| | - Teresa Winata
- Infant, Child and Adolescent Mental Health Services, Liverpool Hospital, Liverpool, NSW Australia
| | - Klay Lamprell
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, NSW 2109 Australia
| | - Diana Fajardo Pulido
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, NSW 2109 Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, NSW 2109 Australia
| | - Geoff P. Delaney
- South-Western Sydney Local Health District, Liverpool, NSW Australia
- South Western Sydney Clinical School, University of New South Wales, Liverpool, NSW Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW Australia
| | - Winston Liauw
- St. George Cancer Care Centre, St. George Hospital, Kogarah, NSW Australia
- St. George Hospital Clinical School, University of New South Wales, Sydney, NSW Australia
| | - Kylie Smith
- South-Western Sydney Local Health District, Liverpool, NSW Australia
| | - Sandra Avery
- South-Western Sydney Local Health District, Liverpool, NSW Australia
| | - Kim Rigg
- St. George Cancer Care Centre, St. George Hospital, Kogarah, NSW Australia
| | - Johanna Westbrook
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, NSW 2109 Australia
| | - Ian Olver
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA Australia
| | - David Currow
- College of Medicine and Public Health, Flinders University, Adelaide, SA Australia
- Faculty of Health, University of Technology Sydney, Sydney, NSW Australia
| | - Afaf Girgis
- South Western Sydney Clinical School, University of New South Wales, Liverpool, NSW Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW Australia
| | - Jonathan Karnon
- College of Medicine and Public Health, Flinders University, Adelaide, SA Australia
| | - Robyn L. Ward
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, NSW 2109 Australia
| |
Collapse
|
36
|
Cheng J, Li M, Tzeng CM, Gou X, Chen S. Suppression of Tumorigenicity 5 Ameliorates Tumor Characteristics of Invasive Breast Cancer Cells via ERK/JNK Pathway. Front Oncol 2021; 11:621500. [PMID: 34395234 PMCID: PMC8356645 DOI: 10.3389/fonc.2021.621500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 06/04/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Suppression of tumorigenicity 5 (ST5) has been considered as a tumor suppressor gene in HeLa tumor cells. However, its role in the progression of breast cancer remains vague. METHODS Online database analysis was determined by Oncomine and Breast Cancer Gene-Expression Miner v4.4 (bc-GenExMiner v4.4). Tumor biology behaviors were measured by MTT assay, wound healing model, Transwell and Flow cytometry assays. Methylation-specific PCR (MSP) was employed to detect promoter methylation. RESULTS Low level of ST5 was observed in breast cancer specimens, particularly in recurrent, invasive breast cancer cases compared to para-carcinoma tissue or non-invasive breast cancer. The downregulation of ST5 was also proved in MDA-MB-231 and SKBR3 cell lines with a high invasive capability as compared to MCF-7 cell with a low invasive capability. ST5 was negatively associated with pathological stages of breast cancer. ST5-downregulation promoted, while ST5-upregulation inhibited the progression of cell proliferation, cell cycle and migration of MDA-MB-231 cells. Additionally, ST5 knockdown inhibited, whereas ST5 overexpression promoted apoptosis of MDA-MB-231 cells. However, ST5 modification, either upregulation or downregulation, had no significant impact on tumor behaviors of MCF-7 cells. Mechanistically, ST5 protein ablation activated, while ST5-upregulation repressed the activities of phosphorylated ERK1/2 and JNK, and subsequently the expression of c-Myc. PD98059-mediated ERK1/2 inhibition abolished the stimulatory effects of ST5-depletion on ERK1/2/JNK/c-Myc signaling axis, and ST5 depletion-mediated cell over-proliferation and migration. Of note, ST5 reduction in invasive breast cancer cells should implicate in the hypermethylation of ST5 promoter region. CONCLUSION Our findings suggest that ST5 potentially acts as a tumor suppressor gene in invasive breast cancer through regulating ERK/JNK signaling pathway and provide a novel insight for breast cancer treatment.
Collapse
Affiliation(s)
- Jianghong Cheng
- Shaanxi Key Laboratory of Brain Disorders and School of Basic Medical Science, Xi’an Medical University, Xi’an, China
| | - Mingli Li
- Translational Medicine Research Center (TMRC), School of Pharmaceutical Science, Xiamen University, Xiamen, China
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Xiamen University, Xiamen, China
- Xiamen Key Laboratory of Otolaryngology Head and Neck Surgery, Xiamen, China
| | - Chi-Meng Tzeng
- Translational Medicine Research Center (TMRC), School of Pharmaceutical Science, Xiamen University, Xiamen, China
| | - Xingchun Gou
- Shaanxi Key Laboratory of Brain Disorders and School of Basic Medical Science, Xi’an Medical University, Xi’an, China
- Institute of Basic and Translational Medicine, Xi’an Medical University, Xi’an, China
- Academician Workstation of Chen Zhi-nan, Xi’an Medical University, Xi’an, China
| | - Shuai Chen
- Shaanxi Key Laboratory of Brain Disorders and School of Basic Medical Science, Xi’an Medical University, Xi’an, China
- Institute of Basic and Translational Medicine, Xi’an Medical University, Xi’an, China
- Academician Workstation of Chen Zhi-nan, Xi’an Medical University, Xi’an, China
| |
Collapse
|
37
|
Qiao X, Zhang Y, Sun L, Ma Q, Yang J, Ai L, Xue J, Chen G, Zhang H, Ji C, Gu X, Lei H, Yang Y, Liu C. Association of human breast cancer CD44 -/CD24 - cells with delayed distant metastasis. eLife 2021; 10:65418. [PMID: 34318746 PMCID: PMC8346282 DOI: 10.7554/elife.65418] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 07/25/2021] [Indexed: 12/09/2022] Open
Abstract
Tumor metastasis remains the main cause of breast cancer-related deaths, especially delayed breast cancer distant metastasis. The current study assessed the frequency of CD44-/CD24- breast cancer cells in 576 tissue specimens for associations with clinicopathological features and metastasis and investigated the underlying molecular mechanisms. The results indicated that higher frequency (≥19.5%) of CD44-/CD24- cells was associated with delayed postoperative breast cancer metastasis. Furthermore, CD44-/CD24-triple negative breast cancer (TNBC) cells spontaneously converted into CD44+/CD24-cancer stem cells (CSCs) with properties similar to CD44+/CD24-CSCs from primary human breast cancer cells and parental TNBC cells in terms of stemness marker expression, self-renewal, differentiation, tumorigenicity, and lung metastasis in vitro and in NOD/SCID mice. RNA sequencing identified several differentially expressed genes (DEGs) in newly converted CSCs and RHBDL2, one of the DEGs, expression was upregulated. More importantly, RHBDL2 silencing inhibited the YAP1/USP31/NF-κB signaling and attenuated spontaneous CD44-/CD24- cell conversion into CSCs and their mammosphere formation. These findings suggest that the frequency of CD44-/CD24- tumor cells and RHBDL2 may be valuable for prognosis of delayed breast cancer metastasis, particularly for TNBC.
Collapse
Affiliation(s)
- Xinbo Qiao
- Department of Oncology, Shengjing Hospital, China Medical University, Shenyang, China
| | - Yixiao Zhang
- Department of Oncology, Shengjing Hospital, China Medical University, Shenyang, China.,Dapartment of Urology, Shengjing Hospital, China Medical University, Shenyang, China
| | - Lisha Sun
- Department of Oncology, Shengjing Hospital, China Medical University, Shenyang, China
| | - Qingtian Ma
- Department of Oncology, Shengjing Hospital, China Medical University, Shenyang, China
| | - Jie Yang
- Department of Oncology, Shengjing Hospital, China Medical University, Shenyang, China
| | - Liping Ai
- Department of Oncology, Shengjing Hospital, China Medical University, Shenyang, China
| | - Jinqi Xue
- Department of Oncology, Shengjing Hospital, China Medical University, Shenyang, China
| | - Guanglei Chen
- Department of Oncology, Shengjing Hospital, China Medical University, Shenyang, China
| | - Hao Zhang
- Department of Oncology, Shengjing Hospital, China Medical University, Shenyang, China.,Department of Breast Surgery, Liaoning Cancer Hospital and Institute, Cancer Hospital of China Medical University, Shenyang, China
| | - Ce Ji
- Department of Oncology, Shengjing Hospital, China Medical University, Shenyang, China.,Department of General Surgery, Shengjing Hospital, China Medical University, Shenyang, China
| | - Xi Gu
- Department of Oncology, Shengjing Hospital, China Medical University, Shenyang, China
| | - Haixin Lei
- Institute of Cancer Stem Cell, Cancer Center, Dalian Medical University, Dalian, China
| | - Yongliang Yang
- Center for Molecular Medicine, School of Life Science and Biotechnology, Dalian University of Technology, Dalian, China
| | - Caigang Liu
- Department of Oncology, Shengjing Hospital, China Medical University, Shenyang, China
| |
Collapse
|
38
|
Steitz BD, Sulieman L, Warner JL, Fabbri D, Brown JT, Davis AL, Unertl KM. Classification and analysis of asynchronous communication content between care team members involved in breast cancer treatment. JAMIA Open 2021; 4:ooab049. [PMID: 34396056 PMCID: PMC8358477 DOI: 10.1093/jamiaopen/ooab049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 05/06/2021] [Accepted: 06/16/2021] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE A growing research literature has highlighted the work of managing and triaging clinical messages as a major contributor to professional exhaustion and burnout. The goal of this study was to discover and quantify the distribution of message content sent among care team members treating patients with breast cancer. MATERIALS AND METHODS We analyzed nearly two years of communication data from the electronic health record (EHR) between care team members at Vanderbilt University Medical Center. We applied natural language processing to perform sentence-level annotation into one of five information types: clinical, medical logistics, nonmedical logistics, social, and other. We combined sentence-level annotations for each respective message. We evaluated message content by team member role and clinic activity. RESULTS Our dataset included 81 857 messages containing 613 877 sentences. Across all roles, 63.4% and 21.8% of messages contained logistical information and clinical information, respectively. Individuals in administrative or clinical staff roles sent 81% of all messages containing logistical information. There were 33.2% of messages sent by physicians containing clinical information-the most of any role. DISCUSSION AND CONCLUSION Our results demonstrate that EHR-based asynchronous communication is integral to coordinate care for patients with breast cancer. By understanding the content of messages sent by care team members, we can devise informatics initiatives to improve physicians' clerical burden and reduce unnecessary interruptions.
Collapse
Affiliation(s)
- Bryan D Steitz
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lina Sulieman
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jeremy L Warner
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Daniel Fabbri
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - J Thomas Brown
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Alyssa L Davis
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kim M Unertl
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| |
Collapse
|
39
|
Corey B, Smania MA, Spotts H, Andersen M. Young Women With Breast Cancer: Treatment, Care, and Nursing Implications. Clin J Oncol Nurs 2021; 24:139-147. [PMID: 32196004 DOI: 10.1188/20.cjon.139-147] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Young women with breast cancer (YWBC) are more likely to have aggressive disease, carry mutations for hereditary cancer genes, and experience higher mortality. They also may face reduced fertility because of the toxicity of chemotherapy. OBJECTIVES This article aims to present a review of YWBC treatments, sequelae of treatment, and psychosocial challenges. METHODS The authors performed a review of guideline-supported treatment options, patient resources, and nursing implications. FINDINGS Because of high-risk cancers and a lack of specific treatment guidelines, healthcare providers may consider aggressive treatments for younger patients. However, studies indicate that the foundation for treatment decisions for YWBC are best based on disease stage and National Comprehensive Cancer Network guidelines.
Collapse
|
40
|
Schellenberger B, Diekmann A, Heuser C, Gambashidze N, Ernstmann N, Ansmann L. Decision-Making in Multidisciplinary Tumor Boards in Breast Cancer Care - An Observational Study. J Multidiscip Healthc 2021; 14:1275-1284. [PMID: 34103928 PMCID: PMC8179814 DOI: 10.2147/jmdh.s300061] [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: 01/01/2021] [Accepted: 03/16/2021] [Indexed: 12/16/2022] Open
Abstract
Purpose Healthcare providers decide on recommendations for further treatment of patients with cancer in multidisciplinary tumor boards (MTBs). As such, communicative processes during MTBs are assumed to influence decision-making and, thereby, treatment planning. The aim of this exploratory study is to gain insights into decision-making during MTBs. Methods Case discussions from MTBs in breast cancer centers in North Rhine-Westphalia, Germany, were observed and audiotaped. The transcripts of the audio recordings were analyzed by procedures of conversation analysis. Results Based on 38 case discussions from 15 MTBs in four breast cancer centers, an action scheme for decision-making in MTBs in breast cancer care was developed. In addition, the conversational practices used by the participants during interactions were analyzed. Conclusion Analysis indicated that conventions in MTBs were observed during individual phases of decision-making but not for the entire process. Although exchanging multidisciplinary knowledge is an essential aspect of MTBs, this exchange does not always seem to occur in practice. The extent to which recommendations are derived from consensus during MTBs remains unclear. Thus, the study suggests developing standards for communication during MTBs to optimize decision-making and, thus, the quality of recommendation.
Collapse
Affiliation(s)
- Barbara Schellenberger
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, Germany
| | - Annika Diekmann
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, Germany
| | - Christian Heuser
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, Germany
| | | | - Nicole Ernstmann
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, Germany.,Institute for Patient Safety, University Hospital Bonn, Bonn, Germany
| | - Lena Ansmann
- Division for Organizational Health Services Research, Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| |
Collapse
|
41
|
Bohmeier B, Schellenberger B, Diekmann A, Ernstmann N, Ansmann L, Heuser C. Opportunities and limitations of shared decision making in multidisciplinary tumor conferences with patient participation - A qualitative interview study with providers. PATIENT EDUCATION AND COUNSELING 2021; 104:792-799. [PMID: 33051128 DOI: 10.1016/j.pec.2020.09.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/01/2020] [Accepted: 09/06/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The aim of this study was to examine opportunities and limitations of shared decision making in multidisciplinary tumor conferences with patient participation from the providers' perspective in breast and gynecological cancer centers. METHODS Semi-structured guideline-based expert interviews were conducted with providers from breast and gynecological cancer centers with and without patient participation in multidisciplinary tumor conferences. Interviews were transcribed, anonymized and analyzed using qualitative content analysis. RESULTS The providers (n = 30) reported that some process steps of shared decision making can be implemented in limited form and under certain conditions in multidisciplinary tumor conferences with patient participation. Above all, patients can potentially ask questions and contribute individual additional information and their preferences. CONCLUSION This study contributes first insights into the implementation of shared decision making in multidisciplinary tumor conferences with patient participation. From the providers' perspective, the implementation of shared decision making seems difficult under the current circumstances. Further studies, using patient experiences, participative observations or interventional designs, are required. PRACTICE IMPLICATIONS Despite the limited implementation of shared decision making in tumor conferences, patient participation can be advantageous as it can allow patients to ask questions and contribute individual additional information as well as their preferences.
Collapse
Affiliation(s)
- Barbara Bohmeier
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Germany; Center for Integrated Oncology (CIO), University Hospital Bonn, Germany.
| | - Barbara Schellenberger
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Germany; Center for Integrated Oncology (CIO), University Hospital Bonn, Germany
| | - Annika Diekmann
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Germany; Center for Integrated Oncology (CIO), University Hospital Bonn, Germany
| | - Nicole Ernstmann
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Germany; Center for Integrated Oncology (CIO), University Hospital Bonn, Germany; Institute for Patient Safety, University Hospital Bonn, Germany
| | - Lena Ansmann
- Division for Organizational Health Services Research, Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Germany
| | - Christian Heuser
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Germany; Center for Integrated Oncology (CIO), University Hospital Bonn, Germany
| |
Collapse
|
42
|
Dodelzon K, Grimm LJ, Tran K, Dontchos BN, Destounis S, Dialani V, Dogan B, Sonnenblick E, Zuley M, Milch HS. Impact of COVID-19 on Breast Imaging Practice Operations and Recovery Efforts: A North American Study. JOURNAL OF BREAST IMAGING 2021; 3:156-167. [PMID: 38424821 PMCID: PMC7928933 DOI: 10.1093/jbi/wbab002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To assess the impact of the COVID-19 pandemic on breast imaging facilities' operations and recovery efforts across North America. METHODS A survey on breast imaging facilities' operations and strategies for recovery during the COVID-19 pandemic was distributed to the membership of the Society of Breast Imaging and National Consortium of Breast Centers from June 4, 2020, to July 14, 2020. A descriptive summary of responses was performed. Comparisons were made between demographic variables of respondents and questions of interest using a Pearson chi-square test. RESULTS There were 473 survey respondents (response rate of 13%). The majority of respondents (70%; 332/473) reported 80%-100% breast imaging volume reduction, with 94% (447/473) reporting postponement of screening mammography. The majority of respondents (97%; 457/473) continued to perform biopsies. There were regional differences in safety measures taken for staff (P = 0.004), with practices in the West more likely reporting no changes in the work environment compared to other regions. The most common changes to patients' experience included spacing out of furniture in waiting rooms (94%; 445/473), limiting visitors (91%; 430/473), and spacing out appointments (83%). A significantly higher proportion of practices in the Northeast (95%; 104/109) initiated patient scheduling changes compared to other regions (P = 0.004). CONCLUSION COVID-19 had an acute impact on breast imaging facilities. Although common national operational patterns emerged, geographic variability was notable in particular in recovery efforts. These findings may inform future best practices for delivering breast imaging care amid the ongoing and geographically shifting COVID-19 pandemic.
Collapse
Affiliation(s)
- Katerina Dodelzon
- Weill Cornell at NewYork-Presbyterian, Department of Radiology, New York, NYUSA
| | - Lars J Grimm
- Duke University Medical Center, Department of Radiology, Durham, NC, USA
| | - Khai Tran
- SutterHealth, Breast Imaging Division, Sacramento, CA, USA
| | - Brian N Dontchos
- Massachusetts General Hospital, Department of Radiology, Boston, MA, USA
| | - Stamatia Destounis
- Elizabeth Wende Breast Care, Department of Radiology, Rochester, NY, USA
| | - Vandana Dialani
- Beth Israel Lahey Health, Department of Radiology, Boston, MA, USA
| | - Basak Dogan
- The University of Texas Southwestern Medical Center, Department of Radiology, Dallas, TX, USA
| | - Emily Sonnenblick
- Icahn School of Medicine at Mount Sinai, Department of Radiology, New York, NY, USA
| | - Margarita Zuley
- University of Pittsburgh, Department of Radiology, Pittsburgh, PA, USA
| | - Hannah S Milch
- David Geffen School of Medicine at UCLA, Department of Radiology, Los Angeles, CA, USA
| |
Collapse
|
43
|
Kurniawan A, Halim DA, Giselvania A, Sutandyo N, Panigoro SS, Adisasmita A, Hatma RD. Breast Cancer Management during Coronavirus Disease 2019 Pandemic: A Literature Review. ASIAN JOURNAL OF ONCOLOGY 2021. [DOI: 10.1055/s-0040-1722809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Abstract
Introduction Breast cancer is the most prevalent cancer found in women. The World Health Organization declared the coronavirus disease 2019 (COVID-19) as a public health emergency of international concern. Delaying treatment was associated with mortality. The aim is to evaluate breast cancer management during the pandemic.
Methods We searched articles evaluating the management of breast cancer in the midst of COVID-19 outbreak, by searching in PubMed, PubMed Central, and Oncology Society related websites. We only included articles discussing adult breast cancer management in COVID-19 era. The two reviewers screened the titles and abstracts.
Results Around 124 articles were found through the searching process. Eight observational trials, two review articles, six guidelines or recommendations, and one letter to the editor were included in final review. It was concluded that breast cancer posed a risk to contract COVID-19. Newly suspected breast cancer could be deferred for screening or diagnosis, except for special breast cancer cases with bleeding, invasive, and complicated tumors. The benefit of radiotherapy option in every case should be carefully weighed against the risk of infection. Oral chemotherapy and hormonal therapy drugs were preferred to be given than intravenous chemotherapy. The scheduled chemotherapy could be adjusted to reduce hospital visit. Each breast cancer patient is different, so they should be discussed in multidisciplinary team consisting of surgical, radiation, and medical oncologists, pathologist, radiologist, palliative care people, nurses, nutritionist, and others related to the field.
Conclusion The International Oncology Society has released recommendations for breast cancer during COVID-19 pandemic but there is still questionable-quality evidence.
Collapse
Affiliation(s)
- Andree Kurniawan
- Department of Internal Medicine, Faculty of Medicine, Pelita Harapan University, Tangerang, Indonesia
- Clinical Epidemiology, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | | | - Angela Giselvania
- Department of Radiation Oncology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Noorwati Sutandyo
- Hematology and Medical Oncology, Department of Internal Medicine, Dharmais Cancer Center Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Sonar Soni Panigoro
- Department of Surgical Oncology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Asri Adisasmita
- Department of Epidemiology, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Ratna Djuwita Hatma
- Department of Epidemiology, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| |
Collapse
|
44
|
Blackwood O, Deb R. Multidisciplinary team approach in breast cancer care: Benefits and challenges. INDIAN J PATHOL MICR 2020; 63:S105-S112. [PMID: 32108641 DOI: 10.4103/ijpm.ijpm_885_19] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The multidisciplinary team approach has been employed internationally for decades, as an attempt to bring collaborative decision-making and concentrate clinical experience from multiple specialties on single patient cases in a systematic fashion. Adoption is not yet worldwide, but is increasing. The role of the histopathologist is central, providing vital information and context to clinical diagnosis and management. Our review summarizes some of the most relevant research on the topic of MDT usage and efficacy in relation to breast cancer, attempting to draw together its advantages and challenges. It is hoped that this review will make a contribution to the current international literature regarding multidisciplinary approaches in breast cancer care.
Collapse
Affiliation(s)
- Owain Blackwood
- Department of Postgraduate Medical Education, Kingæs Mill Hospital, Sherwood Forest Hospitals Foundation Trust, Sutton-in-Ashfield, Nottinghamshire, United Kingdom
| | - Rahul Deb
- Department of Pathology, Royal Derby Hospital, University Hospitals of Derby and Burton, Derby, United Kingdom
| |
Collapse
|
45
|
Heuser C, Diekmann A, Schellenberger B, Bohmeier B, Kuhn W, Karbach U, Ernstmann N, Ansmann L. Patient Participation in Multidisciplinary Tumor Conferences from the Providers' Perspective: Is It Feasible in Routine Cancer Care? J Multidiscip Healthc 2020; 13:1729-1739. [PMID: 33273821 PMCID: PMC7708776 DOI: 10.2147/jmdh.s283166] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 11/16/2020] [Indexed: 12/18/2022] Open
Abstract
Objective Recent studies from Germany show that a small amount of breast and gynecological cancer patients participate in multidisciplinary tumor conferences (MTCs) at some cancer centers. One reason for the variation by center might be the providers’ attitudes about and experiences with MTC patient participation (MTCpp), which has not been analyzed before. Therefore, it is the aim of this study to analyze the providers’ expected or experienced feasibility concerning MTCpp at breast and gynecological cancer centers in Germany. Methods This paper presents cross-sectional qualitative interview data from the PINTU study. From April to December 2018, n=30 health-care providers from n=6 breast and gynecological cancer centers in North-Rhine-Westphalia, Germany, were interviewed. One-half of the providers had no experience and the other half had experience with MTCpp. Inductive and deductive coding was performed in order to capture the feasibility aspects of participation. Results MTCpp seems not to be feasible in routine cancer care following providers’ expected barriers and negative experiences. However, MTCpp seems to be feasible for selected cancer patients following providers’ expected opportunities and positive experiences. Our results show that both provider groups report positive and negative experiences or expectations. Conclusion The mixed findings regarding expected or experienced feasibility of MTCpp provide first insights into differences concerning MTCpp between organizations. Our results suggest that the providers’ perceptions (expectations and experiences) influence the possibility for patients to participate in an MTC in a cancer center.
Collapse
Affiliation(s)
- Christian Heuser
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, Germany
| | - Annika Diekmann
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, Germany
| | - Barbara Schellenberger
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, Germany
| | - Barbara Bohmeier
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, Germany
| | - Walther Kuhn
- Gynecological Cancer Center Deggendorf, DONAUISAR Hospital, Deggendorf, Germany
| | - Ute Karbach
- Sociology in Rehabilitation, Faculty of Rehabilitation Sciences, Technical University Dortmund, Dortmund, Germany
| | - Nicole Ernstmann
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, Germany
| | - Lena Ansmann
- Division for Organizational Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| |
Collapse
|
46
|
Tsai CH, Hsieh HF, Lai TW, Kung PT, Kuo WY, Tsai WC. Effect of multidisciplinary team care on the risk of recurrence in breast cancer patients: A national matched cohort study. Breast 2020; 53:68-76. [PMID: 32652461 PMCID: PMC7375674 DOI: 10.1016/j.breast.2020.07.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 07/01/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Cancer has been the leading cause of death in the past decade in Taiwan, with breast cancer being the most common type of cancer in females. Very few studies looked at the risk of recurrence in patients who received multidisciplinary team (MDT) care. We analyzed the influence of MDT on the risk of recurrence and death in breast cancer patients. METHOD In this retrospective study, we included newly diagnosed patients from 2004 to 2010. The study included 9,266 breast cancer patients who were enrolled in MDT care and 9,266 patients who were not. The study used log-rank test to analyze patients' characteristics, hospital characteristics, cancer staging, and treatment methods to compare the recurrence rates in MDT care and non-MDT care participants. We used Cox proportional hazards model to examine the effect of MDT and associated factors on the risk of recurrence and mortality of breast cancer patients. RESULTS Relative risk of recurrence was lower for patients who received MDT care than for patients who did not (HR, 0.84; 95%CI: 0.70-0.99) after matching. The mortality risk for breast cancer patients with relapse was 8.48 times (95%CI: 7.53-9.54) than that for patients without relapse. CONCLUSIONS The relative risk of recurrence and death was significantly lower for breast cancer patients who received MDT care than for those who did not. We suggest that MDT care be implanted in the National Health Policy settings of breast cancer patients.
Collapse
Affiliation(s)
- Chang-Hung Tsai
- Miao-Li General Hospital, Ministry of Health and Welfare, Taiwan, ROC; Department of Health Services Administration, China Medical University, Taichung, Taiwan, ROC; Department of Public Health, China Medical University, Taichung, Taiwan, ROC
| | | | - Ting-Wei Lai
- Management Center, China Medical University Hospital, Taichung, Taiwan, ROC
| | - Pei-Tseng Kung
- Department of Healthcare Administration, Asia University, Taichung, Taiwan, ROC; Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan, ROC
| | - Wei-Yin Kuo
- Department of Health Services Administration, China Medical University, Taichung, Taiwan, ROC
| | - Wen-Chen Tsai
- Department of Health Services Administration, China Medical University, Taichung, Taiwan, ROC.
| |
Collapse
|
47
|
Moilanen T, Leino-Kilpi H, Kuusisto H, Rautava P, Seppänen L, Siekkinen M, Sulosaari V, Vahlberg T, Stolt M. Leadership and administrative support for interprofessional collaboration in a cancer center. J Health Organ Manag 2020; ahead-of-print. [PMID: 32894012 DOI: 10.1108/jhom-01-2020-0007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The interprofessional collaboration is a key practice for providing cancer care. However, the realization of collaboration requires effective leadership and administrative support. In this study, the aim was to analyze healthcare professionals' perceptions of leadership and administrative support (strategic and management) in interprofessional collaboration for developing practices in cancer care. DESIGN/METHODOLOGY/APPROACH A descriptive survey design was used to collect data from healthcare professionals (n = 350, response rate 33.3%), including nurses, physicians and other professionals participating in patient care in one Finnish cancer center (out of five) in 05/2018-10/2018. The data were analyzed using descriptive and inferential statistics. The instrument focused on leadership in the work unit and administrative support including organization strategy and organizational management. FINDINGS Healthcare professionals perceived leadership in the work unit, organization strategy and management for the support of interprofessional collaboration as weak. However, the ratings of male respondents and those in leading positions were more positive. The findings indicate that healthcare professionals in the cancer care setting are dissatisfied with the leadership and administrative support. RESEARCH LIMITATIONS/IMPLICATIONS Interprofessional collaboration, including its leadership, requires systematic and constant evaluation and development. ORIGINALITY/VALUE Healthcare leaders in the cancer care setting can use the results to identify factors that might be in need of attention and development in the field of interprofessional collaboration.
Collapse
Affiliation(s)
| | - Helena Leino-Kilpi
- Department of Nursing Science, University of Turku, Turku, Finland.,Turku University Hospital, Turku, Finland
| | | | - Päivi Rautava
- University of Turku, Turku, Finland.,Turku University Hospital, Turku, Finland
| | - Laura Seppänen
- Finnish Institute of Occupational Health, Helsinki, Finland
| | | | - Virpi Sulosaari
- Department of Nursing Science, University of Turku, Turku, Finland.,Turku University of Applied Sciences, Turku, Finland
| | - Tero Vahlberg
- Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Minna Stolt
- Department of Nursing Science, University of Turku, Turku, Finland.,Turku University Hospital, Turku, Finland
| |
Collapse
|
48
|
Rankin NM, Fradgley EA, Barnes DJ. Implementation of lung cancer multidisciplinary teams: a review of evidence-practice gaps. Transl Lung Cancer Res 2020; 9:1667-1679. [PMID: 32953540 PMCID: PMC7481625 DOI: 10.21037/tlcr.2019.11.32] [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] [Indexed: 12/11/2022]
Abstract
Multidisciplinary care (MDC) is considered best practice in lung cancer care. Health care services have made significant investments in MDC through the establishment of multidisciplinary team (MDT) meetings. This investment is likely to be sustained in future. It is imperative that MDT meetings are efficient, effective, and sufficiently nimble to introduce new innovations to enable best practice. In this article, we consider the ‘evidence-practice gaps’ in the implementation of lung cancer MDC. These gaps were derived from the recurrent limitations outlined in existing studies and reviews. We address the contributions that implementation science and quality improvement can make to bridge these gaps by increasing translation and improving the uptake of innovations by teams.
Collapse
Affiliation(s)
- Nicole M Rankin
- Faculty of Medicine and Health Sciences, University of Sydney, Camperdown, New South Wales, Australia
| | - Elizabeth A Fradgley
- University of Newcastle Priority Research Centre for Cancer Research, Innovation and Translation, Callaghan, New South Wales, Australia.,University of Newcastle Priority Research Centre for Health Behaviour, Callaghan, New South Wales, Australia.,School of Medicine & Public Health, University Drive, Callaghan, New South Wales, Australia
| | - David J Barnes
- Faculty of Medicine and Health Sciences, University of Sydney, Camperdown, New South Wales, Australia.,Sydney Local Health District, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| |
Collapse
|
49
|
Cardoso F, Wilking N, Bernardini R, Biganzoli L, Espin J, Miikkulainen K, Schuurman S, Spence D, Spitz S, Ujupan S, Zernik N, Gordon J. A multi-stakeholder approach in optimising patients' needs in the benefit assessment process of new metastatic breast cancer treatments. Breast 2020; 52:78-87. [PMID: 32450470 PMCID: PMC7487948 DOI: 10.1016/j.breast.2020.04.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/24/2020] [Accepted: 04/24/2020] [Indexed: 11/25/2022] Open
Abstract
There is a growing understanding as science evolves that different cancer types require different approaches to treatment evaluation, especially in the metastatic stages. The introduction of new metastatic breast cancer (MBC) treatments may be hindered by several elements, including the availability of relevant evidence related to disease-specific outcomes, the benefit assessment process around the evaluation of the clinical benefit and the patients' need of new treatments. The Steering Committee (SC) found that not all issues relevant to MBC patients are consistently considered in the current benefit assessment process of new treatments. Among these are overall survival, time-to-event endpoints (e.g. progression-free survival), patients' priorities, burden of disease, MBC-specific quality of life, value in delaying chemotherapy, route of administration, side effects and toxicities, treatment adherence and the benefit of real-world evidence. This paper calls on decision makers to (1) Include MBC-specific patient priorities and outcomes in the overall benefit assessments of new MBC treatments; (2) Enhance multi-stakeholder collaboration in order to improve MBC patient outcomes.
Collapse
Affiliation(s)
- Fatima Cardoso
- Champalimaud Clinical Centre, Champalimaud Foundation and ABC Global Alliance, Lisbon, Portugal.
| | | | | | - Laura Biganzoli
- Hospital of Prato and European Society of Breast Cancer Specialists, Florence, Italy
| | - Jaime Espin
- Andalusian School of Public Health, Escuela Andaluza de Salud Pública (EASP), Granada, Spain; CIBER en Epidemiología y Salud Pública / CIBER of Epidemiology and Public Health (CIBERESP), Spain; Instituto de Investigación Biosanitaria ibs, Granada, Spain
| | | | | | | | - Sabine Spitz
- Europa Donna, Vienna, Austria and European Patients' Academy on Therapeutic Innovation (EUPATI)
| | | | | | - Jenn Gordon
- Canadian Breast Cancer Network, Ottawa, ON, Canada
| |
Collapse
|
50
|
Liu R, Wang J, Ukai M, Sewon K, Chen P, Suzuki Y, Wang H, Aihara K, Okada-Hatakeyama M, Chen L. Hunt for the tipping point during endocrine resistance process in breast cancer by dynamic network biomarkers. J Mol Cell Biol 2020; 11:649-664. [PMID: 30383247 PMCID: PMC7727267 DOI: 10.1093/jmcb/mjy059] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 09/29/2018] [Accepted: 10/31/2018] [Indexed: 02/07/2023] Open
Abstract
Acquired drug resistance is the major reason why patients fail to respond to cancer therapies. It is a challenging task to determine the tipping point of endocrine resistance and detect the associated molecules. Derived from new systems biology theory, the dynamic network biomarker (DNB) method is designed to quantitatively identify the tipping point of a drastic system transition and can theoretically identify DNB genes that play key roles in acquiring drug resistance. We analyzed time-course mRNA sequence data generated from the tamoxifen-treated estrogen receptor (ER)-positive MCF-7 cell line, and identified the tipping point of endocrine resistance with its leading molecules. The results show that there is interplay between gene mutations and DNB genes, in which the accumulated mutations eventually affect the DNB genes that subsequently cause the change of transcriptional landscape, enabling full-blown drug resistance. Survival analyses based on clinical datasets validated that the DNB genes were associated with the poor survival of breast cancer patients. The results provided the detection for the pre-resistance state or early signs of endocrine resistance. Our predictive method may greatly benefit the scheduling of treatments for complex diseases in which patients are exposed to considerably different drugs and may become drug resistant.
Collapse
Affiliation(s)
- Rui Liu
- School of Mathematics, South China University of Science and Technology, Guangzhou, China
| | - Jinzeng Wang
- School of Life Sciences and Technology, Tongji University, Shanghai, China.,National Research Center for Translational Medicine (Shanghai), Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Masao Ukai
- Graduate School of Medical Life Science, Yokohama City University, Yokohama 230-0045, Japan.,Laboratory for Integrated Cellular Systems, RIKEN Center for Integrative Medical Sciences (IMS), Yokohama, Japan
| | - Ki Sewon
- Laboratory for Integrated Cellular Systems, RIKEN Center for Integrative Medical Sciences (IMS), Yokohama, Japan
| | - Pei Chen
- School of Mathematics, South China University of Science and Technology, Guangzhou, China.,Key Laboratory of Systems Biology, Center for Excellence in Molecular Cell Science, Shanghai Institute of Biochemistry and Cell Biology, Chinese Academy of Sciences, Shanghai, China
| | - Yutaka Suzuki
- Department of Medical Genome Sciences, Graduate School of Frontier Sciences, The University of Tokyo, Chiba, Japan
| | - Haiyun Wang
- School of Life Sciences and Technology, Tongji University, Shanghai, China
| | - Kazuyuki Aihara
- Institute of Industrial Science, The University of Tokyo, Tokyo, Japan
| | - Mariko Okada-Hatakeyama
- Graduate School of Medical Life Science, Yokohama City University, Yokohama 230-0045, Japan.,Laboratory for Integrated Cellular Systems, RIKEN Center for Integrative Medical Sciences (IMS), Yokohama, Japan.,Laboratory of Cell Systems, Osaka University, Osaka, Japan
| | - Luonan Chen
- Key Laboratory of Systems Biology, Center for Excellence in Molecular Cell Science, Shanghai Institute of Biochemistry and Cell Biology, Chinese Academy of Sciences, Shanghai, China.,Institute of Industrial Science, The University of Tokyo, Tokyo, Japan.,Center for Excellence in Animal Evolution and Genetics, Chinese Academy of Sciences, Kunming, China.,School of Life Science and Technology, ShanghaiTech University, Shanghai, China.,Shanghai Research Center for Brain Science and Brain-Inspired Intelligence, Shanghai, China
| |
Collapse
|