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Cavanna L, Citterio C, Mordenti P, Proietto M, Bosi C, Vecchia S. Cancer Treatment Closer to the Patient Reduces Travel Burden, Time Toxicity, and Improves Patient Satisfaction, Results of 546 Consecutive Patients in a Northern Italian District. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2121. [PMID: 38138224 PMCID: PMC10744793 DOI: 10.3390/medicina59122121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/20/2023] [Accepted: 11/23/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: The distance to cancer facilities may cause disparities by creating barriers to oncologic diagnosis and treatment, and travel burden may cause time and financial toxicity. Materials and Methods: To relieve travel burden, a program to deliver oncologic treatment closer to the patient was initiated in the district of Piacenza (Northern Italy) several years ago. The oncologic activities are performed by oncologists and by nurses who travel from the oncologic ward of the city hospital to territorial centres to provide cancer patient management. This model is called Territorial Oncology Care (TOC): patients are managed near their home, in three territorial hospitals and in a health centre, named "Casa della Salute" (CDS). A retrospective study was performed and the records of patients with cancer managed in the TOC program were analysed. The primary endpoints were the km and time saved, the secondary endpoints: reduction of caregiver need for transport and patient satisfaction. Results: 546 cancer patients managed in the TOC program from 2 January 2021 to 30 June 2022 were included in this study. Primary endpoints: median km to reach the city hospital: 26 (range 11-79 km) median time: 44 min (range 32-116); median km to reach the territorial clinicians in the TOC program: 7 (range 1-35 km), median time: 16 minutes (range 6-54), p < 0.001. Secondary endpoints: 64.8% of patients who needed a caregiver for the city hospital could travel alone in the TOC program and 99.63% of patients were satisfied. Conclusions: The results of this retrospective study highlight the possibility of treating cancer patients near their residence, reducing travel burden and saving time.
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Affiliation(s)
- Luigi Cavanna
- Casa di Cura Piacenza, Internal Medicine and Oncology, Via Morigi 3, 29121 Piacenza, Italy
| | - Chiara Citterio
- Department of Oncology and Hematology, AUSL Piacenza, Via Taverna 49, 29121 Piacenza, Italy; (C.C.); (P.M.); (M.P.); (C.B.)
| | - Patrizia Mordenti
- Department of Oncology and Hematology, AUSL Piacenza, Via Taverna 49, 29121 Piacenza, Italy; (C.C.); (P.M.); (M.P.); (C.B.)
| | - Manuela Proietto
- Department of Oncology and Hematology, AUSL Piacenza, Via Taverna 49, 29121 Piacenza, Italy; (C.C.); (P.M.); (M.P.); (C.B.)
| | - Costanza Bosi
- Department of Oncology and Hematology, AUSL Piacenza, Via Taverna 49, 29121 Piacenza, Italy; (C.C.); (P.M.); (M.P.); (C.B.)
| | - Stefano Vecchia
- Pharmacy Unit, AUSL Piacenza, Via Taverna 49, 29121 Piacenza, Italy;
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Mroczkowski P, Dziki Ł, Vosikova T, Otto R, Merecz-Sadowska A, Zajdel R, Zajdel K, Lippert H, Jannasch O. Rectal Cancer: Are 12 Lymph Nodes the Limit? Cancers (Basel) 2023; 15:3447. [PMID: 37444557 DOI: 10.3390/cancers15133447] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/18/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023] Open
Abstract
Lymph node dissection is a crucial element of oncologic rectal surgery. Many guidelines regard the removal of at least 12 lymph nodes as the quality criterion in rectal cancer. However, this recommendation remains controversial. This study examines the factors influencing the lymph node yield and the validity of the 12-lymph node limit. Patients with rectal cancer who underwent low anterior resection or abdominoperineal amputation between 2000 and 2010 were analyzed. In total, 20,966 patients from 381 hospitals were included. Less than 12 lymph nodes were found in 20.53% of men and 19.31% of women (p = 0.03). The number of lymph nodes yielded increased significantly from 2000, 2005 and 2010 within the quality assurance program for all procedures. The univariate analysis indicated a significant (p < 0.001) correlation between lymph node yield and gender, age, pre-therapeutic T-stage, risk factors and neoadjuvant therapy. The multivariate analyses found T3 stage, female sex, the presence of at least one risk factor and neoadjuvant therapy to have a significant influence on yield. The probability of finding a positive lymph node was proportional to the number of examined nodes with no plateau. There is a proportional relationship between the number of examined lymph nodes and the probability of finding an infiltrated node. Optimal surgical technique and pathological evaluation of the specimen cannot be replaced by a numeric cut-off value.
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Affiliation(s)
- Paweł Mroczkowski
- Department for General and Colorectal Surgery, Medical University of Lodz, Pl. Hallera 1, 90-647 Lodz, Poland
- Institute for Quality Assurance in Operative Medicine Ltd., Otto-von-Guericke-University, Leipziger Str. 44, D-39120 Magdeburg, Germany
- Department for Surgery, University Hospital Knappschaftskrankenhaus, Ruhr-University, In der Schornau 23-25, D-44892 Bochum, Germany
| | - Łukasz Dziki
- Department for General and Colorectal Surgery, Medical University of Lodz, Pl. Hallera 1, 90-647 Lodz, Poland
| | - Tereza Vosikova
- Institute for Quality Assurance in Operative Medicine Ltd., Otto-von-Guericke-University, Leipziger Str. 44, D-39120 Magdeburg, Germany
| | - Ronny Otto
- Institute for Quality Assurance in Operative Medicine Ltd., Otto-von-Guericke-University, Leipziger Str. 44, D-39120 Magdeburg, Germany
| | - Anna Merecz-Sadowska
- Department of Economic and Medical Informatics, University of Lodz, 90-214 Lodz, Poland
| | - Radosław Zajdel
- Department of Economic and Medical Informatics, University of Lodz, 90-214 Lodz, Poland
| | - Karolina Zajdel
- Department of Medical Informatics and Statistics, Medical University of Lodz, 90-645 Lodz, Poland
| | - Hans Lippert
- Institute for Quality Assurance in Operative Medicine Ltd., Otto-von-Guericke-University, Leipziger Str. 44, D-39120 Magdeburg, Germany
- Department for General, Visceral and Vascular Surgery, Otto-von-Guericke-University, Leipziger Str. 44, D-39120 Magdeburg, Germany
| | - Olof Jannasch
- Institute for Quality Assurance in Operative Medicine Ltd., Otto-von-Guericke-University, Leipziger Str. 44, D-39120 Magdeburg, Germany
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The influence of socioeconomic aspects and hospital case volume on survival in colorectal cancer in Saxony, Germany. BMC Cancer 2023; 23:228. [PMID: 36899313 PMCID: PMC9999591 DOI: 10.1186/s12885-023-10672-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/23/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is one of the most common types of cancer in Western civilization and responsible for a high number of yearly deaths. Long-term outcome is influenced by many factors, potentially including socioeconomic aspects like income, education, and employment. Furthermore, annual surgical case volume plays a major role in achieving good oncological results. In our retrospective study, we evaluated the effect of socioeconomic deprivation and hospital volume on overall survival (OS) in the federal state of Saxony, Germany. METHODS All patients with CRC who underwent surgery in Saxony, Germany between 2010 and 2020 and were living in Saxony at the time of diagnosis were included in our retrospective analysis. Uni- and multivariate analyses were conducted considering age, sex, tumor localization, UICC tumor stage, surgical approach (open/laparoscopic), number of resected lymph nodes, adjuvant chemotherapy, year of surgery, and hospital case volume. In addition, our model was adjusted for social disparity using the German Index of Socioeconomic Deprivation (GISD). RESULTS A total of 24,085 patients were analyzed (15,883 with colon cancer and 8,202 with rectal cancer). Age, sex, UICC tumor stage and tumor localization were distributed as expected for CRC. Median overall survival time was 87.9 months for colon cancer and 110.0 months for rectal cancer. Univariate analysis revealed laparoscopic surgery (colon and rectum P < 0.001), high case volume (rectum: P = 0.002) and low levels of socioeconomic deprivation (colon and rectum P < 0.001) to be significantly associated with better survival. In multivariate analyses, the associations of laparoscopic surgery (colon: HR = 0.76, P < 0.001; rectum: HR = 0.87, P < 0.01), and mid-low to mid-high socioeconomic deprivation (colon: HR = 1.18-1.22, P < 0.001; rectum: HR = 1.18-1.36, P < 0.001-0.01) remained statistically significant. Higher hospital case volume was associated with better survival only in rectal cancer (HR = 0.89; P < 0.01). CONCLUSION In Saxony, Germany, better long-term survival after CRC surgery was associated with low socioeconomic deprivation, laparoscopic surgery and partly with high hospital case volume. Thus, there is a need to reduce social differences in access to high-quality treatment and prevention and increase hospital patient volume.
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Warps AK, Saraste D, Westerterp M, Detering R, Sjövall A, Martling A, Dekker JWT, Tollenaar RAEM, Matthiessen P, Tanis PJ. National differences in implementation of minimally invasive surgery for colorectal cancer and the influence on short-term outcomes. Surg Endosc 2022; 36:5986-6001. [PMID: 35258664 PMCID: PMC9283170 DOI: 10.1007/s00464-021-08974-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 12/31/2021] [Indexed: 12/24/2022]
Abstract
Background The timing and degree of implementation of minimally invasive surgery (MIS) for colorectal cancer vary among countries. Insights in national differences regarding implementation of new surgical techniques and the effect on postoperative outcomes are important for quality assurance, can show potential areas for country-specific improvement, and might be illustrative and supportive for similar implementation programs in other countries. Therefore, this study aimed to evaluate differences in patient selection, applied techniques, and results of minimal invasive surgery for colorectal cancer between the Netherlands and Sweden. Methods Patients who underwent elective minimally invasive surgery for T1-3 colon or rectal cancer (2012–2018) registered in the Dutch ColoRectal Audit or Swedish ColoRectal Cancer Registry were included. Time trends in the application of MIS were determined. Outcomes were compared for time periods with a similar level of MIS implementation (Netherlands 2012–2013 versus Sweden 2017–2018). Multilevel analyses were performed to identify factors associated with adverse short-term outcomes. Results A total of 46,095 Dutch and 8,819 Swedish patients undergoing MIS for colorectal cancer were included. In Sweden, MIS implementation was approximately 5 years later than in the Netherlands, with more robotic surgery and lower volumes per hospital. Although conversion rates were higher in Sweden, oncological and surgical outcomes were comparable. MIS in the Netherlands for the years 2012–2013 resulted in a higher reoperation rate for colon cancer and a higher readmission rate but lower non-surgical complication rates for rectal cancer if compared with MIS in Sweden during 2017–2018. Conclusion This study showed that the implementation of MIS for colorectal cancer occurred later in Sweden than the Netherlands, with comparable outcomes despite lower volumes. Our study demonstrates that new surgical techniques can be implemented at a national level in a controlled and safe way, with thorough quality assurance. Supplementary Information The online version contains supplementary material available at 10.1007/s00464-021-08974-1.
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Affiliation(s)
- A K Warps
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, Netherlands.,Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, 2333 AA, Leiden, Netherlands
| | - D Saraste
- Department of Surgery, Södersjukhuset, 118 83, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Insitutet, 171 76, Stockholm, Sweden
| | - M Westerterp
- Department of Surgery, Haagland Medisch Centrum, Lijnbaan 32, 2512 VA, Den Haag, Netherlands
| | - R Detering
- Department of Surgery, Amsterdam University Medical Centres, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands
| | - A Sjövall
- Department of Molecular Medicine and Surgery, Karolinska Insitutet, 171 76, Stockholm, Sweden.,Department of Surgery, Karolinska University Hospital, Anna Steckséns gata 53, 171 64, Solna, Sweden
| | - A Martling
- Department of Molecular Medicine and Surgery, Karolinska Insitutet, 171 76, Stockholm, Sweden.,Department of Surgery, Karolinska University Hospital, Anna Steckséns gata 53, 171 64, Solna, Sweden
| | - J W T Dekker
- Department of Surgery, Reinier de Graaf Groep, Reinier de Graafweg 5, 2625 AD, Delft, Netherlands
| | - R A E M Tollenaar
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, Netherlands.,Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, 2333 AA, Leiden, Netherlands
| | - P Matthiessen
- Department of Surgery, Örebro University Hospital, von Rosens väg 1, 70185, Örebro, Sweden.,Department of Surgery, Faculty of Medicine and Health Sciences, Örebro University, 70182, Örebro, Sweden
| | - P J Tanis
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam University Medical Centres, University of Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands.
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Hendren S, Kanters AE, Morris AM, Abdelsattar ZM, Berry RR, Resnicow K, Birkmeyer NJ. Barriers to high-quality rectal cancer care: A qualitative study. Am J Surg 2022; 224:483-488. [DOI: 10.1016/j.amjsurg.2022.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/27/2021] [Accepted: 01/19/2022] [Indexed: 11/25/2022]
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Pooni A, Schmocker S, Brown C, MacLean A, Hochman D, Williams L, Baxter N, Simunovic M, Liberman S, Drolet S, Neumann K, Jhaveri K, Kirsch R, Kennedy ED. Quality indicator selection for the Canadian Partnership against Cancer rectal cancer project: A modified Delphi study. Colorectal Dis 2021; 23:1393-1403. [PMID: 33626193 DOI: 10.1111/codi.15599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 12/17/2022]
Abstract
AIM It is well established that (i) magnetic resonance imaging, (ii) multidisciplinary cancer conference (MCCs), (iii) preoperative radiotherapy, (iv) total mesorectal excision surgery and (v) pathological assessment as described by Quirke are key processes necessary for high quality, rectal cancer care. The objective was to select a set of multidisciplinary quality indicators to measure the uptake of these clinical processes in clinical practice. METHOD A multidisciplinary panel was convened and a modified two-phase Delphi method was used to select a set of quality indicators. Phase 1 included a literature review with written feedback from the panel. Phase 2 included an in-person workshop with anonymous voting. The selection criteria for the indicators were strength of evidence, ease of capture and usability. Indicators for which ≥90% of the panel members voted 'to keep' were selected as the final set of indicators. RESULTS During phase 1, 68 potential indicators were generated from the literature and an additional four indicators were recommended by the panel. During phase 2, these 72 indicators were discussed; 48 indicators met the 90% inclusion threshold and included eight pathology, five radiology, 11 surgical, six radiation oncology and 18 MCC indicators. CONCLUSION A modified Delphi method was used to select 48 multidisciplinary quality indicators to specifically measure the uptake of key processes necessary for high quality care of patients with rectal cancer. These quality indicators will be used in future work to identify and address gaps in care in the uptake of these clinical processes.
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Affiliation(s)
- Amandeep Pooni
- Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada.,Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, ON, Canada
| | - Selina Schmocker
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, ON, Canada
| | - Carl Brown
- Department of Colorectal Surgery, St Paul's Hospital, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Anthony MacLean
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - David Hochman
- Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Lara Williams
- Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Nancy Baxter
- University of Toronto, Toronto, ON, Canada.,Department of Surgery, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Marko Simunovic
- Department of Surgery, St Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
| | - Sender Liberman
- Department of Surgery, McGill University, Montreal, QC, Canada
| | - Sébastien Drolet
- Department of Surgery, Université Laval, Quebec City, QC, Canada
| | - Katerina Neumann
- Department of Surgery, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | - Kartik Jhaveri
- University of Toronto, Toronto, ON, Canada.,Joint Department of Medical Imaging, Mount Sinai Hospital and Women's College Hospital, University Health Network, Toronto, ON, Canada
| | - Richard Kirsch
- University of Toronto, Toronto, ON, Canada.,Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada
| | - Erin D Kennedy
- Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada.,Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, ON, Canada
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7
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Lawler M, Oliver K, Gijssels S, Aapro M, Abolina A, Albreht T, Erdem S, Geissler J, Jassem J, Karjalainen S, La Vecchia C, Lievens Y, Meunier F, Morrissey M, Naredi P, Oberst S, Poortmans P, Price R, Sullivan R, Velikova G, Vrdoljak E, Wilking N, Yared W, Selby P. The European Code of Cancer Practice. J Cancer Policy 2021; 28:100282. [DOI: 10.1016/j.jcpo.2021.100282] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/19/2021] [Accepted: 03/31/2021] [Indexed: 12/11/2022]
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Atallah C, Oduyale O, Stem M, Eltahir A, Almaazmi HH, Efron JE, Safar B. Are academic hospitals better at treating metastatic colorectal cancer? Surgery 2020; 169:248-256. [PMID: 32680747 DOI: 10.1016/j.surg.2020.05.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/03/2020] [Accepted: 05/05/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND There is a strong association between hospital volume and surgical outcomes in resectable colorectal cancer. The purpose of our study was to investigate the association between hospital facility type and survival of patients with metastatic colorectal cancer. METHODS Adults from the National Cancer Database (2010-2015) with a primary diagnosis of colorectal metastases were included and stratified by facility type: community cancer program, comprehensive community cancer program, and academic/research program. The primary outcome was 5-year overall survival, analyzed using Kaplan-Meier survival curves, log-rank test, and the Cox proportional hazards regression model. RESULTS Among the 52,958 included patients, 13.72% were treated at a community cancer program, 49.89% at a comprehensive community cancer program, and 36.29% at an academic/research program. A significant increase in the proportion of patients being treated in an academic/research program has been observed from 2010 to 2015. An academic/research program tended to use more chemotherapy with colorectal radical resection and liver or lung resection and immunotherapy with chemotherapy. In adjusted analysis, the academic/research program had decreased risk of mortality in comparison to the community cancer program and the comprehensive community cancer program (hazard ratio 0.90, 95% confidence interval 0.86-0.94; 0.87, 0.85-0.90; each P < .001; respectively). Similar results were seen after stratifying by metastatic site and treatment type. CONCLUSION The prognosis and overall survival of patients with metastatic disease is better in an academic/research program compared with a community cancer program or a comprehensive community cancer program, with this difference persisting across sites of metastatic disease and treatment types. Further studies are required to validate these results and investigate disparities in the management of metastatic colorectal cancer.
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Affiliation(s)
- Chady Atallah
- Colorectal Research Unit, Ravitch Colorectal Division, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Oluseye Oduyale
- Colorectal Research Unit, Ravitch Colorectal Division, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Miloslawa Stem
- Colorectal Research Unit, Ravitch Colorectal Division, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ahmed Eltahir
- Colorectal Research Unit, Ravitch Colorectal Division, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Hamda H Almaazmi
- Colorectal Research Unit, Ravitch Colorectal Division, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Jonathan E Efron
- Colorectal Research Unit, Ravitch Colorectal Division, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Bashar Safar
- Colorectal Research Unit, Ravitch Colorectal Division, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
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Simon C, Nicolai P, Paderno A, Dietz A. Best Practice in Surgical Treatment of Malignant Head and Neck Tumors. Front Oncol 2020; 10:140. [PMID: 32117778 PMCID: PMC7028740 DOI: 10.3389/fonc.2020.00140] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 01/27/2020] [Indexed: 02/05/2023] Open
Abstract
Purpose of review: Defining the best practice of surgical care for patients affected by malignant head and neck tumors is of great importance. In this review we aim to describe the evolution of “best practice” guidelines in the context of quality-of-care measures and discuss current evidence on “best practice” for the surgical treatment of cancers of the sino-nasal tract, skull base, aero-digestive tract, and the neck. Recent findings: Current evidence based on certain structure and outcome indicators, but mostly based on process indicators already helps defining the framework of “Best practice” for head and neck cancer surgery. However, many aspects of surgical treatment still require in-depth research. Summary: While a framework of “Best practice” strategies already exists for the conduction of the surgical treatment of head and neck cancers, many questions still require additional research in particular in case of rare histologies in the head and neck region.
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Affiliation(s)
- Christian Simon
- Service d'Oto-rhino-laryngologie - Chirurgie cervico-faciale, Centre Hospitalier Universitaire Vaudois (CHUV), Université de Lausanne (UNIL), Lausanne, Switzerland
| | - Piero Nicolai
- Department of Otolaryngology-Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Alberto Paderno
- Department of Otolaryngology-Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Andreas Dietz
- Department of Otolaryngology, Head and Neck Surgery, University Leipzig, Leipzig, Germany
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Kanters AE, Cleary RK, Obi SH, Asgeirsson T, Evilsizer SK, Fasbinder LG, Campbell DA, Hendren SK. Uptake of Total Mesorectal Excision and Total Mesorectal Excision Grading for Rectal Cancer: A Statewide Study. Dis Colon Rectum 2020; 63:53-59. [PMID: 31633602 PMCID: PMC6895431 DOI: 10.1097/dcr.0000000000001526] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Total mesorectal excision is associated with decreased local recurrence and improved disease-free survival following rectal cancer resection. The extent to which total mesorectal excision has been adopted in the United States is unknown. OBJECTIVE We sought to assess trends in total mesorectal excision performance and grading in Michigan hospitals. DESIGN This is a retrospective cohort study from the Michigan Surgical Quality Collaborative. Trends in total mesorectal excision performance and grade assignment were analyzed by using χ tests and linear regression. SETTINGS Participating hospitals (initially 14 hospitals, now 38) abstracted medical records data for rectal cancer cases from 2007 to 2016. PATIENTS Patients who underwent rectal cancer resection were included. MAIN OUTCOME MEASURE The main outcome measures were surgeon-documented total mesorectal excision performance and pathologist-reported total mesorectal excision grade. RESULTS Of 510 rectal cancer cases, 367 (72.0%) had surgeon-reported total mesorectal excision performance and 78 (15.3%) had pathologist-reported total mesorectal excision grade. Between-hospital variability in total mesorectal excision performance ranged from 0% to 97% and total mesorectal excision grading ranged from 0% to 90%. Total mesorectal excision grading was associated with a higher likelihood of also having adequate lymph node assessment (88.5% versus 71.9%, p = 0.002). There has been a statistically significant trend toward an increase in total mesorectal excision grading in the original 14 hospitals (p = 0.001), but not in the complete cohort of all hospitals (p = 0.057). LIMITATIONS This is a retrospective cohort design with sampled rectal cancer cases. In addition, there is insufficient granularity to capture all factors associated with total mesorectal excision performance or grade assignment. CONCLUSIONS The rates of total mesorectal excision performance and grade assignment are widely variable throughout the state of Michigan. Overall, grade assignment remains very low. This suggests an opportunity for quality improvement projects to increase total mesorectal excision performance and grading, involving both the surgeons and pathologists for effective implementation. See Video Abstract at http://links.lww.com/DCR/B53. IMPLEMENTACIÓN DE LA ESCISIÓN MESORRECTAL TOTAL Y LA CLASIFICACIÓN POR ESCISIÓN MESORRECTAL TOTAL PARA EL CÁNCER RECTAL: UN ESTUDIO A NIVEL ESTATAL.: La escisión mesorrectal total se asocia con una menor recurrencia local y una mejor supervivencia libre de enfermedad después de la resección del cáncer rectal. Se desconoce hasta que punto se ha adoptado la escisión mesorrectal total en los Estados Unidos.Se intento evaluar las tendencias en el rendimiento y la clasificación de la escisión mesorrectal total en los hospitales de Michigan.Este es un estudio de cohorte retrospectivo de la "Michigan Surgical Quality Collaborative". Las tendencias en el rendimiento de la escisión mesorrectal total y la asignación de grado se analizaron mediante pruebas de chi-cuadrada y regresión lineal.Los hospitales participantes (inicialmente 14 hospitales, ahora 38) extrajeron datos de registros médicos de los casos de cáncer rectal desde 2007 hasta 2016.Pacientes que se sometieron a resección de cáncer rectal.Las principales medidas de resultado fueron el rendimiento de la escisión mesorrectal total documentado por el cirujano y el grado de escisión mesorrectal total informada por el patólogo.De 510 casos de cáncer rectal, 367 (72.0%) tenían un rendimiento de escisión mesorrectal total reportado por el cirujano y 78 (15.3%) tenían un grado de escisión mesorrectal total reportado por el patólogo. La variabilidad entre hospitales en el rendimiento de la escisión mesorrectal total varió del 0 al 97% y la clasificación de la escisión mesorrectal total varió del 0 al 90%. La clasificación de la escisión mesorrectal total se asoció con una mayor probabilidad de tener también una evaluación adecuada de los ganglios linfáticos (88.5% versus 71.9%, p = 0.002). Ha habido una tendencia estadísticamente significativa hacia un aumento en la clasificación de la escisión mesorrectal total en los 14 hospitales originales (p = 0.001), pero no en la cohorte completa de todos los hospitales (p = 0.057).Diseño de cohorte retrospectivo con casos de cáncer rectal muestreados. Además, no hay suficiente granularidad para capturar todos los factores asociados con el rendimiento de la escisión mesorrectal total o la asignación de grados.Las tasas de rendimiento de escisión mesorrectal total y asignación de grado son muy variables en todo el estado de Michigan. En general, la asignación de calificaciones sigue siendo muy baja. Esto sugiere una oportunidad para que los proyectos de mejora de la calidad aumenten el rendimiento y la clasificación de la escisión mesorrectal total, involucrando tanto a los cirujanos como a los patólogos para una implementación efectiva. Vea el resumen del video en http://links.lww.com/DCR/B53.
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Affiliation(s)
- Arielle E. Kanters
- Department of Surgery, Michigan Medicine, Ann Arbor, MI,Center for Health Outcomes and Policy, University of Michigan, Ann Arbor, MI,Correspondence: Arielle Kanters, MD, Center for Healthcare Outcomes and Policy, 2800 Plymouth Road Building 16, Office 016-168C, Ann Arbor, MI 48105. . Twitter: arikanters, Presentation of work, Telephone: 734-998-7470, Fax: 734-998-7473
| | - Robert K. Cleary
- Department of Surgery, St. Joseph Mercy Ann Arbor, Ann Arbor, MI
| | - Shawn H. Obi
- Department of Surgery, Henry Ford Allegiance, Jackson, MI
| | | | | | | | - Darrell A. Campbell
- Department of Surgery, Michigan Medicine, Ann Arbor, MI,Michigan Surgical Quality Collaborative, Ann Arbor, MI
| | - Samantha K. Hendren
- Department of Surgery, Michigan Medicine, Ann Arbor, MI,Center for Health Outcomes and Policy, University of Michigan, Ann Arbor, MI
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11
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Parizadeh SM, Jafarzadeh-Esfehani R, Ghandehari M, Rezaei-Kalat A, Parizadeh SMR, Javanbakht A, Hassanian SM, Ferns GA, Khazaei M, Avan A. Personalized Peptide-based Vaccination for Treatment of Colorectal Cancer: Rational and Progress. Curr Drug Targets 2019; 20:1486-1495. [DOI: 10.2174/1389450120666190619121658] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 06/11/2019] [Accepted: 06/13/2019] [Indexed: 12/26/2022]
Abstract
Colorectal cancer (CRC) is one of the most common cancers globally and is associated with
a high rate of morbidity and mortality. A large proportion of patients with early stage CRC, who undergo
conventional treatments develop local recurrence or distant metastasis and in this group of advanced
disease, the survival rate is low. Furthermore there is often a poor response and/or toxicity associated
with chemotherapy and chemo-resistance may limit continuing conventional treatment alone.
Choosing novel and targeted therapeutic approaches based on clinicopathological and molecular features
of tumors in combination with conventional therapeutic approach could be used to eradicate residual
micrometastasis and therefore improve patient prognosis and also be used preventively. Peptide-
based vaccination therapy is one class of cancer treatment that could be used to induce tumorspecific
immune responses, through the recognition of specific antigen-derived peptides in tumor
cells, and this has emerged as a promising anti-cancer therapeutic strategy. The aim of this review was
to summarize the main findings of recent studies in exciting field of peptide-based vaccination therapy
in CRC patients as a novel therapeutic approach in the treatment of CRC.
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Affiliation(s)
| | - Reza Jafarzadeh-Esfehani
- Department of Medical Genetics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Ghandehari
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Afsaneh Rezaei-Kalat
- Department of Psychiatry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Afsane Javanbakht
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Mahdi Hassanian
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Gordon A. Ferns
- Brighton & Sussex Medical School, Division of Medical Education, Falmer, Brighton, Sussex BN1 9PH, United Kingdom
| | - Majid Khazaei
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir Avan
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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12
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MacCallum C, Skandarajah A, Gibbs P, Hayes I. The Value of Clinical Colorectal Cancer Registries in Colorectal Cancer Research: A Systematic Review. JAMA Surg 2019; 153:841-849. [PMID: 29926104 DOI: 10.1001/jamasurg.2018.1635] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Importance Clinical colorectal cancer registries (CCCRs) are potentially powerful tools in colorectal cancer research. They are resource intensive, but to our knowledge, no formal review of their value exists. While quality control, clinical audit, and benchmarking are important factors in assessing the value of maintaining CCCRs, they are difficult to quantify. This study focuses on registry research output as a measure of value; the study hypothesizes that CCCRs do not produce sufficient published research output of clinical significance to justify the resources required to maintain them. Objective To assess the value of maintaining CCCRs by identifying and characterizing existing CCCRs and measuring their comparative research impact. Evidence Review We searched MEDLINE (PubMed) and Google Scholar for articles published from January 1990 to July 2016 that identified multi-institutional CCCRs with peer-reviewed published outcomes. Purely population-based registries were excluded. We then searched the same databases in the same time period for articles that were published by each included CCCR. The articles must have been based on outcomes relating to individual CCCR data. We categorized published outcomes into oncological, surgical, or other outcomes. We measured the research impact of each CCCR using the number of articles, citation index, impact factor, and Altmetric score. Findings A total of 18 CCCRs were identified, with sample sizes between 104 and 1 400 000 cases. Data fields, published aims, and outcomes were similar between registries. The most frequently published outcomes related to anastomotic leak following colorectal surgery. The National Cancer Database formed the basis of the highest number of publications (66), the Northern Region Colorectal Cancer Audit Group had the highest median article citation number (28.5), the National Bowel Cancer Audit had the highest median impact factor (4.72), and the National Cancer Database had the highest median Altmetric score (4.5). Conclusions and Relevance There is a significant body of colorectal cancer outcomes research generated from the CCCRs. However, given the enormous resources required, the overall research output and impact of CCCRs is low in proportion to the size of the data sets. These registries hold key oncological and surgical outcomes data; focusing on data linkage between registries and developing automated data collection will enable international comparisons in colorectal cancer management and will increase the research impact of CCCRs, thereby increasing their value.
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Affiliation(s)
- Caroline MacCallum
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Anita Skandarajah
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Peter Gibbs
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Ian Hayes
- Colorectal Surgery Unit, Department of General Surgical Specialties, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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13
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Quality assurance in head and neck cancer surgery: where are we, and where are we going? Curr Opin Otolaryngol Head Neck Surg 2019; 27:151-156. [PMID: 30664051 DOI: 10.1097/moo.0000000000000519] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE OF REVIEW The scope of this review is to summarize current efforts in quality assurance for head and neck cancer surgery. National and international initiatives are summarized and progress in terms of identification of process indicators and outcome indicators delineated. RECENT FINDINGS Massive efforts have been made in order to improve quality of head and neck cancer surgery. New guidelines for quality assurance of head and neck cancer surgery in clinical trials have recently been proposed by EORTC. SUMMARY Quality assurance programs can be tested within the clearly defined environment of prospective clinical trials. If positive, such programs could be rolled out within national healthcare systems, if feasible. Testing quality programs in clinical trials could be a versatile tool to help head neck cancer patients benefit from such initiatives on a global level.
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14
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Breugom AJ, Bastiaannet E, Dekker JWT, Wouters MWJM, van de Velde CJH, Liefers GJ. Decrease in 30-day and one-year mortality over time in patients aged ≥75 years with stage I-III colon cancer: A population-based study. Eur J Surg Oncol 2018; 44:1889-1893. [PMID: 30262327 DOI: 10.1016/j.ejso.2018.08.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 08/03/2018] [Accepted: 08/17/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Monitoring time trends of cancer mortality is essential. Thirty-day mortality is an important surgical outcome measure, though postoperative mortality exceeds to one year after surgery in patients with colorectal cancer. The aim of this nationwide observational study was to assess changes over time in 30-day and one-year mortality in patients with stage I-III colorectal cancer. METHODS All surgically treated patients with stage I-III colorectal cancer, diagnosed between 2009 and 2013 were selected from the Netherlands Cancer Registry. Changes in 30-day and one-year mortality were assessed using logistic regression by tumour localisation (colon, rectum) and age group (<75 years, ≥75 years). RESULTS Overall, 41,186 patients were included. Among patients with colon cancer ≥75 years, 30-day mortality decreased from 8.3% in 2009 to 6.2% in 2013 (p-value for trend = 0.011), and one-year mortality from 18.5% in 2009 to 15.0% in 2013 (p-value for trend = 0.007). No significant differences in mortality over time were observed for patients <75 years with colon cancer and for patients with rectal cancer. CONCLUSION Thirty-day and one-year mortality decreased over time in patients ≥75 years with stage I-III colon cancer, though the absolute decrease is small. However, 30-day mortality and in particular the one-year mortality are both still high in older patients with colorectal cancer and will need to be focused on to further improve outcomes for these patient subgroups.
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Affiliation(s)
- A J Breugom
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - E Bastiaannet
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands; Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - J W T Dekker
- Department of Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - M W J M Wouters
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - C J H van de Velde
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - G J Liefers
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
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15
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Poskus E, Kryzauskas M, Poskus T, Mikalauskas S, Samalavicius NE, Aliosin O, Dailidenas S, Tamelis A, Saladzinskas Z, Lizdenis P, Jakaitiene A, Smailyte G, Strupas K. Improved perioperative care is associated with improved long-term survival in colorectal cancer. Int J Colorectal Dis 2018. [PMID: 29532205 DOI: 10.1007/s00384-018-3021-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE To compare perioperative colorectal cancer care and survival in patient cohorts operated in 2005 and in 2010 in Lithuania. METHODS Comparative observational cohort study was performed. The study was conducted in the three Lithuanian cancer hospitals. Patients, who underwent curative surgery for colorectal cancer in 2005 and 2010, were included. Demographic characteristics, distribution of the tumors, preoperative diagnostics and staging, surgical treatment, the quality of pathological examination, morbidity, and mortality were analyzed. One- and 5-year overall survival data were compared between the groups. RESULTS Colorectal cancer diagnostics and treatment improved from 2005 to 2010 significantly. The disease was identified as stage III-IV for 45 vs. 48% of the patients; however, computed tomography staging scan was performed only for 5.9 vs. 17.8% in 2005 and 2010, respectively. Laparoscopic operations were performed 1.5 vs. 10.5% and abdominoperineal resections-42.7 vs. 31.7% in 2005 and 2010, respectively. The number of harvested lymph nodes was mentioned in 55.8 vs. 97.7% of the cases, whereas more than 12 lymph nodes were examined in 18 vs. 66.6% of cases after histological examination. The overall 5-year survival was 52.1 vs. 63.1% (p < 0.0001), while the 5-year survival of the patients with stage IV of disease was 4.2 vs. 17.8% in 2005 and 2010, respectively. CONCLUSION Preoperative investigation, surgical treatment, pathological examination, and postoperative course are associated with improved overall survival in colorectal cancer patients, undergoing curative surgery in the resource-limited settings.
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Affiliation(s)
- Eligijus Poskus
- Institute of Clinical Medicine, Clinic of Gastroenterology, Nephrourology and Surgery, Vilnius University, Vilnius, Lithuania
| | - Marius Kryzauskas
- Institute of Clinical Medicine, Clinic of Gastroenterology, Nephrourology and Surgery, Vilnius University, Vilnius, Lithuania.
| | - Tomas Poskus
- Institute of Clinical Medicine, Clinic of Gastroenterology, Nephrourology and Surgery, Vilnius University, Vilnius, Lithuania
| | - Saulius Mikalauskas
- Institute of Clinical Medicine, Clinic of Gastroenterology, Nephrourology and Surgery, Vilnius University, Vilnius, Lithuania
| | - Narimantas Evaldas Samalavicius
- Department of Surgery, Klaipeda University Hospital, 41 Liepojos Str, LT-92288, Klaipeda, Lithuania.,Department of Abdominal and General Surgery and Oncology, National Cancer Institute, Clinic of Internal, Family Medicine and Oncology, Faculty of Medicine, Vilnius University, 1 Santariskiu Str, LT-08406, Vilnius, Lithuania
| | - Oleg Aliosin
- Department of Surgery, Klaipeda University Hospital, 41 Liepojos Str, LT-92288, Klaipeda, Lithuania
| | - Sarunas Dailidenas
- Department of Abdominal and General Surgery and Oncology, National Cancer Institute, Clinic of Internal, Family Medicine and Oncology, Faculty of Medicine, Vilnius University, 1 Santariskiu Str, LT-08406, Vilnius, Lithuania
| | - Algimantas Tamelis
- Department of Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Paulius Lizdenis
- Department of Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Audrone Jakaitiene
- Centre of Bioinformatics and Biostatistics, Department of Human and Medical Genetics, Vilnius University, Vilnius, Lithuania
| | - Giedre Smailyte
- Laboratory of Cancer Epidemiology, National Cancer Institute, Vilnius, Lithuania
| | - Kestutis Strupas
- Institute of Clinical Medicine, Clinic of Gastroenterology, Nephrourology and Surgery, Vilnius University, Vilnius, Lithuania
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16
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Becerra AZ, Wexner SD, Dietz DW, Xu Z, Aquina CT, Justiniano CF, Swanger AA, Temple LK, Noyes K, Monson JR, Fleming FJ. Nationwide Heterogeneity in Hospital-Specific Probabilities of Rectal Cancer Understaging and Its Effects on Outcomes. Ann Surg Oncol 2018; 25:2332-2339. [DOI: 10.1245/s10434-018-6530-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Indexed: 01/09/2023]
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17
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Simon C, Caballero C. Quality Assurance and Improvement in Head and Neck Cancer Surgery: From Clinical Trials to National Healthcare Initiatives. Curr Treat Options Oncol 2018; 19:34. [PMID: 29797284 DOI: 10.1007/s11864-018-0552-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
OPINION STATEMENT It is without question in the best interest of our patients, if we can identify ways to improve the quality of care we deliver to them. Great progress has been made within the last 25 years in terms of development and implementation of quality-assurance (QA) platforms and quality improvement programs for surgery in general, and within this context for head and neck surgery. As of now, we have successfully identified process indicators that impact outcome of our patients and the quality of care we deliver as surgeons. We have developed risk calculators to determine the risk for complications of individual surgical patients. We have created perioperative guidelines for complex head and neck procedures. We have in Europe and North America created audit registries that can gather and analyze data from institutions across the world to better understand which processes need change to obtain good outcomes and improve quality of care. QA platforms can be tested within the clearly defined environment of prospective clinical trials. If positive, such programs could be rolled out within national healthcare systems, if feasible. Testing quality programs in clinical trials could be a versatile tool to help head neck cancer patients benefit directly from such initiatives on a global level.
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Affiliation(s)
- Christian Simon
- Service d'Oto-rhino-laryngologie - Chirurgie cervico-faciale, Centre Hospitalier Universitaire Vaudois (CHUV), Université de Lausanne (UNIL), Rue du Bugnon 21, 1011, Lausanne, Switzerland.
| | - Carmela Caballero
- European Organization for Research and Treatment of Cancer, Avenue Emmanuel Mounier 83, 1200, Brussels, Belgium
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18
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Kowalski C, Graeven U, von Kalle C, Lang H, Beckmann MW, Blohmer JU, Burchardt M, Ehrenfeld M, Fichtner J, Grabbe S, Hoffmann H, Iro H, Post S, Scharl A, Schlegel U, Seufferlein T, Stummer W, Ukena D, Ferencz J, Wesselmann S. Shifting cancer care towards Multidisciplinarity: the cancer center certification program of the German cancer society. BMC Cancer 2017; 17:850. [PMID: 29241445 PMCID: PMC5731059 DOI: 10.1186/s12885-017-3824-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 11/23/2017] [Indexed: 12/11/2022] Open
Abstract
Background Over the last decades numerous initiatives have been set up that aim at translating the best available medical knowledge and treatment into clinical practice. The inherent complexity of the programs and discrepancies in the terminology used make it difficult to appreciate each of them distinctly and compare their specific strengths and weaknesses. To allow comparison and stimulate dialogue between different programs, we in this paper provide an overview of the German Cancer Society certification program for multidisciplinary cancer centers that was established in 2003. Main body In the early 2000s the German Cancer Society assessed the available information on quality of cancer care in Germany and concluded that there was a definite need for a comprehensive, transparent and evidence-based system of quality assessment and control. This prompted the development and implementation of a voluntary cancer center certification program that was promoted by scientific societies, health-care providers, and patient advocacy groups and based on guidelines of the highest quality level (S3). The certification system structures the entire process of care from prevention to screening and multidisciplinary treatment of cancer and places multidisciplinary teams at the heart of this program. Within each network of providers, the quality of care is documented using tumor-specific quality indicators. The system started with breast cancer centers in 2003 and colorectal cancer centers in 2006. In 2017, certification systems are established for the majority of cancers. Here we describe the rationale behind the certification program, its history, the development of the certification requirements, the process of data collection, and the certification process as an example for the successful implementation of a voluntary but powerful system to ensure and improve quality of cancer care. Conclusion Since 2003, over 1 million patients had their primary tumors treated in a certified center. There are now over 1200 sites for different tumor entities in four countries that have been certified in accordance with the program and transparently report their results from multidisciplinary treatment for a substantial proportion of cancers. This led to a fundamental change in the structure of cancer care in Germany and neighboring countries within one decade.
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Affiliation(s)
- Christoph Kowalski
- German Cancer Society, Department for Certification, Kuno-Fischer-Strasse 8, 14057, Berlin, Germany.
| | - Ullrich Graeven
- Kliniken Maria Hilf GmbH, Viersener Strasse 450, 41063, Mönchengladbach, Germany
| | - Christof von Kalle
- NCT University Hospital, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
| | - Hauke Lang
- University Hospital, Langenbeckstrasse 1, 55131, Mainz, Germany
| | | | - Jens-Uwe Blohmer
- Charité University Hospital, Charitéplatz 1, 10117, Berlin, Germany
| | - Martin Burchardt
- University Hospital, Fleischmannstrasse 42, 17489, Greifswald, Germany
| | | | - Jan Fichtner
- Johanniter Krankenhaus, Steinbrinkstr. 96, 46145, Oberhausen, Germany
| | - Stephan Grabbe
- University Hospital, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Hans Hoffmann
- University Hospital, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
| | - Heinrich Iro
- University Hospital, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Stefan Post
- University Medical Center, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Anton Scharl
- Klinikum St. Marien, Mariahilfbergweg 7, 92224, Amberg, Germany
| | - Uwe Schlegel
- Knappschaftskrankenhaus, Dept. of Neurology, Ruhr-University Bochum, In der Schornau 23, 44892, Bochum, Germany
| | | | - Walter Stummer
- University Hospital, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Dieter Ukena
- Hospital Ost, Züricher Strasse 40, 28325, Bremen, Germany
| | - Julia Ferencz
- OnkoZert GmbH, Certification Institute of the German Cancer Society, Gartenstrasse 24, 89231, Neu-Ulm, Germany
| | - Simone Wesselmann
- German Cancer Society, Department for Certification, Kuno-Fischer-Strasse 8, 14057, Berlin, Germany
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19
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Cavanna L, Fornari F, Di Nunzio C. Distance from hospital in clinical practices. Gastrointest Endosc 2017; 86:412. [PMID: 28728673 DOI: 10.1016/j.gie.2017.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 02/11/2017] [Indexed: 02/08/2023]
Affiliation(s)
- Luigi Cavanna
- Department of Oncology and Hematology, Hospital of Piacenza, Piacenza, Italy
| | - Fabio Fornari
- Department of Internal Medicine and Gastroenterology, Hospital of Piacenza, Piacenza, Italy
| | - Camilla Di Nunzio
- Department of Oncology and Hematology, Hospital of Piacenza, Piacenza, Italy
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20
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Link KH, Coy P, Roitman M, Link C, Kornmann M, Staib L. Minimum Volume Discussion in the Treatment of Colon and Rectal Cancer: A Review of the Current Status and Relevance of Surgeon and Hospital Volume regarding Result Quality and the Impact on Health Economics. Visc Med 2017; 33:140-147. [PMID: 28560230 PMCID: PMC5447170 DOI: 10.1159/000456044] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND To answer the question whether minimum caseloads need to be stipulated in the German S3 (or any other) guidelines for colorectal cancer, we analyzed the current representative literature. The question is important regarding medical quality as well as health economics and policy. METHODS A literature research was conducted in PubMed for papers concerning 'colon cancer' (CC), 'rectal cancer' (RC), and 'colorectal cancer' (CRC), with 'results', 'quality', and 'mortality' between the years 2000 and 2016 being relevant factors. We graded the recommendations as 'pro', 'maybe', or 'contra' in terms of a significant correlation between hospital volume (HV) or surgeon volume (SV) and treatment quality. We also listed the recommended numbers suggested for HV or SV as minimum caseloads and calculated and discussed the socio-economic impact of setting minimum caseloads for CRC. RESULTS The correlations of caseloads of hospitals or surgeons turned out to be highly controversial concerning the influence of HV or SV on short- and long-term surgical treatment quality of CRC. Specialized statisticians made the point that the reports in the literature might not use the optimal biometrical analytical/reporting methods. A Dutch analysis showed that if a decision towards minimum caseloads, e.g. >50 for CRC resections, would be made, this would exclude a lot of hospitals with proven good treatment quality and include hospitals with a treatment quality below average. Our economic analysis envisioned that a yearly loss of EUR <830,000 might ensue for hospitals with volumes <50 per year. CONCLUSIONS Caseload (HV, SV) definitely is an inconsistent surrogate parameter for treatment quality in the surgery of CC, RC, or CRC. If used at all, the lowest tolerable numbers but the highest demands for structural, process and result quality in the surgical/interdisciplinary treatment of CC and RC must be imposed and independently controlled. Hospitals fulfilling these demands should be medically and socio-economically preferred concerning the treatment of CC and RC patients.
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Affiliation(s)
- Karl-Heinrich Link
- Department of Surgery, Asklepios Paulinen Klinik, Wiesbaden, Germany
- Forschungsgruppe Onkologie Gastrointestinale Tumoren (FOGT), University of Ulm, Ulm, Germany
| | - Peter Coy
- Department of Health Economics, RheinMain University of Applied Sciences, Wiesbaden, Germany
| | - Mark Roitman
- Department of Surgery, Asklepios Paulinen Klinik, Wiesbaden, Germany
| | - Carola Link
- Forschungsgruppe Onkologie Gastrointestinale Tumoren (FOGT), University of Ulm, Ulm, Germany
| | - Marko Kornmann
- Forschungsgruppe Onkologie Gastrointestinale Tumoren (FOGT), University of Ulm, Ulm, Germany
- Department of General and Visceral Surgery, University of Ulm, Ulm, Germany
| | - Ludger Staib
- Forschungsgruppe Onkologie Gastrointestinale Tumoren (FOGT), University of Ulm, Ulm, Germany
- Department of General and Visceral Surgery, Klinikum Esslingen, Esslingen, Germany
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21
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Beets G, Sebag-Montefiore D, Andritsch E, Arnold D, Beishon M, Crul M, Dekker JW, Delgado-Bolton R, Fléjou JF, Grisold W, Henning G, Laghi A, Lovey J, Negrouk A, Pereira P, Roca P, Saarto T, Seufferlein T, Taylor C, Ugolini G, Velde CVD, Herck BV, Yared W, Costa A, Naredi P. ECCO Essential Requirements for Quality Cancer Care: Colorectal Cancer. A critical review. Crit Rev Oncol Hematol 2017; 110:81-93. [DOI: 10.1016/j.critrevonc.2016.12.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 12/05/2016] [Indexed: 01/08/2023] Open
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22
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Kanters A, Mullard AJ, Arambula J, Fasbinder L, Krapohl G, Wong SL, Campbell DA, Hendren S. Colorectal cancer: Quality of surgical care in Michigan. Am J Surg 2016; 213:548-552. [PMID: 27939006 DOI: 10.1016/j.amjsurg.2016.11.038] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 11/22/2016] [Accepted: 11/25/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Surgery remains the cornerstone therapy for colorectal cancer (CRC). This study assesses CRC quality measures for surgical cases in Michigan. METHODS In this retrospective cohort study, processes of care and outcomes for CRC resection cases were abstracted in 30 hospitals in the Michigan Surgical Quality Collaborative (2014-2015). Measures were case-mix and reliability adjusted, using logistic regression models. RESULTS For 871 cases (640 colon cancer, 231 rectal cancer), adjusted morbidity (27.4%) and mortality rates (1.5%) were low. Adjusted process measures showed gaps in quality of care. Mesorectal excision was documented in 59.4% of rectal cancer (RC) cases, 65% of RC cases had sphincter preserving surgery, 18.7% of cases had < 12 lymph nodes examined, 7.9% had a positive margin, 52.1% of stage II/III RC cases had neoadjuvant therapy, and 36% of ostomy cases had site marking. CONCLUSION This study finds gaps in quality of care measures for CRC, suggesting opportunity for regional quality improvement.
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Affiliation(s)
- Arielle Kanters
- Department of Surgery, University of Michigan Health System, Ann Arbor, MI, United States.
| | - Andrew J Mullard
- Michigan Surgical Quality Collaborative, Ann Arbor, MI, United States
| | - Jennifer Arambula
- Michigan Surgical Quality Collaborative, Ann Arbor, MI, United States
| | - Laurie Fasbinder
- Michigan Surgical Quality Collaborative, Ann Arbor, MI, United States
| | - Greta Krapohl
- Michigan Surgical Quality Collaborative, Ann Arbor, MI, United States
| | - Sandra L Wong
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | | | - Samantha Hendren
- Department of Surgery, University of Michigan Health System, Ann Arbor, MI, United States
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23
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Bianco F, De Franciscis S, Belli A, Di Lena M, Avallone A, Bianco MA, Di Marzo S, Gigli L, Rotondano G, Spena SR, Tatangelo F, Tempesta A, Romano GM. Surgery has a key role for quality assurance of colorectal cancer screening programs: impact of the third level multidisciplinary team on lymph nodal staging. Int J Colorectal Dis 2016; 31:587-92. [PMID: 26715436 DOI: 10.1007/s00384-015-2472-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/14/2015] [Indexed: 02/04/2023]
Abstract
PURPOSE From 2011 to 2013 in the area of the Naples 3 public health district (ASL-NA3), a colorectal cancer screening program (CCSP) was developed. In order to stress the need of quality assurance procedures for surgery and pathology, a third level oncologic pathway was added and set up at a referral colorectal cancer center (RC). Lymph nodal (LN) harvesting, as a process indicator, and nodal positivity were adopted for an interim analysis. METHODS The program was implemented by a series of audit meetings and a double type of multidisciplinary team (MDT): "horizontal" and "vertical." Three hundred and forty colorectal cancer (CRC) patients underwent surgery: 119 chose to be operated at the RC (Gr In), 65 were operated at 22 district hospitals (DH) (Gr Out), and 156 symptomatic not screened patients were operated at the RC (Gr Sym). RESULTS Statistical analysis revealed differences between Gr In and Gr Out colon groups both for LN harvesting (median of 26 and 11, respectively, P = 0.0001), and for nodal positivity after the first screening round (34.78 and 19.45%, respectively, P = 0.0169). Results were all the more significant in a subset analysis on early T stage colon subgroups (In vs Out) both for LN harvesting (P < 0.0001) and nodal positivity (P < 0.0001). CONCLUSION xSignificant differences between RC and DHs were found, particularly for early-stage CRC patients. LN harvesting should be considered as a surrogate marker of quality assurance for at least screening hospitals for "minimum best" standard of care. This should lead to set up a third level in any CCSP.
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Affiliation(s)
- Francesco Bianco
- Department of Surgical Oncology, Istituto Nazionale per lo studio e la cura dei tumori "Fondazione Giovanni Pascale" - IRCCS, Via M. Semmola, 80131, Naples, Italy.
| | - Silvia De Franciscis
- Department of Surgical Oncology, Istituto Nazionale per lo studio e la cura dei tumori "Fondazione Giovanni Pascale" - IRCCS, Via M. Semmola, 80131, Naples, Italy
| | - Andrea Belli
- Department of Surgical Oncology, Istituto Nazionale per lo studio e la cura dei tumori "Fondazione Giovanni Pascale" - IRCCS, Via M. Semmola, 80131, Naples, Italy
| | - Maria Di Lena
- Department of Surgical Oncology, Istituto Nazionale per lo studio e la cura dei tumori "Fondazione Giovanni Pascale" - IRCCS, Via M. Semmola, 80131, Naples, Italy
| | - Antonio Avallone
- Department of Medical Oncology, Istituto Nazionale per lo studio e la cura dei tumori "Fondazione Giovanni Pascale" - IRCCS, Naples, Italy
| | - Maria Antonia Bianco
- Gastroenterology and Digestive Endoscopy, Maresca Hospital, Torre Del Greco, Italy
| | - Sabato Di Marzo
- Gastroenterology and Digestive Endoscopy, Apicella Hospital, Pollena Trocchia, Italy
| | - Letizia Gigli
- Epidemiology and Prevention Unit, ASL NA3sud, Naples, Italy
| | - Gianluca Rotondano
- Gastroenterology and Digestive Endoscopy, Maresca Hospital, Torre Del Greco, Italy
| | | | - Fabiana Tatangelo
- Department of Pathology, Istituto Nazionale per lo studio e la cura dei tumori "Fondazione Giovanni Pascale" - IRCCS, Naples, Italy
| | - Alfonso Tempesta
- Department of Endoscopy, Istituto Nazionale per lo studio e la cura dei tumori "Fondazione Giovanni Pascale" - IRCCS, Naples, Italy
| | - Giovanni Maria Romano
- Department of Surgical Oncology, Istituto Nazionale per lo studio e la cura dei tumori "Fondazione Giovanni Pascale" - IRCCS, Via M. Semmola, 80131, Naples, Italy
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Relación entre volumen de casos y mortalidad intrahospitalaria en la cirugía del cáncer digestivo. Cir Esp 2016; 94:151-8. [DOI: 10.1016/j.ciresp.2015.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 09/24/2015] [Accepted: 09/27/2015] [Indexed: 11/15/2022]
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Sullivan R, Alatise OI, Anderson BO, Audisio R, Autier P, Aggarwal A, Balch C, Brennan MF, Dare A, D'Cruz A, Eggermont AMM, Fleming K, Gueye SM, Hagander L, Herrera CA, Holmer H, Ilbawi AM, Jarnheimer A, Ji JF, Kingham TP, Liberman J, Leather AJM, Meara JG, Mukhopadhyay S, Murthy SS, Omar S, Parham GP, Pramesh CS, Riviello R, Rodin D, Santini L, Shrikhande SV, Shrime M, Thomas R, Tsunoda AT, van de Velde C, Veronesi U, Vijaykumar DK, Watters D, Wang S, Wu YL, Zeiton M, Purushotham A. Global cancer surgery: delivering safe, affordable, and timely cancer surgery. Lancet Oncol 2016; 16:1193-224. [PMID: 26427363 DOI: 10.1016/s1470-2045(15)00223-5] [Citation(s) in RCA: 403] [Impact Index Per Article: 50.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Revised: 08/07/2015] [Accepted: 08/07/2015] [Indexed: 12/20/2022]
Abstract
Surgery is essential for global cancer care in all resource settings. Of the 15.2 million new cases of cancer in 2015, over 80% of cases will need surgery, some several times. By 2030, we estimate that annually 45 million surgical procedures will be needed worldwide. Yet, less than 25% of patients with cancer worldwide actually get safe, affordable, or timely surgery. This Commission on global cancer surgery, building on Global Surgery 2030, has examined the state of global cancer surgery through an analysis of the burden of surgical disease and breadth of cancer surgery, economics and financing, factors for strengthening surgical systems for cancer with multiple-country studies, the research agenda, and the political factors that frame policy making in this area. We found wide equity and economic gaps in global cancer surgery. Many patients throughout the world do not have access to cancer surgery, and the failure to train more cancer surgeons and strengthen systems could result in as much as US $6.2 trillion in lost cumulative gross domestic product by 2030. Many of the key adjunct treatment modalities for cancer surgery--e.g., pathology and imaging--are also inadequate. Our analysis identified substantial issues, but also highlights solutions and innovations. Issues of access, a paucity of investment in public surgical systems, low investment in research, and training and education gaps are remarkably widespread. Solutions include better regulated public systems, international partnerships, super-centralisation of surgical services, novel surgical clinical trials, and new approaches to improve quality and scale up cancer surgical systems through education and training. Our key messages are directed at many global stakeholders, but the central message is that to deliver safe, affordable, and timely cancer surgery to all, surgery must be at the heart of global and national cancer control planning.
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Affiliation(s)
- Richard Sullivan
- Institute of Cancer Policy, King's Health Partners Comprehensive Cancer Centre, London, UK; King's Centre for Global Health, King's Health Partners and King's College London, London, UK.
| | | | - Benjamin O Anderson
- University of Washington School of Medicine, Seattle, WA, USA; Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | | | - Ajay Aggarwal
- Institute of Cancer Policy, King's Health Partners Comprehensive Cancer Centre, London, UK; Guy's and St Thomas' NHS Foundation Trust, London, UK; London School of Hygiene & Tropical Medicine, London, UK
| | - Charles Balch
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Anna Dare
- Centre for Global Health Research, St Michael's Hospital, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Anil D'Cruz
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | | | - Kenneth Fleming
- Green Templeton College, University of Oxford, Oxford, UK; Oxford University Hospitals NHS Trust, Oxford, UK
| | - Serigne Magueye Gueye
- University Cheikh Anta Diop, Dakar, Senegal; Grand Yoff General Hospital, Dakar, Senegal
| | - Lars Hagander
- Paediatric Surgery and Global Paediatrics, Department of Paediatrics, Lund University, Lund, Sweden
| | - Cristian A Herrera
- Cabinet of the Minister, Ministry of Health, Santiago, Chile; Department of Public Health, School of Medicine, Pontificia Universidad Católica, Santiago, Chile
| | - Hampus Holmer
- Paediatric Surgery and Global Paediatrics, Department of Paediatrics, Lund University, Lund, Sweden
| | - André M Ilbawi
- University of Texas MD Anderson Cancer Centre, Houston, TX, USA; Union for International Cancer Control, Geneva, Switzerland
| | - Anton Jarnheimer
- Paediatric Surgery and Global Paediatrics, Department of Paediatrics, Lund University, Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Jia-Fu Ji
- Peking University Cancer Hospital and Institute, Beijing, China; Chinese Anti-Cancer Association, Tianjin, China
| | | | | | - Andrew J M Leather
- King's Centre for Global Health, King's Health Partners and King's College London, London, UK
| | - John G Meara
- Program in Global Surgery and Social Change, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Swagoto Mukhopadhyay
- Program in Global Surgery and Social Change, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Shilpa S Murthy
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard School of Public Health, Boston, MA, USA; Department of General Surgery, Indiana University, Bloomington, IN, USA
| | | | - Groesbeck P Parham
- Department of Obstetrics and Gynecology, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA; University of Zambia, Lusaka, Zambia
| | - C S Pramesh
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Robert Riviello
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard School of Public Health, Boston, MA, USA
| | - Danielle Rodin
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Luiz Santini
- INCA (Brazilian National Cancer Institute), Rio de Janeiro, Brazil
| | | | - Mark Shrime
- Program in Global Surgery and Social Change, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert Thomas
- Department of Health & Human Services, Melbourne, VIC, Australia
| | - Audrey T Tsunoda
- Gyne-Oncology Department, Barretos Cancer Hospital, Barretos, Brazil
| | - Cornelis van de Velde
- Department of Surgical Oncology, Endocrine and Gastrointestinal Surgery, Leiden University Medical Centre, Leiden, Netherlands
| | | | | | - David Watters
- Deakin University, Geelong, VIC, Australia; Barwon Health, Geelong, VIC, Australia
| | - Shan Wang
- Peking University People's Hospital, Beijing, China; Chinese College of Surgeons, Beijing, China
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangzhou, China; Guangdong Academy of Medical Sciences, Guangzhou, China; Chinese Society of Clinical Oncology, Beijing, China
| | - Moez Zeiton
- Sadeq Institute, Tripoli, Libya; Trauma and Orthopaedic Rotation, North-West Deanery, Manchester, UK
| | - Arnie Purushotham
- Institute of Cancer Policy, King's Health Partners Comprehensive Cancer Centre, London, UK; King's Centre for Global Health, King's Health Partners and King's College London, London, UK; Guy's and St Thomas' NHS Foundation Trust, London, UK
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Meldolesi E, van Soest J, Damiani A, Dekker A, Alitto AR, Campitelli M, Dinapoli N, Gatta R, Gambacorta MA, Lanzotti V, Lambin P, Valentini V. Standardized data collection to build prediction models in oncology: a prototype for rectal cancer. Future Oncol 2015; 12:119-36. [PMID: 26674745 DOI: 10.2217/fon.15.295] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The advances in diagnostic and treatment technology are responsible for a remarkable transformation in the internal medicine concept with the establishment of a new idea of personalized medicine. Inter- and intra-patient tumor heterogeneity and the clinical outcome and/or treatment's toxicity's complexity, justify the effort to develop predictive models from decision support systems. However, the number of evaluated variables coming from multiple disciplines: oncology, computer science, bioinformatics, statistics, genomics, imaging, among others could be very large thus making traditional statistical analysis difficult to exploit. Automated data-mining processes and machine learning approaches can be a solution to organize the massive amount of data, trying to unravel important interaction. The purpose of this paper is to describe the strategy to collect and analyze data properly for decision support and introduce the concept of an 'umbrella protocol' within the framework of 'rapid learning healthcare'.
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Affiliation(s)
- Elisa Meldolesi
- Radiotherapy Department, Sacred Heart University, Rome, Italy
| | - Johan van Soest
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology & Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Andrea Damiani
- Radiotherapy Department, Sacred Heart University, Rome, Italy
| | - Andre Dekker
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology & Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | | | - Nicola Dinapoli
- Radiotherapy Department, Sacred Heart University, Rome, Italy
| | - Roberto Gatta
- Radiotherapy Department, Sacred Heart University, Rome, Italy
| | | | - Vito Lanzotti
- Radiotherapy Department, Sacred Heart University, Rome, Italy
| | - Philippe Lambin
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology & Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
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Kuipers EJ, Grady WM, Lieberman D, Seufferlein T, Sung JJ, Boelens PG, van de Velde CJH, Watanabe T. Colorectal cancer. Nat Rev Dis Primers 2015; 1:15065. [PMID: 27189416 PMCID: PMC4874655 DOI: 10.1038/nrdp.2015.65] [Citation(s) in RCA: 968] [Impact Index Per Article: 107.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Colorectal cancer had a low incidence several decades ago. However, it has become a predominant cancer and now accounts for approximately 10% of cancer-related mortality in western countries. The 'rise' of colorectal cancer in developed countries can be attributed to the increasingly ageing population, unfavourable modern dietary habits and an increase in risk factors, such as smoking, low physical exercise and obesity. New treatments for primary and metastatic colorectal cancer have emerged, providing additional options for patients; these treatments include laparoscopic surgery for primary disease, more-aggressive resection of metastatic disease (such as liver and pulmonary metastases), radiotherapy for rectal cancer, and neoadjuvant and palliative chemotherapies. However, these new treatment options have had limited impact on cure rates and long-term survival. For these reasons, and the recognition that colorectal cancer is long preceded by a polypoid precursor, screening programmes have gained momentum. This Primer provides an overview of the current state of the art of knowledge on the epidemiology and mechanisms of colorectal cancer, as well as on diagnosis and treatment.
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Affiliation(s)
- Ernst J. Kuipers
- Erasmus MC University Medical Center, s-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | - William M. Grady
- Clinical Research Division, Fred Hutchinson Cancer Research Center; Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - David Lieberman
- Division of Gastroenterology and Hepatology, Oregon Health and Science University, Portland, OR, USA
| | | | - Joseph J. Sung
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong, China
| | - Petra G. Boelens
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Toshiaki Watanabe
- Department of Surgical Oncology and Vascular Surgery, University of Tokyo, and the University of Tokyo Hospital, Tokyo, Japan
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28
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Guren MG, Kørner H, Pfeffer F, Myklebust TÅ, Eriksen MT, Edna TH, Larsen SG, Knudsen KO, Nesbakken A, Wasmuth HH, Vonen B, Hofsli E, Færden AE, Brændengen M, Dahl O, Steigen SE, Johansen MJ, Lindsetmo RO, Drolsum A, Tollåli G, Dørum LM, Møller B, Wibe A. Nationwide improvement of rectal cancer treatment outcomes in Norway, 1993-2010. Acta Oncol 2015; 54:1714-22. [PMID: 25924970 DOI: 10.3109/0284186x.2015.1034876] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The Norwegian Rectal Cancer Project was initated in 1993 with the aims of improving surgery, decreasing local recurrence rates, improving survival, and establishing a national rectal cancer registry. Here we present results from the Norwegian Colorectal Cancer Registry (NCCR) from 1993 to 2010. MATERIAL AND METHODS A total of 15 193 patients were diagnosed with rectal cancer in Norway 1993-2010, and were registered with clinical data regarding diagnosis, treatment, locoregional recurrences and distant metastases. Of these, 10 796 with non-metastatic disease underwent tumour resection. The results were stratified into five time periods, and the treatment outcomes were compared. Recurrence rates are presented for the 9785 patients who underwent curative major resection (R0/R1). RESULTS Among all 15 193 patients, relative five-year survival increased from 54.1% in 1993-1997 to 63.4% in 2007-2010 (p < 0.001). Among the 10 796 patients with stage I-III disease who underwent tumour resection, from 1993-1997 to 2007-2010, relative five-year survival improved from 71.2% to 80.6% (p < 0.001). An increasing proportion of these patients underwent surgery at large-volume hospitals; and 30- and 100-day mortality rates, respectively, decreased from 3.0% to 1.4% (p < 0.001) and from 5.1% to 3.0% (p < 0.011). Use of preoperative chemoradiotherapy increased from 6.5% in 1993 to 39.0% in 2010 (p < 0.001). Estimated local recurrence rate after major resection (R0/R1) decreased from 14.5% in 1993-1997 to 5.0% in 2007-2009 (p < 0.001), and distant recurrence rate decreased from 26.0% to 20.2% (p < 0.001). CONCLUSION Long-term outcomes from a national population-based rectal cancer registry are presented. Improvements in rectal cancer treatment have led to decreased recurrence rates of 5% and increased survival on a national level.
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Affiliation(s)
- Marianne G Guren
- a Department of Oncology , Oslo University Hospital , Oslo , Norway
- b K. G. Jebsen Colorectal Cancer Research Centre, Oslo University Hospital , Oslo , Norway
| | - Hartwig Kørner
- c Department of GI Surgery , Stavanger University Hospital , Stavanger , Norway
- d Department of Clinical Medicine , University of Bergen , Bergen , Norway
| | - Frank Pfeffer
- d Department of Clinical Medicine , University of Bergen , Bergen , Norway
- e Department of Surgery , Haukeland University Hospital , Bergen , Norway
| | - Tor Å Myklebust
- f Department of Registration , Cancer Registry of Norway , Oslo , Norway
| | - Morten T Eriksen
- g Department of Digestive Surgery , Akershus University Hospital , Lørenskog , Norway
| | - Tom-Harald Edna
- h Department of Surgery , Levanger Hospital, North-Trondelag Hospital Trust , Levanger , Norway
- i Unit for Applied Clinical Research, Institute of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology , Trondheim , Norway
| | - Stein G Larsen
- j Department of Gastroenterological Surgery , Oslo University Hospital , Oslo , Norway
| | - Kristin O Knudsen
- f Department of Registration , Cancer Registry of Norway , Oslo , Norway
| | - Arild Nesbakken
- b K. G. Jebsen Colorectal Cancer Research Centre, Oslo University Hospital , Oslo , Norway
- j Department of Gastroenterological Surgery , Oslo University Hospital , Oslo , Norway
- k Institute of Clinical Medicine, University of Oslo , Oslo , Norway
- l Centre for Cancer Biomedicine, University of Oslo , Oslo , Norway
| | - Hans H Wasmuth
- m Department of Gastrointestinal Surgery , St. Olavs Hospital, Trondheim University Hospital , Trondheim , Norway
| | - Barthold Vonen
- n Nordland Hospital Trust , Bodø , Norway
- o University of Tromsø, Institute of Community Medicine , Tromsø , Norway
| | - Eva Hofsli
- p Department of Oncology , St. Olavs Hospital, Trondheim University Hospital , Trondheim , Norway
| | - Arne E Færden
- g Department of Digestive Surgery , Akershus University Hospital , Lørenskog , Norway
| | | | - Olav Dahl
- q Department of Clinical Science , MOF, University of Bergen , Bergen , Norway
- r Department of Oncology , Haukeland University Hospital , Bergen , Norway
| | - Sonja E Steigen
- s Department of Pathology , University Hospital of North Norway , Tromsø , Norway
| | - Magnar J Johansen
- t Department of Oncology , University Hospital of North Norway , Tromsø , Norway
| | - Rolv-Ole Lindsetmo
- u Department of Gastrointestinal Surgery , University Hospital of North Norway , Tromsø , Norway
- v Institute of Clinical Medicine, The Arctic University of Norway , Tromsø , Norway
| | - Anders Drolsum
- w Department of Radiology and Nuclear Medicine , Oslo University Hospital , Oslo , Norway
| | - Geir Tollåli
- x Department of Gastroenterology , Nordland Hospital , Bodø , Norway
| | - Liv M Dørum
- f Department of Registration , Cancer Registry of Norway , Oslo , Norway
| | - Bjørn Møller
- f Department of Registration , Cancer Registry of Norway , Oslo , Norway
| | - Arne Wibe
- m Department of Gastrointestinal Surgery , St. Olavs Hospital, Trondheim University Hospital , Trondheim , Norway
- y Institute of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology , Trondheim , Norway
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Ambroggi M, Biasini C, Del Giovane C, Fornari F, Cavanna L. Distance as a Barrier to Cancer Diagnosis and Treatment: Review of the Literature. Oncologist 2015; 20:1378-85. [PMID: 26512045 DOI: 10.1634/theoncologist.2015-0110] [Citation(s) in RCA: 305] [Impact Index Per Article: 33.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 09/16/2015] [Indexed: 11/17/2022] Open
Abstract
The burden of travel from a patient's residence to health care providers is an important issue that can influence access to diagnosis and treatment of cancer. Although several studies have shown that the travel burden can result in delays in diagnosis and treatment of many common cancers, its role appears underestimated in the treatment of patients in clinical practice. Therefore, we performed a review of the published data on the role of travel burden influencing four items: delay of diagnosis, adequate treatment of cancer, outcome, and quality of life of cancer patients. Forty-seven studies published up to December 2014 were initially identified. Twenty studies were excluded because they did not regard specifically the four items of our review. Twenty-seven studies formed the basis of our study and involved 716,153 patients. The associations between travel burden and (a) cancer stage at diagnosis (12 studies), (b) appropriate treatment (8 studies), (c) outcome (4 studies), and (d) quality of life (1 study) are reported. In addition, in two studies, the relation between travel burden and compliance with treatment was examined. The results of our review show that increasing travel requirements are associated with more advanced disease at diagnosis, inappropriate treatment, a worse prognosis, and a worse quality of life. These results suggest that clinical oncologists should remember the specific travel burden problem for cancer patients, who often need health care services every week or every month for many years.
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Affiliation(s)
- Massimo Ambroggi
- Department of Oncology-Hematology, G. da Saliceto Hospital, Piacenza, Italy
| | - Claudia Biasini
- Department of Oncology-Hematology, G. da Saliceto Hospital, Piacenza, Italy
| | - Cinzia Del Giovane
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabio Fornari
- Department of Medicine, G. da Saliceto Hospital, Piacenza, Italy
| | - Luigi Cavanna
- Department of Oncology-Hematology, G. da Saliceto Hospital, Piacenza, Italy
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30
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Endorsing good quality assurance practices in molecular pathology: risks and recommendations for diagnostic laboratories and external quality assessment providers. Virchows Arch 2015; 468:31-41. [PMID: 26306715 DOI: 10.1007/s00428-015-1839-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 08/06/2015] [Accepted: 08/17/2015] [Indexed: 12/13/2022]
Abstract
Quality assurance is an indispensable element in a molecular diagnostic laboratory. The ultimate goal is to warrant patient safety. Several risks that can compromise high quality procedures are at stake, from sample collection to the test performed by the laboratory, the reporting of test results to clinicians, and the organization of effective external quality assessment schemes. Quality assurance should therefore be safeguarded at each level and should imply a holistic multidisciplinary approach. This review aims to provide an overview of good quality assurance practices and discusses certain risks and recommendations to promote and improve quality assurance for both diagnostic laboratories and for external quality assessment providers. The number of molecular targets is continuously rising, and new technologies are evolving. As this poses challenges for clinical implementation and increases the demand for external quality assessment, the formation of an international association for improving quality assurance in molecular pathology is called for.
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Fuchs HF, Broderick RC, Harnsberger CR, Chang DC, Mclemore EC, Ramamoorthy S, Horgan S. Variation of outcome and charges in operative management for diverticulitis. Surg Endosc 2014; 29:3090-6. [PMID: 25539698 DOI: 10.1007/s00464-014-4046-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 12/11/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND Outcomes after surgery for diverticulitis are of continued interest to improve quality of care. The aim of this study was to assess variations in mortality, length of stay, and patient charges between geographic regions of the United States. METHODS A retrospective analysis of the Nationwide Inpatient Sample database was performed. Adults with diverticulitis who underwent laparoscopic or open segmental colectomy were identified using ICD-9 codes. Subset analyses were performed by state and then compared. Outcomes included mortality, length of stay (LOS), and total charges. Results were adjusted for age, race, gender, findings of peritonitis, stoma placement, Charlson comorbidity index, and insurance status on multivariate analysis. RESULTS 148,874 patients underwent segmental colectomy for diverticulitis from 1998 to 2010. Using California as the comparison state and after adjusting for covariates, in-hospital mortality was significantly higher in the State of New York (OR 1.32; 95 % CI 1.13-1.55; P < 0.05) and Mississippi (OR 2.84; 95 % CI 1.24-6.51, P < 0.02). Wisconsin had a significant lower mortality rate (OR 0.74; 95 % CI 0.59-0.94, P < 0.01). LOS was 1.4 days longer in New York and 0.54 days shorter in Wisconsin than in California (P < 0.01). Patients with age >40 years, findings of peritonitis, and without private insurance had higher in-hospital mortality and longer length of stay. Average hospital charges differed dramatically between the states in the observation period. The highest hospital charges occurred in California, Nebraska, and Nevada while lowest occurred in Maryland, Wisconsin and Utah. CONCLUSIONS Patients who undergo surgical treatment for diverticulitis in the United States have high geographic variation in mortality, LOS, and hospital charges despite adjusting for demographic and socioeconomic factors. Further analysis should be performed to identify the causes of outlier regions, with the goal of improving and standardizing best practices.
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Affiliation(s)
- Hans F Fuchs
- Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA. .,Department of General Surgery, University of Cologne, Cologne, Germany.
| | - Ryan C Broderick
- Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA
| | - Cristina R Harnsberger
- Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA
| | - David C Chang
- Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA.,Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Elisabeth C Mclemore
- Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA
| | - Sonia Ramamoorthy
- Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA
| | - Santiago Horgan
- Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA
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Boelens PG, Taylor C, Henning G, Marang-van de Mheen PJ, Espin E, Wiggers T, Gore-Booth J, Moss B, Valentini V, van de Velde CJH. Involving patients in a multidisciplinary European consensus process and in the development of a 'patient summary of the consensus document for colon and rectal cancer care'. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2014; 7:261-70. [PMID: 24862378 DOI: 10.1007/s40271-014-0061-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CONTEXT High-quality cancer care should be accessible for patients and healthcare professionals. Involvement of patients as partners in guideline formation and consensus processes is still rarely found. EURECCA, short for European Registration of Cancer Care, is the platform to improve outcomes of cancer care by reducing variation in the diagnostic and treatment process. EURECCA acknowledges the important role of patients in implementation of consensus information in clinical practice. OBJECTIVE The aim of this article is to describe the process of involving patients in the consensus process and in developing the patient summary of the consensus for colon and rectal cancer care. METHODS The Delphi method for achieving consensus was used. Three online voting rounds and one tele-voting round were offered to an expert panel of oncology professionals and patient representatives. At four different stages, patients and/or patient representatives were involved in the process: (1) during the consensus process, (2) lecturing about the role of the patient, (3) development of the patient summary, and (4) testing the patient summary. RESULTS Representatives were invited to the voting and commenting rounds of this process and given an equal vote. Although patients were not consulted during the planning stages of this process, patient involvement increased following the panel's discussion of the implementation of the consensus among the patient population. After the consensus meeting, the patient summary was written by patient representatives, oncologists and nurses. A selection of proactive patients reviewed the draft patient summary; responses were positive and several patient-reported outcomes were added. Questionnaires to evaluate the use and implementation of the patient summary in daily practice are currently being developed and tested. Patient consultation will be needed in future planning for selection of topics. DISCUSSION The present study may function as a model for future consensus processes to involve patients at different stages and to implement both patient and healthcare professional versions in daily practice.
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Affiliation(s)
- Petra G Boelens
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, PO Box 9600, 2300 RC, Leiden, The Netherlands,
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