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Mathur P, Ramamoorthy T, Lakshminarayana SK, Nath A, Mathew S, Rajput GK. Utilization of clinical practice guidelines for cancer care in routine practice and during the coronavirus disease 2019 pandemic in India. Asia Pac J Clin Oncol 2024; 20:507-514. [PMID: 38667342 DOI: 10.1111/ajco.14071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 04/05/2024] [Indexed: 07/24/2024]
Abstract
AIM The coronavirus disease 2019 (COVID-19) pandemic affected cancer service delivery and the feasibility of following the standard treatment guidelines. The present paper describes the use of clinical care guidelines for cancer management in routine practice and the approach adopted towards cancer care during the COVID-19 pandemic in India. METHODS A web-based survey was done in 107 hospitals (including public and private health facilities) that hosted Hospital-Based Cancer Registries under the National Cancer Registry Programme. The participants comprised Principal Investigators of these registries, who were also medical, surgical, and radiation oncology clinicians. The survey was done between May 1, 2021, and July 31, 2021. Participants were provided with a web link for the survey questionnaire, confidential login, and password. RESULTS The study found high utilization of Clinical Practice Guidelines (CPGs) during practice, with eight out of ten physicians constantly to referring them. The study reported lack of knowledge, skills, and training to administer the treatment based on the guidelines followed by organizational infrastructure and affordability of treatment by the patients as the factors hampering utilization. International clinical guidelines were preferred when compared to national guidelines. The COVID-19 pandemic decreased the use of CPGs, wherein six out of ten clinicians reported their use. CONCLUSION Stakeholders who formulate clinical guidelines must consider the practical aspects and feasibility of implementing such guidelines during a pandemic and similar situations. This should be coupled with adequate changes in care practice to ensure optimal care delivery and a continuum of cancer care in routine and pandemic-imposed situations.
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Affiliation(s)
- Prashant Mathur
- Indian Council of Medical Research-National Centre for Disease Informatics and Research, Bengaluru, India
| | - Thilagavathi Ramamoorthy
- Indian Council of Medical Research-National Centre for Disease Informatics and Research, Bengaluru, India
| | | | - Anita Nath
- Indian Council of Medical Research-National Centre for Disease Informatics and Research, Bengaluru, India
| | - Stany Mathew
- Indian Council of Medical Research-National Centre for Disease Informatics and Research, Bengaluru, India
| | - Gurpreet Kaur Rajput
- Indian Council of Medical Research-National Centre for Disease Informatics and Research, Bengaluru, India
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Hoier D, Groß-Ophoff-Müller C, Franklin C, Hallek M, von Stebut E, Elter T, Mauch C, Kreuzberg N, Koll P. Digital decision support for structural improvement of melanoma tumor boards: using standard cases to optimize workflow. J Cancer Res Clin Oncol 2024; 150:115. [PMID: 38457085 PMCID: PMC10923955 DOI: 10.1007/s00432-024-05627-3] [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: 05/31/2023] [Accepted: 01/18/2024] [Indexed: 03/09/2024]
Abstract
PURPOSE Choosing optimal cancer treatment is challenging, and certified cancer centers must present all patients in multidisciplinary tumor boards (MDT). Our aim was to develop a decision support system (DSS) to provide treatment recommendations for apparently simple cases already at conference registration and to classify these as "standard cases". According to certification requirements, discussion of standard cases is optional and would thus allow more time for complex cases. METHODS We created a smartphone query that simulated a tumor conference registration and requested all information needed to provide a recommendation. In total, 111 out of 705 malignant melanoma cases discussed at a skin cancer center from 2017 to 2020 were identified as potential standard cases, for which a digital twin recommendation was then generated by DSS. RESULTS The system provided reliable advice in all 111 cases and showed 97% concordance of MDT and DSS for therapeutic recommendations, regardless of tumor stage. Discrepancies included two cases (2%) where DSS advised discussions at MDT and one case (1%) with deviating recommendation due to advanced patient age. CONCLUSIONS Our work aimed not to replace clinical expertise but to alleviate MDT workload and enhance focus on complex cases. Overall, our DSS proved to be a suitable tool for identifying standard cases as such, providing correct treatment recommendations, and thus reducing the time burden of tumor conferences in favor for the comprehensive discussion of complex cases. The aim is to implement the DSS in routine tumor board software for further qualitative assessment of its impact on oncological care.
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Affiliation(s)
- David Hoier
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
| | | | - Cindy Franklin
- Department of Dermatology and Venereology, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Michael Hallek
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Esther von Stebut
- Department of Dermatology and Venereology, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Thomas Elter
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Cornelia Mauch
- Department of Dermatology and Venereology, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Nicole Kreuzberg
- Department of Dermatology and Venereology, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Philipp Koll
- Department of Dermatology and Venereology, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
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Martinez-Cannon BA, Soto-Perez-de-Celis E, Erazo Valle-Solis A, Arce-Salinas C, Bargallo-Rocha E, Bautista-Piña V, Cervantes-Sanchez G, Flores-Balcázar CH, Lara Tamburrino MDC, Lluch A, Maffuz-Aziz A, Pérez-Sánchez VM, Poitevin-Chacón A, Salas-González E, Torrecillas Torres L, Valero V, Villaseñor-Navarro Y, Cárdenas-Sánchez J. Physicians' attitudes and perceived barriers to adherence to the national breast cancer clinical practice guidelines in Mexico: a survey study. CLINICAL & TRANSLATIONAL ONCOLOGY : OFFICIAL PUBLICATION OF THE FEDERATION OF SPANISH ONCOLOGY SOCIETIES AND OF THE NATIONAL CANCER INSTITUTE OF MEXICO 2023; 25:151-159. [PMID: 35986133 DOI: 10.1007/s12094-022-02921-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/02/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Adherence to clinical practice guidelines improves outcomes for patients with breast cancer. However, their implementation may not be feasible in low- and middle-income countries. This study aimed to evaluate physicians' adherence, attitudes, and barriers towards the Colima Consensus, which is the Mexican national breast cancer clinical practice guideline. METHODS A cross-sectional, 31-item survey was e-mailed to Consensus attendees and members of the Mexican Society of Oncology and Mexican Mastology Association. Descriptive statistics, univariate, and multivariate analysis were used to analyze the associations between participants' characteristics, adherence, attitudes, and barriers. RESULTS Of 439 respondents, 78% percent adhered to Consensus recommendations and 94% believed it was applicable to their clinical practice. Forty percent reported using the Consensus as their sole breast cancer guideline. This was associated with being a surgical oncologist (OR 3.3, 95% CI 2.0-5.3) and practicing at a public hospital (OR 2.1, 95% CI 1.2-3.7). The most common barriers to adherence were lack of resources and logistical problems. Regarding attitudes towards the Consensus, 90% considered it a good educational tool, 89% considered it a reliable source of information, and 90% thought it improved quality of care. CONCLUSIONS We showed high levels of adherence and positive attitudes towards the Colima Consensus, with a significant proportion of physicians using it as their only guideline. Lack of resources and logistical issues were the main barriers to adherence. Our results highlight the relevance of local breast cancer guidelines and suggest a need for the creation of resource-stratified guidelines.
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Affiliation(s)
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, Cancer Care in the Elderly Clinic, Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubiran, Vasco de Quiroga 15, Belisario Dominguez Secc 16, Tlalpan, 14080, Mexico City, Mexico.
| | - Aura Erazo Valle-Solis
- Neoplastic and Proliferative Disorders Division, Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mexico City, Mexico
| | - Claudia Arce-Salinas
- Departamento de Tumores Mamarios, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Enrique Bargallo-Rocha
- Departamento de Tumores Mamarios, Instituto Nacional de Cancerología, Mexico City, Mexico
| | | | - Guadalupe Cervantes-Sanchez
- Department of Medical Oncology, Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mexico City, Mexico
| | - Christian Haydeé Flores-Balcázar
- Radiotherapy and Medical Physics Service, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | | | - Ana Lluch
- Medical Oncology Unit, Centro de Investigacion Biomedica en Red de OncologiaGEICAM Spanish Breast Cancer Group, Hospital Clinico Universitario de Valencia, Biomedical Research Institute INCLIVA, Universidad de Valencia, CIBERONC-ISCIII, Valencia, Spain
| | - Antonio Maffuz-Aziz
- Department of Surgical Oncology, American British Cowdray Medical Center, Mexico City, Mexico
| | | | | | - Efraín Salas-González
- Hospital de Gineco-Obstetricia, Centro Médico Nacional de Occidente IMSS, Guadalajara, Mexico
| | - Laura Torrecillas Torres
- Department of Medical Oncology, Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mexico City, Mexico
| | - Vicente Valero
- Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yolanda Villaseñor-Navarro
- Subdireccion de Servicios Auxiliares de Diagnostico Y Tratamiento, Instituto Nacional de Cancerologia, Mexico City, Mexico
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Prostate Cancer Survival by Risk and Other Prognostic Factors in Mallorca, Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111156. [PMID: 34769675 PMCID: PMC8583124 DOI: 10.3390/ijerph182111156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/08/2021] [Accepted: 10/21/2021] [Indexed: 11/16/2022]
Abstract
Studies about the survival of patients with prostate cancer by stage or risk of progression are scarce. The aims of this study were (1) to determine the cause-specific survival by risk in prostate cancer patients in Mallorca diagnosed in the period 2006-2011; (2) to identify the factors that explain and predict the likelihood of survival and the risk of dying from this type of cancer; and (3) to determine the distribution of prostate cancer by risk in the patients in Mallorca diagnosed in the period 2006-2011. Incident prostate cancer cases diagnosed between 2006 and 2011 were identified through the Mallorca Cancer Registry. We collected age; date and method of diagnosis; date of follow-up or death; T, N, M and stage according to the TNM 7th edition; Gleason score; prostate-specific antigen (PSA); histology according to the International Classification of Diseases for Oncology (ICD-O) 3rd edition, comorbidities and treatments. We calculated risk in four categories: low, medium, high and very high. The end point of follow-up was 31 December 2014. Multiple imputation (MI) was performed to estimate cases with unknown risk. We identified 2921 cases. Five years after diagnosis, survival after MI was 89% globally, and was 100% for low-risk cases, 96% for medium risk, 93% for high risk and 69% for very-high-risk cases. Cases with histology other than adenocarcinoma, with high (and especially very high) risk, as well as with systemic, mixed and observation/unspecified treatments had worse prognoses.
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George SZ, Lentz TA, Goertz CM. Back and neck pain: in support of routine delivery of non-pharmacologic treatments as a way to improve individual and population health. Transl Res 2021; 234:129-140. [PMID: 33901699 PMCID: PMC8340679 DOI: 10.1016/j.trsl.2021.04.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/15/2021] [Accepted: 04/15/2021] [Indexed: 12/29/2022]
Abstract
Chronic back and neck pain are highly prevalent conditions that are among the largest drivers of physical disability and cost in the world. Recent clinical practice guidelines recommend use of non-pharmacologic treatments to decrease pain and improve physical function for individuals with back and neck pain. However, delivery of these treatments remains a challenge because common care delivery models for back and neck pain incentivize treatments that are not in the best interests of patients, the overall health system, or society. This narrative review focuses on the need to increase use of non-pharmacologic treatment as part of routine care for back and neck pain. First, we present the evidence base and summarize recommendations from clinical practice guidelines regarding non-pharmacologic treatments. Second, we characterize current use patterns for non-pharmacologic treatments and identify potential barriers to their delivery. Addressing these barriers will require coordinated efforts from multiple stakeholders to prioritize evidence-based non-pharmacologic treatment approaches over low value care for back and neck pain. These stakeholders include patients, health care providers, health care organizations, administrators, payers, policymakers and researchers.
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Affiliation(s)
- Steven Z George
- Department of Orthopaedic Surgery and Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Trevor A Lentz
- Department of Orthopaedic Surgery and Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Christine M Goertz
- Department of Orthopaedic Surgery and Duke Clinical Research Institute, Duke University, Durham, North Carolina
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6
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Keikes L, Kos M, Verbeek XAAM, Van Vegchel T, Nagtegaal ID, Lahaye MJ, Méndez Romero A, De Bruijn S, Verheul HMW, Rütten H, Punt CJA, Tanis PJ, Van Oijen MGH. Conversion of a colorectal cancer guideline into clinical decision trees with assessment of validity. Int J Qual Health Care 2021; 33:6184988. [PMID: 33760073 PMCID: PMC8023581 DOI: 10.1093/intqhc/mzab051] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/11/2021] [Accepted: 03/23/2021] [Indexed: 12/14/2022] Open
Abstract
Objective The interpretation and clinical application of guidelines can be challenging and time-consuming, which may result in noncompliance to guidelines. The aim of this study was to convert the Dutch guideline for colorectal cancer (CRC) into decision trees and subsequently implement decision trees in an online decision support environment to facilitate guideline application. Methods The recommendations of the Dutch CRC guidelines (published in 2014) were translated into decision trees consisting of decision nodes, branches and leaves that represent data items, data item values and recommendations, respectively. Decision trees were discussed with experts in the field and published as interactive open access decision support software (available at www.oncoguide.nl). Decision tree validation and a concordance analysis were performed using consecutive reports (January 2016–January 2017) from CRC multidisciplinary tumour boards (MTBs) at Amsterdam University Medical Centers, location AMC. Results In total, we developed 34 decision trees driven by 101 decision nodes based on the guideline recommendations. Decision trees represented recommendations for diagnostics (n = 1), staging (n = 10), primary treatment (colon: n = 1, rectum: n = 5, colorectal: n = 9), pathology (n = 4) and follow-up (n = 3) and included one overview decision tree for optimal navigation. We identified several guideline information gaps and areas of inconclusive evidence. A total of 158 patients’ MTB reports were eligible for decision tree validation and resulted in treatment recommendations in 80% of cases. The concordance rate between decision tree treatment recommendations and MTB advices was 81%. Decision trees reported in 22 out of 24 non-concordant cases (92%) that no guideline recommendation was available. Conclusions We successfully converted the Dutch CRC guideline into decision trees and identified several information gaps and areas of inconclusive evidence, the latter being the main cause of the observed disagreement between decision tree recommendations and MTB advices. Decision trees may contribute to future strategies to optimize quality of care for CRC patients.
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Affiliation(s)
- Lotte Keikes
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Noord-Holland 1105 AZ, Netherlands.,Department of Research, Netherlands Comprehensive Cancer Organisation, Godebaldkwartier 419, Utrecht 3511 DT, Netherlands
| | - Milan Kos
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Noord-Holland 1105 AZ, Netherlands.,Department of Research, Netherlands Comprehensive Cancer Organisation, Godebaldkwartier 419, Utrecht 3511 DT, Netherlands
| | - Xander A A M Verbeek
- Department of Research, Netherlands Comprehensive Cancer Organisation, Godebaldkwartier 419, Utrecht 3511 DT, Netherlands
| | - Thijs Van Vegchel
- Department of Research, Netherlands Comprehensive Cancer Organisation, Godebaldkwartier 419, Utrecht 3511 DT, Netherlands
| | - Iris D Nagtegaal
- Department of Pathology, Radboud University Medical Center, Geert Grooteplein Zuid 10, Nijmegen, Gelderland 6525 GA, Netherlands
| | - Max J Lahaye
- Department of Radiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, Amsterdam, Noord-Holland 1066 CX, Netherlands
| | - Alejandra Méndez Romero
- Department of Radiation Oncology, Erasmus University Medical Center, Doctor Molewaterplein 40, Rotterdam, Zuid-Holland 3015 GD, Netherlands
| | - Sandra De Bruijn
- Department of Surgery, Reinier de Graaf Hospital, Reinier de Graafweg 5, Delft, Zuid-Holland, 2625 AD, Netherlands
| | - Henk M W Verheul
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, Gelderland 6525 GA, Netherlands
| | - Heidi Rütten
- Department of Radiation Oncology, Radboud University Medical Center, Geert Grooteplein Zuid 10, Nijmegen, Gelderland 6525 GA, Netherlands
| | - Cornelis J A Punt
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands
| | - Pieter J Tanis
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Noord-Holland 1105 AZ, Netherlands
| | - Martijn G H Van Oijen
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Noord-Holland 1105 AZ, Netherlands.,Department of Research, Netherlands Comprehensive Cancer Organisation, Godebaldkwartier 419, Utrecht 3511 DT, Netherlands
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Kamusheva M, Dimitrova M, Tachkov K, Petrova G, Mitkova Z. Pharmacotherapeutic Patterns and Patients' Access to Pharmacotherapy for Some Rare Diseases in Bulgaria - A Pilot Comparative Study. Front Pharmacol 2021; 12:695181. [PMID: 34349654 PMCID: PMC8326790 DOI: 10.3389/fphar.2021.695181] [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: 04/14/2021] [Accepted: 06/21/2021] [Indexed: 11/13/2022] Open
Abstract
Provision of the latest innovative and advanced therapies for rare diseases (RDs) patients, following the international therapeutic recommendations, is crucial and necessary for both practitioners and patients. The goal is to assess the access of Bulgarian patients with the most cost-consuming RDs to medicines and to compare the pharmacotherapeutic patterns in Bulgaria and the relevant European professional associations. Pharmaco-therapeutic guidelines for treating the most cost-consuming RDs in Bulgaria were analyzed to assess their compliance with the European ones. Market entrance was evaluated through analysis of the availability of medicines in the Positive Drug List (PDL) and their date of inclusion since marketing authorization. Guidelines’ compliance index was calculated and patient access was analyzed through evaluation of the National Health Insurance Fund (NHIF) standards, which provide additional criteria for treatment initiation. The analyzed guidelines follow the adopted recommendations by the relevant European professional associations. NHIF have exclusion and inclusion criteria for initiating treatment with medicines for rare diseases and for continuation. The average time-lag between centralized procedure approval and inclusion in the Bulgarian PDL for orphan medicinal products (MPs) is 6.75 years (SD = 4.96) with the longest time observed for eptacog alfa (20 years) and the shortest for rurioctocog alfa pegol, octocog alfa and simoctocog alfa (1 year). Bulgarian patients with cystic fibrosis with pulmonary manifestation had a wait time of only 1.6 years to get access to innovative, centrally authorized medicines, whereas the period for access to acromegaly treatment was 8.2 years. The main factors influencing market entrance and patient access are the time to inclusion in the PDL and the NHIF criteria.
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Affiliation(s)
- Maria Kamusheva
- Department of Organization and Economics of Pharmacy, Faculty of Pharmacy, Medical University-Sofia, Sofia, Bulgaria
| | - Maria Dimitrova
- Department of Organization and Economics of Pharmacy, Faculty of Pharmacy, Medical University-Sofia, Sofia, Bulgaria
| | - Konstantin Tachkov
- Department of Organization and Economics of Pharmacy, Faculty of Pharmacy, Medical University-Sofia, Sofia, Bulgaria
| | - Guenka Petrova
- Department of Organization and Economics of Pharmacy, Faculty of Pharmacy, Medical University-Sofia, Sofia, Bulgaria
| | - Zornitsa Mitkova
- Department of Organization and Economics of Pharmacy, Faculty of Pharmacy, Medical University-Sofia, Sofia, Bulgaria
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Guidelines for Myelodysplastic Syndromes: Converting Evidence into Action? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147629. [PMID: 34300079 PMCID: PMC8306017 DOI: 10.3390/ijerph18147629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/05/2021] [Accepted: 07/06/2021] [Indexed: 11/17/2022]
Abstract
The heterogeneous group of myelodysplastic syndromes (MDS) needs an individualized and patient-tailored therapeutic approach. Consensus-based guidelines for diagnosis and treatment provide a basis for clinical decision making. MDS guidelines are issued by expert panels. Our main objective was to examine how guidelines influence patients’ adherence to expert recommendations and how they ensure healthcare quality. To approach this question, we reviewed the most common guidelines for diagnosing and treating MDS in adult patients. Furthermore, we critically looked at quality indicators for everyday practice and studied adherence in an everyday outpatient setting. Finally, we also paid close attention to patient-reported outcome measures and studied how they are used as endpoints in clinical trials. We can conclude that the combination of evidence-based diagnostic tools, standardized treatment recommendations, and patient-centered shared decision making will eventually lead to a healthcare standard that will significantly improve outcomes in adult patients with MDS.
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Yang Y, Lu J, Ma Y, Xi C, Kang J, Zhang Q, Jia X, Liu K, Du S, Kocher F, Seeber A, Gridelli C, Provencio M, Seki N, Tomita Y, Zhang X. Evaluation of the reporting quality of clinical practice guidelines on lung cancer using the RIGHT checklist. Transl Lung Cancer Res 2021; 10:2588-2602. [PMID: 34295664 PMCID: PMC8264321 DOI: 10.21037/tlcr-21-405] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 06/11/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND In recent years, the number of clinical practice guidelines (CPGs) for lung cancer has increased, but the quality of these guidelines has not been systematically assessed so far. Our aim was to assess the reporting quality of CPGs on lung cancer published since 2018 using the International Reporting Items for Practice Guidelines in Health Care (RIGHT) instrument. METHODS We systematically searched the major electronic literature databases, guideline databases and medical society websites from January 2018 to November 2020 to identify all CPGs for small cell and non-small cell lung cancer (NSCLC). The search and extraction were completed using standardized forms. The quality of included guidelines was evaluated using the RIGHT statement. We present the results descriptively, including a stratification by selected determinants. RESULTS A total of 49 CPGs were included. The mean proportion across the guidelines of the 22 items of the RIGHT checklist that were appropriately reported was 57.9%. The items most common to be poorly reported were quality assurance (item 17) and description of the role of funders (item 18b), both of which were reported in only one guideline. The proportions of items within each of the seven domains of the RIGHT checklist that were correctly reported were Basic information 75.9%; background 83.2%; evidence 44.5%; recommendations 55.4%; review and quality assurance 12.2%; funding and declaration and management of interests 42.9%; and other information 38.1%. The reporting quality of guidelines did not differ between publication years. CPGs published in journals with impact factor >30 tended to be best reported. CONCLUSIONS Our results revealed that reporting in CPGs for lung cancer is suboptimal. Particularly the declaration of funding and quality assurance are poorly reported in recent CPGs on lung cancer.
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Affiliation(s)
- Yongjie Yang
- Department of Pharmacy, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China;,Henan Key Laboratory of Precision Clinical Pharmacy, Zhengzhou University, Zhengzhou, China
| | - Jingli Lu
- Department of Pharmacy, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China;,Henan Key Laboratory of Precision Clinical Pharmacy, Zhengzhou University, Zhengzhou, China
| | - Yanfang Ma
- School of Chinese Medicine of Hong Kong Baptist University, Hong Kong, China
| | - Chen Xi
- Department of Pharmacy, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China;,Henan Key Laboratory of Precision Clinical Pharmacy, Zhengzhou University, Zhengzhou, China
| | - Jian Kang
- Department of Pharmacy, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China;,Henan Key Laboratory of Precision Clinical Pharmacy, Zhengzhou University, Zhengzhou, China
| | - Qiwen Zhang
- Department of Pharmacy, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China;,Henan Key Laboratory of Precision Clinical Pharmacy, Zhengzhou University, Zhengzhou, China
| | - Xuedong Jia
- Department of Pharmacy, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China;,Henan Key Laboratory of Precision Clinical Pharmacy, Zhengzhou University, Zhengzhou, China
| | - Kefeng Liu
- Department of Pharmacy, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China;,Henan Key Laboratory of Precision Clinical Pharmacy, Zhengzhou University, Zhengzhou, China
| | - Shuzhang Du
- Department of Pharmacy, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China;,Henan Key Laboratory of Precision Clinical Pharmacy, Zhengzhou University, Zhengzhou, China
| | - Florian Kocher
- Department of Hematology and Oncology, Comprehensive Cancer Center Innsbruck, Medical University Innsbruck, Innsbruck, Austria
| | - Andreas Seeber
- Department of Hematology and Oncology, Comprehensive Cancer Center Innsbruck, Medical University Innsbruck, Innsbruck, Austria
| | - Cesare Gridelli
- A.O.R.N. San Giuseppe Moscati, Contrada Amoretta, Avellino, AV, Italy
| | - Mariano Provencio
- Medical Oncology Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Nobuhiko Seki
- Division of Medical Oncology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Yusuke Tomita
- Department of Respiratory Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Xiaojian Zhang
- Department of Pharmacy, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China;,Henan Key Laboratory of Precision Clinical Pharmacy, Zhengzhou University, Zhengzhou, China
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Pallauf M, Hempel MC, Hupe MC, May M, Haccius M, Weckermann D, Lebentrau S, Hoschke B, Necknig U, Pfitzenmaier J, Manka L, Nuhn P, Törzsök P, Lusuardi L, Merseburger AS. Adherence to the EAU Guideline Recommendations for Local Tumor Treatment in Penile Cancer: Results of the European PROspective Penile Cancer Study Group Survey (E-PROPS). Adv Ther 2020; 37:4969-4980. [PMID: 33038006 PMCID: PMC7595959 DOI: 10.1007/s12325-020-01514-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 09/23/2020] [Indexed: 11/30/2022]
Abstract
Introduction Penile cancer (PeCa) is an orphan disease in European countries. The current guidelines are predominantly based on retrospective studies with a low level of evidence. In our study, we aimed to identify predictors for guideline-conform treatment and hypothesize that reference centers for PeCa and physicians' experience promote guideline compliance and therefore correct local tumor therapy. Methods This study is part of the European PROspective Penile Cancer Study (E-PROPS), an international collaboration group evaluating therapeutic management for PeCa in Central Europe. For this module, a 14-item-survey was developed and sent to 681 urologists in 45 European centers. Three questions focused on therapeutic decisions for PeCa in clinical stage Tis, Ta-T1a, and T1b. Four questions addressed potential personal confounders. Survey results were analyzed by bootstrap-adjusted stepwise multivariate linear regression analysis to identify predictors for EAU guideline-conform local treatment of PeCa. Results For local therapy of cTis 80.4% recommended guideline-conform treatment, for cTa-cT1a 87.3% and for cT1b 59.1%. In total, 42.4% chose a correct approach in all tumor stages. The number of PeCa patients treated at the hospital, a higher level of training of the physicians, resource-based answering and the option of penile-sparing surgery offered at the hospital matched with giving guideline-conform recommendations and thus accurate local tumor treatment. Conclusion Patients with PeCa are best treated by experienced physicians, in centers with a high number of cases, which also offer a wide range of local tumor therapy. This could be offered in reference centers.
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Affiliation(s)
- Maximilian Pallauf
- Department of Urology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Marie C Hempel
- Department of Urology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.
| | - Marie C Hupe
- Department of Urology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Matthias May
- Department of Urology, St. Elisabeth-Hospital Straubing, Straubing, Germany
| | - Marlene Haccius
- Department of Urology, St. Elisabeth-Hospital Straubing, Straubing, Germany
| | | | - Steffen Lebentrau
- Department of Urology, Brandenburg Medical School Theodor Fontane, Ruppiner Kliniken, Neuruppin, Germany
| | - Bernd Hoschke
- Department of Urology, Carl-Thiem-Clinic Cottbus, Cottbus, Germany
| | - Ulrike Necknig
- Department of Urology and Pediatric Urology, Garmisch-Partenkirchen Medical Center, Garmisch-Partenkirchen, Germany
| | | | - Lukas Manka
- Clinic of Braunschweig, Braunschweig, Germany
| | - Philipp Nuhn
- Department of Urology, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Peter Törzsök
- Department of Urology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Lukas Lusuardi
- Department of Urology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Axel S Merseburger
- Department of Urology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
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11
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Niño de Guzmán E, Song Y, Alonso-Coello P, Canelo-Aybar C, Neamtiu L, Parmelli E, Pérez-Bracchiglione J, Rabassa M, Rigau D, Parkinson ZS, Solà I, Vásquez-Mejía A, Ricci-Cabello I. Healthcare providers' adherence to breast cancer guidelines in Europe: a systematic literature review. Breast Cancer Res Treat 2020; 181:499-518. [PMID: 32378052 PMCID: PMC7220981 DOI: 10.1007/s10549-020-05657-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 04/27/2020] [Indexed: 12/19/2022]
Abstract
Purpose Clinical guidelines’ (CGs) adherence supports high-quality care. However, healthcare providers do not always comply with CGs recommendations. This systematic literature review aims to assess the extent of healthcare providers’ adherence to breast cancer CGs in Europe and to identify the factors that impact on healthcare providers’ adherence. Methods We searched for systematic reviews and quantitative or qualitative primary studies in MEDLINE and Embase up to May 2019. The eligibility assessment, data extraction, and risk of bias assessment were conducted by one author and cross-checked by a second author. We conducted a narrative synthesis attending to the modality of the healthcare process, methods to measure adherence, the scope of the CGs, and population characteristics. Results Out of 8137 references, we included 41 primary studies conducted in eight European countries. Most followed a retrospective cohort design (19/41; 46%) and were at low or moderate risk of bias. Adherence for overall breast cancer care process (from diagnosis to follow-up) ranged from 54 to 69%; for overall treatment process [including surgery, chemotherapy (CT), endocrine therapy (ET), and radiotherapy (RT)] the median adherence was 57.5% (interquartile range (IQR) 38.8–67.3%), while for systemic therapy (CT and ET) it was 76% (IQR 68–77%). The median adherence for the processes assessed individually was higher, ranging from 74% (IQR 10–80%), for the follow-up, to 90% (IQR 87–92.5%) for ET. Internal factors that potentially impact on healthcare providers’ adherence were their perceptions, preferences, lack of knowledge, or intentional decisions. Conclusions A substantial proportion of breast cancer patients are not receiving CGs-recommended care. Healthcare providers’ adherence to breast cancer CGs in Europe has room for improvement in almost all care processes. CGs development and implementation processes should address the main factors that influence healthcare providers' adherence, especially patient-related ones. Registration: PROSPERO (CRD42018092884). Electronic supplementary material The online version of this article (10.1007/s10549-020-05657-8) contains supplementary material, which is available to authorised users.
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Affiliation(s)
- Ena Niño de Guzmán
- Iberoamerican Cochrane Centre - Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antonio María Claret 167, 08025, Barcelona, Spain.
| | - Yang Song
- Iberoamerican Cochrane Centre - Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antonio María Claret 167, 08025, Barcelona, Spain
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre - Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antonio María Claret 167, 08025, Barcelona, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Carlos Canelo-Aybar
- Iberoamerican Cochrane Centre - Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antonio María Claret 167, 08025, Barcelona, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Luciana Neamtiu
- European Commission, Joint Research Centre (JRC), Via E. Fermi 2749, 21027, Ispra, VA, Italy.
| | - Elena Parmelli
- European Commission, Joint Research Centre (JRC), Via E. Fermi 2749, 21027, Ispra, VA, Italy
| | | | - Montserrat Rabassa
- Iberoamerican Cochrane Centre - Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antonio María Claret 167, 08025, Barcelona, Spain
| | - David Rigau
- Iberoamerican Cochrane Centre - Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antonio María Claret 167, 08025, Barcelona, Spain
| | - Zuleika Saz Parkinson
- European Commission, Joint Research Centre (JRC), Via E. Fermi 2749, 21027, Ispra, VA, Italy
| | - Iván Solà
- Iberoamerican Cochrane Centre - Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antonio María Claret 167, 08025, Barcelona, Spain
| | - Adrián Vásquez-Mejía
- Facultad de Medicina Humana, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Ignacio Ricci-Cabello
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Balearic Islands Health Research Institute (IdISBa), Palma, Spain.,Primary Care Research Unit of Mallorca, Balearic Islands Health Service, Palma, Spain
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12
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Xu Z, Fleming FJ. Quality Assurance, Metrics, and Improving Standards in Rectal Cancer Surgery in the United States. Front Oncol 2020; 10:655. [PMID: 32411608 PMCID: PMC7202129 DOI: 10.3389/fonc.2020.00655] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 04/08/2020] [Indexed: 12/20/2022] Open
Abstract
Rectal cancer surgery has seen significant improvement in recent years. This has been possible in part due to focus on surgeon education and training, specific surgical quality metrics, and longitudinal tracking of data through the use of registries. In countries that have implemented such efforts, data has shown significant improvement in outcomes. However, there continues to be significant variation in rectal cancer outcomes and practices worldwide. Just within the United States, county level mortality rates from rectal cancer range from 8-15 per 100,000 to 38-59 per 100,000. In order to continue to improve rectal cancer patient outcomes, there needs to be evidence based guidelines and standards centered around the framework of structure, process, and outcomes. In addition, there must be a feedback system by which programs can continually assess their performance. Obtaining evidence for specific standards and measures can be challenging and requires analyzing available data and literature, some of which may be conflicting. This article evaluates the evolution of metrics and standards used for quality improvement in rectal cancer and ongoing efforts to further improve patient outcomes.
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Affiliation(s)
- Zhaomin Xu
- Surgical Health Outcomes and Research Enterprise (SHORE), Division of Colorectal Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY, United States
| | - Fergal J Fleming
- Surgical Health Outcomes and Research Enterprise (SHORE), Division of Colorectal Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY, United States
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13
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Ting FIL, Sacdalan DBL, Tampo MMT, Apellido RT, Monroy HJ, Sacdalan MDP, Sacdalan DL. Treatment Outcomes of Patients With Colorectal Cancer Enrolled in a Comprehensive Benefits Program of the National Insurance System in the Philippines: Data From the Pilot Site. JCO Glob Oncol 2020; 6:35-46. [PMID: 32031435 PMCID: PMC7000227 DOI: 10.1200/jgo.19.00332] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2019] [Indexed: 01/15/2023] Open
Abstract
PURPOSE Cancer treatment causes significant financial burden, especially in developing countries such as the Philippines. This led the Philippine Department of Health to create the Z-Package colorectal cancer benefit program, an insurance system specifically designed to treat Filipinos with colorectal cancers with early to locally advanced-stage disease. The main goal of this program is to optimize treatment outcomes for this curable disease without causing financial toxicity. MATERIALS AND METHODS Three-year data on patients enrolled in the Z-Package colorectal cancer benefit program from 2016 to 2018 were reviewed by the University of the Philippines, Philippine General Hospital Colorectal Polyp and Cancer Study Group. RESULTS A total of 251 patients were enrolled in the Z-package colorectal cancer benefit program from 2016 to 2018. Mean age was 57 years old and a majority of patients (66%) were male. A majority of patients had rectal cancer (78%) and were diagnosed with stage III disease (82%). A majority (75%) were compliant to their treatment plans and clinic follow-up. Specifically, compliance to the prescribed surgery, chemotherapy, and/or radiation treatment were 90%, 77%, and 96%, respectively. Recurrence, morbidity, and mortality rates of enrolled patients in the Z-Package program from 2016 to 2018 were 17%, 22%, and 19%, respectively. Morbidities were mostly chemotherapy related (8%). Finally, patients in this program had a 2- and 3-year survival probability of 74% and 70%, respectively, which are comparable with data from more developed nations. CONCLUSION Results of this study include real-world data that show that when the highest standards of patient care are provided through a multidisciplinary team, patients' overall survival is also maximized.
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Affiliation(s)
| | | | | | | | | | | | - Dennis L. Sacdalan
- University of the Philippines, Philippine General Hospital, Manila, Philippines
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14
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Distler FA, Pahernik S, Gakis G, Hutterer G, Lebentrau S, Rink M, Nuhn P, Brookman-May S, Burger M, Gratzke C, Wolff I, May M. Adherence to the EAU guideline recommendations for systemic chemotherapy in penile cancer: results of the E-PROPS study group survey. World J Urol 2019; 38:2523-2530. [PMID: 31834472 DOI: 10.1007/s00345-019-03052-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 12/06/2019] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES To validate the adherence of urologists to chemotherapy recommendations given in the EAU guidelines on PeCa. The European Association of Urology (EAU) guidelines on penile cancer (PeCa) are predominantly based on retrospective studies with low level of evidence. MATERIALS AND METHODS A 14-item-survey addressing general issues of PeCa treatment was developed and sent to 45 European hospitals. 557 urologists participated in the survey of which 43.5%, 19.3%, and 37.2% were in-training, certified, and in leading positions, respectively. Median response rate among participating departments was 85.7% (IQR 75-94%). Three of 14 questions addressed clinical decisions on neoadjuvant, adjuvant, and palliative chemotherapy. Survey results were analyzed by bootstrap-adjusted multivariate logistic-regression-analysis to identify predictors for chemotherapy recommendations consistent with the guidelines. RESULTS Neoadjuvant, adjuvant, and palliative chemotherapy was recommended according to EAU guidelines in 21%, 26%, and 48%, respectively. For neoadjuvant chemotherapy, urologists holding leading positions or performing chemotherapy were more likely to recommend guideline-consistent treatment (OR 1.85 and 1.92 with p(bootstrap) = 0.007 and 0.003, respectively). Supporting resources (i.e., guidelines, textbooks) were used by 23% of survey participants and significantly improved consistency between treatment recommendations and Guideline recommendations in all chemotherapy settings (p(bootstrap) = 0.010-0.001). Department size and university center status were no significant predictors for all three endpoints. CONCLUSIONS In this study, we found a very low rate of adherence to the EAU guidelines on systemic treatment for PeCa. Further investigations are needed to clarify whether this missing adherence is a consequence of limited individual knowledge level or of the low grade of guideline recommendations.
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Affiliation(s)
- F A Distler
- Department of Urology, Klinikum Nuremberg, Paracelsus Medical University Nuremberg, Nuremberg, Germany.
| | - S Pahernik
- Department of Urology, Klinikum Nuremberg, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - G Gakis
- Department of Urology and Pediatric Urology, University Hospital of Würzburg, Würzburg, Germany
| | - G Hutterer
- Department of Urology, Medical University of Graz, Graz, Austria
| | - S Lebentrau
- Department of Urology, Brandenburg Medical School Theodor Fontane, Ruppiner Kliniken, Neuruppin, Germany
| | - M Rink
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - P Nuhn
- Department of Urology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - S Brookman-May
- Department of Urology, Großhadern, LMU Munich, Munich, Germany
| | - M Burger
- Department of Urology, St. Josef-Hospital Regensburg, Medical University Regensburg, Regensburg, Germany
| | - C Gratzke
- Department of Urology, University of Freiburg, Freiburg, Germany
| | - I Wolff
- Department of Urology, University Medicine Greifswald, Greifswald, Germany
| | - M May
- Department of Urology, St. Elisabeth-Hospital Straubing, Straubing, Germany
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15
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Krimphove MJ, Tully KH, Friedlander DF, Marchese M, Ravi P, Lipsitz SR, Kilbridge KL, Kibel AS, Kluth LA, Ott PA, Choueiri TK, Trinh QD. Adoption of immunotherapy in the community for patients diagnosed with metastatic melanoma. J Immunother Cancer 2019; 7:289. [PMID: 31699149 PMCID: PMC6836520 DOI: 10.1186/s40425-019-0782-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 10/22/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The introduction of immune checkpoint inhibitors has led to a survival benefit in patients with advanced melanoma; however data on the adoption of immunotherapy in the community are scarce. METHODS Using the National Cancer Database, we identified 4725 patients aged ≥20 diagnosed with metastatic melanoma in the United States between 2011 and 2015. Multinomial regression was used to identify factors associated with the receipt of treatment at a low vs. high immunotherapy prescribing hospital, defined as the bottom and top quintile of hospitals according to their proportion of treating metastatic melanoma patients with immunotherapy. RESULTS We identified 246 unique hospitals treating patients with metastatic melanoma. Between 2011 and 2015, the proportion of hospitals treating at least 20% of melanoma patients with immunotherapy within 90 days of diagnosis increased from 14.5 to 37.7%. The mean proportion of patients receiving immunotherapy was 7.8% (95% Confidence Interval [CI] 7.47-8.08) and 50.9% (95%-CI 47.6-54.3) in low and high prescribing hospitals, respectively. Predictors of receiving care in a low prescribing hospital included underinsurance (no insurance: relative risk ratio [RRR] 2.44, 95%-CI 1.28-4.67, p = 0.007; Medicaid: RRR 2.10, 95%-CI 1.12-3.92, p = 0.020), care in urban areas (RRR 2.58, 95%-CI 1.34-4.96, p = 0.005) and care at non-academic facilities (RRR 5.18, 95%CI 1.69-15.88, p = 0.004). CONCLUSION While the use of immunotherapy for metastatic melanoma has increased over time, adoption varies widely across hospitals. Underinsured patients were more likely to receive treatment at low immunotherapy prescribing hospitals. The variation suggests inequity in access to these potentially life-saving drugs.
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Affiliation(s)
- Marieke J. Krimphove
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Karl H. Tully
- Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - David F. Friedlander
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Maya Marchese
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Praful Ravi
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Stuart R. Lipsitz
- Department of General Internal Medicine and Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Kerry L. Kilbridge
- Department of Medical Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA USA
| | - Adam S. Kibel
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Luis A. Kluth
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Patrick A. Ott
- Department of Medical Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA USA
| | - Toni K. Choueiri
- Department of Medical Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA USA
| | - Quoc-Dien Trinh
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
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16
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Eid Y, Menahem B, Bouvier V, Lebreton G, Thobie A, Bazille C, Finochi M, Fohlen A, Galais M, Dupont B, Lubrano J, Dejardin O, Morello R, Alves A. Has adherence to treatment guidelines for mid/low rectal cancer affected the management of patients? A monocentric study of 604 consecutive patients. J Visc Surg 2019; 156:281-290. [DOI: 10.1016/j.jviscsurg.2019.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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17
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Bada M, Berardinelli F, Nyiràdy P, Varga J, Ditonno P, Battaglia M, Chiodini P, De Nunzio C, Tema G, Veccia A, Antonelli A, Cindolo L, Simeone C, Puliatti S, Micali S, Schips L. Adherence to the EAU guidelines on Penile Cancer Treatment: European, multicentre, retrospective study. J Cancer Res Clin Oncol 2019; 145:921-926. [PMID: 30825028 DOI: 10.1007/s00432-019-02864-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 02/13/2019] [Indexed: 12/01/2022]
Abstract
PURPOSE The European Association of Urology (EAU) guidelines for penile cancer (PC) are exclusively based on retrospective studies and have low grades of recommendation. The aim of this study was to assess the adherence to guidelines by investigating the management strategies for primary tumours and inguinal lymph nodes. METHODS We retrospectively reviewed the clinical charts of 176 PC patients who underwent surgery in eight European centres from 2010 to 2016. The stage and grade were assessed according to the 2009 AJCC-UICC TNM classification system. To assess adherence rates, we compared theoretical and practical adherence to the EAU guidelines. RESULTS Overall, 176 patients were enrolled. Partial amputation was the most frequent surgical approach (39%). 53.7% of tumours were stage Tis-T1b and the remaining 46.3% were stage T2-T4. Palpable lymph nodes were detected in 30.1% of patients and 45.1% underwent lymphadenectomy (LY). A sizeable group of tumours (43.2%) were N0. For primary treatment, adherence to the EAU guidelines was good (66%). In non-adherent cases, reasons for discrepancy were patient's choice (17%), surgeon's preference (36%), and other causes (47%). For LY, the guideline adherence was 70%, with either patient's or surgeon's choice or other causes accounting for discrepancy in 28, 20, and 52% of non-adherent cases, respectively. CONCLUSION Adherence to the EAU guidelines for PC was quite high across the eight European centres involved in the study. This notwithstanding, strategies for further improvement should be developed and evenly adopted.
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Affiliation(s)
- Maida Bada
- Department of Urology, S. Pio da Pietrelcina Hospital, ASL 2 Abruzzo, Vasto, Italy.
| | | | - Peter Nyiràdy
- Department of Urology, Hospital of Budapest, Budapest, Hungary
| | - Judith Varga
- Department of Urology, Hospital of Budapest, Budapest, Hungary
| | - Pasquale Ditonno
- Department of Emergency and Organ Transplantation, Urology and Andrology Unit II, University of Bari, Bari, Italy
| | - Michele Battaglia
- Department of Emergency and Organ Transplantation, Urology and Andrology Unit II, University of Bari, Bari, Italy
| | - Paolo Chiodini
- Department of Medical Statistics Unit, Second University, Naples, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Giorgia Tema
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | | | | | - Luca Cindolo
- Department of Urology, S. Pio da Pietrelcina Hospital, ASL 2 Abruzzo, Vasto, Italy
| | - Claudio Simeone
- Department of Urology, Spedali Civili Hospital, Brescia, Italy
| | - Stefano Puliatti
- Department of Urology, Baggiovara Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | - Salvatore Micali
- Department of Urology, Baggiovara Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | - Luigi Schips
- Department of Urology, G. D'Annunzio University, Chieti, Italy
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18
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Cindolo L, Spiess PE, Bada M, Chipollini JJ, Nyirády P, Chiodini P, Varga J, Ditonno P, Battaglia M, De Nunzio C, Tema G, Veccia A, Antonelli A, Musi G, De Cobelli O, Conti A, Micali S, Álvarez-Maestro M, Olarte JQ, Diogenes E, Lima MVA, Tracey A, Guruli G, Autorino R, Sountoulides P, Schips L. Adherence to EAU guidelines on penile cancer translates into better outcomes: a multicenter international study. World J Urol 2018; 37:1649-1657. [PMID: 30377813 DOI: 10.1007/s00345-018-2549-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 10/25/2018] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION We aimed to evaluate adherence to the EAU guidelines (GL) on penile cancer (PC) with regard to primary surgical treatment and management of lymph nodes and to estimate the influence of adherence to GL on clinical outcome. MATERIALS AND METHODS This is a retrospective multicenter study (PEnile Cancer ADherence study, PECAD Study) on PC patients treated at 12 European and American centers between 2010 and 2016. Adherence to the EAU GL on the surgical management of the primary penile tumor and lymphadenectomy was evaluated. Descriptive analyses were performed, and survival curves were estimated. RESULTS Data on 425 patients were considered for the analysis. The EAU GL on surgical treatment of the primary tumor and lymphadenectomy were respected in 74.8% and 73.7% of cases, respectively. Survival analysis showed that adherence to the GL on primary penile surgery was significantly associated with a good overall survival [adjusted HR 0.40 (95% CI 0.20-0.83, p value = 0.014)]. Also, the adherence to the GL on lymphadenectomy was statistically significantly associated with overall survival [adjusted HR 0.48 (95% CI 0.24-0.96, p value = 0.038)]. Limited follow-up and retrospective design represent limitations of this study. CONCLUSIONS Our findings suggest that there is a good adherence to the EAU GL on PC. However, this should be further reinforced, endorsed and encouraged as it might translate into better clinical outcomes for PC patients.
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Affiliation(s)
- Luca Cindolo
- Department of Urology, ASL 2 Abruzzo, Hospital "S. Pio da Pietrelcina", Vasto, Italy.
| | - Philippe E Spiess
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Maida Bada
- Department of Urology, ASL 2 Abruzzo, Hospital "S. Pio da Pietrelcina", Vasto, Italy
| | - Juan J Chipollini
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Peter Nyirády
- Department of Urology, Hospital of Budapest, Budapest, Hungary
| | - Paolo Chiodini
- Medical Statistics Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Judith Varga
- Department of Urology, Hospital of Budapest, Budapest, Hungary
| | - Pasquale Ditonno
- Department of Emergency and Organ Transplantation, Urology and Andrology Unit II, University of Bari, Bari, Italy
| | - Michele Battaglia
- Department of Emergency and Organ Transplantation, Urology and Andrology Unit II, University of Bari, Bari, Italy
| | - Cosimo De Nunzio
- Department of Urology, Hospital "Sant' Andrea", Sapienza University, Rome, Italy
| | - Giorgia Tema
- Department of Urology, Hospital "Sant' Andrea", Sapienza University, Rome, Italy
| | | | | | - Gennaro Musi
- Department of Urology, Istituto Europeo di Oncologia, University of Milan, Milan, Italy
| | - Ottavio De Cobelli
- Department of Urology, Istituto Europeo di Oncologia, University of Milan, Milan, Italy
| | - Andrea Conti
- Department of Urology, Istituto Europeo di Oncologia, University of Milan, Milan, Italy
| | - Salvatore Micali
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | - Erico Diogenes
- Department of Urology, Ceara Cancer Institute, Fortaleza, Brazil
| | | | - Andrew Tracey
- Department of Urology, Virginia Commonwealth University, Richmond, VA, USA
| | - Georgi Guruli
- Department of Urology, Virginia Commonwealth University, Richmond, VA, USA
| | - Riccardo Autorino
- Department of Urology, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Luigi Schips
- Department of Urology, "G.D'Annunzio" University, Chieti, Italy
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19
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Shen X, Diao M, Lu M, Feng R, Zhang P, Jiang T, Wang D. Pathways and cost-effectiveness of routine lung cancer inpatient care in rural Anhui, China: a retrospective cohort study protocol. BMJ Open 2018; 8:e018519. [PMID: 29463588 PMCID: PMC5879485 DOI: 10.1136/bmjopen-2017-018519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Routine inpatient care (RIC) for patients with cancer forms various pathways of clinical procedures. Although most individual procedures comprising the pathways have been tested via clinical trials, little is known about the collective cost and effectiveness of the pathways as a whole. This study aims at exploring RIC pathways for patients with lung cancer from rural Anhui, China, and their determinants and economic impacts. METHODS AND ANALYSIS The study adopts a retrospective cohort design and proceeds in five steps. Step 1 defines the four main categories of study variables, including clinical procedures, direct cost and effectiveness of procedures, and factors affecting use of these procedures and their cost and effectiveness. Step 2 selects a cohort of 5000 patients with lung cancer diagnosed between 1 July 2015 and 30 June 2016 from rural Anhui by clustered random sampling. Step 3 retrieves the records of all the inpatient care episodes due to lung cancer and extracts data about RIC procedures, proximate variables (eg, Karnofsky Performance Status, Lung Function Score) of patient outcomes and related factors (eg, stage of cancer, age, gender), by two independent clinician researchers using a web-based form. Step 4 estimates the direct cost of each of the RIC procedures using micro-costing and collects data about ultimate patient outcomes (survival and progression-free survival) through a follow-up survey of patients and/or their close relatives. Step 5 analyses the data collected and explores pathways of RIC procedures and their relations with patient outcomes, costs, cost:effect ratios, and a whole range of clinical and sociodemographic factors using multivariate regression and path models. ETHICS AND DISSEMINATION The study protocol has been approved by an authorised ethics committee of Anhui Medical University (reference number: 20170312). Findings from the study will be disseminated through conventional academic routes such as peer-reviewed publications and presentations at regional, national and international conferences. TRIAL REGISTRATION NUMBER ISRCTN25595562.
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Affiliation(s)
- XingRong Shen
- School of Health Services Management, Anhui Medical University, Hefei, Anhui, China
| | - MengJie Diao
- School of Health Services Management, Anhui Medical University, Hefei, Anhui, China
| | - ManMan Lu
- School of Health Services Management, Anhui Medical University, Hefei, Anhui, China
| | - Rui Feng
- Department of Literature Review and Analysis, Library of Anhui Medical University, Hefei, Anhui, China
| | - PanPan Zhang
- School of Health Services Management, Anhui Medical University, Hefei, Anhui, China
| | - Tao Jiang
- School of Health Services Management, Anhui Medical University, Hefei, Anhui, China
| | - DeBin Wang
- School of Health Services Management, Anhui Medical University, Hefei, Anhui, China
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20
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Mohammadzadeh Z, Ghazisaeedi M, Nahvijou A, Rostam Niakan Kalhori S, Davoodi S, Zendehdel K. Systematic Review of Hospital Based Cancer Registries (HBCRs): Necessary Tool to Improve Quality of Care in Cancer
Patients. Asian Pac J Cancer Prev 2017; 18:2027-2033. [PMID: 28843217 PMCID: PMC5697455 DOI: 10.22034/apjcp.2017.18.8.2027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction: Incidence and mortality rate of cancer is increasing in all countries including low and middle-income countries. Hospital based cancer registry (HBCR) is an important tool for administration purpose and improvement of the quality of care. It is also important resource for population based cancer registries. In this study we reviewed HBCRs in different countries. Methods: We searched the published literature using the MEDLINE (PubMed), Google scholar, Scopus, ProQuest and Google. We also reviewed websites of the HBCRs in different countries. The search was carried out based on proper keywords in English for all motor engines including “hospital-based”, “clinical” and “data quality” combined with “registry”, “cancer” and “tumor” including all subheadings. We reviewed objectives, developer institutions, minimum datasets, data sources, quality control indicators and processes. Results: In total we found 163 papers in the first step. After screening of the titles, abstracts and the full texts, 14 papers remained for analysis. Analysis of the 14 papers showed that the improvement of the quality of the care were the most important objectives among the registries. HBCRs collect information about patients, tumor diagnosis, treatment and follow-up. Generally, indicators such as completeness and validity were used for quality control. Conclusion: Because of the increases in cancer burden in the world, more attention is needed to be paid on cancer surveillance systems, including HBCRs. We evaluated and highlighted the importance and characteristics HBCRs and believe that this paper would help the hospitals and policy makers for planning and establishment of new HBCRs. We suggest the establishment of a worldwide network for coordination and collaboration between HBCRs.
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Affiliation(s)
- Zeinab Mohammadzadeh
- Health Information Management Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran.
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