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Debs P, Belzberg A, Blakeley J, Fayad L, Langmead S, Little E, Romo C, Schatz K, Slobogean B, Ahlawat S. Multidisciplinary neurofibromatosis conference in the management of patients with neurofibromatosis type 1 and schwannomatosis in a single tertiary care institution. Skeletal Radiol 2024; 53:909-916. [PMID: 37950060 DOI: 10.1007/s00256-023-04511-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/02/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE To evaluate the role of weekly neurofibromatosis (NF) multi-disciplinary conferences (MDC) on the diagnostic and therapeutic plan for patients with NF type 1 (NF1) and schwannomatosis (SWN). MATERIALS AND METHODS This retrospective study reviewed patients with confirmed or suspected NF1 and SWN discussed in weekly MDC from March to July 2021. Demographic data collected included patient age, sex, pre-conference and post-conference diagnosis, radiological studies reviewed, and provider specialties in attendance. Outcomes reported included changes in imaging interpretation and treatment plans, changes in post-conference diagnosis relative to pre-conference diagnosis, and time to completion of the recommended change in treatment. RESULTS Data from 17 MDC "pre-conference" lists included 75 patients (38 female, 37 males, mean age (years): 38 (range: 6-80)) with NF1 (52%, 39/75) and SWN (36%, 27/75) discussed over a total of 91 case reviews. 18.7% (14/75) of all patients had NF2-related SWN, and 17.3% (13/75) of all patients had non-NF2 SWN. The MDC led to changes in imaging interpretation in 18.7% and changes in patient management in 74.7% (diagnostic testing (n = 52), surgical plan (n = 24), medical treatment (n = 9), clinical trial status (n = 4), and radiation treatment (n = 1)) of cases. Among patients for whom a change in management was recorded, 91% (62/68) completed at least one recommendation (mean time to completion (days): 41.4 (range: 0-278)). CONCLUSION Weekly MDC changes the diagnostic and therapeutic management of the majority of patients discussed (74.7%) and promotes a high adherence rate to recommendations (91%).
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Affiliation(s)
- Patrick Debs
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, 601 North Caroline Street, JHOC 3014, Baltimore, MD, 21287, USA
| | - Allan Belzberg
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jaishri Blakeley
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Laura Fayad
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, 601 North Caroline Street, JHOC 3014, Baltimore, MD, 21287, USA
- Division of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shannon Langmead
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Emily Little
- Comprehensive Neurofibromatosis Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carlos Romo
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Krista Schatz
- McKusick-Nathans Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bronwyn Slobogean
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shivani Ahlawat
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, 601 North Caroline Street, JHOC 3014, Baltimore, MD, 21287, USA.
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Joneborg U, Bergamini A, Wallin E, Mangili G, Solheim O, Marquina G, Casado A, Rokkones E, Coulter J, Lok CAR, van Trommel N, Amant F, Bolze PA, Sehouli J, Han S, Kridelka F, Goffin F, Pautier P, Ray-Coquard I, Seckl M. European multidisciplinary tumor boards support cross-border networking and increase treatment options for patients with rare gynecological tumors. Int J Gynecol Cancer 2023; 33:1621-1626. [PMID: 37783481 PMCID: PMC10579460 DOI: 10.1136/ijgc-2023-004599] [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: 04/26/2023] [Accepted: 08/24/2023] [Indexed: 10/04/2023] Open
Abstract
OBJECTIVE To evaluate outcomes of European cross-border multidisciplinary tumor boards in terms of participation, adherence to treatment recommendations, and access to novel treatment strategies. METHODS The European reference network for rare gynecological tumors (EURACAN G2 domain) aims to improve the diagnosis, management, and treatment of patients with these cancers. Cross-border multidisciplinary tumor boards were initiated to facilitate intercollegiate clinical discussions across Europe and increase patients' access to specialist treatment recommendations and clinical trials. All G2 healthcare providers were invited to participate in monthly multidisciplinary meetings. Patient data were collected using a standardized form and case summaries were distributed before each meeting. After each tumor board, a meeting summary with treatment recommendations was sent to all participants and the project manager at the coordinating center. The multidisciplinary tumor board format and outcomes were regularly discussed at G2 domain meetings. Anonymized clinical data and treatment recommendations were registered in a prospective database. For this report, clinical data were collected between November 2017 and December 2020 and follow-up data retrieved until May 2021. RESULTS During the 3-year period, 31 multidisciplinary tumor boards were held with participants from 10 countries and 20 centers. 91 individual patients were discussed between one and six times for a total of 109 case discussions. Follow-up data were retrieved from 64 patients and 80 case discussions. Adherence to treatment recommendations was 99%. Multidisciplinary tumor board recommendations resulted in 11 patients getting access to off-label treatment and one patient being enrolled in a clinical trial in another European country. 14/91 patients were recommended for surveillance only when additional treatment had been considered locally. CONCLUSION Cross-border multidisciplinary tumor boards enable networking and clinical collaboration between healthcare professionals in different countries. Surveillance strategies, off-label drug use, and increased participation in clinical trials are possible benefits to patients with rare gynecological tumors.
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Affiliation(s)
- Ulrika Joneborg
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Alice Bergamini
- San Raffaele Hospital Department of Obstetrics and Gynaecology, Milano, Italy
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milano, Italy
| | - Emelie Wallin
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Giorgia Mangili
- San Raffaele Hospital Department of Obstetrics and Gynaecology, Milano, Italy
| | - Olesya Solheim
- Department of Gynecological Oncology, Oslo University Hospital, Oslo, Norway
| | - Gloria Marquina
- Department of Medical Oncology, Hospital Clinico San Carlos, Madrid, Spain
- Department of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Antonio Casado
- Department of Medicine, Complutense University of Madrid, Madrid, Spain
- Department of Medical Oncology, Hospital Clínico San Carlos, Madrid, Spain
| | - Erik Rokkones
- Department of Gynecological Oncology, Oslo University Hospital, Oslo, Norway
| | - John Coulter
- Department of Gynaecological Oncology, Cork University Hospital, Cork, Ireland
| | - Christianne A R Lok
- Department of Gynecologic Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Nienke van Trommel
- Department of Gynecologic Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Frédéric Amant
- Division of Gynecologic Oncology, KU Leuven University Hospitals Leuven, Leuven, Belgium
- Division of Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Pierre-Adrien Bolze
- Hospices Civils de Lyon, Universite Lyon 1 Faculte de Medecine et de Maieutique Lyon-Sud Charles Merieux, Lyon, France
- Department of Gynecological and Oncological Surgery and Obstetrics, Hospital Lyon-South, Lyon, France
| | - Jalid Sehouli
- Department of Gynecology with Center of Oncological Surgery, Charite Medical Faculty Berlin, Berlin, Germany
| | - Sileny Han
- Division of Gynecologic Oncology, KU Leuven University Hospitals Leuven, Leuven, Belgium
| | - Frédéric Kridelka
- Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, Central University Hospital of Liege, Liege, Belgium
| | - Frederic Goffin
- Department of Obstetrics and gynecology, Central University Hospital of Liege, Liege, Belgium
| | - Patricia Pautier
- Gustave Roussy Institute, Villejuif, France
- Paris-Saclay University, Villejuif, France
| | - Isabelle Ray-Coquard
- Centre Leon Berard, Lyon, France
- Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Michael Seckl
- Department of Medical Oncology, Imperial College London - Charing Cross Campus, London, UK
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Hendrickx JJ, Mennega T, Uppelschoten JM, Leemans CR. Changes in multidisciplinary team decisions in a high volume head and neck oncological center following those made in its preferred partner. Front Oncol 2023; 13:1205224. [PMID: 37727212 PMCID: PMC10505803 DOI: 10.3389/fonc.2023.1205224] [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: 04/13/2023] [Accepted: 07/24/2023] [Indexed: 09/21/2023] Open
Abstract
Objective Head and neck cancer care is highly complex, and multidisciplinary team meetings (MDTs) are vital for improved outcomes. In the Netherlands, head and neck cancer care is practiced in eight high-volume head and neck oncologic centers (HNOC) and six affiliated hospitals preferred partner (PP) centers. Patients treated in the PP are presented and discussed in the HNOC. To evaluate the importance of these mandatory and decisive steps in decision making, we have assessed the changes in treatment. Materials and methods Retrospective evaluation of head and neck cancer patients referred between January 2011 and October 2018 for a MDT evaluation to the HNOC was conducted. The differences in MDT recommendation were classified with regards to major and minor changes. Results Management recommendation(MR) changed after 113 of 515 MDT discussions within the PP (487 patients; 22%), of which 86 cases (16%) were major changes. In 67 cases (59.3%), escalation of management was recommended, while in 43 cases (38.1%) de-escalation was recommended. Conclusion There was a high rate of change of MRs, when comparing the PP recommendations with the HNOC recommendations. Since patient and tumor characteristics seem unable to predict these changes, we recommend all patients be seen for a clinical presentation, revision of diagnostics, and MDT discussion in a high volume HNOC.
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Affiliation(s)
- Jan-Jaap Hendrickx
- Department of Otolaryngology-Head and Neck Surgery, Amsterdam University Medical Center-location VUmc, Amsterdam, Netherlands
| | - Tommy Mennega
- Department of Otolaryngology-Head and Neck Surgery, Amsterdam University Medical Center-location VUmc, Amsterdam, Netherlands
| | | | - C. René Leemans
- Department of Otolaryngology-Head and Neck Surgery, Amsterdam University Medical Center-location VUmc, Amsterdam, Netherlands
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Mann M, Annable N, Emch TM, Wu J, Chao ST, Benzel E, Winkelman R, Angelov L. Management of Patients with Spine Tumors Strengthened by a Dedicated Multidisciplinary Spine Tumor Board: A 15-Year Single-Institutional Experience. World Neurosurg 2023; 175:e397-e405. [PMID: 37011761 DOI: 10.1016/j.wneu.2023.03.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/22/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Patients with spine tumors frequently require timely, multistep, and multidisciplinary care. A Spine Tumor Board (STB) provides a consistent forum wherein diverse specialists can interact, facilitating complex coordinated care for these patients. This study aims to present a single, large academic center's STB experience specifically reviewing case diversity, recommendations, and quantifying growth over time. METHODS All patient cases discussed at STB from May 2006 (STB inception) to May 2021 were evaluated. Collected data submitted by presenting physicians and formal documentation completed during the STB are summarized. RESULTS A total of 4549 cases were reviewed by STB over the study period, representing 2618 unique patients. Over the course of the study, a 266% increase in number of cases presented per week was observed (4.1 to 15.0). Cases were presented by surgeons (74%), radiation oncologists (18%), neurologists (2%), and other specialists (6%). The most common pathologic diagnoses discussed were spinal metastases (n = 1832; 40%), intradural extramedullary tumors (n = 798; 18%), and primary glial tumors (n = 567; 12%). Treatment recommendations included surgery, radiation therapy, or systemic therapy for 1743 cases (38%), continued routine follow-up/expectant management for 1592 cases (35%), supplementary imaging to better clarify the diagnosis for 549 cases (12%), and variable tailored recommendations for the remainder of cases (18%). CONCLUSIONS Care of patients with spine tumors is complex. We believe that the formation of a stand-alone STB is instrumental to accessing multidisciplinary input, enhancing confidence in management decisions for both patients and providers, assisting with care orchestration, and improving quality of care for patients with spine tumors.
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Affiliation(s)
- Michael Mann
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Nicole Annable
- Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Todd M Emch
- Department of Diagnostic Radiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jenny Wu
- Department of Diagnostic Radiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Samuel T Chao
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA; Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Edward Benzel
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA; Center for Spine Health, Cleveland Clinic, Cleveland, Ohio, USA
| | - Robert Winkelman
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lilyana Angelov
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA; Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA; Center for Spine Health, Cleveland Clinic, Cleveland, Ohio, USA.
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Dell’Aquila K, Hodges H, Moshiri M, Katz DS, Elojeimy S, Revzin MV, Tembelis M, Revels JW. Imaging evaluation of lymphoma in pregnancy with review of clinical assessment and treatment options. Abdom Radiol (NY) 2023; 48:1663-1678. [PMID: 36595067 PMCID: PMC9808767 DOI: 10.1007/s00261-022-03779-9] [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: 10/15/2022] [Revised: 12/11/2022] [Accepted: 12/12/2022] [Indexed: 01/04/2023]
Abstract
Lymphoma-related malignancies can be categorized as Hodgkin's lymphoma (HL) or non-Hodgkin's lymphoma (NHL) based on histologic characteristics. Although quite rare during pregnancy, HL and NHL are the fourth and fifth most common malignancies during the pregnancy period, respectively. Given the rarity of lymphoma among pregnant patients, radiologists are usually unfamiliar with the modifications required for staging and treatment of this population, even those who work at centers with busy obstetrical services. Therefore, this manuscript serves to not only review the abdominopelvic imaging features of lymphoma in pregnancy, but it also discusses topics including birthing parent and fetal lymphoma-related prognosis, both antenatal and postpartum, current concepts in the management of pregnancy-related lymphoma, as well as the current considerations regarding birthing parent onco-fertility.
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Affiliation(s)
- Kevin Dell’Aquila
- grid.260914.80000 0001 2322 1832New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY USA
| | - Hannah Hodges
- grid.266832.b0000 0001 2188 8502Department of Radiology, University of New Mexico, Albuquerque, NM USA
| | - Mariam Moshiri
- grid.412807.80000 0004 1936 9916Department of Radiology, Vanderbilt University Medical Center, Nashville, TN USA
| | - Douglas S. Katz
- grid.137628.90000 0004 1936 8753Department of Radiology, New York University Langone Health–Long Island, Mineola, NY USA
| | - Saeed Elojeimy
- grid.259828.c0000 0001 2189 3475Department of Radiology, Medical University of South Carolina, Charleston, SC USA
| | - Margarita V. Revzin
- grid.47100.320000000419368710Department of Radiology, Yale University School of Medicine, New Haven, CT USA
| | - Miltiadis Tembelis
- grid.137628.90000 0004 1936 8753Department of Radiology, New York University Langone Health–Long Island, Mineola, NY USA
| | - Jonathan W. Revels
- grid.137628.90000 0004 1936 8753Department of Radiology, New York University Langone Health–Long Island Division, 560 1St Avenue, 2nd Floor, New York, NY 10016 USA
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Wong BO, Blythe JA, Wu A, Batten JN, Kennedy KM, Kouaho AS, Wren SM. Exploration of Clinician Perspectives on Multidisciplinary Tumor Board Function Beyond Clinical Decision-making. JAMA Oncol 2022; 8:1210-1212. [PMID: 35653129 DOI: 10.1001/jamaoncol.2022.1763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Bonnie O Wong
- School of Medicine, Stanford University, Stanford, California
| | - Jacob A Blythe
- Department of Surgery, Massachusetts General Hospital, Boston
| | - Adela Wu
- Department of Neurosurgery, Stanford University, Stanford, California
| | - Jason N Batten
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California
| | | | | | - Sherry M Wren
- Department of Surgery, Stanford University, Stanford, California
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Prospective Analysis of Radiology Resource Utilization and Outcomes for Participation in Oncology Multidisciplinary Conferences. Acad Radiol 2021; 28:1219-1224. [PMID: 32622744 PMCID: PMC7328639 DOI: 10.1016/j.acra.2020.05.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/19/2020] [Accepted: 05/27/2020] [Indexed: 12/24/2022]
Abstract
RATIONALE AND OBJECTIVES Radiology participation is necessary in oncology multidisciplinary conferences (MDCs), but the resources required to do so are often unaccounted for. In this prospective study we provide an analysis of resource utilization as a function of outcomes for all MDCs covered by an entire radiology section and provide a time-based cost estimate. MATERIALS AND METHODS Following institutional review board approval, prospective data on all MDCs covered by abdominal radiologists at a single tertiary care academic center were obtained over nine weeks. A predefined questionnaire was used by a single observer who attended every imaging review and recorded the total time spent by the radiologists and several outcome measures. The total time recorded was used to provide a time-based cost estimate using a national salary survey. RESULTS Six radiologists participated in a total of 57 MDCs, with 577 cases reviewed and discussed. 181 (31%) cases were performed at outside facilities requiring full reinterpretation. Clinically significant revisions to original reports were recorded in 107 (18.5%) cases. Radiologist input directly resulted in alteration of cancer staging in 65 (11%) patients and specific recommendations for follow-up diagnostic workup in 280 (48%) of cases. The mean total time devoted by the staff radiologist per week to MDCs was 18.7 hours/week, nearly a half of full-time effort, or 8% of total effort per radiologist. The total annual projected cost of radiology coverage for each weekly MDC was $26,920. CONCLUSION Section-wide radiologist participation in MDCs directly resulted in change in clinical management in nearly half of reviewed cases. This was achieved at a notable time cost, highlighting the need for efficient integration of radiology MDC participation into radiologist workflow and compensation models.
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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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Lavrador JP, Pang G, Vergani F, Bhangoo R, Gullan R, Ashkan K. Letter to the Editor. Multidisciplinary meetings for neuro-oncology services. J Neurosurg 2021; 135:335-336. [PMID: 33636697 DOI: 10.3171/2020.12.jns204247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Khalafallah AM, Jimenez AE, Romo CG, Kamson DO, Kleinberg L, Weingart J, Brem H, Grossman SA, Mukherjee D. Quantifying the utility of a multidisciplinary neuro-oncology tumor board. J Neurosurg 2021; 135:87-92. [PMID: 32947258 DOI: 10.3171/2020.5.jns201299] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/22/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE There has been limited research on the efficacy of multidisciplinary tumor boards (MDTBs) in improving the treatment of patients with tumors affecting the nervous system. The objective of the present study was to quantify the utility of MDTBs in providing alternative diagnostic interpretations and treatment plans for this patient population. METHODS The authors performed a prospective study of patients in 4 hospitals whose cases were discussed at MDTBs between July and November 2019. Patient demographic data, diagnoses, treatment plans, and eligibility for clinical trials were recorded, among other variables. RESULTS A total of 176 cases met eligibility criteria for study inclusion. The majority (53%) of patients were male, and the mean patient age was 52 years. The most frequent diagnosis was glioblastoma (32.4%). Among the evaluable cases, MDTBs led to 38 (21.6%) changes in image interpretation and 103 (58.2%) changes in patient management. Additionally, patients whose cases were discussed at MDTBs had significantly shorter referral times than patients whose cases were not discussed (p = 0.024). CONCLUSIONS MDTB discussions led to significant numbers of diagnostic and treatment plan changes as well as shortened referral times, highlighting the potential clinical impact of multidisciplinary care for patients with nervous system tumors.
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Affiliation(s)
- Adham M Khalafallah
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore
| | - Adrian E Jimenez
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore
| | - Carlos G Romo
- 2Department of Neurology, Brain Cancer Program, Johns Hopkins University School of Medicine, Baltimore
- 3Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda
| | - David Olayinka Kamson
- 2Department of Neurology, Brain Cancer Program, Johns Hopkins University School of Medicine, Baltimore
- 3Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda
| | - Lawrence Kleinberg
- 4Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Hospital, Baltimore; and
| | - Jon Weingart
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore
| | - Henry Brem
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore
| | - Stuart A Grossman
- 5Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Debraj Mukherjee
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore
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Pan M, Yu J, Sidhu M, Seto T, Fang A. Impact of a Virtual Multidisciplinary Sarcoma Case Conference on Treatment Plan and Survival in a Large Integrated Healthcare System. JCO Oncol Pract 2021; 17:e1711-e1718. [PMID: 33852341 DOI: 10.1200/op.20.01078] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
PURPOSE Quantifying the impact of a multidisciplinary cancer case conference on patient outcome and care quality remains challenging. PATIENTS AND METHODS We prospectively investigated the impact of our virtual multidisciplinary sarcoma case conference (VMSCC) on treatment plan in patients presented to the VMSCC from July to October 2020 (prospective cohort) and retrospectively in patients with metastatic or locally advanced high-grade soft-tissue sarcoma (STS) reviewed in the VMSCC in 2016 and 2017 (high-grade STS cohort). We also investigated the factors related to the nonadherence to the VMSCC-recommended plan in both cohorts. RESULTS In both cohorts, approximately 28% of the patients were referred to the VMSCC for review without a treatment plan. In significantly more cases, referring physicians outside of the sarcoma group did not have a plan formulated before the VMSCC review compared with the referring physicians within the sarcoma group. In 28.2% (prospective cohort) and 19.5% (high-grade STS cohort) of the patients, VMSCC recommended a different plan. The adherence to the VMSCC-recommended plan was 87.9% and 83.1%, respectively. The causes of the nonadherence were primarily due to disease progression or patient's decision against recommended therapy. The median overall survival for the high-grade STS cohort was 26 months. CONCLUSION VMSCC affected the treatment plan in approximately 50% of the patients in both cohorts. The median overall survival of the patients with high-grade STS reviewed by the VMSCC in our cohort is comparable with the literature.
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Affiliation(s)
- Minggui Pan
- Department of Oncology and Hematology, Kaiser Permanente, Santa Clara, CA.,Division of Research, Kaiser Permanente, Oakland, CA
| | - Jeanette Yu
- Department of Oncology and Hematology, Kaiser Permanente, Oakland, CA
| | - Manpreet Sidhu
- Department of Oncology and Hematology, Kaiser Permanente, Roseville, CA
| | - Tiffany Seto
- Oncology and Hematology Fellowship Program, Kaiser Permanente, San Francisco, CA
| | - Andrew Fang
- Department of Musculoskeletal Oncology, Kaiser Permanente, South San Francisco, CA
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Leonardi M, Espada M, Condous G. Closing the communication loop between gynecological surgeons, diagnostic imaging experts and pathologists in endometriosis: building bridges between specialties. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:523-525. [PMID: 33491846 DOI: 10.1002/uog.23595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/02/2021] [Accepted: 01/20/2021] [Indexed: 06/12/2023]
Affiliation(s)
- M Leonardi
- Acute Gynaecology, Early Pregnancy, and Advanced Endoscopy Surgery Unit, Nepean Hospital, Kingswood, NSW, Australia
- Sydney Medical School Nepean, University of Sydney, Sydney, NSW, Australia
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - M Espada
- Acute Gynaecology, Early Pregnancy, and Advanced Endoscopy Surgery Unit, Nepean Hospital, Kingswood, NSW, Australia
- Sydney Medical School Nepean, University of Sydney, Sydney, NSW, Australia
| | - G Condous
- Acute Gynaecology, Early Pregnancy, and Advanced Endoscopy Surgery Unit, Nepean Hospital, Kingswood, NSW, Australia
- Sydney Medical School Nepean, University of Sydney, Sydney, NSW, Australia
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13
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Berardi R, Morgese F, Rinaldi S, Torniai M, Mentrasti G, Scortichini L, Giampieri R. Benefits and Limitations of a Multidisciplinary Approach in Cancer Patient Management. Cancer Manag Res 2020; 12:9363-9374. [PMID: 33061625 PMCID: PMC7533227 DOI: 10.2147/cmar.s220976] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 05/26/2020] [Indexed: 12/17/2022] Open
Abstract
Over the years, a growing body of literature has confirmed as beneficial the implementation of a multidisciplinary approach in the so-often-intricate scenario of cancer patients' management. Together with the consolidation of tumor-board experience in clinical practice, certain aspects have emerged as controversial and a source of current debate. In this systematic literature review, we focused our attention on the impact of multidisciplinary tumor boards, assessing benefits and limitations as a result of the dissemination of such approaches. On the bright side, adherence to clinical guidelines, treatment outcomes, and overall improvement in decision-making processes have been recognized as advantages. On the other side, our analysis highlights a few limitations that should be taken into account to optimize cancer patients' management. Of note, some issues, such as costs, legal responsibility, geographic barriers, and treatment delays, have yet to be resolved. In order partly to address this matter, software platforms and novel methods of computational analysis may provide the needed support. Therefore, the aim of our analysis was to describe the multidisciplinary approach in cancer care in terms of adherence to clinical guidelines, treatment outcomes, and overall improvement in decision-making processes through a systematic review of the literature.
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Affiliation(s)
- Rossana Berardi
- Clinica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - Francesca Morgese
- Clinica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - Silvia Rinaldi
- Clinica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - Mariangela Torniai
- Clinica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - Giulia Mentrasti
- Clinica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - Laura Scortichini
- Clinica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - Riccardo Giampieri
- Clinica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
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14
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Ferraioli D, Bally O, Meeus P, Benayoun D, Bakrin N, De Saint Hilaire P, Beal Ardisson D, Provençal J, Barletta H, Mousseau M, Chauleur C, Verbaere S, Knibiehly A, Fuso L, Charreton A, Devouassoux-Shisheboran M, Chopin N, Glehen O, Labrosse-Canat H, Farsi F, Ray-Coquard I. Impact of multidisciplinary tumour board in the management of ovarian carcinoma in the first-line setting. Exhaustive analysis from the Rhone-Alpes region. Eur J Cancer Care (Engl) 2020; 29:e13313. [PMID: 32894629 DOI: 10.1111/ecc.13313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 06/18/2020] [Accepted: 08/07/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Epithelial ovarian cancer (EOC) is a poor prognosis disease partly linked to diagnosis at an advanced stage. The quality of care management is a factor that needs to be explored, more specifically optimal organisation of first-line treatment. METHODS A retrospective study, dealing with all patients diagnosed within the Rhone-Alpes region with initial diagnosis EOC in 2012, was performed. The aim was to describe the impact of multidisciplinary tumour boards (MTB) in the organisation of care and the consequence on the patient's outcomes. RESULTS 271 EOC were analysed. 206 patients had an advanced EOC. Median progression-free survival (PFS) is 17.8 months (CI95%, 14.6-21.2) for AOC. 157 patients (57.9%) had a front-line surgery versus 114 patients (42.1%) interval debulking surgery. PFS for AOC patients with no residual disease is 24.3 months compared with 15.3 months for patients with residual disease (p = .01). No macroscopic residual disease is more frequent in the patients discussed before surgery in MTB compared with patients not submitted before surgery (73% vs. 56.2%, p < .001). CONCLUSION These results highlight the heterogeneity of medical practices in terms of front-line surgery versus interval surgery, in the administration of neoadjuvant chemotherapy and in the setting of MTB discussion.
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Affiliation(s)
- Domenico Ferraioli
- Gynecology Department, Leon Berard Cancer Center, Lyon, France.,Department of Internal Medicine, University of Genoa and IRCCS AOU San Martino-IST, Genoa, Italy
| | - Olivia Bally
- Oncology Department, Private Hospital Jean Mermoz, Lyon, France
| | - Pierre Meeus
- Surgical Department, Leon Berard Cancer Center, Lyon, France
| | - David Benayoun
- Oncology Department, University Hospital of Lyon, Lyon, France
| | - Naoual Bakrin
- Surgical Department, University Hospital of Lyon, Lyon, France
| | | | | | | | - Hugues Barletta
- Surgical Department, Private Hospital Drome Ardeche, Valence, France
| | - Mireille Mousseau
- Surgical Department, University Hospital of Grenoble, Grenoble, France
| | - Céline Chauleur
- Oncology Department, Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Sylvain Verbaere
- Surgical Department, Private Hospital of Saint-Etienne, Saint-Etienne, France
| | - Alain Knibiehly
- Surgical Department, Hospital of Montelimar, Montelimar, France
| | - Luca Fuso
- Gynecology Oncology Department, Ordine Mauriziano Hospital, Turin, Italy
| | | | | | - Nicolas Chopin
- Gynecology Department, Leon Berard Cancer Center, Lyon, France
| | - Olivier Glehen
- Surgical Department, University Hospital of Lyon, Lyon, France
| | | | - Fadila Farsi
- Regional Network of Cancer (ONCO AuRA), Lyon, France
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15
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Naidoo J, Zhang J, Lipson EJ, Forde PM, Suresh K, Moseley KF, Mehta S, Kwatra SG, Parian AM, Kim AK, Probasco JC, Rouf R, Thorne JE, Shanbhag S, Riemer J, Shah AA, Pardoll DM, Bingham CO, Brahmer JR, Cappelli LC. A Multidisciplinary Toxicity Team for Cancer Immunotherapy-Related Adverse Events. J Natl Compr Canc Netw 2020; 17:712-720. [PMID: 31200355 DOI: 10.6004/jnccn.2018.7268] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 01/04/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs) may cause immune-related adverse events (irAEs). Methods to obtain real-time multidisciplinary input for irAEs that require subspecialist care are unknown. This study aimed to determine whether a virtual multidisciplinary immune-related toxicity (IR-tox) team of oncology and medicine subspecialists would be feasible to implement, be used by oncology providers, and identify patients for whom multidisciplinary input is sought. PATIENTS AND METHODS Patients treated with ICIs and referred to the IR-tox team in August 2017 through March 2018 were identified. Feasibility was defined as receipt of electronic referrals and provision of recommendations within 24 hours of referral. Use was defined as the proportion of referring providers who used the team's recommendations, which was determined through a postpilot survey. Demographics and tumor, treatment, and referral data were collected. Patient features and irAE associations were analyzed. RESULTS The IR-tox team was found to be feasible and used: 117 referrals from 102 patients were received in 8 months, all providers received recommendations within 24 hours, 100% of surveyed providers used the recommendations, and 74% changed patient management based on IR-tox team recommendations. Referrals were for suspected irAEs (n=106; 91%) and suitability to treat with ICIs (n=11; 10%). In referred patients, median age was 64 years, 54% were men, 13% had prior autoimmunity, and 46% received ICI combinations versus monotherapy (54%). The most commonly referred toxicities were pneumonitis (23%), arthritis (16%), and dermatitis (15%); 15% of patients had multisystem toxicities. Multiple referrals were more common in those treated with combination ICIs (odds ratio [OR], 6.0; P=.035) or with multisystem toxicities (OR, 8.1; P=.005). The IR-tox team provided a new multidisciplinary forum to assist providers in diagnosing and managing complex irAEs. This model identifies educational and service needs, and patients with irAEs for whom multidisciplinary care is most sought. CONCLUSIONS A virtual multidisciplinary toxicity team for irAEs was a feasible and used service, and facilitated toxicity identification and management.
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Affiliation(s)
- Jarushka Naidoo
- Bloomberg-Kimmel Institute for Cancer Immunotherapy, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | - Jiajia Zhang
- Bloomberg-Kimmel Institute for Cancer Immunotherapy, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | - Evan J Lipson
- Bloomberg-Kimmel Institute for Cancer Immunotherapy, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | - Patrick M Forde
- Bloomberg-Kimmel Institute for Cancer Immunotherapy, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | - Karthik Suresh
- Department of Medicine, Division of Pulmonary and Critical Care Medicine
| | - Kendall F Moseley
- Department of Medicine, Division of Endocrinology, Diabetes & Metabolism
| | - Seema Mehta
- Department of Medicine, Division of Infectious Diseases
| | | | | | - Amy K Kim
- Department of Medicine, Division of Gastroenterology
| | | | | | - Jennifer E Thorne
- Department of Medicine, Division of Ophthalmology.,Department of Epidemiology, and
| | - Satish Shanbhag
- Bloomberg-Kimmel Institute for Cancer Immunotherapy, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | - Joanne Riemer
- Bloomberg-Kimmel Institute for Cancer Immunotherapy, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | - Ami A Shah
- Department of Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Drew M Pardoll
- Bloomberg-Kimmel Institute for Cancer Immunotherapy, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | - Clifton O Bingham
- Department of Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Julie R Brahmer
- Bloomberg-Kimmel Institute for Cancer Immunotherapy, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | - Laura C Cappelli
- Department of Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Abstract
BACKGROUND Recent advances in diagnostic and therapeutic modalities have made oncologic care ever more challenging, and multidisciplinary tumor boards (MTBs) are increasingly being used as a forum to discuss and coordinate care for complex oncology patients. Literature on the use of MTBs specific to cutaneous oncology and dermatologic surgery remains limited. OBJECTIVE To share our experiences with cutaneous oncology MTBs at the University of Vermont Medical Center (UVMMC). METHODS We describe the formation, timing, participation, clinical discussion, case follow-up, and coordination of care of our MTBs. RESULTS A log of all cases discussed at cutaneous oncology MTBs from August 2018 to August 2019 is presented as an example. Five specific cases are described in further detail to demonstrate critical components of multidisciplinary care. CONCLUSION The MTBs at UVMMC has created a collaborative environment for providers in multiple specialties to jointly formulate and coordinate optimal treatment plans for difficult cases, particularly when treatment guidelines do not exist or are insufficient. Furthermore, MTBs can serve as an educational forum for all participants.
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17
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Michot JM, Lappara A, Le Pavec J, Simonaggio A, Collins M, De Martin E, Danlos FX, Ammari S, Cauquil C, Ederhy S, Barreau E, Belkhir R, Berdelou A, Lazarovici J, Chanson P, Izzedine H, Seferian A, Le Pajolec C, Baldini C, Martin-Romano P, Mariette X, Robert C, Besse B, Hollebecque A, Varga A, Laghouati S, Mateus C, Voisin AL, Soria JC, Massard C, Marabelle A, Champiat S, Lambotte O. The 2016-2019 ImmunoTOX assessment board report of collaborative management of immune-related adverse events, an observational clinical study. Eur J Cancer 2020; 130:39-50. [PMID: 32172197 DOI: 10.1016/j.ejca.2020.02.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 02/11/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE We investigated the activities of an ImmunoTOX board, an academic, multidisciplinary group of oncologists and organ specialists that adopts a real-life, case-by-case approach in the management of patients with immune-related adverse events (irAEs). EXPERIMENTAL DESIGN The ImmunoTOX assessment board was set up in 2016 at Gustave Roussy in France. It meets every 2 weeks to discuss the case-by-case management of patients presenting with irAEs. Here, we describe the ImmunoTOX board's activities between 2016 and 2019. RESULTS Over study period, 398 requests (concerning 356 patients) were submitted to the ImmunoTOX board. Most of the requests concerned the putative causal link between immunotherapy and the irAE (n = 148, 37%), followed by possible retreatment after temporary withdrawal because of an adverse event (n = 109, 27%), the clinical management of complex situations (n = 100, 25%) and the initiation of immunotherapy in patients with pre-existing comorbidities (n = 41, 10%). The ImmunoTOX board discerned 273 irAEs. The five organ systems most frequently involved by irAEs were lung (n = 58, 21%), gastrointestinal tract (n = 36, 13%), liver or biliary tract (n = 33, 12%), musculoskeletal system (n = 27, 10%), and nervous system (n = 23, 8%). The time to occurrence was shorter for severe irAEs (grade III and VI) than for mild irAEs (grades I and II), with medians of 47 and 91 days, respectively (p = 0.0216). CONCLUSION The main medical needs in the management of irAEs involved the lung organ. Severe irAEs were expected to occur earlier than mild irAEs. This real-life study can help to better estimate medical needs and therefore help to assess the management of irAEs.
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Affiliation(s)
- Jean-Marie Michot
- Gustave Roussy, Université Paris-Saclay, Département des Innovations Thérapeutiques et Essais Précoces, Villejuif, France.
| | - Ariane Lappara
- Assistance Publique - Hôpitaux de Paris, Hôpital Bicêtre, Service de Médecine Interne and Immunologie clinique, Le Kremlin-Bicêtre, France
| | - Jérôme Le Pavec
- Hôpital Marie-Lannelongue, Department of Thoracic and Cardiovascular, and Transplantation Cardio-Pulmonary, Le Plessis-Robinson, France
| | - Audrey Simonaggio
- Gustave Roussy, Université Paris-Saclay, Département des Innovations Thérapeutiques et Essais Précoces, Villejuif, France
| | - Michael Collins
- Assistance Publique-Hôpitaux de Paris, Université Paris-Sud, Hôpitaux Universitaires Paris Sud, Gastroenterology Unit, Le Kremlin Bicêtre, France
| | - Eléonora De Martin
- Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paul Brousse, Centre Hépato-Biliaire, Villejuif, France
| | - François-Xavier Danlos
- Gustave Roussy, Université Paris-Saclay, Département des Innovations Thérapeutiques et Essais Précoces, Villejuif, France
| | - Samy Ammari
- Gustave Roussy, Université Paris-Saclay, Department of Diagnostic Radiology, Villejuif, France
| | - Cécile Cauquil
- Assistance Publique - Hôpitaux de Paris, Hôpital Bicêtre, Division of Adult Neurology, Le Kremlin Bicêtre, France
| | - Stéphane Ederhy
- Assistance Publique-Hôpitaux de Paris, Saint-Antoine Hospital, Service de cardiologie, Unite de cardio-oncologie, Pierre et Marie Curie University, Paris, France
| | - Emmanuel Barreau
- Assistance Publique - Hôpitaux de Paris, Hôpital Bicêtre, Department of Ophthalmology, Le Kremlin Bicêtre, France
| | - Rakiba Belkhir
- Assistance Publique - Hôpitaux de Paris, Hôpital Bicêtre, Department of Rheumatology, Le Kremlin Bicêtre, France
| | - Amandine Berdelou
- Gustave Roussy, Université Paris-Saclay, Department of Cancer Medicine, Villejuif, France
| | - Julien Lazarovici
- Gustave Roussy, Université Paris-Saclay, Department of Hematology, Villejuif, France
| | - Philippe Chanson
- Assistance Publique - Hôpitaux de Paris, Hôpital Bicêtre, Unit of Endocrinology and Reproductive Health, Le Kremlin Bicêtre, France
| | - Hassan Izzedine
- Peupliers Private Hospital, Nephrology Department, Paris, France
| | - Andrei Seferian
- Assistance Publique - Hôpitaux de Paris, Hôpital Bicêtre, Service de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire, Le Kremlin Bicêtre, France
| | - Christine Le Pajolec
- Assistance Publique - Hôpitaux de Paris, Hôpital Bicêtre, Ear Nose and Throat Department, Le Kremlin Bicêtre, France
| | - Capucine Baldini
- Gustave Roussy, Université Paris-Saclay, Département des Innovations Thérapeutiques et Essais Précoces, Villejuif, France
| | - Patricia Martin-Romano
- Gustave Roussy, Université Paris-Saclay, Département des Innovations Thérapeutiques et Essais Précoces, Villejuif, France
| | - Xavier Mariette
- Assistance Publique - Hôpitaux de Paris, Hôpital Bicêtre, Department of Rheumatology, Le Kremlin Bicêtre, France
| | - Caroline Robert
- Gustave Roussy, Université Paris-Saclay, Department of Cancer Medicine, Villejuif, France
| | - Benjamin Besse
- Gustave Roussy, Université Paris-Saclay, Department of Cancer Medicine, Villejuif, France
| | - Antoine Hollebecque
- Gustave Roussy, Université Paris-Saclay, Département des Innovations Thérapeutiques et Essais Précoces, Villejuif, France
| | - Andrea Varga
- Gustave Roussy, Université Paris-Saclay, Département des Innovations Thérapeutiques et Essais Précoces, Villejuif, France
| | - Salim Laghouati
- Gustave Roussy, Université Paris-Saclay, Unité de Pharmacovigilance, Villejuif, France
| | - Christine Mateus
- Gustave Roussy, Université Paris-Saclay, Department of Cancer Medicine, Villejuif, France
| | - Anne-Laure Voisin
- Gustave Roussy, Université Paris-Saclay, Unité de Pharmacovigilance, Villejuif, France
| | - Jean-Charles Soria
- Gustave Roussy, Université Paris-Saclay, Département des Innovations Thérapeutiques et Essais Précoces, Villejuif, France
| | - Christophe Massard
- Gustave Roussy, Université Paris-Saclay, Département des Innovations Thérapeutiques et Essais Précoces, Villejuif, France
| | - Aurélien Marabelle
- Gustave Roussy, Université Paris-Saclay, Département des Innovations Thérapeutiques et Essais Précoces, Villejuif, France
| | - Stéphane Champiat
- Gustave Roussy, Université Paris-Saclay, Département des Innovations Thérapeutiques et Essais Précoces, Villejuif, France
| | - Olivier Lambotte
- Assistance Publique - Hôpitaux de Paris, Hôpital Bicêtre, Service de Médecine Interne and Immunologie clinique, Le Kremlin-Bicêtre, France; INSERM U1184, Immunology of Viral Infections and Autoimmune Diseases, Le Kremlin Bicêtre, France; Université Paris Sud, UMR 1184, Le Kremlin Bicêtre, France; CEA, DSV/iMETI, IDMIT, Fontenay-aux-Roses, France
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18
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Maeng CH, Ahn HK, Oh SY, Lim S, Kim BS, Kim DY. Practice patterns of multidisciplinary team meetings in Korean cancer care and patient satisfaction with this approach. Korean J Intern Med 2020; 35:205-214. [PMID: 31795023 PMCID: PMC6960038 DOI: 10.3904/kjim.2019.189] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 07/31/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND/AIMS The multidisciplinary team (MDT) approach is a cornerstone of clinical oncology. This study investigated the current state of MDT care, including patient satisfaction, in Korea. METHODS We obtained the annual number of cancer patients who have received MDT care since 2014 from the registry of the Health Insurance Review and Assessment Service (HIRA). In addition, patients who received MDT care from August 2014 to May 2017 at four university hospitals were further characterized, and patient satisfaction was measured prospectively using a patient-reported questionnaire. RESULTS The total number of patients who received MDT care increased from 2014 to 2016 (2,113 to 9,998 patients, respectively) in the HIRA Cohort. The type of cancer that most often required MDT was breast cancer (23.8%), followed by colorectal cancer (19.1%). In the Representative Cohort (n = 1,032), MDT was requested by the surgeon more than half the time (55.7%). The main focus of MDT was decision making for further treatment planning (99.0%). The number of doctors participating in the MDT was usually five (70.0%). After initiating an MDT approach, the treatment plan changed for 17.4% of patients. Among these patients, 359 completed a prospective satisfaction survey regarding their MDT care. The overall satisfaction with the MDT approach was very high, with an average score of 9.6 out of 10 points. CONCLUSION The application of MDT care is a rapidly growing trend in clinical oncology, and shows high patient satisfaction. Further research is needed to determine which types of cancer patients could benefit most from MDT, and to enable MDT care to operate more efficiently so that it may expand successfully throughout Korea.
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Affiliation(s)
- Chi Hoon Maeng
- Department of Medical Oncology and Hematology, Kyung Hee University Hospital, Seoul, Korea
| | - Hee Kyung Ahn
- Department of Oncology, Gachon University Gil Medical Center, Incheon, Korea
| | - Sung Yong Oh
- Department of Hematology-Oncology, Dong-A University College of Medicine, Busan, Korea
| | - Seungtaek Lim
- Department of Internal Medicine, Wonju Severance Christian Hospital, Wonju, Korea
| | - Bong-Seog Kim
- Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Korea
| | - Do Yeun Kim
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
- Correspondence to Do Yeun Kim, M.D. Department of Internal Medicine, Dongguk University Ilsan Hospital, 27 Dongguk-ro, Ilsandong-gu, Goyang 10326, Korea Tel: +82-31-961-7143 Fax: +82-31-961-7141 E-mail:
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19
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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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Abstract
Multidisciplinary tumor boards have evolved to address the increasing complexity of cancer care management. Given that hepatocellular carcinoma (HCC) often arises in the setting of underlying cirrhosis, expert input from hepatologists alongside hepatobiliary and transplant surgeons, radiation oncologists, interventional and body radiologists, and medical oncologists has become increasingly important in order to offer patients appropriate cancer treatments. The MDLTB structure has evolved since the early 2000s to bring these specialists together at regularly scheduled meetings to develop a therapeutic treatment plan for HCC management. MDLTBs have reduced the time to treatment and improved patient satisfaction. Standardized documentation with common data elements has been recommended to ensure adequate communication from MDLTB to referring healthcare providers. Retrospective studies consistently highlight the frequency of changes in treatment plans after MDLTB review to better adhere to guideline recommended care. Despite several decades of MDLTBs implementation, few studies describe clinical outcomes associated with MDLTBs such as patient survival and cost benefits. More research is needed in this area to further justify the heavy use of resources that are needed to maintain MDLTBs. Development and use of a centralized database to store such information may assist with future studies of clinical outcomes and inform quality improvement projects.
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Affiliation(s)
- Melissa M Gadsden
- Department of Medicine, Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, 7th Floor, 3400 Civic Center Drive, Philadelphia, PA, 19104, USA.,Gastroenterology Section, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - David E Kaplan
- Department of Medicine, Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, 7th Floor, 3400 Civic Center Drive, Philadelphia, PA, 19104, USA. .,Gastroenterology Section, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.
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21
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Lycan TW, Ahmed T, Seegars MB, Patel M, Woods R, Melin SA. An evidence-based medicine approach for case presentations by trainees. CLINICAL TEACHER 2018; 16:575-579. [PMID: 30506887 DOI: 10.1111/tct.12978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Evidence-based medicine (EBM) is a key aspect of medical training that can be challenging for trainees to learn. Tumour boards (TBs) are multidisciplinary meetings that are often opportunities for trainees to deliver patient case presentations, which is another integral part of medical education; however, TBs are time intensive, typically lack academic structure and may fail to emphasise EBM. OBJECTIVE To design a systematic approach to improve both trainee satisfaction and the level of evidence cited at typical academic TBs. METHODS From 2017 to 2018, Plan-Do-Study-Act (PDSA) methodology was used to develop a systematic approach for medical oncology trainees towards TBs. Statistical testing was used to assess which characteristics of a patient case made it more difficult to apply EBM. Anonymous surveys were distributed to trainees before and after the intervention to assess the educational utility. RESULTS We developed a shared voluntary case database, so that references with higher levels of evidence could be rapidly recalled and applied to similar cases. We then developed EBM-focused review sessions to highlight database trends. Both the database and the review sessions had high participation rates (>90% cases had voluntary data entry), and each were reported to have educational value by trainees. CONCLUSIONS A two-step implementation of an easy-to-use case database followed by review sessions focused on high-yield sources of evidence improved trainee satisfaction for TBs, but did not significantly improve the strength of the evidence cited.
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Affiliation(s)
- Thomas W Lycan
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Tamjeed Ahmed
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Meera Patel
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Ryan Woods
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Susan A Melin
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Goede V, Stauder R. Multidisciplinary care in the hematology clinic: Implementation of geriatric oncology. J Geriatr Oncol 2018; 10:497-503. [PMID: 30241779 DOI: 10.1016/j.jgo.2018.09.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 08/04/2018] [Accepted: 09/05/2018] [Indexed: 11/19/2022]
Abstract
Multidisciplinary care is believed to provide benefits to patients with cancer. Tumor board conferences as well aspalliative care or psycho-oncological services have not only become common in oncology, but also in hematology clinics dedicated to the treatment of hematological cancers. Malignant hematological diseases are highly prevalent among older persons. Demographic changes in many countries worldwide are prompting the integration of geriatric principles, methodology, and expertise into existing procedures and infrastructure of multidisciplinary care in hematology clinics. Achieving this goal requires the close collaboration or even incorporation of multiple new professions in the hematology clinic in order to meet the needs of older patients with hematological malignancies who also have comorbidities and functional impairments. We here review the rationale, current evidence, and practical approaches of integrating geriatric oncology into multidisciplinary care in the hematology clinic.
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Affiliation(s)
- Valentin Goede
- Oncogeriatric Unit, Dept. of Geriatric Medicine, St. Marien Hospital, Cologne, Germany.
| | - Reinhard Stauder
- Dept. of Internal Medicine V (Hematology and Oncology), Innsbruck Medical University, Innsbruck, Austria
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