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Krankenberg DJ, Muallem MZ, Pietzner K, Chekerov R, Armbrust R, Beteta C, Schöning W, Lee M, Klews J, Sehouli J. Ovarian cancer management in an ESGO ovarian cancer center of excellence: a systematic case study of the interprofessional and interdisciplinary interaction. Arch Gynecol Obstet 2024; 309:2821-2828. [PMID: 38507090 PMCID: PMC11147944 DOI: 10.1007/s00404-023-07368-z] [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: 12/07/2023] [Accepted: 12/28/2023] [Indexed: 03/22/2024]
Abstract
PURPOSE With growing knowledge about ovarian cancer over the last decades, diagnosis, evaluation and treatment of ovarian cancer patients have become highly specialized, and an individually adapted approach should be made in each woman by interdisciplinary cooperation. The present study aims to show the variety and extent of medical specialties involved at our institution according to the European Society of Gynecologic Oncology (ESGO) Quality indicators (QI). METHODS A woman, diagnosed with high-grade ovarian cancer, International Federation of Gynecology and Obstetrics (FIGO) class IVb was selected for a single case observational study. The observation period (total = 22d) comprised preoperative diagnostic procedures, including imaging, the in-patient stay for cytoreductive surgery, and the postoperative course and case discussion at our interdisciplinary tumor board. Data were obtained by self-reporting and by patient file review. RESULTS Patient tracking demonstrated an interdisciplinary cooperation of 12 medical specialties [62 physicians (63% male, 37% female)], 8 different types of nursing staff [n = 59 (22% male, 78% female)], and 9 different types of perioperative/administrative staff (n = 23; male 17,4%, female n = 19, 82,6%). Contact with the patient was direct (n = 199; 76%) or without face-to-face interaction (n = 63; 24%). CONCLUSION The present study demonstrates the high diversity of physicians and the affiliated medical staff, as well as interdisciplinary intersections within teams of a specialized hospital. Matching the ESGO QIs, this report underlines the requirement of an adequate infrastructure for the complex management of advanced ovarian cancer patients. Future prospective studies are warranted to evaluate the specific procedures and actions to optimize the interprofessional and interdisciplinary workflows.
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Affiliation(s)
- David J Krankenberg
- Department of Gynecology with Center for Oncological Surgery, European Competence Center for Ovarian Cancer Campus Virchow Klinikum and Charité Comprehensive Cancer Center (CCCC), Medical University of Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Mustafa Zelal Muallem
- Department of Gynecology with Center for Oncological Surgery, European Competence Center for Ovarian Cancer Campus Virchow Klinikum and Charité Comprehensive Cancer Center (CCCC), Medical University of Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Klaus Pietzner
- Department of Gynecology with Center for Oncological Surgery, European Competence Center for Ovarian Cancer Campus Virchow Klinikum and Charité Comprehensive Cancer Center (CCCC), Medical University of Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Radoslav Chekerov
- Department of Gynecology with Center for Oncological Surgery, European Competence Center for Ovarian Cancer Campus Virchow Klinikum and Charité Comprehensive Cancer Center (CCCC), Medical University of Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Robert Armbrust
- Department of Gynecology with Center for Oncological Surgery, European Competence Center for Ovarian Cancer Campus Virchow Klinikum and Charité Comprehensive Cancer Center (CCCC), Medical University of Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Carmen Beteta
- Department of Gynecology with Center for Oncological Surgery, European Competence Center for Ovarian Cancer Campus Virchow Klinikum and Charité Comprehensive Cancer Center (CCCC), Medical University of Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Wenzel Schöning
- Departement of the Surgical Clinic, Campus Charité Mitte and Campus Virchow-Clinic, Charité - University Clinic, Berlin, Germany
- Corporate Member of Free University of Berlin and Humboldt-University of Berlin, Berlin, Germany
| | - Marlene Lee
- Department of Gynecology with Center for Oncological Surgery, European Competence Center for Ovarian Cancer Campus Virchow Klinikum and Charité Comprehensive Cancer Center (CCCC), Medical University of Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Julia Klews
- Department of Gynecology with Center for Oncological Surgery, European Competence Center for Ovarian Cancer Campus Virchow Klinikum and Charité Comprehensive Cancer Center (CCCC), Medical University of Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Jalid Sehouli
- Department of Gynecology with Center for Oncological Surgery, European Competence Center for Ovarian Cancer Campus Virchow Klinikum and Charité Comprehensive Cancer Center (CCCC), Medical University of Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
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Poddar P, Shylasree TS, Bhandare M. Splenectomy and Distal Pancreaticosplenectomy: Surgical Anatomy and Technique Specific to Advanced Ovarian Cancer. Indian J Surg Oncol 2023; 14:252-263. [PMID: 36891436 PMCID: PMC9986191 DOI: 10.1007/s13193-021-01412-7] [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: 10/10/2020] [Accepted: 07/28/2021] [Indexed: 10/20/2022] Open
Abstract
Ovarian cancer is one of the most aggressive malignancies in women and usually presents at an advanced stage. Complete tumor debulking and platinum sensitivity are the two important determinants of survival in ovarian cancer. Upper abdominal surgery with bowel resections and peritonectomy are usually needed to achieve optimal cytoreduction. Splenic disease in the form of diaphragmatic peritoneal disease or omental caking at the splenic hilum is not infrequent. Around 1-2% of these require distal pancreaticosplenectomy (DPS) and the decision to perform DPS versus splenectomy should be made early in the intraoperative period to prevent unnecessary hilar dissection and bleeding. We hereby describe the surgical anatomy of the spleen and pancreas and point of technique of splenectomy and DPS specific to advanced ovarian cancers.
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Affiliation(s)
- Pabashi Poddar
- Department of Gynecological Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Dr Ernst Borges Marg, Parel, Mumbai, 400012 Maharashtra India
| | - T. S. Shylasree
- Department of Gynecological Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Dr Ernst Borges Marg, Parel, Mumbai, 400012 Maharashtra India
| | - Manish Bhandare
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Dr Ernst Borges Marg, Parel, Mumbai, 400012 Maharashtra India
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Huang YC, Kung PT, Ho SY, Tyan YS, Chiu LT, Tsai WC. Effect of multidisciplinary team care on survival of oesophageal cancer patients: a retrospective nationwide cohort study. Sci Rep 2021; 11:13243. [PMID: 34168186 PMCID: PMC8225808 DOI: 10.1038/s41598-021-92618-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/14/2021] [Indexed: 12/24/2022] Open
Abstract
Oesophageal cancer is the sixth leading cause of cancer death worldwide. This nationwide study analyses the survival results of oesophageal cancer under multidisciplinary team (MDT) care. We enrolled oesophageal cancer patients diagnosed between 2010 and 2015 with follow-up for at least 1 year. This study performed propensity score matching with a ratio of 1:1 between MDT participants and non-MDT participants. We performed conditional Cox proportional hazards model to research relative risk of survival and associated factors of survival. The adjusted survival curves were plotted. 8184 newly diagnosed oesophageal cancer patients were included. The favourable survival factors include participant status of MDT, gender, monthly salary, urbanization level, other catastrophic illness, stage of cancer, treatment methods, and service volume of physicians (P < 0.05). MDT participants showed lower risk of death (HR = 0.73; 95% CI 0.67–0.79). Further stratification analysis revealed that the incorporation of an MDT reduced the death risk of patients with stages 2, 3, and 4 cancer, with the greatest reduction observed in patients with stage 3 cancer (HR = 0.72; 95% CI 0.67–0.79). The risk of death was lower for oesophageal cancer patients who enrolled in MDT care.
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Affiliation(s)
- Yuan-Chun Huang
- Department of Health Services Administration, China Medical University, No. 100, Sec. 1, Jingmao Road, Taichung, 404060, Taiwan.,Department of Medical Imaging, Changhua Christian Hospital, Changhua, Taiwan.,School of Medical Imaging and Radiological Sciences, School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan.,Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan
| | - Pei-Tseng Kung
- Department of Healthcare Administration, Asia University, Taichung, Taiwan.,Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Shang-Yun Ho
- Department of Medical Imaging, Changhua Christian Hospital, Changhua, Taiwan
| | - Yeu-Sheng Tyan
- School of Medical Imaging and Radiological Sciences, School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Li-Ting Chiu
- Department of Health Services Administration, China Medical University, No. 100, Sec. 1, Jingmao Road, Taichung, 404060, Taiwan
| | - Wen-Chen Tsai
- Department of Health Services Administration, China Medical University, No. 100, Sec. 1, Jingmao Road, Taichung, 404060, Taiwan.
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Shylasree TS, Kattepur AK, Gupta M, Ghosh J, Maheshwari A, Bajpai J, Hawaldar R, Gulia S, Deodhar K, Popat P, Gupta S, Kerkar RA. Compliance to treatment guidelines and survival in women undergoing interval debulking surgery for advanced epithelial ovarian cancer. Cancer Rep (Hoboken) 2019; 3:e1217. [PMID: 32671995 DOI: 10.1002/cnr2.1217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 08/08/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND One of the primary treatment strategies for advanced epithelial ovarian cancers includes neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) and adjuvant chemotherapy. Compliance to treatment is important to possibly improve outcomes. AIM To audit treatment compliance and its effect on overall survival (OS) and disease free survival (DFS) in women undergoing IDS. METHODS AND RESULTS Women diagnosed with advanced epithelial ovarian cancer undergoing IDS were included. Details of compliance to chemotherapy and surgery as per standard guidelines were assessed, and correlation with survival was studied. Reasons for protocol deviation at various levels were documented and analysed. A total of 182 patients were included. The total number of deviations was 134 with deviation at any level being 89 (48.9%) and at all levels 5%. Both patient- and treatment-related factors contributed towards deviation. Deviation or noncompliance towards treatment resulted in a significantly reduced 5-year OS (34.4% vs 58.2%; P = .001) compared with compliant patients, which retained its significance on multivariate analysis (P = .024) as well. CONCLUSION Deviation from treatment guidelines resulted in a significantly lower 5-year OS compared with those who remained treatment compliant. Both patient- and treatment-related factors contributed towards noncompliance and hence towards lower survival.
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Affiliation(s)
| | - Abhay K Kattepur
- Department of Gynecological Oncology, Tata Memorial Hospital, Mumbai, India
| | - Monisha Gupta
- Department of Gynecological Oncology, Tata Memorial Hospital, Mumbai, India
| | - Jaya Ghosh
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Amita Maheshwari
- Department of Gynecological Oncology, Tata Memorial Hospital, Mumbai, India
| | - Jyoti Bajpai
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Rohini Hawaldar
- Department of Clinical Research Methodology and Biostatistics, Tata Memorial Hospital, Mumbai, India
| | - Seema Gulia
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Kedar Deodhar
- Department of Pathology, Tata Memorial Hospital, Mumbai, India
| | - Palak Popat
- Department of Radio-diagnosis, Tata Memorial Hospital, Mumbai, India
| | - Sudeep Gupta
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Rajendra A Kerkar
- Department of Gynecological Oncology, Tata Memorial Hospital, Mumbai, India
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Querleu D, Planchamp F, Chiva L, Fotopoulou C, Barton D, Cibula D, Aletti G, Carinelli S, Creutzberg C, Davidson B, Harter P, Lundvall L, Marth C, Morice P, Rafii A, Ray-Coquard I, Rockall A, Sessa C, van der Zee A, Vergote I, duBois A. European Society of Gynaecological Oncology (ESGO) Guidelines for Ovarian Cancer Surgery. Int J Gynecol Cancer 2019; 27:1534-1542. [PMID: 30814245 DOI: 10.1097/igc.0000000000001041] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 04/14/2017] [Indexed: 01/05/2023] Open
Abstract
METHODS The European Society of Gynaecological Oncology council nominated an international multidisciplinary development group made of practicing clinicians who have demonstrated leadership and interest in the care of ovarian cancer (20 experts across Europe). To ensure that the statements are evidence based, the current literature identified from a systematic search has been reviewed and critically appraised. In the absence of any clear scientific evidence, judgment was based on the professional experience and consensus of the development group (expert agreement). The guidelines are thus based on the best available evidence and expert agreement. Before publication, the guidelines were reviewed by 66 international reviewers independent from the development group including patients representatives. RESULTS The guidelines cover preoperative workup, specialized multidisciplinary decision making, and surgical management of diagnosed epithelial ovarian, fallopian tube, and peritoneal cancers. The guidelines are also illustrated by algorithms.
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Affiliation(s)
| | | | - Luis Chiva
- Clinica Universidad de Navarra, Pamplona, Spain
| | | | | | - David Cibula
- Charles University Hospital, Prague, Czech Republic
| | | | | | | | - Ben Davidson
- Oslo University Hospital, Norwegian Radium Hospital/Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Philip Harter
- Clinica Universidad de Navarra, Pamplona, Spain.,Imperial College London
| | - Lene Lundvall
- Clinica Universidad de Navarra, Pamplona, Spain.,Imperial College London
| | | | | | - Arash Rafii
- Weill Cornell Medical College in Qatar, Doha, Qatar
| | | | | | - Christiana Sessa
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | | | | | - Andreas duBois
- Clinica Universidad de Navarra, Pamplona, Spain.,Imperial College London
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Why Routine Clinical Follow-up for Patients With Early Stage Endometrial Cancer Is Not Always Necessary: A Study on Women in South Wales. Int J Gynecol Cancer 2014; 24:556-63. [DOI: 10.1097/igc.0000000000000088] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
ObjectiveThis study aimed to examine the existing methods of follow-up in women who have undergone treatment of early endometrial carcinoma in South Wales and to assess if they are appropriate.DesignThis study used a retrospective analysis of follow-up data.SettingThis study was performed in the Virtual Gynaecological Oncology Centre, South Wales, United Kingdom.SampleThis study sample is composed of 552 women.MethodsData regarding follow-up were collected retrospectively from patient case notes and computerized data systems. Data were analyzed using the Pearson χ2 test, Cox proportional hazard regression analysis, and Kaplan-Meier curves.Main Outcome MeasuresThis study aimed to determine whether routine follow-up was beneficial in detecting disease recurrence and whether outcome was influenced by routine follow-up.ResultsBetween January 1, 2000, and December 31, 2010, 552 women were treated for early stage endometrial carcinoma. The 5-year survival was 81%, and the 5-year progression-free survival was 77%. Of these 552 women, 81 (15%) developed a disease recurrence; the majority (61/81 [75%]) recurred within 3 years. The median survival was 35 months compared with 47 months in patients who did not develop a recurrence. Of the 81 patients, 73 (90%) were symptomatic and only 5 patients were truly asymptomatic at follow-up. The most important and significant prognostic factor was “recurrent disease” with overall survival (hazard ratio, 2.20; P < 0.001; 95% confidence interval, 1.75–2.65) and progression-free survival (hazard ratio, 2.52; P < 0.001; 95% confidence interval, 2.09–2.95). “Asymptomatic recurrence” was not an independent predictor of outcome.ConclusionsRoutine follow-up for early endometrial cancer is not beneficial for patients because most were symptomatic at the time of detection. It does not significantly improve the outcome. We propose altering the follow-up time regimen and adopting alternative follow-up strategies for women in South Wales.
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7
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Woo YL, Kyrgiou M, Bryant A, Everett T, Dickinson HO. Centralisation of services for gynaecological cancers - a Cochrane systematic review. Gynecol Oncol 2012; 126:286-90. [PMID: 22507534 DOI: 10.1016/j.ygyno.2012.04.012] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 04/07/2012] [Indexed: 02/09/2023]
Abstract
OBJECTIVE Gynaecological cancers are the second most common cancers among women. It has been suggested that centralised care improves outcomes but consensus is lacking. This systematic review assesses the effectiveness of centralisation of care for patients with gynaecological cancer, in particular, survival advantage. METHODS A comprehensive search of the Cochrane Gynaecological Cancer Group Trials Register, CENTRAL (The Cochrane Library, Issue 4, 2010), MEDLINE, and EMBASE up to November 2010 was conducted. Registers of clinical trials, abstracts of scientific meetings, and reference lists of included studies were also searched. Randomised controlled trials (RCTs), quasi-RCTs, controlled before-and-after studies, interrupted time series studies, and observational studies were included and multivariable analysis to adjust for baseline case mix were used. RESULTS Five retrospective observational studies met the inclusion criteria. Meta-analysis of three studies assessing over 9000 women suggested that institutions with gynaecologic oncologists on site may prolong survival in women with ovarian cancer, compared to community or general hospitals: hazard ratio (HR) of death was 0.90 (95% confidence interval (CI) 0.82 to 0.99). Similarly, another meta-analysis of three studies assessing over 50,000 women, found that teaching centres or regional cancer centres may prolong survival in women with any gynaecological cancer compared to community or general hospitals (HR 0.91; 95% CI 0.84 to 0.99). The largest of these studies included all gynaecological malignancies and assessed 48,981 women, so the findings extend beyond ovarian cancer. One study compared community hospitals with semi-specialised gynaecologists versus general hospitals and reported non-significantly better disease-specific survival in women with ovarian cancer (HR 0.89; 95% CI 0.78 to 1.01). The findings of included studies were highly consistent. CONCLUSIONS The meta-analysis provides evidence to suggest that women with gynaecological cancer who received treatment in specialised centres had longer survival than those managed elsewhere.
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Affiliation(s)
- Yin Ling Woo
- Department of Obstetrics and Gynaecology, Affiliated with University Malaya Cancer Research Institute, Faculty of Medicine, University Malaya, Lembah Pantai, 50603 Kuala Lumpur, Malaysia.
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Abstract
BACKGROUND Gynaecological cancers are the second most common cancers among women. It has been suggested that centralised care improves outcomes but consensus is lacking. OBJECTIVES To assess the effectiveness of centralisation of care for patients with gynaecological cancer. SEARCH METHODS We searched the Cochrane Gynaecological Cancer Group Trials Register, CENTRAL (The Cochrane Library, Issue 4, 2010), MEDLINE, and EMBASE up to November 2010. We also searched registers of clinical trials, abstracts of scientific meetings, and reference lists of included studies. SELECTION CRITERIA We included randomised controlled trials (RCTs), quasi-RCTs, controlled before-and-after studies, interrupted time series studies, and observational studies that examined centralisation of services for gynaecological cancer, and used multivariable analysis to adjust for baseline case mix. DATA COLLECTION AND ANALYSIS Three review authors independently extracted data, and two assessed risk of bias. Where possible, we synthesised the data on survival in a meta-analysis. MAIN RESULTS Five studies met our inclusion criteria; all were retrospective observational studies and therefore at high risk of bias.Meta-analysis of three studies assessing over 9000 women suggested that institutions with gynaecologic oncologists on site may prolong survival in women with ovarian cancer, compared to community or general hospitals: hazard ratio (HR) of death was 0.90 (95% confidence interval (CI) 0.82 to 0.99). Similarly, another meta-analysis of three studies assessing over 50,000 women, found that teaching centres or regional cancer centres may prolong survival in women with any gynaecological cancer compared to community or general hospitals (HR 0.91; 95% CI 0.84 to 0.99). The largest of these studies included all gynaecological malignancies and assessed 48,981 women, so the findings extend beyond ovarian cancer. One study compared community hospitals with semi-specialised gynaecologists versus general hospitals and reported non-significantly better disease-specific survival in women with ovarian cancer (HR 0.89; 95% CI 0.78 to 1.01). The findings of included studies were highly consistent. Adverse event data were not reported in any of the studies. AUTHORS' CONCLUSIONS We found low quality, but consistent evidence to suggest that women with gynaecological cancer who received treatment in specialised centres had longer survival than those managed elsewhere. The evidence was stronger for ovarian cancer than for other gynaecological cancers.Further studies of survival are needed, with more robust designs than retrospective observational studies. Research should also assess the quality of life associated with centralisation of gynaecological cancer care. Most of the available evidence addresses ovarian cancer in developed countries; future studies should be extended to other gynaecological cancers within different healthcare systems.
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Affiliation(s)
- Yin Ling Woo
- Department of Obstetrics and Gynaecology, Affiliated to University of Malaya Cancer Research Institute, Kuala Lumpur, Malaysia.
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Hong NJL, Wright FC, Gagliardi AR, Paszat LF. Examining the potential relationship between multidisciplinary cancer care and patient survival: an international literature review. J Surg Oncol 2010; 102:125-34. [PMID: 20648582 DOI: 10.1002/jso.21589] [Citation(s) in RCA: 129] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND OBJECTIVES The aim of this review is to examine the relationship between multidisciplinary cancer care and patient survival. METHODS A literature review was undertaken between January 1950 and September 2009. Included studies described multidisciplinary cancer care and its relation to patient survival. Multidisciplinary care was defined as involvement of a team of clinical and allied specialists whose intent is individualized patient management. Studies were critically appraised for internal and external validity. All study designs were included. RESULTS Twenty-one studies met eligibility criteria for this review, including two systematic reviews, one abstract, and 18 original studies. Pooling of results was not possible due to heterogeneity of patient populations, disease sites, measured outcomes, and follow-up periods. Twelve studies (one prospective and six retrospective cohort studies, five before-after series) reported statistically significant association between multidisciplinary care and patient survival. CONCLUSIONS Due to methodological limitations, this review is unable to assert a causal relationship between multidisciplinary care and patient survival. In order to better evaluate this relationship, the oncology community must first accept a common definition of multidisciplinary care. Future efforts can then elucidate which aspects of multidisciplinary care impact survival, with consideration of confounding patient and tumour factors.
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Affiliation(s)
- Nicole J Look Hong
- Department of Health Policy Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
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10
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Verleye L, Vergote I, van der Zee AGJ. Patterns of care in surgery for ovarian cancer in Europe. Eur J Surg Oncol 2010; 36 Suppl 1:S108-14. [PMID: 20580524 DOI: 10.1016/j.ejso.2010.06.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Accepted: 06/03/2010] [Indexed: 12/24/2022] Open
Abstract
Quality of surgery is one of the most important determinants of the outcome in ovarian cancer patients. Surgery by a gynaecological oncologist in a specialised, high-volume environment and removal of all visible tumours are associated with a higher likelihood of favourable outcome for patients with advanced-stage ovarian cancer. Population-based studies in Europe however show that a substantial number of patients do not receive optimal surgical care. Less than half of the patients suffering from advanced-stage ovarian cancer are operated by a gynaecological oncologists. Also the proportion of patients operated in a high-volume or specialised hospital is lower than 50%. In a substantial number of patients, minimum standard procedures are not performed and optimal tumor debulking is not achieved. To improve the quality of care, efforts are needed to develop and implement robust evidence-based European guidelines, provide surgical training for gynaecological oncologists and establish comprehensive cancer networks with sufficient resources.
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Affiliation(s)
- L Verleye
- EORTC Headquarters, E. Mounierlaan 83/11, Brussels, Belgium.
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11
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Foster T, Brown TM, Chang J, Menssen HD, Blieden MB, Herzog TJ. A review of the current evidence for maintenance therapy in ovarian cancer. Gynecol Oncol 2009; 115:290-301. [PMID: 19717182 DOI: 10.1016/j.ygyno.2009.07.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2009] [Revised: 07/13/2009] [Accepted: 07/18/2009] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Ovarian cancer (OC) typically is diagnosed at advanced stages, in which the primary goal of therapy is to prolong progression-free survival (PFS) and overall survival (OS). In recent years, maintenance therapy has been tested for this purpose in advanced OC (AOC). Literature on maintenance therapy in AOC was systematically reviewed to assess current knowledge regarding the impact of this therapeutic approach. METHODS A MEDLINE search was performed 2/2009 for articles published 1/2001-1/2009 pertaining to OC maintenance therapy guidelines, patterns, and outcomes. A second search used keywords specific to maintenance and included primary studies published in the last 10 years. Of 406 sources identified, 36 primary studies and 16 review articles were included in this systematic review. A third search used the keyword "consolidation" to find maintenance articles not identified through other searches; of 48 additional sources, 13 primary studies and 6 reviews were included. A fourth search of non-MEDLINE-indexed sources yielded 14 additional relevant publications from the same time period. RESULTS Among practice guidelines identified, only the National Comprehensive Cancer Network (NCCN) 2008 guidelines provide recommendations regarding maintenance therapy, assigning it a category 2B recommendation. No studies were identified that reported current treatment patterns or economic outcomes in maintenance therapy; quality of life data were reported in one study. A variety of agents have been tested for maintenance, with paclitaxel the most commonly evaluated. The Southwest Oncology Group-Gynecologic Oncology Group 178 trial has found that 12 cycles of paclitaxel extend PFS (by 7 months) compared to 3 months paclitaxel, but could not adequately evaluate OS. CONCLUSIONS Maintenance therapy may improve clinical outcomes in AOC, but additional research is needed to demonstrate an OS advantage. Future studies should investigate the long-term clinical benefit of maintenance treatment and its impact on resource utilization and health-related quality of life.
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Akyuz A, Sever N, Gürhan N, Dede M, Göktolga U. Effect of desire to have a baby on risk acceptance in Turkish infertile women. Psychol Rep 2008; 103:577-87. [PMID: 19102482 DOI: 10.2466/pr0.103.2.577-587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this study was to assess whether the desire to escape the psychological condition created by infertility (to have a baby) affected risk-taking behavior, with the possible relationship between ovarian cancer and infertility as the "accepted risk" to overcome infertility. 229 infertile and 204 fertile women who were patients at the Gulhane Military Medical Academy were administered a semistructured questionnaire. Increased ovarian cancer risk was accepted by 67.2% of the infertile women in order to have baby. There was no significant relation between the woman's age, duration of infertility, knowledge of the preventability and curability of ovarian cancer, or acceptable risk. These results indicate the importance to Turkish women of overcoming infertility.
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Affiliation(s)
- Aygul Akyuz
- Department of Obstetrics and Gynecologic Nursing Nursing School, Gulhane Military Medical Academy.
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13
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du Bois A, Rochon J, Pfisterer J, Hoskins WJ. Variations in institutional infrastructure, physician specialization and experience, and outcome in ovarian cancer: a systematic review. Gynecol Oncol 2008; 112:422-36. [PMID: 18990435 DOI: 10.1016/j.ygyno.2008.09.036] [Citation(s) in RCA: 135] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2008] [Revised: 09/24/2008] [Accepted: 09/29/2008] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Ovarian cancer outcome varies among different institutions, regions, and countries. This systematic review summarizes the available data evaluating the impact of different physician and hospital characteristics on outcome in ovarian cancer patients. METHODS A MEDLINE database search for pertinent publications was conducted and reference lists of each relevant article were screened. Experts in the field were contacted. Selected studies assessed the relationship between physician and/or hospital specialty or volume and at least one of the outcomes of interest. The primary outcome was survival. Additional parameters included surgical outcome (debulking), completeness of staging, and quality of chemotherapy. The authors independently reviewed each article and applied the inclusion/exclusion criteria. The quality of each study was assessed by focusing on strategies to control for important prognostic factors. RESULTS Forty-four articles met inclusion criteria. Discipline and sub-specialization of the primary treating physician were identified as the most important variable associated with superior outcome. Evidence showing a beneficial impact of institutional factors was weaker, but followed the same trend. Hospital volume was hardly related to any outcome parameter. CONCLUSIONS The limited evidence available showed considerable heterogeneity and has to be interpreted cautiously. Better utilization of knowledge about institutional factors and well-established board certifications may improve outcome in ovarian cancer. Patients and primary-care physicians should select gynecologic oncologists for primary treatment in countries with established sub-specialty training. Policymakers, insurance companies, and lay organizations should support development of respective programs.
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Affiliation(s)
- Andreas du Bois
- Department of Gynecology and Gynecologic Oncology, Dr. Horst Schmidt Klinik (HSK), Ludwig-Erhard-Str. 100, D-65199 Wiesbaden, Germany.
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AKYUZ AYGUL. EFFECT OF DESIRE TO HAVE A BABY ON RISK ACCEPTANCE IN TURKISH INFERTILE WOMEN. Psychol Rep 2008. [DOI: 10.2466/pr0.103.6.577-587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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