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Tseng YC, Kung PT, Peng CY, Chou WY, Tsai WC. Effect of multidisciplinary team care on patient survival in chronic hepatitis B or C hepatocellular carcinoma. Front Oncol 2023; 13:1251571. [PMID: 38179172 PMCID: PMC10764426 DOI: 10.3389/fonc.2023.1251571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/31/2023] [Indexed: 01/06/2024] Open
Abstract
Introduction Multidisciplinary team care coordinates with medical teams to improve the quality of cancer care. This study explored multidisciplinary team care in hepatitis B or hepatitis C virus-related hepatocellular carcinoma patients from the time of diagnosis to the first-time treatment interval and investigated treatment outcomes and prognosis. Methods This retrospective cohort study included data from a nationwide population from 2007 to 2016. Data were collected from the Taiwan Cancer Registry Database, linked to the Taiwan National Health Insurance Research Database. Propensity score matching was applied at a ratio of 1:2 to reduce the selection bias. A multiple regression model with generalized estimating equations was used to analyze whether multidisciplinary team care affected the diagnosis-to-treatment interval. The stratified Cox proportional hazards model examined whether involvement in multidisciplinary team care influenced survival status. Results A total of 10,928 and 21,856 patients with hepatocellular carcinoma received multidisciplinary and non-multidisciplinary care, respectively. Participants with multidisciplinary care had a longer diagnosis-to-treatment interval but a lower risk of cumulative cancer death (HR=0.88, 95% CI:0.84-0.92). In patients with intermediate- to advanced-stage hepatocellular carcinoma, multidisciplinary team care has obvious benefits for improving survival. Conclusion Patients with hepatocellular carcinoma who participated in multidisciplinary team care had a longer diagnosis-to-treatment interval but a lower risk of cancer death. Patients with intermediate- to advanced-stage hepatocellular carcinoma who received multidisciplinary team care significantly benefited from this outcome. Hospitals should provide HCC patients with multidisciplinary team care to improve cancer care.
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Affiliation(s)
- Yu-Chen Tseng
- Department of Public Health, China Medical University, Taichung, Taiwan
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Armed Forces General Hospital, Taichung, Taiwan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Pei-Tseng Kung
- Department of Healthcare Administration, Asia University, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Yuan Peng
- Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Wen-Yu Chou
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Wen-Chen Tsai
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
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Taqi K, Kim D, Yip L, Laane C, Rana Z, Hameed M, Hamilton T, Stuart H. Emergency surgical consultation for cancer patients: identifying the prognostic determinants of health. World J Surg Oncol 2022; 20:232. [PMID: 35820927 PMCID: PMC9277930 DOI: 10.1186/s12957-022-02694-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 07/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with malignancy often require urgent surgical consultation for treatment or palliation of disease. The objective of this study is to explore the prognostic determinants affecting care in acute cancer-related surgical presentations and the effect on patient outcomes. MAIN BODY This is a retrospective review of patients referred to the acute general surgery (ACS) service at a tertiary hospital for management of cancer-related problem from July 2017 to September 2018. Patient demographics, course in hospital, and survival were recorded. Multivariant logistic regression and Kaplan-Meier estimates were performed. One hundred eighty-nine patients were identified (53% female) with a mean age of 65.9 years. Forty-two patients (22%) were newly diagnosed with cancer on presentation, and 94 (50%) patients had metastatic disease. Cancer staging was completed in 84% of patients, and 65% had multidisciplinary team (MDT) assessment during their hospital stay. Surgery was performed on 90 (48%) patients, of which 31.2% was with palliative intent. Overall mortality was 56% with 30- and 60-day mortality of 15% and 22%, respectively. The adjusted odds ratio (OR) for a 60-day mortality was high in patients presenting with new cancer diagnosis (OR 3.18, 95% CI 1.18-9.02, p=0.03), metastatic disease (OR 5.11, 95% CI 2.03-12.85, p=0.001), or systemic therapy on presentation (OR 3.46, 95% CI 1.30-9.22, p=0.013). CONCLUSION Emergency surgical referral is common in patients with malignancy. Surgical decision making can be challenging due to the heterogeneity of this population and their associated comorbidities. Optimizing prognostic determinants such as goal-directed palliative care, MDT discussions, and bridging to systemic therapy can improve patient outcomes.
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Affiliation(s)
- Kadhim Taqi
- Department of Surgery - Division of General Surgery, University of British Columbia, 2103, 638 Beach Crescent, Vancouver, BC, V6Z3H4, Canada.
| | - Diane Kim
- University of British Columbia, Faculty of Medicine, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Lily Yip
- University of British Columbia, Faculty of Medicine, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Charlotte Laane
- Department of Surgery - Division of General Surgery, Vancouver General Hospital, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada
| | - Zeeshan Rana
- Department of Surgery - Division of General Surgery, Vancouver General Hospital, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada
| | - Morad Hameed
- Department of Surgery - Division of General Surgery, Vancouver General Hospital, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada
| | - Trevor Hamilton
- Department of Surgery - Division of General Surgery, Vancouver General Hospital, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada
| | - Heather Stuart
- Department of Surgery - Division of General Surgery, Vancouver General Hospital, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada
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Chen TL, Feng YH, Kao SL, Lu JW, Loh CH. Impact of integrated health care on elderly population: A systematic review of Taiwan's experience. Arch Gerontol Geriatr 2022; 102:104746. [PMID: 35691276 DOI: 10.1016/j.archger.2022.104746] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/04/2022] [Accepted: 06/06/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Care fragmentation in the elderly population prompted the need for integrated health care systems. However, evidence regarding the impact of the integrated care system in Taiwan is unclear. We aimed to conduct a systematic review to evaluate the impact of Taiwan's integrated health care programs on geriatric population. METHODS We searched bibliographic databases MEDLINE, Embase, Web of Science, and Airiti Library for relevant publications throughout May 2022. Studies investigating the effectiveness of Taiwan's integrated care programs were included. We used the critical appraisal skills programme (CASP) checklist, to assess the risk of bias of included studies. RESULTS Thirty-four studies, with a total of 838,026 study subjects, were assessed. The systematic review on 11 subthemes (diabetes mellitus, chronic kidney disease, hepatitis C virus, fractures, cancer, dementia, atrial fibrillation, chronic obstructive pulmonary disease, mechanical ventilation, terminal illness, outpatients and community-dwelling patients), demonstrated that the implementation of integrated health care could not only provide benefits on survival, self-care ability, health quality, physical, and functional rehabilitation outcomes, but also significantly reduce medical utilization and expenditures. CONCLUSION The integrated health care system for multiple morbidities benefits the Taiwanese geriatric population in physical and functional outcomes. The thematic synthesis provides references for future rigorous clinical trials.
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Affiliation(s)
- Tai-Li Chen
- Center for Aging and Health, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan; Department of Dermatology, Taipei Veterans Hospital, Taipei, Taiwan
| | - Yun-Hsuan Feng
- School of Medicine, Tzu Chi University, Hualien, Taiwan; Department of Medical Education, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Sheng-Lun Kao
- Division of Geriatric Medicine, Department of Family Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Jing-Wun Lu
- Department of Physical Medicine and Rehabilitation, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Ching-Hui Loh
- Center for Aging and Health, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan; Division of Geriatric Medicine, Department of Family Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
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Huang YC, Kung PT, Ho SY, Tyan YS, Chiu LT, Tsai WC. Effect of multidisciplinary team care on survival of oesophageal cancer patients: a retrospective nationwide cohort study. Sci Rep 2021; 11:13243. [PMID: 34168186 PMCID: PMC8225808 DOI: 10.1038/s41598-021-92618-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/14/2021] [Indexed: 12/24/2022] Open
Abstract
Oesophageal cancer is the sixth leading cause of cancer death worldwide. This nationwide study analyses the survival results of oesophageal cancer under multidisciplinary team (MDT) care. We enrolled oesophageal cancer patients diagnosed between 2010 and 2015 with follow-up for at least 1 year. This study performed propensity score matching with a ratio of 1:1 between MDT participants and non-MDT participants. We performed conditional Cox proportional hazards model to research relative risk of survival and associated factors of survival. The adjusted survival curves were plotted. 8184 newly diagnosed oesophageal cancer patients were included. The favourable survival factors include participant status of MDT, gender, monthly salary, urbanization level, other catastrophic illness, stage of cancer, treatment methods, and service volume of physicians (P < 0.05). MDT participants showed lower risk of death (HR = 0.73; 95% CI 0.67–0.79). Further stratification analysis revealed that the incorporation of an MDT reduced the death risk of patients with stages 2, 3, and 4 cancer, with the greatest reduction observed in patients with stage 3 cancer (HR = 0.72; 95% CI 0.67–0.79). The risk of death was lower for oesophageal cancer patients who enrolled in MDT care.
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Affiliation(s)
- Yuan-Chun Huang
- Department of Health Services Administration, China Medical University, No. 100, Sec. 1, Jingmao Road, Taichung, 404060, Taiwan.,Department of Medical Imaging, Changhua Christian Hospital, Changhua, Taiwan.,School of Medical Imaging and Radiological Sciences, School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan.,Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan
| | - Pei-Tseng Kung
- Department of Healthcare Administration, Asia University, Taichung, Taiwan.,Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Shang-Yun Ho
- Department of Medical Imaging, Changhua Christian Hospital, Changhua, Taiwan
| | - Yeu-Sheng Tyan
- School of Medical Imaging and Radiological Sciences, School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Li-Ting Chiu
- Department of Health Services Administration, China Medical University, No. 100, Sec. 1, Jingmao Road, Taichung, 404060, Taiwan
| | - Wen-Chen Tsai
- Department of Health Services Administration, China Medical University, No. 100, Sec. 1, Jingmao Road, Taichung, 404060, Taiwan.
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Lu J, Jiang Y, Qian M, Lv L, Ying X. The Improved Effects of a Multidisciplinary Team on the Survival of Breast Cancer Patients: Experiences from China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:ijerph17010277. [PMID: 31906051 PMCID: PMC6982185 DOI: 10.3390/ijerph17010277] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 12/17/2019] [Accepted: 12/25/2019] [Indexed: 12/16/2022]
Abstract
This study aimed to explore whether different multidisciplinary team (MDT) organizations have different effects on the survival of breast cancer patients. A total of 16354 patients undergoing breast cancer surgery during the period 2006–2016 at the Fudan University Shanghai Cancer Center were retrospectively extracted. Patients treated by MDT were divided into a well-organized group and a disorganized group based on their organized MDT, professional attendance, style of data and information delivery, and the length of discussion time for each patient. Other patients, who were not treated by MDT, were placed in a non-MDT group as a comparator group. Each MDT patient was matched with a non-MDT patient, using propensity score matching to reduce selection bias. The Cox regression model was used to examine the difference in effects between groups. We found that the five-year survival rate of the well-organized MDT group was 15.6% higher than the non-MDT group. However, five-year survival rate of the disorganized MDT group was 19.9% lower than that of the non-MDT group. Patients in the well-organized MDT group had a longer survival time than patients in the non-MDT group (HR = 0.4), while the disorganized MDT group had a worse survival rate than the non-MDT group (HR = 2.8) based on the Cox model result. However, our findings indicate that a well-organized MDT may improve the survival rate of patients with breast cancer in China.
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Affiliation(s)
- Jianlong Lu
- NHC Key Laboratory of Health Technology Assessment (Fudan University), School of Public Health, Fudan University, Dongan Road 130, Shanghai 200032, China; (J.L.); (M.Q.)
- Shanghai Cancer Center, Fudan University, Dongan Road 270, Shanghai 200032, China; (Y.J.); (L.L.)
| | - Yan Jiang
- Shanghai Cancer Center, Fudan University, Dongan Road 270, Shanghai 200032, China; (Y.J.); (L.L.)
| | - Mengcen Qian
- NHC Key Laboratory of Health Technology Assessment (Fudan University), School of Public Health, Fudan University, Dongan Road 130, Shanghai 200032, China; (J.L.); (M.Q.)
| | - Lilang Lv
- Shanghai Cancer Center, Fudan University, Dongan Road 270, Shanghai 200032, China; (Y.J.); (L.L.)
| | - Xiaohua Ying
- NHC Key Laboratory of Health Technology Assessment (Fudan University), School of Public Health, Fudan University, Dongan Road 130, Shanghai 200032, China; (J.L.); (M.Q.)
- Correspondence:
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Nasir S, Anwar S, Ahmed M. Multidisciplinary team (MDT) meeting and Radiologist workload, a prospective review in a tertiary care hospital. Pak J Med Sci 2018; 33:1501-1506. [PMID: 29492086 PMCID: PMC5768852 DOI: 10.12669/pjms.336.12905] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To quantify the increase in workload associated with multidisciplinary team meetings for radiologists in a tertiary care hospital over a period of 15 months. Methods Data was collected prospectively regarding number of multidisciplinary team meetings, number of clinical cases discussed, number of individual imaging studies reviewed, and preparation time of residents, senior registrar and consultants and the delivery time of meeting. Results Total 223 meetings were held over 15 months (April 2014 to June 2015) for 12 clinical specialty areas. There were 1120 clinical case discussions and a total of 2759 documented individual imaging studies reviewed. Resident's preparation time was 74.6 hours/month, senior registrar's preparation time was 47.93 hours/month, consultant's preparation time was 18.67 hours/month and the total duration time for meetings was 18 hours/month. Conclusion Multidisciplinary team meetings now represent a significant workload of radiology and has reduced the time for other academic activities within the department.
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Affiliation(s)
- Sadaf Nasir
- Sadaf Nasir, MBBS, FCPS.Department of Radiology, Liaquat National Hospital, National Stadium Road, Karachi, Pakistan
| | - Saleha Anwar
- Saleha Anwar, MCPS, FCPS.Department of Radiology, Liaquat National Hospital, National Stadium Road, Karachi, Pakistan
| | - Moinuddin Ahmed
- Moinuddin Ahmed, FCPS. Department of Radiology, Liaquat National Hospital, National Stadium Road, Karachi, Pakistan
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