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Rajadevan N, Flinkier A, Saunders H, Lee YC, Scott C, Khaw P, Allan P, Davies C, Andrews J, Wilson M, Lombard JM, Harrison M, Nesfield H, DeFazio A, Meniawy T, Gorringe KL. Mucinous ovarian carcinoma: A survey of practice in Australia and New Zealand. Aust N Z J Obstet Gynaecol 2024; 64:319-325. [PMID: 38299485 DOI: 10.1111/ajo.13792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 01/06/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Mucinous ovarian carcinoma (MOC) is a rare ovarian cancer with limited evidence to support clinical care. AIMS We undertook a clinician survey to better understand current practice in treating MOC in Australia and New Zealand, and to determine any features associated with variation in care. In addition, we aimed to understand future research priorities. METHODS A RedCap survey was distributed to clinician members of the Australia New Zealand Gynaecological Oncology Group (ANZGOG). Questions included respondent demographics, three case studies and future research priorities. Clinicians were asked questions specific to their speciality. RESULTS Respondents (n = 47) were commonly experienced gynae-oncology specialists, most often surgical (38%) or medical (30%) oncologists. There was good consensus for surgical approaches for stage I disease; however, variation in practice was noted for advanced or recurrent MOC. Variation was also observed for medical oncologists; in early-stage disease there was no clear consensus on whether to offer chemotherapy, or which regimen to recommend. For advanced and recurrent disease a wide range of chemotherapy options was considered, with a trend away from an ovarian-type toward gastrointestinal (GI)-type regimens in advanced MOC. This practice was reflected in future research priorities, with 'Is a GI chemotherapy regimen better than an ovarian regimen?' the most highly ranked option, followed by 'Should stage 1C patients receive chemotherapy?' CONCLUSIONS Although the number of respondents limited the analyses, it was clear that chemotherapy selection was a key point of divergence for medical oncologists. Future research is needed to establish well-evidenced guidelines for clinical care of MOC.
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Affiliation(s)
- Niveditha Rajadevan
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Ariane Flinkier
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Hugo Saunders
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Yeh Chen Lee
- Prince of Wales Hospital and Royal Hospital for Women, Sydney, New South Wales, Australia
- The University of Sydney, Sydney, New South Wales, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Clare Scott
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Walter and Eliza Hall Institute, Melbourne, Victoria, Australia
| | - Pearly Khaw
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Prue Allan
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Claire Davies
- Australia New Zealand Gynaecological Oncology Group, Sydney, New South Wales, Australia
| | - John Andrews
- Australia New Zealand Gynaecological Oncology Group, Sydney, New South Wales, Australia
| | - Michelle Wilson
- Auckland City Hospital and The University of Auckland, Auckland, New Zealand
| | | | | | - Heshani Nesfield
- Australia New Zealand Gynaecological Oncology Group, Sydney, New South Wales, Australia
| | - Anna DeFazio
- The University of Sydney, Sydney, New South Wales, Australia
- Department of Gynaecological Oncology, Westmead Hospital, Sydney, New South Wales, Australia
- The Westmead Institute for Medical Research, Sydney, New South Wales, Australia
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - Tarek Meniawy
- St John of God Hospital and University of Western Australia, Perth, Western Australia, Australia
| | - Kylie L Gorringe
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Ospina AV, Bolufer Nadal S, Campo-Cañaveral de la Cruz JL, González Larriba JL, Macía Vidueira I, Massutí Sureda B, Nadal E, Trancho FH, Álvarez Kindelán A, Del Barco Morillo E, Bernabé Caro R, Bosch Barrera J, Calvo de Juan V, Casal Rubio J, de Castro J, Cilleruelo Ramos Á, Cobo Dols M, Dómine Gómez M, Figueroa Almánzar S, Garcia Campelo R, Insa Mollá A, Jarabo Sarceda JR, Jiménez Maestre U, López Castro R, Majem M, Martinez-Marti A, Martínez Téllez E, Sánchez Lorente D, Provencio M. Multidisciplinary approach for locally advanced non-small cell lung cancer (NSCLC): 2023 expert consensus of the Spanish Lung Cancer Group GECP. Clin Transl Oncol 2024; 26:1647-1663. [PMID: 38530556 PMCID: PMC11178633 DOI: 10.1007/s12094-024-03382-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 01/03/2024] [Indexed: 03/28/2024]
Abstract
INTRODUCTION Recent advances in the treatment of locally advanced NSCLC have led to changes in the standard of care for this disease. For the selection of the best approach strategy for each patient, it is necessary the homogenization of diagnostic and therapeutic interventions, as well as the promotion of the evaluation of patients by a multidisciplinary oncology team. OBJECTIVE Development of an expert consensus document with suggestions for the approach and treatment of locally advanced NSCLC leaded by Spanish Lung Cancer Group GECP. METHODS Between March and July 2023, a panel of 28 experts was formed. Using a mixed technique (Delphi/nominal group) under the guidance of a coordinating group, consensus was reached in 4 phases: 1. Literature review and definition of discussion topics 2. First round of voting 3. Communicating the results and second round of voting 4. Definition of conclusions in nominal group meeting. Responses were consolidated using medians and interquartile ranges. The threshold for agreement was defined as 85% of the votes. RESULTS New and controversial situations regarding the diagnosis and management of locally advanced NSCLC were analyzed and reconciled based on evidence and clinical experience. Discussion issues included: molecular diagnosis and biomarkers, radiologic and surgical diagnosis, mediastinal staging, role of the multidisciplinary thoracic committee, neoadjuvant treatment indications, evaluation of response to neoadjuvant treatment, postoperative evaluation, and follow-up. CONCLUSIONS Consensus clinical suggestions were generated on the most relevant scenarios such as diagnosis, staging and treatment of locally advanced lung cancer, which will serve to support decision-making in daily practice.
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Affiliation(s)
- Aylen Vanessa Ospina
- Head of the Oncology Department at the Hospital Universitario Puerta de Hierro. Full Professor of Medicine, Universidad Autónoma de Madrid, C/Manuel de Falla, 1 Majadahonda, 28222, Madrid, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Mariano Provencio
- Head of the Oncology Department at the Hospital Universitario Puerta de Hierro. Full Professor of Medicine, Universidad Autónoma de Madrid, C/Manuel de Falla, 1 Majadahonda, 28222, Madrid, Spain.
- Universidad Autónoma de Madrid, Ciudad Universitaria de Cantoblanco, 28049, Madrid, Spain.
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Orlowski C, Lai J, Vereker M, Antill Y, Richardson G, White M, Gregory P, Kemp S, Morgan J, Ooi C, Senior J, David S. Impact of multidisciplinary team meetings on the management of patients with breast cancer in a large private healthcare facility. Asia Pac J Clin Oncol 2024; 20:285-291. [PMID: 36791022 DOI: 10.1111/ajco.13947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 09/26/2022] [Accepted: 01/29/2023] [Indexed: 02/16/2023]
Abstract
AIMS Multidisciplinary meetings (MDMs) play a crucial role in decision-making in breast cancer patient care. This study aimed to firstly assess the impact of breast cancer MDMs in decision-making for breast cancer patients and secondly to determine the concordance between MDM recommendations and implementation of clinical practice. METHODS Patient cases to be presented at the weekly breast cancer MDMs were identified and prospectively enrolled. Management plans were predicted by the treating surgeon with the pre-MDM management plans then compared to MDM recommendations. Changes in decision-making were assessed in the following domains: further surgery, systemic therapy (endocrine, chemotherapy or targeted), radiotherapy, enrolment in a clinical trial, further investigations, and referral to other specialists or services. Patient records were subsequently reviewed at 3 months post-MDM to assess the rate of implementation of MDM recommendations and any reasons for discordance. RESULTS Out of 50 cases, 66% (CI 53-79%; p < .005) experienced a change in management plan as a result of MDM discussion, with a total of 66 episodes of recorded change per decision-making domain affecting the following: further surgery (7.6%), endocrine therapy (4.5%), chemotherapy (19.7%), targeted therapy (4.5%), radiotherapy (18.2%), enrolment for a clinical trial (12.1%), additional investigations (22.7%), and further referrals (10.6%). MDM recommendations were implemented in 83.7% of cases. CONCLUSION The breast cancer MDMs were found to substantially impact on the management plans for breast cancer patients, with 83.7% of MDM recommendations being implemented into clinical practice. This study reinforces the importance of MDMs in the management of these patients, as well as highlighting the need for further investigating and addressing the potential barriers to the implementation of MDM recommendations.
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Affiliation(s)
| | - John Lai
- Cabrini Health, Melbourne, Victoria, Australia
- Epworth Freemasons Hospital, Melbourne, Victoria, Australia
| | - Melissa Vereker
- Cabrini Institute, Cabrini Health, Melbourne, Victoria, Australia
| | - Yoland Antill
- Cabrini Health, Melbourne, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Gary Richardson
- Cabrini Health, Melbourne, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | | | | | - Sarah Kemp
- Cabrini Health, Melbourne, Victoria, Australia
| | | | - Corinne Ooi
- Cabrini Health, Melbourne, Victoria, Australia
| | | | - Steven David
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Eckhaus J. Connections and collaboration: Thoracic surgeons and thoracic physicians. Respirology 2023; 28:826-827. [PMID: 37492938 DOI: 10.1111/resp.14559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/13/2023] [Indexed: 07/27/2023]
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Rizky D, Yunarvika V, Putra YR, Pangarsa EA, Kartiyani I, Panunggal DG, Hutajulu SH, Setiawan B, Hariadi KW, Santosa D, Herdini C, Yoshuantari N, Dhamiyati W, Purwanto I. Impact of independent multidisciplinary work on the survival rate of stage 3 and 4 nasopharyngeal cancer in Indonesia: a retrospective cohort study. Ann Med Surg (Lond) 2023; 85:4248-4255. [PMID: 37663678 PMCID: PMC10473326 DOI: 10.1097/ms9.0000000000001074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 07/02/2023] [Indexed: 09/05/2023] Open
Abstract
Background The utilization of a multidisciplinary team (MDT) strategy is a beneficial approach in integrating the knowledge and proficiencies of various fields to produce thorough and advantageous cancer treatment plans for patients. Nevertheless, MDT has yet to be widely adopted in Indonesia. In this study, the authors examined an early form of MDT in Indonesia that does not involve dedicated meetings, referred as independent multidisciplinary work (IMW). The objective is to investigate the differences in survival rates of nasopharyngeal cancer (NPC) patients who underwent treatment with and without IMW. Materials and methods This study has a retrospective cohort design. Data were collected from the medical records of newly diagnosed stage 3 and 4 NPC patients between 2016 and 2018. The subjects were divided into two groups: the IMW group and the non-IMW group. The primary end point of the study is overall survival rate between the two groups. Kaplan-Meier survival analysis, log-rank test, and cox proportional hazard analysis were used for statistical analysis. Results This study included a total of 124 patients with NPC, 81 patients in the IMW group and 43 patients in the non-IMW group. At the end of the 36-month follow-up period, the median survival of the IMW group was not reached, while in the non-IMW, it was 12 months [95% confidence intervals (95% CI), 8.78-15.22], hazard ratio (HR): 0.47 (95% CI, 0.28-0.78; P<0.01). The 1-year survival rate was 66.7% in the IMW group versus 46.5% in the non-IMW group (HR=0.7, 95% CI 0.49-0.99; P=0.03); the 2-year survival rate was 40.7% in the IMW group versus 16.3% in the non-IMW group (HR=0.4, 95% CI 0.19-0.83; P<0.01). Daniel Rizky, Vina Yunarvika, and Yasjudan Rastrama Putra, these authors contributed equally to this work. In the multivariate analysis, the IMW approach, ECOG (The Eastern Cooperative Oncology Group) status, distant metastasis, and treatment approach were significantly associated with survival outcome. Conclusion The use of IMW approach in the treatment of NPC was associated with a better survival outcome compared to non-IMW treatment.
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Affiliation(s)
- Daniel Rizky
- Division of Hematology-Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Diponegoro University/Dr. Kariadi General Hospital
| | - Vina Yunarvika
- Division of Hematology-Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Diponegoro University/Dr. Kariadi General Hospital
| | - Yasjudan R. Putra
- Division of Hematology-Medical Oncology, Department of Internal Medicine
| | - Eko A. Pangarsa
- Division of Hematology-Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Diponegoro University/Dr. Kariadi General Hospital
| | - Ika Kartiyani
- Division of Hematology-Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Diponegoro University/Dr. Kariadi General Hospital
| | | | | | - Budi Setiawan
- Division of Hematology-Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Diponegoro University/Dr. Kariadi General Hospital
| | | | - Damai Santosa
- Division of Hematology-Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Diponegoro University/Dr. Kariadi General Hospital
| | | | | | - Wigati Dhamiyati
- Department of Radiology, Faculty of Medicine, Public Health and Nursing, Gadjah Mada University/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Ibnu Purwanto
- Division of Hematology-Medical Oncology, Department of Internal Medicine
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Ichikawa M, Uematsu K, Yano N, Yamada M, Ono T, Kawashiro S, Akamatsu H, Hagiwara Y, Sato H, Nemoto K. Implementation rate and effects of multidisciplinary team meetings on decision making about radiotherapy: an observational study at a single Japanese institution. BMC Med Inform Decis Mak 2022; 22:111. [PMID: 35477440 PMCID: PMC9044833 DOI: 10.1186/s12911-022-01849-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 04/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cancer treatment requires a multidisciplinary approach. Therefore, multidisciplinary team meetings (MDTMs) have been widely used to determine the direction of treatment. However, no standard provisions exist for conducting MDTMs, and recommendations discussed in MDTMs are sometimes not implemented. This study analyzed the indications for radiotherapy discussed and recommended at MDTMs, identified the rate of radiotherapy recommendations for patients that were not implemented, and clarified the reasons at a single academic center in Japan. METHODS This was a cross-sectional study that analyzed the minutes and electronic medical records of cases discussed at MDTMs held between April 2012-March 2017 at Yamagata University Hospital. We categorized how radiotherapy was initially presented at MDTMs, determined the rate of radiotherapy recommendations made through MDTMs, analyzed whether treatment recommendations were subsequently implemented, and examined the causes of non-implementation. We performed a statistical analysis to assess some clinical factors (sex, age, number of multidisciplinary team meetings, and classification of planned treatment) associated with the non-implementation of radiotherapy recommendations from MDTMs. RESULTS A total of 1813 cases were discussed at MDTMs, of which 71% (1293 cases) were presented with treatment plans, including radiotherapy. Further, 66% (1205 cases) were recommended for radiotherapy through the MDTMs. Recommendations from MDTMs were not implemented in 7% (142 cases). The most typical reason for non-implementation was the clinician's opinion (30%), followed by patient preferences (27%) and disease progression (20%). Change in cancer stage and improvement in symptoms were 12% and 4%, respectively. These ratios were similar each year. We could not find the factors associated with the non-implementation of radiotherapy recommendations from MDTMs. CONCLUSIONS MDTMs had a significant effect on the recommendation of radiotherapy for each patient with a tumor. The primary reason for the non-implementation of decisions made at MDTMs was the opinion of clinicians and the patient's preference. These results were similar to previous studies. We need to establish a monitoring system where patients themselves can decide the treatments based on their choices while using the recommendations from MDTMs.
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Affiliation(s)
- Mayumi Ichikawa
- Department of Radiation Oncology, Yamagata University School of Medicine, 2-2-2, Iida-nishi, Yamagata, 990-9585, Japan.
| | - Ken Uematsu
- Department of Radiation Oncology, Yamagata University School of Medicine, 2-2-2, Iida-nishi, Yamagata, 990-9585, Japan
| | - Natsuko Yano
- Department of Radiation Oncology, Yamagata University School of Medicine, 2-2-2, Iida-nishi, Yamagata, 990-9585, Japan
| | - Masayoshi Yamada
- Department of Radiation Oncology, Yamagata University School of Medicine, 2-2-2, Iida-nishi, Yamagata, 990-9585, Japan
| | - Takashi Ono
- Department of Radiation Oncology, Yamagata University School of Medicine, 2-2-2, Iida-nishi, Yamagata, 990-9585, Japan
| | - Shohei Kawashiro
- Department of Radiation Oncology, Yamagata University School of Medicine, 2-2-2, Iida-nishi, Yamagata, 990-9585, Japan
| | - Hiroko Akamatsu
- Department of Radiation Oncology, Yamagata University School of Medicine, 2-2-2, Iida-nishi, Yamagata, 990-9585, Japan
| | - Yasuhito Hagiwara
- Department of Radiation Oncology, Yamagata University School of Medicine, 2-2-2, Iida-nishi, Yamagata, 990-9585, Japan
| | - Hiraku Sato
- Department of Radiation Oncology, Yamagata University School of Medicine, 2-2-2, Iida-nishi, Yamagata, 990-9585, Japan
| | - Kenji Nemoto
- Department of Radiation Oncology, Yamagata University School of Medicine, 2-2-2, Iida-nishi, Yamagata, 990-9585, Japan
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