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Christ SM, Breitenstein M, Heesen P, Turner B, Muehlematter UJ, Pohl K, Willmann J, Maurer A, Nagpal SK, Ahmadsei M, Badra Vlaskou E, Looman EL, Heusel AE, Mayinger M, Balermpas P, Wicki A, Andratschke N, Balboni T, Anh Huynh M, Huellner M, Guckenberger M. Clinical management of oligometastatic cancer: Applying multidisciplinary tumor board recommendations in practice. Clin Transl Radiat Oncol 2024; 48:100838. [PMID: 39224662 PMCID: PMC11367634 DOI: 10.1016/j.ctro.2024.100838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Revised: 08/05/2024] [Accepted: 08/07/2024] [Indexed: 09/04/2024] Open
Abstract
Aims Multidisciplinary tumor boards (MDTs) are an integral part of ensuring high-quality, evidence-based and personalized cancer care. In this study, we aimed to evaluate the adherence to and implementation of MDT recommendations in patients with oligometastatic disease (OMD). Methods We screened all oncologic positron emission tomography (PET) scans conducted at a single comprehensive cancer center in 2020. Patients were included if they had evidence of imaging-based OMD from a solid organ malignancy on the index scans, had their OMD case discussed at an MDT, and were treated and followed up at the same center. A switch away from the MDT-recommended treatment modalities was classified as a major deviation; non-MDT-mandated adjustments to a recommended treatment modality were coded as minor deviation. Clinical data was obtained via chart review; statistical calculations were computed using the R software. Results After review of PET and/or concurrent brain scans, 787 cases of OMD were identified. Thereof, 347 (44.1 %) cases were discussed at MDT, of which 331 (42.1 %) were therapeutically managed and subsequently followed. The three most commonly recommended therapies were systemic therapy (35.6 %), multimodality treatment including definitive local therapy (17.8 %), and radiotherapy (13.9 %). A major deviation was recorded in 16.3 % of cases (most commonly: none of the MDT-recommended treatment modalities were performed: 19 (35.2 %); not all MDT-planned treatment modalities were performed: 12 (22.2 %); and additional treatment modality was performed: 11 (20.3 %). A minor deviation was found in 1.5 % of cases. On multivariable regression, number of distant metastases (n > 1) was associated with a major deviation (OR: 1.85; 95 % CI, 1.0-3.52). Major deviations were associated with a significantly worse OS (p = 0.0034). Conclusions Adherence to and implementation of MDT recommendations in OMD patients was generally high (83.7%). Major deviations might be further reduced by more careful and elaborate discussions of OMD patient characteristics s and patient preferences.
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Affiliation(s)
- Sebastian M. Christ
- Dept. of Radiation Oncology, University Hospital & University of Zurich, Zurich, CH, Switzerland
| | | | - Philip Heesen
- Faculty of Medicine, University of Zurich, Zurich, CH, Switzerland
| | - Brandon Turner
- Dept. of Radiation Oncology, Brigham and Women’s Hospital, Dana Farber Cancer Institute, Boston, MA, USA
| | - Urs J. Muehlematter
- Dept. of Nuclear Medicine, University Hospital & University of Zurich, Zurich, CH, Switzerland
| | - Kaspar Pohl
- Faculty of Medicine, University of Zurich, Zurich, CH, Switzerland
| | - Jonas Willmann
- Dept. of Radiation Oncology, University Hospital & University of Zurich, Zurich, CH, Switzerland
| | - Alexander Maurer
- Dept. of Nuclear Medicine, University Hospital & University of Zurich, Zurich, CH, Switzerland
| | | | - Maiwand Ahmadsei
- Dept. of Radiation Oncology, University Hospital & University of Zurich, Zurich, CH, Switzerland
| | - Eugenia Badra Vlaskou
- Dept. of Radiation Oncology, University Hospital & University of Zurich, Zurich, CH, Switzerland
| | - Esmée L. Looman
- Dept. of Radiation Oncology, University Hospital & University of Zurich, Zurich, CH, Switzerland
| | - Astrid E. Heusel
- Dept. of Radiation Oncology, University Hospital & University of Zurich, Zurich, CH, Switzerland
| | - Michael Mayinger
- Dept. of Radiation Oncology, University Hospital & University of Zurich, Zurich, CH, Switzerland
| | - Panagiotis Balermpas
- Dept. of Radiation Oncology, University Hospital & University of Zurich, Zurich, CH, Switzerland
| | - Andreas Wicki
- Dept. of Medical Oncology & Hematology, University Hospital & University of Zurich, Zurich, CH, Switzerland
| | - Nicolaus Andratschke
- Dept. of Radiation Oncology, University Hospital & University of Zurich, Zurich, CH, Switzerland
| | - Tracy Balboni
- Dept. of Radiation Oncology, Brigham and Women’s Hospital, Dana Farber Cancer Institute, Boston, MA, USA
| | - Mai Anh Huynh
- Dept. of Radiation Oncology, Brigham and Women’s Hospital, Dana Farber Cancer Institute, Boston, MA, USA
| | - Martin Huellner
- Dept. of Nuclear Medicine, University Hospital & University of Zurich, Zurich, CH, Switzerland
| | - Matthias Guckenberger
- Dept. of Radiation Oncology, University Hospital & University of Zurich, Zurich, CH, Switzerland
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Stirling RG, Harrison A, Huang J, Lee V, Taverner J, Barnes H. Multidisciplinary meeting review in nonsmall cell lung cancer: a systematic review and meta-analysis. Eur Respir Rev 2024; 33:230157. [PMID: 38719736 PMCID: PMC11078104 DOI: 10.1183/16000617.0157-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 02/23/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Lung cancer diagnosis, staging and treatment may be enhanced by multidisciplinary participation and presentation in multidisciplinary meetings (MDM). We performed a systematic review and meta-analysis to explore literature evidence of clinical impacts of MDM exposure. METHODS A study protocol was registered (PROSPERO identifier CRD42021258069). Randomised controlled trials and observational cohort studies including adults with nonsmall cell lung cancer and who underwent MDM review, compared to no MDM, were included. MEDLINE, CENTRAL, Embase and ClinicalTrials.gov were searched on 31 May 2021. Studies were screened and extracted by two reviewers. Outcomes included time to diagnosis and treatment, histological confirmation, receipt of treatments, clinical trial participation, survival and quality of life. Risk of bias was assessed using the ROBINS-I (Risk of Bias in Non-randomised Studies - of Interventions) tool. RESULTS 2947 citations were identified, and 20 studies were included. MDM presentation significantly increased histological confirmation of diagnosis (OR 3.01, 95% CI 2.30-3.95; p<0.00001) and availability of clinical staging (OR 2.55, 95% CI 1.43-4.56; p=0.002). MDM presentation significantly increased likelihood of receipt of surgery (OR 2.01, 95% CI 1.29-3.12; p=0.002) and reduced the likelihood of receiving no active treatment (OR 0.32, 95% CI 0.21-0.50; p=0.01). MDM presentation was protective of both 1-year survival (OR 3.23, 95% CI 2.85-3.68; p<0.00001) and overall survival (hazard ratio 0.63, 95% CI 0.55-0.72; p<0.00001). DISCUSSION MDM presentation was associated with increased likelihood of histological confirmation of diagnosis, documentation of clinical staging and receipt of surgery. Overall and 1-year survival was better in those presented to an MDM, although there was some clinical heterogeneity in participants and interventions delivered. Further research is required to determine the optimal method of MDM presentation, and address barriers to presentation.
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Affiliation(s)
- Rob G Stirling
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Amelia Harrison
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Australia
| | - Joanna Huang
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Australia
| | - Vera Lee
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - John Taverner
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Australia
| | - Hayley Barnes
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
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3
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Huang RS, Mihalache A, Nafees A, Hasan A, Ye XY, Liu Z, Leighl NB, Raman S. The impact of multidisciplinary cancer conferences on overall survival: a meta-analysis. J Natl Cancer Inst 2024; 116:356-369. [PMID: 38123515 DOI: 10.1093/jnci/djad268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/11/2023] [Accepted: 12/16/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Multidisciplinary cancer conferences consist of regular meetings between diverse specialists working together to share clinical decision making in cancer care. The aim of this study was to systematically review and meta-analyze the effect of multidisciplinary cancer conference intervention on the overall survival of patients with cancer. METHODS A systematic literature search was conducted on Ovid MEDLINE, EMBASE, and the Cochrane Controlled Register of Trials for studies published up to July 2023. Studies reporting on the impact of multidisciplinary cancer conferences on patient overall survival were included. A standard random-effects model with the inverse variance-weighted approach was used to estimate the pooled hazard ratio of mortality (multidisciplinary cancer conference vs non-multidisciplinary cancer conference) across studies, and the heterogeneity was assessed by I2. Publication bias was examined using funnel plots and the Egger test. RESULTS A total of 134 287 patients with cancer from 59 studies were included in our analysis, with 48 467 managed by multidisciplinary cancer conferences and 85 820 in the control arm. Across all cancer types, patients managed by multidisciplinary cancer conferences had an increased overall survival compared with control patients (hazard ratio = 0.67, 95% confidence interval = 0.62 to 0.71, I2 = 84%). Median survival time was 30.2 months in the multidisciplinary cancer conference group and 19.0 months in the control group. In subgroup analysis, a positive effect of the multidisciplinary cancer conference intervention on overall survival was found in breast, colorectal, esophageal, hematologic, hepatocellular, lung, pancreatic, and head and neck cancer. CONCLUSIONS Overall, our meta-analysis found a significant positive effect of multidisciplinary cancer conferences compared with controls. Further studies are needed to establish nuanced guidelines when optimizing multidisciplinary cancer conference integration for treating diverse patient populations.
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Affiliation(s)
- Ryan S Huang
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Andrew Mihalache
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Asad Hasan
- University of British Columbia, Vancouver, BC, Canada
| | - Xiang Y Ye
- Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Zhihui Liu
- Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Natasha B Leighl
- Department of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Srinivas Raman
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
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de Oliveira TB, Fontes DMN, Montella TC, Lewgoy J, Dutra C, Miola TM. The Best Supportive Care in Stage III Non-Small-Cell Lung Cancer. Curr Oncol 2023; 31:183-202. [PMID: 38248097 PMCID: PMC10814676 DOI: 10.3390/curroncol31010012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 11/27/2023] [Indexed: 01/23/2024] Open
Abstract
Lung cancer is a major cause of cancer deaths worldwide. Non-small-cell lung cancer (NSCLC) represents most lung cancer cases, and approximately one-third of patients present with stage III disease at diagnosis. As multiple treatment plans can be adopted for these patients depending on tumor size and nodal staging, stage III NSCLC management is challenging. Over the past decades, multidisciplinary teams (MDTs) have been implemented in healthcare services to coordinate actions among the different health care professionals involved in cancer care. The aim of this review was to discuss real-world evidence of the impact of MDTs on stage III NSCLC management, survival, and quality of life. Here, we performed a literature review to investigate the role of nutrition and navigational nursing in NSCLC care and the influence of MDTs in the choice of treatment plans, including immunotherapy consolidation, and in the management of chemotherapy and radiotherapy-related adverse events. We also performed a mapping review to identify gaps in the implementation of cancer care MDTs in healthcare services around the world.
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Affiliation(s)
| | | | | | - Jairo Lewgoy
- Medical Oncology Department, Hospital Mãe de Deus, Porto Alegre 90880-481, Brazil;
| | - Carolina Dutra
- Medical Oncology Department, Clínica Soma, Florianópolis 88020-210, Brazil;
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Tankel J, Spicer J, Chu Q, Fiset PO, Kidane B, Leighl NB, Joubert P, Maziak D, Palma D, McGuire A, Melosky B, Snow S, Bahig H, Blais N. Canadian Consensus Recommendations for the Management of Operable Stage II/III Non-Small-Cell Lung Cancer: Results of a Modified Delphi Process. Curr Oncol 2023; 30:10363-10384. [PMID: 38132389 PMCID: PMC10742991 DOI: 10.3390/curroncol30120755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 11/22/2023] [Accepted: 11/24/2023] [Indexed: 12/23/2023] Open
Abstract
The treatment paradigm for patients with stage II/III non-small-cell lung cancer (NSCLC) is rapidly evolving. We performed a modified Delphi process culminating at the Early-stage Lung cancer International eXpert Retreat (ELIXR23) meeting held in Montreal, Canada, in June 2023. Participants included medical and radiation oncologists, thoracic surgeons and pathologists from across Quebec. Statements relating to diagnosis and treatment paradigms in the preoperative, operative and postoperative time periods were generated and modified until all held a high level of consensus. These statements are aimed to help guide clinicians involved in the treatment of patients with stage II/III NSCLC.
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Affiliation(s)
- James Tankel
- Department of Thoracic Surgery, McGill University Health Center, Montreal, QC H3G 1A4, Canada
| | - Jonathan Spicer
- Department of Thoracic Surgery, McGill University Health Center, Montreal, QC H3G 1A4, Canada
| | - Quincy Chu
- Department of Medical Oncology, Cross Cancer Institute, Edmonton, AB T6G 1Z2, Canada
| | - Pierre Olivier Fiset
- Department of Pathology, McGill University Health Center, Montreal, QC H3G 1A4, Canada
| | - Biniam Kidane
- Section of Thoracic Surgery, University of Manitoba & Cancer Care Manitoba, Winnipeg, MB R3A 1R9, Canada
| | - Natasha B. Leighl
- Division of Medical Oncology, Princess Margaret Cancer Center, Toronto, ON M5G 2C4, Canada
| | - Philippe Joubert
- Department of Pathology, Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université, Laval, QC G1V 4G5, Canada
| | - Donna Maziak
- Department of Thoracic Surgery, Ottawa Hospital, Ottawa, ON K1Y 4E9, Canada
| | - David Palma
- Department of Radiation Oncology, London Health Services Center, London, ON N6A 5A5, Canada
| | - Anna McGuire
- Department of Thoracic Surgery, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada
| | - Barbara Melosky
- Department of Medical Oncology, BCCA, Vancouver, BC V5Z 4E6, Canada
| | - Stephanie Snow
- Department of Medical Oncology, Queen Elizabeth II Health Sciences Center, Halifax, NS B3H 3A7, Canada
| | - Houda Bahig
- Department of Radiation Oncology, Centre Hospitalier de l’Université de Montréal, Montreal, QC H2X 3E4, Canada
| | - Normand Blais
- Department of Medical Oncology, Centre Hospitalier de l’Université de Montréal, Montreal, QC H2X 3E4, Canada
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Naessens C, Laloze J, Leobon S, Gauthier T, Lacorre A, Monteil J, Venat L, Deluche E. Physician compliance with multidisciplinary tumor board recommendations for managing gynecological cancers. Future Oncol 2023; 19:897-908. [PMID: 37232140 DOI: 10.2217/fon-2022-1183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Aims: Evaluation of compliance with gynecological multidisciplinary tumor board (MTB) recommendations and its impact. Patients & methods: All patient records discussed in our MTB from 2018 to 2020 were analyzed. Results: We analyzed 437 MTB recommendations concerning 166 patients. Each patient was discussed an average of 2.6 (1.0-4.2) times. Of the 789 decisions, the decision was not followed 102 times (12.9%), corresponding to 85 MTB meetings (19.5%). Of these, 72 recommendations concerned therapeutic changes (70.5%), and 30 concerned non-therapeutic changes (29.5%). Of these 85 MTB decisions, 60 (71%) led to a new MTB submission. Noncompliance with MTB decisions decreased the overall survival (46 vs 138 months; p = 0.003). Conclusion: Improving compliance with MTB decisions is crucial to enhance patient outcomes.
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Affiliation(s)
- Clara Naessens
- Radiation Therapy Department, Limoges University Hospital, Limoges, 87000, France
| | - Jerome Laloze
- Reconstructive Surgery Department, Limoges University Hospital, Limoges, 87000, France
| | - Sophie Leobon
- Medical Oncology Department, Limoges University Hospital, Limoges, 87000, France
| | - Tristan Gauthier
- Gynecological Department, Limoges University Hospital, Limoges, 87000, France
| | - Aymeline Lacorre
- Gynecological Department, Limoges University Hospital, Limoges, 87000, France
| | - Jacques Monteil
- Nuclear Medicine Department, Limoges University Hospital, Limoges, 87000, France
| | - Laurence Venat
- Medical Oncology Department, Limoges University Hospital, Limoges, 87000, France
| | - Elise Deluche
- Medical Oncology Department, Limoges University Hospital, Limoges, 87000, France
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Blum TG, Morgan RL, Durieux V, Chorostowska-Wynimko J, Baldwin DR, Boyd J, Faivre-Finn C, Galateau-Salle F, Gamarra F, Grigoriu B, Hardavella G, Hauptmann M, Jakobsen E, Jovanovic D, Knaut P, Massard G, McPhelim J, Meert AP, Milroy R, Muhr R, Mutti L, Paesmans M, Powell P, Putora PM, Rawlinson J, Rich AL, Rigau D, de Ruysscher D, Sculier JP, Schepereel A, Subotic D, Van Schil P, Tonia T, Williams C, Berghmans T. European Respiratory Society guideline on various aspects of quality in lung cancer care. Eur Respir J 2023; 61:13993003.03201-2021. [PMID: 36396145 DOI: 10.1183/13993003.03201-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 09/23/2022] [Indexed: 11/18/2022]
Abstract
This European Respiratory Society guideline is dedicated to the provision of good quality recommendations in lung cancer care. All the clinical recommendations contained were based on a comprehensive systematic review and evidence syntheses based on eight PICO (Patients, Intervention, Comparison, Outcomes) questions. The evidence was appraised in compliance with the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Evidence profiles and the GRADE Evidence to Decision frameworks were used to summarise results and to make the decision-making process transparent. A multidisciplinary Task Force panel of lung cancer experts formulated and consented the clinical recommendations following thorough discussions of the systematic review results. In particular, we have made recommendations relating to the following quality improvement measures deemed applicable to routine lung cancer care: 1) avoidance of delay in the diagnostic and therapeutic period, 2) integration of multidisciplinary teams and multidisciplinary consultations, 3) implementation of and adherence to lung cancer guidelines, 4) benefit of higher institutional/individual volume and advanced specialisation in lung cancer surgery and other procedures, 5) need for pathological confirmation of lesions in patients with pulmonary lesions and suspected lung cancer, and histological subtyping and molecular characterisation for actionable targets or response to treatment of confirmed lung cancers, 6) added value of early integration of palliative care teams or specialists, 7) advantage of integrating specific quality improvement measures, and 8) benefit of using patient decision tools. These recommendations should be reconsidered and updated, as appropriate, as new evidence becomes available.
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Affiliation(s)
- Torsten Gerriet Blum
- Department of Pneumology, Lungenklinik Heckeshorn, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - Rebecca L Morgan
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Valérie Durieux
- Bibliothèque des Sciences de la Santé, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Joanna Chorostowska-Wynimko
- Department of Genetics and Clinical Immunology, National Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - David R Baldwin
- Department of Respiratory Medicine, Nottingham University Hospitals, Nottingham, UK
| | | | - Corinne Faivre-Finn
- Division of Cancer Sciences, University of Manchester and The Christie NHS Foundation Trust, Manchester, UK
| | | | | | - Bogdan Grigoriu
- Intensive Care and Oncological Emergencies and Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Georgia Hardavella
- Department of Respiratory Medicine, King's College Hospital London, London, UK
- Department of Respiratory Medicine and Allergy, King's College London, London, UK
| | - Michael Hauptmann
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Neuruppin, Germany
| | - Erik Jakobsen
- Department of Thoracic Surgery, Odense University Hospital, Odense, Denmark
| | | | - Paul Knaut
- Department of Pneumology, Lungenklinik Heckeshorn, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - Gilbert Massard
- Faculty of Science, Technology and Medicine, University of Luxembourg and Department of Thoracic Surgery, Hôpitaux Robert Schuman, Luxembourg, Luxembourg
| | - John McPhelim
- Lung Cancer Nurse Specialist, Hairmyres Hospital, NHS Lanarkshire, East Kilbride, UK
| | - Anne-Pascale Meert
- Intensive Care and Oncological Emergencies and Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Robert Milroy
- Scottish Lung Cancer Forum, Glasgow Royal Infirmary, Glasgow, UK
| | - Riccardo Muhr
- Department of Pneumology, Lungenklinik Heckeshorn, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - Luciano Mutti
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
- SHRO/Temple University, Philadelphia, PA, USA
| | - Marianne Paesmans
- Data Centre, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | | | - Paul Martin Putora
- Departments of Radiation Oncology, Kantonsspital St Gallen, St Gallen and University of Bern, Bern, Switzerland
| | | | - Anna L Rich
- Department of Respiratory Medicine, Nottingham University Hospitals, Nottingham, UK
| | - David Rigau
- Iberoamerican Cochrane Center, Barcelona, Spain
| | - Dirk de Ruysscher
- Maastricht University Medical Center, Department of Radiation Oncology (Maastro Clinic), GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands
- Erasmus Medical Center, Department of Radiation Oncology, Rotterdam, The Netherlands
| | - Jean-Paul Sculier
- Intensive Care and Oncological Emergencies and Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Arnaud Schepereel
- Pulmonary and Thoracic Oncology, Université de Lille, Inserm, CHU Lille, Lille, France
| | - Dragan Subotic
- Clinic for Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Paul Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | | - Thierry Berghmans
- Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Brussels, Belgium
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8
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Recognition of and treatment recommendations for oligometastatic disease in multidisciplinary tumor boards. Clin Transl Radiat Oncol 2022; 38:123-129. [DOI: 10.1016/j.ctro.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/08/2022] [Accepted: 11/10/2022] [Indexed: 11/17/2022] Open
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Bertolaccini L, Mohamed S, Bardoni C, Lo Iacono G, Mazzella A, Guarize J, Spaggiari L. The Interdisciplinary Management of Lung Cancer in the European Community. J Clin Med 2022; 11:jcm11154326. [PMID: 35893419 PMCID: PMC9332145 DOI: 10.3390/jcm11154326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/16/2022] [Accepted: 07/20/2022] [Indexed: 02/01/2023] Open
Abstract
Lung cancer continues to be the largest cause of cancer-related mortality among men and women globally, accounting for around 27% of all cancer-related deaths. Recent advances in lung cancer medicines, particularly for non-small-cell lung cancer (NSCLC), have increased the need for multidisciplinary disease care, thereby enhancing patient outcomes and quality of life. Different studies in the European community have evaluated the impact of multidisciplinary care on outcomes for lung cancer patients, including its impact on survival, adherence to guideline treatment, utilization of all treatment modalities, timeliness of treatment, patient satisfaction, quality of life, and referral to palliative care. This publication will examine the roles and duties of all multidisciplinary members and the influence of multidisciplinary care on lung cancer outcomes in Europe. Multidisciplinary treatment is the foundation of lung cancer treatment. The optimal setting for interdisciplinary collaboration between specialists with complementary functions is multidisciplinary meetings. Multidisciplinary care in lung cancer facilitates the delivery of a high-quality service, which may improve lung cancer patients’ survival, utilization of all treatment modalities, adherence to guideline management, and quality of life, despite the fact that only limited observational data have demonstrated these results. To confirm the relationship between multidisciplinary treatment and improved lung cancer patient outcomes, however, further research is required.
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Affiliation(s)
- Luca Bertolaccini
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (S.M.); (C.B.); (G.L.I.); (A.M.); (L.S.)
- Correspondence: ; Tel.: +39-02-57489665; Fax: +39-02-56562994
| | - Shehab Mohamed
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (S.M.); (C.B.); (G.L.I.); (A.M.); (L.S.)
| | - Claudia Bardoni
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (S.M.); (C.B.); (G.L.I.); (A.M.); (L.S.)
| | - Giorgio Lo Iacono
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (S.M.); (C.B.); (G.L.I.); (A.M.); (L.S.)
| | - Antonio Mazzella
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (S.M.); (C.B.); (G.L.I.); (A.M.); (L.S.)
| | - Juliana Guarize
- Unit of Interventional Pulmonology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy;
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (S.M.); (C.B.); (G.L.I.); (A.M.); (L.S.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20141 Milan, Italy
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Ladekarl M, Rasmussen LS, Kirkegård J, Chen I, Pfeiffer P, Weber B, Skuladottir H, Østerlind K, Larsen JS, Mortensen FV, Engberg H, Møller H, Fristrup CW. Disparity in use of modern combination chemotherapy associated with facility type influences survival of 2655 patients with advanced pancreatic cancer. Acta Oncol 2022; 61:277-285. [PMID: 34879787 DOI: 10.1080/0284186x.2021.2012252] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
AIM Academic and high volume hospitals have better outcome for pancreatic cancer (PC) surgery, but there are no reports on oncological treatment. We aimed to determine the influence of facility types on overall survival (OS) after treatment with chemotherapy for inoperable PC. MATERIAL AND METHODS 2,657 patients were treated in Denmark from 2012 to 2018 and registered in the Danish Pancreatic Cancer Database. Facilities were classified as either secondary oncological units or comprehensive, tertiary referral cancer centers. RESULTS The average yearly number of patients seen at the four tertiary facilities was 71, and 31 at the four secondary facilities. Patients at secondary facilities were older, more frequently had severe comorbidity and lived in non-urban municipalities. As compared to combination chemotherapy, monotherapy with gemcitabine was used more often (59%) in secondary facilities than in tertiary (34%). The unadjusted median OS was 7.7 months at tertiary and 6.1 months at secondary facilities. The adjusted hazard ratio (HR) of 1.16 (confidence interval 1.07-1.27) demonstrated an excess risk of death for patients treated at secondary facilities, which disappeared when taking type of chemotherapy used into account. Hence, more use of combination chemotherapy was associated with the observed improved OS of patients treated at tertiary facilities. Declining HR's per year of first treatment indicated improved outcomes with time, however the difference among facility types remained significant. DISCUSSION Equal access to modern combination chemotherapy at all facilities on a national level is essential to ensure equality in treatment results.
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Affiliation(s)
- Morten Ladekarl
- Department of Oncology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
| | - Louise Skau Rasmussen
- Department of Oncology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
| | - Jakob Kirkegård
- Department of Gastrointestinal Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Inna Chen
- Department of Oncology, Herlev and Gentofte University Hospital, Copenhagen, Denmark
| | - Per Pfeiffer
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Britta Weber
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Kell Østerlind
- Department of Oncology, North Zealand Hospital, Hillerød, Denmark
| | - Jim Stenfatt Larsen
- Department of Oncology, Zealand University Hospital, Naestved and Roskilde, Denmark
| | | | - Henriette Engberg
- The Danish Clinical Quality Program and Clinical Registries (RKKP), Aalborg, Denmark
| | - Henrik Møller
- The Danish Clinical Quality Program and Clinical Registries (RKKP), Aalborg, Denmark
- Danish Center for Clinical Health Services Research, Aalborg University, Aalborg, Denmark
| | - Claus Wilki Fristrup
- Odense Pancreas Center (OPAC), Odense University Hospital, Odense, Denmark
- Danish Pancreatic Cancer Database (DPCD), Denmark
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11
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Gebbia V, Guarini A, Piazza D, Bertani A, Spada M, Verderame F, Sergi C, Potenza E, Fazio I, Blasi L, La Sala A, Mortillaro G, Roz E, Marchese R, Chiarenza M, Soto-Parra H, Valerio MR, Agneta G, Amato C, Lipari H, Baldari S, Ferraù F, Di Grazia A, Mancuso G, Rizzo S, Firenze A. Virtual Multidisciplinary Tumor Boards: A Narrative Review Focused on Lung Cancer. Pulm Ther 2021; 7:295-308. [PMID: 34089169 PMCID: PMC8177259 DOI: 10.1007/s41030-021-00163-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/20/2021] [Indexed: 01/31/2023] Open
Abstract
To date, the virtual multidisciplinary tumor boards (vMTBs) are increasingly used to achieve high-quality treatment recommendations across health-care regions, which expands and develops the local MTB team to a regional or national expert network. This review describes the process of lung cancer-specific MTBs and the transition process from face-to-face tumor boards to virtual ones. The review also focuses on the project organization's description, advantages, and disadvantages. Semi-structured interviews identified five major themes for MTBs: current practice, attitudes, enablers, barriers, and benefits for the MTB. MTB teams exhibited positive responses to modeled data feedback. Virtualization reduces time spent for travel, allowing easier and timely patient discussions. This process requires a secure web platform to assure the respect of patients' privacy and presents the same unanswered problems. The implementation of vMTB also permits the implementation of networks especially in areas with geographical barriers facilitating interaction between large referral cancer centers and tertiary or community hospitals as well as easier access to clinical trial opportunities. Studies aimed to improve preparations, structure, and conduct of MTBs, research methods to monitor their performance, teamwork, and outcomes are also outlined in this article. Analysis of literature shows that MTB participants discuss 5-8 cases per meeting and that the use of a vMTB for lung cancer and in particular stage III NSCLC and complex stage IV cases is widely accepted by most health professionals. Despite still-existing gaps, overall vMTB represents a unique opportunity to optimize patient management in a patient-centered approach.
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Affiliation(s)
- Vittorio Gebbia
- Medical Oncology Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, La Maddalena Clinic for Cancer, University of Palermo, Via San Lorenzo Colli n. 312D, 90100, Palermo, Italy.
- GSTU Foundation, Palermo, Italy.
| | - Aurelia Guarini
- Medical Oncology Unit, Fondazione Ospedale Giglio, Cefalù, Palermo, Italy
| | | | - Alessandro Bertani
- Division of Thoracic Surgery and Lung Transplantation, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS Ismett, UPMC, Palermo, Italy
| | - Massimiliano Spada
- Medical Oncology Unit, Fondazione Ospedale Giglio, Cefalù, Palermo, Italy
| | | | - Concetta Sergi
- Thoracic Surgery Unit, ARNAS, Ospedale Garibaldi, Nesima, Catania, Italy
| | - Enrico Potenza
- Thoracic Surgery Unit, ARNAS, Ospedale Garibaldi, Nesima, Catania, Italy
| | - Ivan Fazio
- Radiation Therapy Unit, Clinica Macchiarella, Palermo, Italy
| | - Livio Blasi
- Medical Oncology Unit, Arnas Civico, Palermo, Italy
| | - Alba La Sala
- Bronchial Endoscopy Unit, Arnas Civico, Palermo, Italy
| | | | - Elena Roz
- Pathology Unit, La Maddalena Clinic for Cancer, Palermo, Italy
| | - Roberto Marchese
- Thoracic Surgery Unit, La Maddalena Clinic for Cancer, Palermo, Italy
| | | | | | | | - Giuseppe Agneta
- Thoracic Surgery Unit, Ospedale Cervello Villa Sofia, Palermo, Italy
| | - Carmela Amato
- Patients Advocacy "Serena a Palermo", Palermo, Italy
| | - Helga Lipari
- Medical Oncology Unit, Ospedale Cannizzaro, Catania, Italy
| | - Sergio Baldari
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University Hospital G. Martino, Messina, Italy
| | - Francesco Ferraù
- Medical Oncology Unit, Ospedale San Vincenzo, Taormina, Messina, Italy
| | - Alfio Di Grazia
- Radiation Oncology Unit, Istituto Clinico Humanitas, Catania, Italy
| | - Gianfranco Mancuso
- Medical Oncology Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, La Maddalena Clinic for Cancer, University of Palermo, Via San Lorenzo Colli n. 312D, 90100, Palermo, Italy
| | - Sergio Rizzo
- Medical Oncology Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, La Maddalena Clinic for Cancer, University of Palermo, Via San Lorenzo Colli n. 312D, 90100, Palermo, Italy
| | - Alberto Firenze
- Risk Management Unit, Policlinico, University of Palermo, Palermo, Italy
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12
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Guirado M, Sanchez-Hernandez A, Pijuan L, Teixido C, Gómez-Caamaño A, Cilleruelo-Ramos Á. Quality indicators and excellence requirements for a multidisciplinary lung cancer tumor board by the Spanish Lung Cancer Group. Clin Transl Oncol 2021; 24:446-459. [PMID: 34665437 PMCID: PMC8525055 DOI: 10.1007/s12094-021-02712-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 09/18/2021] [Indexed: 12/24/2022]
Abstract
Multidisciplinary care is needed to decide the best therapeutic approach and to provide optimal care to patients with lung cancer (LC). Multidisciplinary teams (MDTs) are optimal strategies for the management of patients with LC and have been associated with better outcomes, such as an increase in quality of life and survival. The Spanish Lung Cancer Group has promoted this review about the current situation of the existing national LC-MDTs, which also offers a set of excellence requirements and quality indicators to achieve the best care in any patient with LC. Time and sufficient resources; leadership; administrative and institutional support; and recording of activity are key factors for the success of LC-MDTs. A set of excellence requirements in terms of staff, resources and organization of the LC-MDT have been proposed. At last, a list of quality indicators has been agreed to achieve and measure the performance of current LC-MDTs.
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Affiliation(s)
- M Guirado
- Medical Oncology Department, Hospital General Universitario de Elche, 03203, Elche, Spain
| | - A Sanchez-Hernandez
- Medical Oncology Department, Consorcio Hospitalario Provincial de Castellón, 12002, Castellón de la Plana, Spain
| | - L Pijuan
- Pathology Department, Bellvitge University Hospital, 08907, L'Hospitalet de Llobregat, Spain
| | - C Teixido
- Thoracic Oncology Unit, Department of Pathology, IDIBAPS, Hospital Clinic of Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain.
| | - A Gómez-Caamaño
- Department of Radiation Oncology, Hospital Clínico Universitario Santiago de Compostela, 15706, Santiago de Compostela, Spain
| | - Á Cilleruelo-Ramos
- Thoracic Surgery Department, Hospital Clínico Universitario Valladolid, 47005, Valladolid, Spain
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13
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The Effects of Multidisciplinary Team Meetings on Clinical Practice for Colorectal, Lung, Prostate and Breast Cancer: A Systematic Review. Cancers (Basel) 2021; 13:cancers13164159. [PMID: 34439312 PMCID: PMC8394238 DOI: 10.3390/cancers13164159] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/29/2021] [Accepted: 08/16/2021] [Indexed: 02/06/2023] Open
Abstract
Simple Summary Multidisciplinary team meetings have increasingly been implemented in cancer care worldwide to ensure timely, accurate and evidence-based diagnosis, and treatment plans. Nowadays, multidisciplinary team meetings are generally considered indispensable. However, they are considered time-consuming and expensive, while the effects of multidisciplinary team meetings are not yet fully understood. The aim of this systematic review is to update and summarize the literature and create an overview of the existing knowledge. Cancer types such as colorectal, lung, prostate and breast cancer with rapidly increasing incidence rates will inevitably impact the workload of clinicians. Understanding the effects of the widely implemented multidisciplinary team meetings in oncology care is fundamental in order to optimize care pathways and allocate resources in the rapidly diversifying landscape of cancer therapies. Abstract Objective: The aim of our systematic review is to identify the effects of multidisciplinary team meetings (MDTM) for lung, breast, colorectal and prostate cancer. Methods: Our systematic review, performed following PRISMA guidelines, included studies examining the impact of MDTMs on treatment decisions, patient and process outcomes. Electronic databases PUBMED, EMBASE, Cochrane Library and Web of Science were searched for articles published between 2000 and 2020. Risk of bias and level of evidence were assessed using the ROBINS-I tool and GRADE scale. Results: 41 of 13,246 articles were selected, evaluating colorectal (21), lung (10), prostate (6) and breast (4) cancer. Results showed that management plans were changed in 1.6–58% of cases after MDTMs. Studies reported a significant impact of MDTMs on surgery type, and a reduction of overall performed surgery after MDTM. Results also suggest that CT and MRI imaging significantly increased after MDTM implementation. Survival rate increased significantly with MDTM discussions according to twelve studies, yet three studies did not show significant differences. Conclusions: Despite heterogeneous data, MDTMs showed a significant impact on management plans, process outcomes and patient outcomes. To further explore the impact of MDTMs on the quality of healthcare, high-quality research is needed.
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14
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Kelley S, Beck AC, Weigel RJ, Howe JR, Sugg SL, Lal G. Influence of endocrine multidisciplinary tumor board on patient management and treatment decision making. Am J Surg 2021; 223:76-80. [PMID: 34303521 DOI: 10.1016/j.amjsurg.2021.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/15/2021] [Accepted: 07/16/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Multidisciplinary Tumor Boards (MDT) are used to obtain input regarding cancer management. This study assessed the impact of our institutional Endocrine MDT. METHODS MDT notes on patients with thyroid cancer treated during 2012-2018 were abstracted retrospectively from the electronic medical record. Management change (MC) was prospectively collected by the MDT coordinator. Biannual evaluations reviewed the impact of the MDT as observed by attendees. RESULTS MC was recommended in 47 (15%) of 286 presentations, with additional imaging being the most frequent (43%). Presentation of recurrences were more likely to result in MC (24% vs. 13% initial, p = 0.03). Overall, 98% of attendees found the conference exceeded educational expectations. About 24% reported intending to use a more evidence/guideline-based approach after attending and this trend increased over time (p = 0.002). CONCLUSION MDT presentations led to a higher rate of MC particularly in recurrent TC patients and increased evidenced-based practice for attendees.
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Affiliation(s)
- Sarah Kelley
- University of Iowa Hospitals and Clinics, Department of Internal Medicine, 200 Hawkins Dr, Iowa City, IA, 52242, USA
| | - Anna C Beck
- University of Iowa Hospitals and Clinics, Department of Surgery, 200 Hawkins Dr, Iowa City, IA, 52242, USA
| | - Ronald J Weigel
- University of Iowa Hospitals and Clinics, Department of Surgery, 200 Hawkins Dr, Iowa City, IA, 52242, USA
| | - James R Howe
- University of Iowa Hospitals and Clinics, Department of Surgery, 200 Hawkins Dr, Iowa City, IA, 52242, USA
| | - Sonia L Sugg
- University of Iowa Hospitals and Clinics, Department of Surgery, 200 Hawkins Dr, Iowa City, IA, 52242, USA
| | - Geeta Lal
- University of Iowa Hospitals and Clinics, Department of Surgery, 200 Hawkins Dr, Iowa City, IA, 52242, USA.
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15
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Pêgo-Fernandes PM, Haddad FJ, Imaeda CJ, Sandrini M. The role of the surgeon in treating patients with lung cancer. An updating article. SAO PAULO MED J 2021; 139:293-300. [PMID: 34076231 PMCID: PMC9625005 DOI: 10.1590/1516-3180.2020.0763.16022021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 12/17/2020] [Accepted: 02/16/2021] [Indexed: 12/04/2022] Open
Abstract
Lung cancer is a type of neoplasia with one of the highest incidences worldwide and is the largest cause of mortality due to cancer in the world today. It is classified according to its histological and biological characteristics, which will determine its treatment and prognosis. Non-small cell lung cancer accounts for 85% of the cases, and these are the cases that surgeons mostly deal with. Small cell lung cancer accounts for the remaining 15%. Surgery is the main method for treating early stage lung cancer, and lobectomy is the preferred procedure for treating primary lung cancer, while sublobar resection is an alternative for patients with poor reserve or with very small tumors. Surgeons need to be trained to use the resources and techniques available for lung resection, including less invasive approaches such as video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery (RATS), and need to be familiar with new oncological approaches, including curative, adjuvant or palliative treatments for patients with lung cancer.
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Affiliation(s)
- Paulo Manuel Pêgo-Fernandes
- MD, PhD. Full Professor, Thoracic Surgery Program, Instituto do Coração (InCor), Hospital das Clínicas (HC), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo (SP), Brazil; Cardiothoracic Surgeon, Hospital Beneficência Portuguesa (BP), São Paulo (SP), Brazil.
| | - Fabio José Haddad
- MD, PhD. Thoracic Surgeon, Hospital Beneficência Portuguesa (BP) and Hospital Sírio-Libanês, São Paulo (SP), Brazil.
| | - Carlos Jogi Imaeda
- MD. Thoracic Surgeon, Hospital Beneficência Portuguesa (BP), São Paulo (SP), Brazil.
| | - Marcel Sandrini
- MD. Thoracic Surgeon, Hospital Beneficência Portuguesa (BP), São Paulo (SP), Brazil.
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16
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The Evolving Concept of Complete Resection in Lung Cancer Surgery. Cancers (Basel) 2021; 13:cancers13112583. [PMID: 34070418 PMCID: PMC8197519 DOI: 10.3390/cancers13112583] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 05/22/2021] [Accepted: 05/23/2021] [Indexed: 12/25/2022] Open
Abstract
Simple Summary In the surgical treatment of lung cancer, the complete removal of the portion of the lung where the cancer is and of the involved adjacent structures is of paramount importance to achieve long-term survival. The International Association for the Study of Lung Cancer (IASLC) proposed a definition of complete resection that included a well-defined type of removal of the regional lymph nodes as a fundamental step. The lymph nodes may contain cancer cells and, if left behind, cancer will soon progress. The IASLC also defined incomplete resection when there is any evidence of persistent cancer after the operation. It also defined an intermediate condition, uncertain resection, when no evidence of residual disease can be proved, but all the conditions of complete resection are not fulfilled. Four validations of the definitions have proved their prognostic value and, therefore, the definitions should be followed when a surgical resection of lung cancer is planned. Abstract Different definitions of complete resection were formulated to complement the residual tumor (R) descriptor proposed by the American Joint Committee on Cancer in 1977. The definitions went beyond resection margins to include the status of the visceral pleura, the most distant nodes and the nodal capsule and the performance of a complete mediastinal lymphadenectomy. In 2005, the International Association for the Study of Lung Cancer (IASLC) proposed definitions for complete, incomplete and uncertain resections for international implementation. Central to the IASLC definition of complete resection is an adequate nodal evaluation either by systematic nodal dissection or lobe-specific systematic nodal dissection, as well as the integrity of the highest mediastinal node, the nodal capsule and the resection margins. When there is evidence of cancer remaining after treatment, the resection is incomplete, and when all margins are free of tumor, but the conditions for complete resection are not fulfilled, the resection is defined as uncertain. The prognostic relevance of the definitions has been validated by four studies. The definitions can be improved in the future by considering the cells spread through air spaces, the residual tumor cells, DNA or RNA in the blood, and the determination of the adequate margins and lymphadenectomy in sublobar resections.
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Berghmans T, Lievens Y, Aapro M, Baird AM, Beishon M, Calabrese F, Dégi C, Delgado Bolton RC, Gaga M, Lövey J, Luciani A, Pereira P, Prosch H, Saar M, Shackcloth M, Tabak-Houwaard G, Costa A, Poortmans P. European Cancer Organisation Essential Requirements for Quality Cancer Care (ERQCC): Lung cancer. Lung Cancer 2020; 150:221-239. [PMID: 33227525 DOI: 10.1016/j.lungcan.2020.08.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 08/26/2020] [Indexed: 12/24/2022]
Abstract
European Cancer Organisation Essential Requirements for Quality Cancer Care (ERQCC) are written by experts representing all disciplines involved in cancer care in Europe. They give patients, health professionals, managers and policymakers a guide to essential care throughout the patient journey. Lung cancer is the leading cause of cancer mortality and has a wide variation in treatment and outcomes in Europe. It is a major healthcare burden and has complex diagnosis and treatment challenges. Care must only be carried out in lung cancer units or centres that have a core multidisciplinary team (MDT) and an extended team of health professionals detailed here. Such units are far from universal in European countries. To meet European aspirations for comprehensive cancer control, healthcare organisations must consider the requirements in this paper, paying particular attention to multidisciplinarity and patient-centred pathways from diagnosis, to treatment, to survivorship.
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Affiliation(s)
- Thierry Berghmans
- European Organisation for Research and Treatment of Cancer (EORTC); Thoracic Oncology Clinic, Institut Jules Bordet, Brussels, Belgium
| | - Yolande Lievens
- European Society for Radiotherapy and Oncology (ESTRO); Radiation Oncology Department, Ghent University Hospital, Belgium
| | - Matti Aapro
- European Cancer Organisation; Genolier Cancer Center, Genolier, Switzerland
| | - Anne-Marie Baird
- European Cancer Organisation Patient Advisory Committee; Central Pathology Laboratory, St James's Hospital, Dublin, Ireland
| | - Marc Beishon
- Cancer World, European School of Oncology (ESO), Milan, Italy.
| | - Fiorella Calabrese
- European Society of Pathology (ESP); Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova Medical School, Padova, Italy
| | - Csaba Dégi
- International Psycho-Oncology Society (IPOS); Faculty of Sociology and Social Work, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Roberto C Delgado Bolton
- European Association of Nuclear Medicine (EANM); Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, San Pedro Hospital and Centre for Biomedical Research of La Rioja (CIBIR); University of La Rioja, Logroño, La Rioja, Spain
| | - Mina Gaga
- European Respiratory Society (ERS); 7th Respiratory Medicine Department, Athens Chest Hospital Sotiria, Athens, Greece
| | - József Lövey
- Organisation of European Cancer Institutes (OECI); National Institute of Oncology, Budapest, Hungary
| | - Andrea Luciani
- International Society of Geriatric Oncology (SIOG); Medical Oncology, Ospedale S. Paolo, Milan, Italy
| | - Philippe Pereira
- Cardiovascular and Interventional Radiological Society of Europe (CIRSE); Clinic for Radiology, Minimally-Invasive Therapies and Nuclear Medicine, SLK-Kliniken, Heilbronn, Germany
| | - Helmut Prosch
- European Society of Radiology (ESR); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria
| | - Marika Saar
- European Society of Oncology Pharmacy (ESOP); Tartu University Hospital, Tartu, Estonia
| | - Michael Shackcloth
- European Society of Surgical Oncology (ESSO); Department of Thoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | | | | | - Philip Poortmans
- European Cancer Organisation; Iridium Kankernetwerk and University of Antwerp, Wilrijk-Antwerp, Belgium
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18
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Varela G, Novoa NM. EGFR and non-small cell lung cancer: implications for surgical practice. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1115. [PMID: 33145334 PMCID: PMC7575960 DOI: 10.21037/atm.2020.04.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Gonzalo Varela
- Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain
| | - Nuria M. Novoa
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain
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19
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Heinke MY, Vinod SK. A review on the impact of lung cancer multidisciplinary care on patient outcomes. Transl Lung Cancer Res 2020; 9:1639-1653. [PMID: 32953538 PMCID: PMC7481642 DOI: 10.21037/tlcr.2019.11.03] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
International guidelines recommend a multidisciplinary approach to the management of lung cancer due to the complexity of both patients and their disease and the multiple treatment options available. This care can be provided through patient discussion at multidisciplinary meetings where relevant medical and allied health staff formulate a consensus management plan taking all factors into consideration. This model can be extended further to include multidisciplinary clinics where the patient is present for assessment and discussion. However, conducting regular multidisciplinary meetings or clinics has significant time, resource and financial costs and therefore, it is important to assess the impact of multidisciplinary care. We aimed to review published evidence, from 2000 to 2019, to evaluate the impact of multidisciplinary care on lung cancer outcomes. There were 29 studies found, 11 evaluating multidisciplinary clinics, 14 studying multidisciplinary meetings and four where the model of care was not defined. There was only one randomised trial and three prospective studies, the remainder being retrospective studies. Despite limitations in trial design and confounding factors, overall, multidisciplinary care in lung cancer was associated with improvements in patient outcomes, in particular improved survival for all stages of lung cancer. Lung cancer patients managed in a multidisciplinary setting were more likely to receive active treatment and had improved utilisation of all treatment modalities: surgery, radiotherapy and chemotherapy. In addition, the treatment recommendations were more likely to be consistent with lung cancer management guidelines. These improved outcomes support the recommendations for a multidisciplinary approach to lung cancer care.
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Affiliation(s)
- Monique Y Heinke
- Liverpool and Macarthur Cancer Therapy Centre, Liverpool, NSW, Australia
| | - Shalini K Vinod
- Liverpool and Macarthur Cancer Therapy Centre, Liverpool, NSW, Australia.,South Western Sydney Clinical School, University of New South Wales, NSW, Australia
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20
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Stahel RA, Curioni-Fontecedro A, Rohrmann S, Dafni U, Sandner U, Opitz I, Andratschke N, Franzen D, Dimopoulou G, Matthes KL, Kohler M, Guckenberger M, Weder W. Survival outcome of non-small cell lung cancer patients: Comparing results between the database of the Comprehensive Cancer Center Zürich and the Epidemiological Cancer Registry Zurich and Zug. Lung Cancer 2020; 146:217-223. [PMID: 32569900 DOI: 10.1016/j.lungcan.2020.05.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cancer cases among the population of the canton Zurich, are registered in the Cancer Registry of the cantons of Zurich and Zug (KKR). The Thoracic Oncology Center, founded in 2011 is one of 17 multidisciplinary centers within the Comprehensive Cancer Center Zurich (CCCZ). METHODS The aim of the current study is to quantify the mortality risk of patients with NSCLC and identify differences on survival and other factors between patients receiving their primary treatment at the CCCZ and those treated elsewhere and registered by KKR. The differential effect between CCCZ and KKR cohorts on survival: overall, by stage, sex and age, is explored. Stratified log-rank and Wilcoxon tests, Cox models and restricted mean survival times (RMST) are estimated. Propensity score matching (PSM) is also used to adjust for confounding factors. RESULTS Analysis included 848 NSCLC cases from the CCCZ and 1759 from the KKR, diagnosed between January 2011 and December 2015. At a median follow-up of 57 months, overall survival (OS) was significantly superior for patients treated at the CCCZ compared to KKR [Median OS: 36.0 months (95%CI: 31.0-45.0) and 12.0 months (95%CI: 11.0-13.0), respectively, stratified log-rank p < 0.001; adjusted HR = 1.31, (95% CI: 1.18-1.46), difference in RMST up to 72 months: 13.8 months (95%CI: 11.5-16.2), p < 0.001]. The effect of cohort was significant for stages III and IV (overall and also by sex and age). After PSM OS remained significantly superior for patients treated at the CCCZ compared to KKR. CONCLUSIONS The survival probability for patients in the CCCZ cohort was superior to that of patients in the canton Zürich treated outside the center. This analysis provides further evidence of the importance of the volume of experience and the availability of a multidisciplinary organization and research environment, as delivered by a comprehensive cancer center, on the outcome of patients with NSCLC.
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Affiliation(s)
- R A Stahel
- Comprehensive Cancer Center Zürich, University Hospital Zürich, Zurich, Switzerland.
| | - A Curioni-Fontecedro
- Department of Medical Oncology and Hematology, University Hospital Zürich, Zurich, Switzerland
| | - S Rohrmann
- Cancer Registry of the Cantons Zurich and Zug, University Hospital Zürich, Zurich, Switzerland
| | - U Dafni
- Laboratory of Biostatistics, School of Health Sciences, University of Athens, Athens, Greece
| | - U Sandner
- Comprehensive Cancer Center Zürich, University Hospital Zürich, Zurich, Switzerland
| | - I Opitz
- Thoracic Surgery Department, University Hospital Zürich, Zurich, Switzerland
| | - N Andratschke
- Department of Radiation Oncology, Universitätsspital Zürich, Zürich, Switzerland
| | - D Franzen
- Department of Pneumonology, University Hospital Zurich, Zurich, Switzerland
| | - G Dimopoulou
- Frontier Science Foundation-Hellas, Athens, Greece
| | - K L Matthes
- Cancer Registry of the Cantons Zurich and Zug, University Hospital Zürich, Zurich, Switzerland
| | - M Kohler
- Department of Pneumonology, University Hospital Zurich, Zurich, Switzerland
| | - M Guckenberger
- Department of Radiation Oncology, Universitätsspital Zürich, Zürich, Switzerland
| | - W Weder
- Thoracic Surgery Department, University Hospital Zürich, Zurich, Switzerland
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21
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Freytag M, Herrlinger U, Hauser S, Bauernfeind FG, Gonzalez-Carmona MA, Landsberg J, Buermann J, Vatter H, Holderried T, Send T, Schumacher M, Koscielny A, Feldmann G, Heine M, Skowasch D, Schäfer N, Funke B, Neumann M, Schmidt-Wolf IGH. Higher number of multidisciplinary tumor board meetings per case leads to improved clinical outcome. BMC Cancer 2020; 20:355. [PMID: 32345242 PMCID: PMC7189747 DOI: 10.1186/s12885-020-06809-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 03/31/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND This analysis aims at evaluating the impact of multidisciplinary tumor boards on clinical outcome of multiple tumor entities, the effect of the specific number of multidisciplinary tumor boards and potential differences between the tumor entities. METHODS By a matched-pair analysis we compared the response to treatment, overall survival, relapse or disease free survival and progression free survival of patients whose cases were discussed in a tumor board meeting with patients whose cases were not. It was performed with patients registered in the cancer registry of the University of Bonn and diagnosed between 2010 and 2016. After the matching process with a pool of 7262 patients a total of 454 patients with 66 different tumor types were included in this study. RESULTS First, patients with three or more multidisciplinary tumor board meetings in their history show a significantly better overall survival than patients with no tumor board meeting. Second, response to treatment, relapse free survival and time to progression were not found to be significantly different. Third, there was no significant difference for a specific tumor entity. CONCLUSION This study revealed a positive impact of a higher number of multidisciplinary tumor boards on the clinical outcome. Also, our analysis hints towards a positive effect of multidisciplinary tumor boards on overall survival.
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Affiliation(s)
- Marius Freytag
- Department of Integrated Oncology, Center of Integrated Oncology ABCD, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | | | - Stefan Hauser
- Department of Urology, University Hospital Bonn, Bonn, Germany
| | | | | | | | - Jens Buermann
- Department of General Surgery, University Hospital Bonn, Bonn, Germany
| | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Tobias Holderried
- Department of Internal Medicine III, University Hospital Bonn, Bonn, Germany
| | - Thorsten Send
- Department of Otorhinolaryngology, University Hospital Bonn, Bonn, Germany
| | - Martin Schumacher
- Department of Internal Medicine III, University Hospital Bonn, Bonn, Germany
| | - Arne Koscielny
- Department of General Surgery, University Hospital Bonn, Bonn, Germany
| | - Georg Feldmann
- Department of Internal Medicine III, University Hospital Bonn, Bonn, Germany
| | - Mario Heine
- Department of Internal Medicine III, University Hospital Bonn, Bonn, Germany
| | - Dirk Skowasch
- Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Niklas Schäfer
- Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Benjamin Funke
- Department of Integrated Oncology, Center of Integrated Oncology ABCD, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Michael Neumann
- Department of Integrated Oncology, Center of Integrated Oncology ABCD, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Ingo G. H. Schmidt-Wolf
- Department of Integrated Oncology, Center of Integrated Oncology ABCD, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
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22
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Gambazzi F, Frey LD, Bruehlmeier M, Janthur WD, Heuberger J, Spirig A, Williams R, Zweifel R, Boerner B, Tini GM, Irani S. Image analysis in posttreatment non-small cell lung cancer surveillance: specialists' interpretations reviewed by the thoracic multidisciplinary tumor board. Multidiscip Respir Med 2019; 14:34. [PMID: 31827794 PMCID: PMC6891985 DOI: 10.1186/s40248-019-0198-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 09/23/2019] [Indexed: 11/10/2022] Open
Abstract
Background Data show that the initial specialist’s image interpretation and final multidisciplinary tumor board (MTB) assessment can vary substantially in the pretherapeutic cancer setting. The aim of this post hoc analysis was to investigate the concordance of the specialist’s and MTB’s image interpretations in patients undergoing systematic posttreatment lung cancer image surveillance. Methods In the initial prospective study, lung cancer patients who had received curative-intent treatment were randomly assigned to undergo either contrast-enhanced computed tomography (CE-CT) or integrated 18F-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT). Imaging was performed every 6 months for 2 years, and all imaging studies were finally assessed by our MTB. This post hoc analysis assessed differences between the initial specialist’s image interpretation and the final MTB’s image interpretation. Results In 89 patients, 266 imaging studies (129 PET-CT, 137 CE-CT) were analyzed. In 87.2% (88.4, 86.1%) of the studies, complete concordance was found. Out of the 12.8% (11.6, 13.9%) with discordant results, 7.5% (6.9, 8.0%) had implications for alterations in patient management (major disagreements). Twenty major disagreements were detected in 17 study patients. Retrospectively, in eight out of these 17 (47%) patients, in contrast to the MTB’s view, the specialist’s interpretation was more appropriate, whereas in nine out of 17 patients (53%), the MTB’s interpretation was more accurate. Conclusions In an experienced MTB, the agreement between imaging specialists and the rest of the MTB with regard to the interpretation of images is high in a setting of posttreatment lung cancer image surveillance. It seems that in cases of disagreements, the rates of more accurate interpretation are well balanced between imaging specialists and the MTB. Trial registration ISRCTN16281786, Date 23. February 2017.
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Affiliation(s)
- Franco Gambazzi
- 1Clinic of Thoracic Surgery, Cantonal Hospital Aarau, Tellstrasse, CH-5001 Aarau, Switzerland
| | - Lukas D Frey
- 2Institute of Nuclear Medicine and PET-Center, Cantonal Hospital Aarau, Tellstrasse, CH-5001 Aarau, Switzerland
| | - Matthias Bruehlmeier
- 2Institute of Nuclear Medicine and PET-Center, Cantonal Hospital Aarau, Tellstrasse, CH-5001 Aarau, Switzerland
| | - Wolf-Dieter Janthur
- 3Clinic of Oncology, Cantonal Hospital Aarau, Tellstrasse, CH-5001 Aarau, Switzerland
| | - Juerg Heuberger
- 4Clinic of Radio-Oncology, Cantonal Hospital Aarau, Tellstrasse, CH-5001 Aarau, Switzerland
| | - Andres Spirig
- 5Department of Radiology, Cantonal Hospital Aarau, Tellstrasse, CH-5001 Aarau, Switzerland
| | - Richard Williams
- 5Department of Radiology, Cantonal Hospital Aarau, Tellstrasse, CH-5001 Aarau, Switzerland
| | - Roland Zweifel
- 6Institute of Pathology, Cantonal Hospital Aarau, Tellstrasse, CH-5001 Aarau, Switzerland
| | - Bettina Boerner
- 7Clinic of Pulmonary and Sleep Medicine, Cantonal Hospital Aarau, Tellstrasse, CH-5001 Aarau, Switzerland
| | - Gabrielo M Tini
- 7Clinic of Pulmonary and Sleep Medicine, Cantonal Hospital Aarau, Tellstrasse, CH-5001 Aarau, Switzerland
| | - Sarosh Irani
- 7Clinic of Pulmonary and Sleep Medicine, Cantonal Hospital Aarau, Tellstrasse, CH-5001 Aarau, Switzerland
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23
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Gedvilaitė V, Danila E, Cicėnas S, Smailytė G. Lung Cancer Survival in Lithuania: Changes by Histology, Age, and Sex From 2003-2007 to 2008-2012. Cancer Control 2019; 26:1073274819836085. [PMID: 31067990 PMCID: PMC6509983 DOI: 10.1177/1073274819836085] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Lung cancer is the most common cancer-related death worldwide. The aim of this study is to describe the most recent survival rates by sex, age group, extent of disease, and histology of lung cancer in Lithuania. The study is based on the Lithuanian Cancer Registry database. The analysis included patients with primary invasive lung cancer diagnosed in 1998 to 2012 (International Classification of Diseases, Tenth Revision C33 and C34). Patients were followed up with respect to vital status until December 31, 2012. Five-year relative survival estimates were calculated using period analysis. Relative survival was calculated as the ratio of the observed survival of patients with cancer and the expected survival of the underlying general population. In our study, the overall 5-year relative survival was low but increased slightly (10.7%) from 2003–2007 to 2008–2012. Positive changes in survival were evident in both sexes, in almost all age groups and for all histological groups and disease stages. Adenocarcinoma relative survival increased from 6.7% in 2003–2007 to 12.8% in 2008–2012 and squamous cell carcinoma increased from 7.4% in 2003–2007 to 11.1% in 2008–2012. Patients with small-cell carcinoma had the worst survival (2.9% in 2003-2007 and 3.6% in 2008–2012). The majority of patients with lung cancer are diagnosed with advanced disease. The number of new cases of advanced lung cancer increased from 35.1% to 37.8%. Despite low overall survival, there were positive changes in survival in both sexes, in almost all age groups, and for all histological groups and disease stages. The survival rate of patients with lung cancer in Lithuania is similar to that in other European countries.
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Affiliation(s)
- Vaida Gedvilaitė
- 1 Department of Thoracic Surgery and Oncology, National Cancer Institute, Vilnius, Lithuania
| | - Edvardas Danila
- 2 Centre of Pulmonology and Allergology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania.,3 Clinic of Chest Diseases, Immunology and Allergology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Saulius Cicėnas
- 1 Department of Thoracic Surgery and Oncology, National Cancer Institute, Vilnius, Lithuania.,4 Clinic of Internal Diseases, Family Medicine and Oncology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Giedrė Smailytė
- 5 Laboratory of Cancer Epidemiology, National Cancer Institute, Vilnius, Lithuania.,6 Department of Public Health, Institute of Health Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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24
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Franceschini D, Bruni A, Borghetti P, Giaj-Levra N, Ramella S, Buffoni L, Badellino S, Andolina M, Comin C, Vattemi E, Bezzi M, Trovò M, Passaro A, Bearz A, Chiari R, Tindara F, Ferrari K, Piperno G, Filippi AR, Genovesi D, Scotti V. Is multidisciplinary management possible in the treatment of lung cancer? A report from three Italian meetings. Radiol Med 2019; 125:214-219. [PMID: 31605353 DOI: 10.1007/s11547-019-01094-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 10/01/2019] [Indexed: 02/08/2023]
Abstract
PURPOSE To report criticisms and barriers to the "real-life" application of international guidelines and recent developments in the management of locally advanced non-small cell lung cancer (NSCLC) in Italy. METHODS Three 2-day courses were organized. During the first day, experts in different fields of thoracic oncology gave their lecture on diagnosis and therapy for locally advanced NSCLC. During the second day, all participants were divided into four groups to discuss on a clinical case as a multidisciplinary team (MDT). The aim was to stimulate the discussion on practical issues in the management of NSCLC patients in the real-life practice. RESULTS A total of 196 physicians were involved in the courses as learners. Invasive diagnosis of nodal disease for staging purposes, a priori definition of "surgical resectability" and a regular MDT with all crucial participants available were the three main key points identified for a good management of these patients. The main barriers to the clinical application of a good diagnostic and therapeutic approach to the patient were the absence of a regular and complete MDT in the South and Centre of Italy, while in the North of Italy, time for discussion of clinical cases in the MDT and waiting lists for staging and therapeutic interventions were deemed as the major concerns. CONCLUSION The meetings showed that diagnosis and treatment of locally advanced NSCLC are still extremely variable between different Italian regions. Logistic issues, waiting lists, paucity of well-trained staff and expertise seem to be the main barriers to international guidelines application.
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Affiliation(s)
- Davide Franceschini
- Radiation Oncology Department, Humanitas Research Hospital and Cancer Center, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
| | - Alessio Bruni
- Radiotherapy Unit, University Hospital of Modena, Modena, Italy
| | - Paolo Borghetti
- Radiation Oncology Department, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | - Niccolò Giaj-Levra
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Sara Ramella
- Radiation Oncology Department, Campus Bio-Medico, Rome, Italy
| | - Lucio Buffoni
- Oncology Department, San Luigi Hospital University of Turin, Orbassano, Turin, Italy
| | - Serena Badellino
- Radiation Oncology Department, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Maria Andolina
- Radiotherapy Unit, University Hospital of Modena, Modena, Italy
| | - Camilla Comin
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Michela Bezzi
- Endoscopic Pneumology Unit, ASST Spedali Civili Brescia, Brescia, Italy
| | - Marco Trovò
- Radiation Oncology Department, Azienda Sanitaria Universitaria Integrata Udine, 33100, Udine, Italy
| | - Antonio Passaro
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Alessandra Bearz
- Medical Oncology Unit, Centro di Riferimento Oncologico-IRCCS, Aviano, Italy
| | - Rita Chiari
- Medical Oncology Unit, Ospedale Madre Teresa di Calcutta, "AULSS6 Euganea-Padova", Padua, Italy
| | - Franchina Tindara
- Department of Human Pathology of the Adult and Evolutive Age "G. Barresi", Messina, Italy
| | - Katia Ferrari
- Section of Respiratory Medicine, Careggi University Hospital, Florence, Italy
| | - Gaia Piperno
- Division of Radiotherapy, European Institute of Oncology, IRCCS, Milan, Italy
| | - Andrea Riccardo Filippi
- Department of Medical Sciences and Infectious Diseases, Unit of Radiation Therapy, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Domenico Genovesi
- Radiation Oncology Department, SS. Annunziata Hospital, "G. D'Annunzio" University of Chieti, Chieti, Italy
| | - Vieri Scotti
- Department of Oncology, Radiation Therapy Unit, Careggi University Hospital, Florence, Italy
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25
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Hsu PC, Chang JWC, Wang CC, Wu CT, Lin YC, Wang CL, Lin TY, Li SH, Wu YC, Kuo SCH, Yang CT, Liu CY, Chen CH. Oral vinorelbine plus cisplatin with concomitant radiotherapy as induction therapy for stage III non-small cell lung cancer: Results of a single-arm prospective cohort study. Thorac Cancer 2019; 10:1683-1691. [PMID: 31276309 PMCID: PMC6669803 DOI: 10.1111/1759-7714.13125] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/29/2019] [Accepted: 05/30/2019] [Indexed: 12/20/2022] Open
Abstract
Background Concurrent chemoradiotherapy (CCRT) is an optimal recommended treatment for stage III non‐small cell lung cancer (NSCLC). Herein, we aimed to investigate the efficacy and safety of oral vinorelbine plus cisplatin with concomitant radiotherapy for stage III NSCLC. Methods This prospective, open‐label, single‐arm, observational cohort study was performed between January 2010 and September 2016. Patients were treated with two cycles of chemotherapy with 60 mg/m2 intravenous cisplatin on day 1 and 50 mg/m2 oral vinorelbine on days 1, 8, and 15; radiotherapy was administered concurrently from day 1 when chemotherapy was initiated. A total dose of 66–70 Gy radiotherapy was delivered in daily fractions of 2 Gy for 6.5–7 consecutive weeks. The tumor response was assessed after completing concomitant treatment. Results A total of 58 patients were enrolled and analyzed; 31 patients had stage IIIA NSCLC and 27 had stage IIIB NSCLC. After induction CCRT, 31 patients achieved an objective response (complete response in one and partial response in 30; the response rate was 53.4%). The median progression‐free survival was 6.73 months (95% confidence interval [CI], 5.42–7.91), duration of response was 12.30 months (95% CI, 5.59–19.01), and overall survival was 24.83 months (95% CI, 19.26–30.21). No treatment‐related mortality was observed, and neutropenia was the most common grade 3 and 4 treatment‐related toxicity (11 patients; 18.9%). Conclusions CCRT with the weekly regimen of oral vinorelbine plus triweekly cisplatin was effective and safe for stage III NSCLC.
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Affiliation(s)
- Ping-Chih Hsu
- Division of Thoracic Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - John Wen-Chang Chang
- Department of Oncology, Chang Gung Memorial Hospital Linkou branch, Taoyuan City, Taiwan
| | - Chun-Chieh Wang
- Division of Radiation Oncology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Chen-Te Wu
- Department of Radiology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Yu-Ching Lin
- Division of Thoracic Oncology, Department of Respiratory and Critical Care Medicine, Chang Gung Memorial Hospital, Chiayi Branch, Chiayi county, Taiwan.,Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi Campus, Chiayi county, Taiwan
| | - Chih-Liang Wang
- Division of Thoracic Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Tin-Yu Lin
- Division of Thoracic Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Shih-Hong Li
- Division of Thoracic Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Yi-Chen Wu
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Scott Chih-Hsi Kuo
- Division of Thoracic Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Cheng-Ta Yang
- Division of Thoracic Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan City, Taiwan.,Department of Respiratory Therapy, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Chien-Ying Liu
- Division of Thoracic Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Chih-Hung Chen
- Division of Thoracic Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan City, Taiwan
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26
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Leigh NL, Solomon D, Feingold D, Magge DR, Golas BJ, Sarpel U, Labow DM. Improved Survival with Experience: A 10-Year Learning Curve in Hyperthermic Intraperitoneal Chemotherapy and Cytoreductive Surgery. Ann Surg Oncol 2019; 27:222-231. [DOI: 10.1245/s10434-019-07518-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Indexed: 12/21/2022]
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27
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Dickhoff C, Dahele M. The multidisciplinary lung cancer team meeting: increasing evidence that it should be considered a medical intervention in its own right. J Thorac Dis 2019; 11:S311-S314. [PMID: 30997206 DOI: 10.21037/jtd.2019.01.14] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Chris Dickhoff
- Department of Surgery, Amsterdam UMC, Cancer Center Amsterdam, Amsterdam, The Netherlands.,Department of Cardiothoracic Surgery, Amsterdam UMC, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Max Dahele
- Department of Radiation Oncology, Amsterdam UMC, Cancer Center Amsterdam, Amsterdam, The Netherlands
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28
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Patient and Health Care Professional Perspectives: A Case Study of the Lung Cancer Integrated Care Pathway. Int J Integr Care 2018; 18:7. [PMID: 30473645 PMCID: PMC6234416 DOI: 10.5334/ijic.3972] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Introduction: The purpose of this study was to evaluate the perception of the quality of care, considering both patient experience and health care professionals’ perceptions as well as patient outcome measures of an integrated lung cancer pathway. Methods: A cross-sectional study was conducted in 2016 at Ferrara University Hospital, Italy. OPportunity for Treatment In ONcology (OPTION) questionnaires were administered to 77 patients, and the Care Process Self-Evaluation Tool (CPSET) questionnaires were given to 38 health care professionals. The effectiveness of the pathway was evaluated by analysing the tool’s positive impact on lung cancer surgery volume and 30-day mortality. Results: Seventy-seven patients were enrolled, and 38 health care professionals assessed the CPSET questionnaire. The highest scores were related to “respect” (100%), “satisfaction” (98.7%), and “trust” (97.4%) on the OPTION and to “patient-focused vision” (97.2%) and “patient engagement” (94.4%) on the CPSET. The lowest scores were related to “information” (26%) and “cooperation with general practitioner” (17.6%) on the OPTION and “cooperation between the hospital and primary care” (23.5%) for the CPSET. The outcomes analysis shows an increase in the volume of activity and a decrease in 30-day mortality after pathway implementation. Discussion: The lung cancer pathway is a patient-centred intervention that enables care to be shaped for patient needs in order to improve the quality and efficiency of service and clinical outcome.
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