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Pattenden TA, Thangasamy IA, Ong WL, Samaranayke D, Morton A, Murphy DG, Evans S, Millar J, Chalasani V, Rashid P, Winter M, Vela I, Pryor D, Mark S, Loeb S, Lawrentschuk N, Pritchard E. Barriers and enablers of active surveillance for prostate cancer: a qualitive study of clinicians. BJU Int 2024; 133 Suppl 3:48-56. [PMID: 37696615 DOI: 10.1111/bju.16176] [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] [Indexed: 09/13/2023]
Abstract
OBJECTIVES To identify and explore barriers to, and enablers of, active surveillance (AS) in men with low-risk prostate cancer (LRPCa), as perceived by PCa clinicians. PATIENTS AND METHODS Urologists and radiation oncologists in Australia and New Zealand were purposively sampled for a cross-section on gender and practice setting (metropolitan/regional; public/private). Using a grounded theory approach, semi-structed interviews were conducted with participants. Interviews were coded independently by two researchers using open, axial, and selective coding. A constant comparative approach was used to analyse data as it was collected. Thematic saturation was reached after 18 interviews, and a detailed model of barriers to, and enablers of, AS for LRPCa, as perceived by clinicians was developed. RESULTS A model explaining what affects clinician decision making regarding AS in LRPCa emerged. It was underpinned by three broad themes: (i) clinician perception of patients' barriers and enablers; (ii) clinician perception of their own barriers and enablers; and (iii) engagement with healthcare team and resource availability. CONCLUSIONS Clinicians unanimously agree that AS is an evidence-based approach for managing LRPCa. Despite this many men do not undergo AS for LRPCa, which is due to the interplay of patient and clinician factors, and their interaction with the wider healthcare system. This study identifies strategies to mitigate barriers and enhance enablers, which could increase access to AS by patients with LRPCa.
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Affiliation(s)
- Trent A Pattenden
- Department of Urology, Ipswich Hospital, Ipswich, Queensland, Australia
| | - Isaac A Thangasamy
- Nepean Urology Research Group, Nepean Hospital, Kingswood, New South Wales, Australia
- School of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Wee Loon Ong
- Alfred Health Radiation Oncology, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Dhanika Samaranayke
- Department of Urology, Ipswich Hospital, Ipswich, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Andrew Morton
- Department of Urology, Ipswich Hospital, Ipswich, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Declan G Murphy
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Sue Evans
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jeremy Millar
- Alfred Health Radiation Oncology, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Venu Chalasani
- School of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Prem Rashid
- Port Macquarie Base Hospital, Port Macquarie, New South Wales, Australia
| | - Matthew Winter
- Nepean Urology Research Group, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Ian Vela
- Australian Prostate Cancer Research Centre - Queensland, Queensland University of Technology, Brisbane, Queensland, Australia
- Department of Urology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - David Pryor
- Department of Radiation Oncology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Stephen Mark
- Department of Urology, Christchurch Hospital, Christchurch, New Zealand
| | - Stacy Loeb
- New York University, New York City, NY, USA
| | - Nathan Lawrentschuk
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- EJ Whitten Prostate Cancer Research Centre, Epworth, Melbourne, Victoria, Australia
| | - Elizabeth Pritchard
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Efstathiou JA, Morgans AK, Bland CS, Shore ND. Novel hormone therapy and coordination of care in high-risk biochemically recurrent prostate cancer. Cancer Treat Rev 2024; 122:102630. [PMID: 38035646 DOI: 10.1016/j.ctrv.2023.102630] [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: 05/30/2023] [Accepted: 09/25/2023] [Indexed: 12/02/2023]
Abstract
Biochemical recurrence (BCR) occurs in 20-50% of patients with prostate cancer (PCa) undergoing primary definitive treatment. Patients with high-risk BCR have an increased risk of metastatic progression and subsequent PCa-specific mortality, and thus could benefit from treatment intensification. Given the increasing complexity of diagnostic and therapeutic modalities, multidisciplinary care (MDC) can play a crucial role in the individualized management of this patient population. This review explores the role for MDC when evaluating the clinical evidence for the evolving definition of high-risk BCR and the emerging therapeutic strategies, especially with novel hormone therapies (NHTs), for patients with either high-risk BCR or oligometastatic PCa. Clinical studies have used different characteristics to define high-risk BCR and there is no consensus regarding the definition of high-risk BCR nor for management strategies. Next-generation imaging and multigene panels offer potential enhanced patient identification and precision-based decision-making, respectively. Treatment intensification with NHTs, either alone or combined with radiotherapy or metastasis-directed therapy, has been promising in clinical trials in patients with high-risk BCR or oligometastases. As novel risk-stratification and treatment options as well as evidence-based literature evolve, it is important to involve a multidisciplinary team to identify patients with high-risk features at an earlier stage, and make informed decisions on the treatments that could optimize their care and long-term outcomes. Nevertheless, MDC data are scarce in the BCR or oligometastatic setting. Efforts to integrate MDC into the standard management of this patient population are needed, and will likely improve outcomes across this heterogeneous PCa patient population.
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Affiliation(s)
- Jason A Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
| | - Alicia K Morgans
- Dana-Farber Cancer Institute, 850 Brookline Ave, Dana 09-930, Boston, MA 02215, USA.
| | - Christopher S Bland
- US Oncology Medical Affairs, Pfizer Inc., 66 Hudson Boulevard, Hudson Yards, Manhattan, New York, NY 10001, USA.
| | - Neal D Shore
- Carolina Urologic Research Center, GenesisCare US, 823 82nd Pkwy, Myrtle Beach, SC, USA.
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Polomeni A, Bordessoule D, Malak S. Multidisciplinary team meetings in Hematology: a national mixed-methods study. BMC Cancer 2023; 23:950. [PMID: 37805458 PMCID: PMC10560417 DOI: 10.1186/s12885-023-11431-y] [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: 12/03/2022] [Accepted: 09/21/2023] [Indexed: 10/09/2023] Open
Abstract
Multidisciplinary team meetings are a current international practice in cancer care, but to date, few data exist on the specificity of its practice in hematology.In this manuscript, we present the result of the first national study, realized with quantitative and qualitative methods in France, which brings new insights in order to improve the collegial decision-making process.To improve the effectiveness of MDTMs, the needs to focus on complex cases, to enhance patient centeredness and teamwork are relevant aspects, and a specific focus on hematological particularities is warranted to truly improve process.Background Understanding the Multidisciplinary team meetings (MDTMs) process in different medical specialties facilitates the identification of core factors supporting effective MDTM work. Our mixed-methods study explores the participants' perceptions of hematology MDTMs.Design Online questionnaires collected data concerning the decision-making process, benefits and inconveniences of MDTMs for both patients and professionals. Semi-directive phone interviews were conducted and analyzed, thereby supplying qualitative data.Results A total of 205 professionals responded to the questionnaire and 22 participated in the qualitative interviews. The data indicate the unique characteristics of hematology, including a specific definition of collegiality, the frequent solicitation of expert advice and the anticipation of treatment even prior to the occurrence of MDTMs. Additional information concerning patients' wishes and psychosocial conditions are also needed. Participants emphasize the subjective aspects and the impact of the climate of MDTMs on medical decisions.Conclusion Although MDTMs are recognized to be a valuable tool, organizational and relational issues may interfere with their efficiency.To improve the effectiveness of MDTMs, the needs to focus on complex cases, to enhance patient centeredness and teamwork are relevant aspects. A specific focus on hematological particularities might be warranted to truly improve the collegial decision-making process in the context of hematology.
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Affiliation(s)
- Alice Polomeni
- Clinical Hematology and Cellular Therapy Department, Hôpital Saint-Antoine - Assistance Publique- Hôpitaux de Paris, 184 Rue du Fbg Saint Antoine, 75012, Paris, France.
- Ethics Commission of the French Society of Hematology, Grenoble, France.
| | - Dominique Bordessoule
- Ethics Commission of the French Society of Hematology, Grenoble, France
- Hematology Department, Centre Hospitalo-Universitaire de Limoges, 2 Avenue Martin Luther King, 87000, Limoges, France
| | - Sandra Malak
- Ethics Commission of the French Society of Hematology, Grenoble, France
- Hematology Department of Institut Curie Hospital, Institut Curie-Saint-Cloud, 35 Rue Dailly, 92210, Saint-Cloud, France
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Wihl J, Falini V, Borg S, Stahl O, Jiborn T, Ohlsson B, Nilbert M. Implementation of the measure of case discussion complexity to guide selection of prostate cancer patients for multidisciplinary team meetings. Cancer Med 2023; 12:15149-15158. [PMID: 37255390 PMCID: PMC10417062 DOI: 10.1002/cam4.6189] [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: 05/23/2022] [Revised: 04/24/2023] [Accepted: 05/21/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Multidisciplinary team meetings (MDTMs) provide an integrated team approach to ensure individualized and evidence-based treatment recommendations and best expert advice in cancer care. A growing number of patients and more complex treatment options challenge MDTM resources and evoke needs for case prioritization. In this process, decision aids could provide streamlining and standardize evaluation of case complexity. We applied the recently developed Measure of Case Discussion Complexity, MeDiC, instrument with the aim to validate its performance in another healthcare setting and diagnostic area as a means to provide cases for full MDTM discussions. METHODS The 26-item MeDiC instrument evaluates case complexity and was applied to 364 men with newly diagnosed prostate cancer in Sweden. MeDiC scores were generated from individual-level health data and were correlated with clinicopathological parameters, healthcare setting, and the observed clinical case selection for MDTMs. RESULTS Application of the MeDiC instrument was feasible with rapid scoring based on available clinical data. Patients with high-risk prostate cancers had significantly higher MeDiC scores than patients with low or intermediate-risk cancers. In the total study, population affected lymph nodes and metastatic disease significantly influenced MDTM referral, whereas comorbidities and age did not predict MDTM referral. When individual patient MeDiC scores were compared to the clinical MDTM case selection, advanced stage, T3/T4 tumors, involved lymph nodes, presence of metastases and significant physical comorbidity were identified as key MDTM predictive factors. CONCLUSIONS Application of the MeDiC instrument in prostate cancer may be used to streamline case selection for MDTMs in cancer care and may complement clinical case selection.
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Affiliation(s)
- Jessica Wihl
- Department of Clinical Sciences, Division of Oncology and PathologyLund UniversityLundSweden
- Regional Cancer Centre South, Region SkåneLundSweden
- Department of Hematology, Oncology and Radiation PhysicsSkåne University HospitalLundSweden
| | - Victor Falini
- Regional Cancer Centre South, Region SkåneLundSweden
| | - Sixten Borg
- Regional Cancer Centre South, Region SkåneLundSweden
- Health Economics Unit, Department of Clinical Sciences in MalmöLund UniversityLundSweden
| | - Olof Stahl
- Department of Clinical Sciences, Division of Oncology and PathologyLund UniversityLundSweden
- Regional Cancer Centre South, Region SkåneLundSweden
- Department of Hematology, Oncology and Radiation PhysicsSkåne University HospitalLundSweden
| | - Thomas Jiborn
- Regional Cancer Centre South, Region SkåneLundSweden
- Department of UrologySkåne University HospitalMalmöSweden
| | - Bjorn Ohlsson
- Regional Cancer Centre South, Region SkåneLundSweden
| | - Mef Nilbert
- Department of Clinical Sciences, Division of Oncology and PathologyLund UniversityLundSweden
- Department of Hematology, Oncology and Radiation PhysicsSkåne University HospitalLundSweden
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Kanesvaran R, Chia PL, Chiong E, Chua MLK, Ngo NT, Ow S, Sim HG, Tan MH, Tay KH, Wong ASC, Wong SW, Tan PH. An approach to genetic testing in patients with metastatic castration-resistant prostate cancer in Singapore. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2023; 52:135-148. [PMID: 38904491 DOI: 10.47102/annals-acadmedsg.2022372] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Abstract
Introduction There has been a rapid evolution in the treatment strategies for metastatic castration-resistant prostate cancer (mCRPC) following the identification of targetable mutations, making genetic testing essential for patient selection. Although several international guidelines recommend genetic testing for patients with mCRPC, there is a lack of locally endorsed clinical practice guidelines in Singapore. Method A multidisciplinary specialist panel with representation from medical and radiation oncology, urology, pathology, interventional radiology, and medical genetics discussed the challenges associated with patient selection, genetic counselling and sample processing in mCRPC. Results A clinical model for incorporating genetic testing into routine clinical practice in Singapore was formulated. Tumour testing with an assay that is able to detect both somatic and germline mutations should be utilised. The panel also recommended the "mainstreaming" approach for genetic counselling in which pre-test counselling is conducted by the managing clinician and post-test discussion with a genetic counsellor, to alleviate the bottlenecks at genetic counselling stage in Singapore. The need for training of clinicians to provide pre-test genetic counselling and educating the laboratory personnel for appropriate sample processing that facilitates downstream genetic testing was recognised. Molecular tumour boards and multidisciplinary discussions are recommended to guide therapeutic decisions in mCRPC. The panel also highlighted the issue of reimbursement for genetic testing to reduce patient-borne costs and increase the reach of genetic testing among this patient population. Conclusion This article aims to provide strategic and implementable recommendations to overcome the challenges in genetic testing for patients with mCRPC in Singapore.
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Affiliation(s)
| | - Puey Ling Chia
- Department of Medical Oncology, Tan Tock Seng Hospital, Singapore
| | - Edmund Chiong
- Department of Urology, National University Hospital, Singapore
- Department of Surgery, National University of Singapore, Singapore
| | | | - Nye Thane Ngo
- Division of Pathology, Singapore General Hospital, Singapore
| | - Samuel Ow
- Department of Haematology-Oncology, National University Cancer Institute, Singapore
| | - Hong Gee Sim
- Ravenna Urology Clinic, Gleneagles Medical Centre, Singapore
| | | | - Kiang Hiong Tay
- Department of Vascular and Interventional Radiation, Singapore General Hospital, Singapore
| | | | | | - Puay Hoon Tan
- Division of Pathology, Singapore General Hospital, Singapore
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6
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Procopio G, Chiuri V, Giordano M, Alitto A, Maisano R, Bordonaro R, Cinieri S, Rossetti S, De Placido S, Airoldi M, Galli L, Gasparro D, Ludovico G, Guglielmini P, Carella C, Nova P, Aglietta M, Schips L, Beccaglia P, Sciarra A, Livi L, Santini D, Procopio G, Chiuri V, Mantini G, Roberto Bordonaro RM, Cinieri S, Rossetti S, De Placido S, Airoldi M, Galli L, Gasparro D, Ludovico GM, Guglielmini PF, Santini D, Naglieri E, Fagnani D, Aglietta M, Livi L, Schips L, Passalacqua R, Fiore M, D'Angelillo RM, Ceresoli GL, Magrini S, Rondonotti D, Mirone V, Ferriero MC, Sciarra A, Acquati M, Boccardo F, Scagliotti GV, Mencoboni M, De Giorgi U, Micheletti G, Lanzetta G, Sartori D, Carlini P, Soto Parra HJ, Battaglia M, Uricchio F, Bernardo A, De Lisa A, Carrieri G, Ardizzoia A, Aieta M, Pisconti S, Marchetti P, Paiar F. Real-world experience of abiraterone acetate plus prednisone in chemotherapy-naive patients with metastatic castration-resistant prostate cancer: long-term results of the prospective ABItude study. ESMO Open 2022; 7:100431. [PMID: 35405438 PMCID: PMC9058899 DOI: 10.1016/j.esmoop.2022.100431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 01/14/2022] [Accepted: 02/07/2022] [Indexed: 12/24/2022] Open
Abstract
Background Limited real-world data exist on the effectiveness and safety of abiraterone acetate plus prednisone (abiraterone hereafter) in the treatment of patients with metastatic castration-resistant prostate cancer (mCRPC) naive to chemotherapy. Most of the few available studies had a retrospective design and included a small number of patients. In the interim analysis of the ABItude study, abiraterone showed good clinical effectiveness and safety profile in the chemotherapy-naive setting over a median follow-up of 18 months. Patients and methods We evaluated clinical and patient-reported outcomes (PROs) of chemotherapy-naive mCRPC patients treated with abiraterone as for clinical practice in the Italian, observational, prospective, multicentric ABItude study. mCRPC patients were enrolled at abiraterone start (February 2016-June 2017) and followed up for 3 years; clinical endpoints and PROs, including quality of life (QoL) and pain, were prospectively collected. Kaplan–Meier curves were estimated. Results Of the 481 patients enrolled, 454 were assessable for final study analyses. At abiraterone start, the median age was 77 years, with 58.6% elderly patients and 69% having at least one comorbidity (57.5% cardiovascular diseases). Visceral metastases were present in 8.4% of patients. Over a median follow-up of 24.8 months, median progression-free survival (any progression reported by the investigators), time to abiraterone discontinuation, and overall survival were, respectively, 17.3 months [95% confidence interval (CI) 14.1-19.4 months], 16.0 months (95% CI 13.1-18.2 months), and 37.3 months (95% CI 36.5 months-not estimable); 64.2% of patients achieved ≥50% reduction in prostate-specific antigen. QoL assessed by Functional Assessment of Cancer Therapy—Prostate, the European Quality of Life 5 Dimensions 3 Level, and European Quality of Life Visual Analog Scale remained stable during treatment. Median time to pain progression according to Brief Pain Inventory data was 31.1 months (95% CI 24.8 months-not estimable). Sixty-two patients (13.1%) had at least one adverse drug reaction (ADR) and 8 (1.7%) one serious ADR. Conclusion With longer follow-up, abiraterone therapy remains safe, well tolerated, and active in a large unselected population. A prospective real-life study of abiraterone acetate in mCRPC patients. In 481 chemotherapy-naive mCRPC patients (median follow-up: 25 months), abiraterone plus prednisone was effective and safe. QoL, measured with various tools, remained stable during treatment with abiraterone plus prednisone. The median time to pain progression was 31.1 months.
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Belda-Ferre M, Garcia-Segui A, Pacheco-Bru JJ, Valencia-Guadalajara VJ, Verdú-Verdú LP, Sánchez-Cano E, Chillón-Sempere FS, Vázquez-Mazón F. Multicenter study on multidisciplinary committees in advanced prostate cancer. Actas Urol Esp 2022; 46:106-113. [PMID: 35135737 DOI: 10.1016/j.acuroe.2021.09.004] [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: 06/20/2021] [Accepted: 09/12/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION AND OBJECTIVE Although Multidisciplinary Teams (MDTs) are recommended in the management of Advanced Prostate Cancer (APC), their functioning in real practice has been poorly evaluated. We carried out a multicenter study with the objective of evaluating the functioning of uro-oncology MDTs in 6 hospitals. MATERIALS AND METHODS A descriptive cross-sectional study was performed. The level of Compliance with the Fundamental Quality Requirements (CFQR) of the MDTs was evaluated by means of a questionnaire filled out by the coordinators of the MDTs in each hospital. The information on the perspective of the members of the MDTs was evaluated through an anonymous survey. RESULTS A high level of CFQR in MDTs was evidenced (75%), showing deficiencies in terms of protocol update, agendas, audits, and scientific production. The survey was answered by 62.32% of the 69 physicians surveyed (urologists, oncologists, radiation therapists, radiologists, and pathologists). The 88.4% consider the duration of the meetings appropriate. There are disparate opinions concerning the protection of the MDT meeting time as well as protocol update. Of the patients with APC presented at the MDTs meeting, 62,8% require intervention from two specialties. Only 50% of respondents believe that all CRPC cases are discussed and that there is a prior agenda. The decisions made by the MDTs are reflected in the clinical history in 65.1% and are binding only in 60.5% of the cases. Half of the respondents have not been trained in MDTs. Most participants (90.7%) agree on the fact that MDTs. convey benefits. CONCLUSIONS The evaluations of the MDTs identify rectifiable deficiencies by modifying hospital inertia and care planning.
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Affiliation(s)
- M Belda-Ferre
- Servicio de Urología, Hospital General Universitario de Elche, Elche, Alicante, Spain.
| | - A Garcia-Segui
- Servicio de Urología, Hospital General Universitario de Elche, Elche, Alicante, Spain
| | - J J Pacheco-Bru
- Servicio de Urología, Hospital Universitari Sant Joan d'Alacant, Alicante, Spain
| | | | - L P Verdú-Verdú
- Servicio de Urología, Hospital Marina Baixa, Alicante, Spain
| | - E Sánchez-Cano
- Servicio de Urología, Hospital Universitario del Vinalopó, Alicante, Spain
| | - F S Chillón-Sempere
- Servicio de Urología, Hospital General Universitario de Alicante, Alicante, Spain
| | - F Vázquez-Mazón
- Servicio de Oncología, Hospital General Universitario de Elche, Alicante, Spain
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8
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Belda-Ferre M, Garcia-Segui A, Pacheco-Bru J, Valencia-Guadalajara V, Verdú-Verdú L, Sánchez-Cano E, Chillón-Sempere S, Vázquez-Mazón F. Estudio multicéntrico sobre los comités multidisciplinarios en cáncer de próstata avanzado. Actas Urol Esp 2022. [DOI: 10.1016/j.acuro.2021.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Vinod SK, Wellege NT, Kim S, Duggan KJ, Ibrahim M, Shafiq J. Translation of oncology multidisciplinary team meeting (MDM) recommendations into clinical practice. BMC Health Serv Res 2021; 21:461. [PMID: 33990198 PMCID: PMC8120898 DOI: 10.1186/s12913-021-06511-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 05/07/2021] [Indexed: 11/10/2022] Open
Abstract
Background Multidisciplinary team meeting (MDM) processes differ according to clinical setting and tumour site. This can impact on decision making. This study aimed to evaluate the translation of MDM recommendations into clinical practice across solid tumour MDMs at an academic centre. Methods A retrospective audit of oncology records was performed for nine oncology MDMs held at Liverpool Hospital, NSW, Australia from 1/2/17–31/7/17. Information was collected on patient factors (age, gender, country of birth, language, postcode, performance status, comorbidities), tumour factors (diagnosis, stage) and MDM factors (number of MDMs, MDM recommendation). Management was audited up to a year post MDM to record management and identify reasons if discordant with MDM recommendations. Univariate and multivariable regression analyses were performed to assess for factors associated with concordant management. Results Eight hundred thirty-five patients were discussed, median age was 65 years and 51.4% were males. 70.8% of patients were presented at first diagnosis, 77% discussed once and treatment recommended in 73.2%. Of 771 patients assessable for concordance, management was fully concordant in 79.4%, partially concordant in 12.8% and discordant in 7.8%. Concordance varied from 84.5% for lung MDM to 97.6% for breast MDMs. On multivariable analysis, breast and upper GI MDMs and discussion at multiple MDMs were significantly associated with concordant management. The most common reason for discordant management was patient/guardian decision (28.3%). Conclusion There was variability in translation of MDM recommendations into clinical practice by tumour site. Routine measurement of implementation of MDM recommendations should be considered as a quality indicator of MDM practice.
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Affiliation(s)
- Shalini K Vinod
- Liverpool Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW, Australia. .,South Western Sydney Clinical School, University of NSW, Liverpool, NSW, Australia. .,Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.
| | - Nisali T Wellege
- South Western Sydney Clinical School, University of NSW, Liverpool, NSW, Australia
| | - Sara Kim
- South Western Sydney Clinical School, University of NSW, Liverpool, NSW, Australia
| | - Kirsten J Duggan
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.,South West Sydney Local Health District Clinical Cancer Registry, Liverpool, NSW, Australia
| | - Mirette Ibrahim
- Liverpool Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW, Australia
| | - Jesmin Shafiq
- South Western Sydney Clinical School, University of NSW, Liverpool, NSW, Australia.,Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
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Brandão M, Guisseve A, Bata G, Firmino-Machado J, Alberto M, Ferro J, Garcia C, Zaqueu C, Jamisse A, Lorenzoni C, Piccart-Gebhart M, Leitão D, Come J, Soares O, Gudo-Morais A, Schmitt F, Tulsidás S, Carrilho C, Lunet N. Survival Impact and Cost-Effectiveness of a Multidisciplinary Tumor Board for Breast Cancer in Mozambique, Sub-Saharan Africa. Oncologist 2021; 26:e996-e1008. [PMID: 33325595 DOI: 10.1002/onco.13643] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 11/13/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Despite the international endorsement of multidisciplinary tumor boards (MTBs) for breast cancer care, implementation is suboptimal worldwide, and evidence regarding their effectiveness in developing countries is lacking. We assessed the impact on survival and the cost-effectiveness of implementing an MTB in Mozambique, sub-Saharan Africa. MATERIALS AND METHODS This prospective cohort study included 205 patients with breast cancer diagnosed between January 2015 and August 2017 (98 before and 107 after MTB implementation), followed to November 2019. Pre- and post-MTB implementation subcohorts were compared for clinical characteristics, treatments, and overall survival. We used hazard ratios and 95% confidence intervals (CI), computed by Cox proportional hazards regression. The impact of MTB implementation on the cost per quality-adjusted life year (QALY) was estimated from the provider perspective. RESULTS We found no significant differences between pre- and post-MTB subcohorts regarding clinical characteristics or treatments received. Among patients with early breast cancer (stage 0-III; n = 163), the 3-year overall survival was 48.0% (95% CI, 35.9-59.1) in the pre-MTB and 73.0% (95% CI, 61.3-81.6) in the post-MTB subcohort; adjusted hazard ratio, 0.47 (95% CI, 0.27-0.81). The absolute 3-year mean cost increase was $119.83 per patient, and the incremental cost-effectiveness ratio was $802.96 per QALY, corresponding to 1.6 times the gross domestic product of Mozambique. CONCLUSION The implementation of a MTB in Mozambique led to a 53% mortality decrease among patients with early breast cancer, and it was cost-effective. These findings highlight the feasibility of implementing this strategy and the need for scaling-up MTBs in developing countries, as a way to improve patient outcomes. IMPLICATIONS FOR PRACTICE Currently, more than half of the deaths from breast cancer in the world occur in developing countries. Strategies that optimize care and that are adjusted for available resources are needed to improve the outcomes of patients with breast cancer in these regions. The discussion of cases at multidisciplinary tumor boards (MTBs) may improve survival outcomes, but implementation is suboptimal worldwide, and evidence regarding their effectiveness in developing countries is lacking. This study evaluated the impact of implementing an MTB on the care and survival of patients with breast cancer in Mozambique, sub-Saharan Africa and its cost-effectiveness in this low-income setting.
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Affiliation(s)
- Mariana Brandão
- EPIUnit - Instituto de Saúde Pública, Porto, Portugal.,Departamentos de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Assucena Guisseve
- Department of Pathology, Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique.,Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Genoveva Bata
- Oncology, Maputo Central Hospital, Maputo, Mozambique
| | - João Firmino-Machado
- EPIUnit - Instituto de Saúde Pública, Porto, Portugal.,Departamentos de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Matos Alberto
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Josefo Ferro
- Department of Pathology, Beira Central Hospital, Beira, Mozambique
| | - Carlos Garcia
- Department of Pathology, Beira Central Hospital, Beira, Mozambique
| | - Clésio Zaqueu
- Department of Pathology, Nampula Central Hospital, Nampula, Mozambique
| | | | - Cesaltina Lorenzoni
- Department of Pathology, Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique.,Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.,National Cancer Control Programme, Ministry of Health, Maputo, Mozambique
| | | | - Dina Leitão
- Patologia e Oncologia, Faculdade de Medicina, da Universidade do Porto, Porto, Portugal.,Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Porto, Portugal.,Pathology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Jotamo Come
- Surgical, Maputo Central Hospital, Maputo, Mozambique
| | - Otília Soares
- Oncology, Maputo Central Hospital, Maputo, Mozambique
| | - Alberto Gudo-Morais
- Oncology, Maputo Central Hospital, Maputo, Mozambique.,Radiotherapy, Maputo Central Hospital, Maputo, Mozambique
| | - Fernando Schmitt
- Patologia e Oncologia, Faculdade de Medicina, da Universidade do Porto, Porto, Portugal.,Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Porto, Portugal
| | - Satish Tulsidás
- EPIUnit - Instituto de Saúde Pública, Porto, Portugal.,Departamentos de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Oncology, Maputo Central Hospital, Maputo, Mozambique
| | - Carla Carrilho
- EPIUnit - Instituto de Saúde Pública, Porto, Portugal.,Department of Pathology, Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique.,Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Nuno Lunet
- EPIUnit - Instituto de Saúde Pública, Porto, Portugal.,Departamentos de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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11
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Olver IN. Prostate cancer treatment in private and public health services. Med J Aust 2020; 213:408-409. [DOI: 10.5694/mja2.50819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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12
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Aly A, Johnson C, Doleh Y, Shenolikar R, Botteman MF, Hussain A. Medical oncology referral and systemic therapy of patients with advanced stage urothelial carcinoma. J Comp Eff Res 2020; 9:945-957. [PMID: 32964721 DOI: 10.2217/cer-2020-0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To understand physician visit patterns among patients with stage IV (including nonmetastatic [M0] and metastatic [M1] disease) urothelial carcinoma (UC) and understand factors associated with a timely referral to a medical oncologist and systemic treatment. Patients & methods: Retrospective analysis of Surveillance, Epidemiology and End Results-Medicare data. Results: First physician encounter was with a urologist (M0: 69%; M1: 53%) or primary care physician ([PCP]; M0: 19%, M1: 25%) for the majority of patients around UC diagnosis. After the index urologist encounter, most patients had a subsequent medical oncologist visit at a median of 52 days (M0: 69.5 days, M1: 33 days). In an adjusted model, older age, index PCP visit, higher comorbidities and M0 disease were negatively associated with a medical oncologist referral. Among those referred to a medical oncologist, older age, Hispanic or non-Hispanic Black race and not being married were negatively associated with subsequent chemotherapy receipt (p < 0.05). Conclusion: Many patients with advanced UC encounter multiple specialists during their disease course. Older patients or those with a first UC-related encounter with a PCP are less likely to be referred to medical oncology. Once referred to medical oncology, social determinants, including race and marital status, are relevant predictors of receiving chemotherapy.
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Affiliation(s)
- Abdalla Aly
- AstraZeneca, 200 Orchard Ridge Drive, Gaithersburg, MD 20878, USA
| | - Courtney Johnson
- Pharmerit International, 4350 East-West Hwy, Suite 1110, Bethesda, MD 20814, USA
| | - Yunes Doleh
- AstraZeneca, 200 Orchard Ridge Drive, Gaithersburg, MD 20878, USA
| | - Rahul Shenolikar
- AstraZeneca, 200 Orchard Ridge Drive, Gaithersburg, MD 20878, USA
| | - Marc F Botteman
- Pharmerit International, 4350 East-West Hwy, Suite 1110, Bethesda, MD 20814, USA
| | - Arif Hussain
- Marlene & Stewart Greenbaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD 21201, USA.,Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.,Veterans Affairs Medical Center, Baltimore, MD 21201, USA
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13
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Rosell L, Wihl J, Nilbert M, Malmström M. Health Professionals' Views on Key Enabling Factors and Barriers of National Multidisciplinary Team Meetings in Cancer Care: A Qualitative Study. J Multidiscip Healthc 2020; 13:179-186. [PMID: 32103978 PMCID: PMC7029585 DOI: 10.2147/jmdh.s240140] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 01/09/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Multidisciplinary team meetings (MDTMs) are an integral component of cancer care. Increasingly, virtual MDTMs are used to grant high-quality treatment recommendations across health-care regions, which expands and develops the local MDTM team to a regional or national expert network. We investigated health professionals' experiences from national, virtual MDTMs for rare cancer with a focus on key enabling factors and barriers. Methods Health professionals who participate in seven national, virtual MDTMs in Swedish health-care responded to a questionnaire exploring key enabling factors, barriers and opportunities for MDTM development. Conventional content analysis was used to identify thematic categories based on free-text responses. Results Participants´ perspectives could be assigned into three categories ie, a national arena with potential for comprehensive knowledge and collaboration, prerequisites for decision-making and organization and responsibilities. These categories consisted of nine sub-categories that referred to, eg, collective competence, resources, clinical research, case discussion, meeting climate, patient-related information, MDTMs potential, referral and technical insufficiencies. Conclusion National, virtual MDTMs represent a new multidisciplinary collaborative arena that introduces benefits as well as challenges. Consideration of key enabling factors and barriers may ease implementation and further optimize MDTMs in cancer care.
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Affiliation(s)
- Linn Rosell
- Regional Cancer Centre South, Region Skåne, Lund, Sweden.,Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Lund, Sweden
| | - Jessica Wihl
- Regional Cancer Centre South, Region Skåne, Lund, Sweden.,Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Lund, Sweden.,Department of Oncology and Hematology, Skåne University Hospital, Lund, Sweden
| | - Mef Nilbert
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Lund, Sweden.,Clinical Research Centre, Hvidovre Hospital and Copenhagen University, Copenhagen, Denmark.,Danish Cancer Society Research Centre, Copenhagen, Denmark
| | - Marlene Malmström
- The Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden.,Lund University, Faculty of Medicine, Department of Health Sciences, Lund, Sweden
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14
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Chierchini S, Ingrosso G, Saldi S, Stracci F, Aristei C. Physician And Patient Barriers To Radiotherapy Service Access: Treatment Referral Implications. Cancer Manag Res 2019; 11:8829-8833. [PMID: 31632142 PMCID: PMC6789154 DOI: 10.2147/cmar.s168941] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 09/14/2019] [Indexed: 12/24/2022] Open
Abstract
Radiotherapy is one of the mainstays of cancer treatment, and about 60% of cancer patients receive this type of treatment during their course of treatment. An evident gap between optimal and actual radiotherapy utilization proportions has recently been reported, which has been ascribed to lack of referral to radiation oncology. There are many factors influencing the radiotherapy referral, including patient anxiety about toxicity, wrong perception of efficacy and side effects by physicians and patients, insufficient knowledge of referral process. These factors, defined as barriers can be categorized in health system barriers, physician and patient barriers. In the present brief narrative review, we discussed barriers to radiotherapy referral focusing on physician and patient barriers.
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Affiliation(s)
- Sara Chierchini
- Radiation Oncology Section, Department of Surgical and Biomedical Sciences, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Gianluca Ingrosso
- Radiation Oncology Section, Department of Surgical and Biomedical Sciences, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Simonetta Saldi
- Radiation Oncology Section, Department of Surgical and Biomedical Sciences, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Fabrizio Stracci
- Department of Experimental Medicine, Section of Public Health, University of Perugia, Perugia, Italy
| | - Cynthia Aristei
- Radiation Oncology Section, Department of Surgical and Biomedical Sciences, University of Perugia and Perugia General Hospital, Perugia, Italy
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15
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Heidenreich A. Multidisciplinary Team Meetings for Prostate Cancer Treatment: We Can Do Much Better in Daily Life. Oncol Res Treat 2019; 42:363-365. [DOI: 10.1159/000500426] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 04/16/2019] [Indexed: 11/19/2022]
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