1
|
Irmici G, Cozzi A, Della Pepa G, De Berardinis C, D'Ascoli E, Cellina M, Cè M, Depretto C, Scaperrotta G. How do large language models answer breast cancer quiz questions? A comparative study of GPT-3.5, GPT-4 and Google Gemini. LA RADIOLOGIA MEDICA 2024:10.1007/s11547-024-01872-1. [PMID: 39138732 DOI: 10.1007/s11547-024-01872-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 08/01/2024] [Indexed: 08/15/2024]
Abstract
Applications of large language models (LLMs) in the healthcare field have shown promising results in processing and summarizing multidisciplinary information. This study evaluated the ability of three publicly available LLMs (GPT-3.5, GPT-4, and Google Gemini-then called Bard) to answer 60 multiple-choice questions (29 sourced from public databases, 31 newly formulated by experienced breast radiologists) about different aspects of breast cancer care: treatment and prognosis, diagnostic and interventional techniques, imaging interpretation, and pathology. Overall, the rate of correct answers significantly differed among LLMs (p = 0.010): the best performance was achieved by GPT-4 (95%, 57/60) followed by GPT-3.5 (90%, 54/60) and Google Gemini (80%, 48/60). Across all LLMs, no significant differences were observed in the rates of correct replies to questions sourced from public databases and newly formulated ones (p ≥ 0.593). These results highlight the potential benefits of LLMs in breast cancer care, which will need to be further refined through in-context training.
Collapse
Affiliation(s)
- Giovanni Irmici
- Breast Radiology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian 1, 20133, Milano, Italy.
| | - Andrea Cozzi
- Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Gianmarco Della Pepa
- Breast Radiology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian 1, 20133, Milano, Italy
| | - Claudia De Berardinis
- Breast Radiology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian 1, 20133, Milano, Italy
| | - Elisa D'Ascoli
- Breast Radiology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian 1, 20133, Milano, Italy
| | - Michaela Cellina
- Radiology Department, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Maurizio Cè
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milano, Italy
| | - Catherine Depretto
- Breast Radiology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian 1, 20133, Milano, Italy
| | - Gianfranco Scaperrotta
- Breast Radiology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian 1, 20133, Milano, Italy
| |
Collapse
|
2
|
Attieh S, Kilpatrick K, Chênevert D, Pomey MP, Loiselle CG. Measuring Team Functioning During the COVID-19 Pandemic: Perspectives of Cancer Care Team Members. J Multidiscip Healthc 2024; 17:2623-2633. [PMID: 38828266 PMCID: PMC11141571 DOI: 10.2147/jmdh.s448985] [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: 01/23/2024] [Accepted: 04/24/2024] [Indexed: 06/05/2024] Open
Abstract
Background In a public health crisis such as COVID-19, cancer teams face significant challenges including acute work disruptions, rapid shifts in clinical practice, and burnout. Within this context, it is crucial to explore team functioning from the perspectives of multiple stakeholders. Objective This quantitative pilot study aimed to 1) measure perceptions of multi-stakeholders on key indicators of team functioning (Team Effectiveness, TE, and Team Relational Coordination, TRC) during COVID-19 and its transition, and 2) document whether patient perceptions of TE/TRC are significantly associated with their cancer care experiences. Methods A descriptive design with repeated measures was used. Through convenience sampling, participants were recruited from two outpatient cancer clinics at a large university-affiliated hospital, in Montréal, Qc, Canada. Sixty-six participants (ie, 13 healthcare professionals, 40 patients, 6 informal caregivers, and 7 volunteers) completed e-measures at T1 (years 2021-2022) and n = 44 at T2 (year 2023). Results At T1, participants reported high perceptions of Team Effectiveness (scale 1 to 6) M = 4.47; SD = 0.7 (Mdn = 4.54; IQR: 4.06-5) and Relational Coordination (scale 1 to 5) M = 3.77; SD = 0.77 (Mdn = 3.81; IQR: 3.12-4.38) with no significant differences in perceptions across the four groups. At T2, no significant changes in TE/TRC perceptions were found. At both time points, patient perceptions of TE/TRC were significantly correlated with positive cancer care experiences (Spearman rank correlation rs ranging from 0.69 and 0.83; p < 0.01). Conclusion To our knowledge, this is the first study documenting perceptions of cancer team functioning amidst the pandemic as reported by multiple stakeholders. Significant relationships between patient perceptions of TE/TRC and their cancer care experiences underscore the importance of including patients' views in team functioning processes. Future work should rely on larger sample sizes to further explore key elements of optimal team functioning.
Collapse
Affiliation(s)
- Samar Attieh
- Department of Experimental Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada
| | - Kelley Kilpatrick
- Susan E. French Chair in Nursing Research and Innovative Practice, Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada
| | - Denis Chênevert
- Department of Human Resources Management, HEC Montréal, Montréal, QC, Canada
| | - Marie-Pascale Pomey
- Research Centre of the University of Montreal Hospital Centre, Montréal, QC, Canada
- Centre d’excellence sur le partenariat avec les patients et le public, Montréal, QC, Canada
- Department of Health Policy, Management and Evaluation, School of Public Health, University of Montréal, Montréal, QC, Canada
| | - Carmen G Loiselle
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada
- Department of Oncology, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada
- Segal Cancer Center, Jewish General Hospital, Montréal, Canada
| |
Collapse
|
3
|
Fatima H, Abbas P, Alshehri SM. Balancing Innovation and Patient Care in Breast Cancer: Integrating Hypofractionated Proton Therapy With Breast Reconstruction Outcomes. Cureus 2024; 16:e58056. [PMID: 38738134 PMCID: PMC11088419 DOI: 10.7759/cureus.58056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2024] [Indexed: 05/14/2024] Open
Abstract
This review aims to assess the application of hypofractionated proton therapy in breast cancer reconstruction, analyzing its advantages, challenges, and broader implications for patient care. The goal is to comprehensively understand how this innovative approach can be integrated into breast cancer treatment. Proton therapy exhibits superior target coverage and safety, reducing radiation-induced complications and sparing critical organs, but skin toxicity outcomes differ from photon therapy. Tissue expanders are vital in breast reconstruction, employing innovative planning for positive long-term outcomes and highlighting the importance of balancing cancer treatment effectiveness with cosmetic outcomes. Hypofractionated proton therapy and breast cancer reconstruction present promising innovations with notable advantages in target coverage and organ sparing. However, variations in skin toxicity outcomes and the need for a careful balance between treatment effectiveness and cosmetic outcomes underscore ongoing challenges. Future directions should focus on refining treatment protocols, optimizing patient selection criteria, and integrating emerging technologies to enhance therapeutic outcomes while minimizing adverse effects.
Collapse
Affiliation(s)
- Hadia Fatima
- Radiation Oncology Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, SAU
| | - Paras Abbas
- Oncology Department, Atomic Energy Cancer Hospital, Nuclear Medicine Oncology and Radiotherapy Institute, Islamabad, PAK
| | - Salem M Alshehri
- Radiation Oncology Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, SAU
| |
Collapse
|
4
|
Fancellu A, Pasqualitto V, Cottu P, Giuliani G, Grasso L, Ariu ML, Porcu A, Sanna V. The importance of the multidisciplinary team in the decision-making process of patients undergoing neoadjuvant chemotherapy for breast cancer. Updates Surg 2024:10.1007/s13304-024-01759-w. [PMID: 38315320 DOI: 10.1007/s13304-024-01759-w] [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: 11/01/2023] [Accepted: 01/12/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND AND OBJECTIVES Recent literature suggests that rates of breast conservation surgery (BCS) are lower than expected in patients submitted to neoadjuvant chemotherapy (NAC) for breast cancer. The aim of this study was to underscore the role of the multidisciplinary team (MDT) in the decision-making process of patients who underwent breast surgery after NAC. METHODS We conducted a retrospective study on patients with breast cancer treated according to an algorithm developed at the Breast Unit of Northern Sardinia between January 2019 and May 2023. Data collected included demographics, tumor characteristics, upfront treatment (surgery or NAC), type of primary surgery (BCS or mastectomy [Ma]) and patients' adherence to the treatment proposed by the MDT. RESULTS Overall, 1061 women were treated during the study period, of whom 164 received NAC (Group A) and 897 upfront surgery (Group B). In group A, conversion from BCS ineligibility to BCS eligibility was observed in 47 patients (40.1%). Final surgery in patients who became BCS-eligible after NAC was BCS in 42 cases (89.3%) and Ma in 5 (10.6%). Rates of patients' adherence to the treatment proposed by the MDT were significantly better in the Group A (p = 0.02). CONCLUSIONS Our results suggest that the MDT has a pivotal role in increasing the rates of breast conservation in women submitted to NAC.
Collapse
Affiliation(s)
- Alessandro Fancellu
- Department of Medicine, Surgery and Pharmacy, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari, Italy.
| | - Valerio Pasqualitto
- Department of Medicine, Surgery and Pharmacy, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari, Italy
| | - Pietrina Cottu
- Department of Medicine, Surgery and Pharmacy, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari, Italy
| | - Giuliana Giuliani
- Department of Medicine, Surgery and Pharmacy, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari, Italy
| | - Lavinia Grasso
- Department of Medicine, Surgery and Pharmacy, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari, Italy
| | - Maria Laura Ariu
- Department of Medicine, Surgery and Pharmacy, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari, Italy
| | - Alberto Porcu
- Department of Medicine, Surgery and Pharmacy, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari, Italy
| | - Valeria Sanna
- AOU Sassari. Unit of Medical Oncology, Sassari, Italy
| |
Collapse
|
5
|
Gutiérrez Urzúa RA, Hernández-Girón CA, Ángeles-Llerenas A, Torres-Mejía G. The marginalization index and its association with selected services within the comprehensive care offered to breast cancer patients. Eur J Oncol Nurs 2024; 68:102508. [PMID: 38219474 DOI: 10.1016/j.ejon.2024.102508] [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: 08/04/2023] [Revised: 12/15/2023] [Accepted: 01/05/2024] [Indexed: 01/16/2024]
Abstract
PURPOSE There is little information on the supportive care offered to breast cancer patients. We investigated the association between the marginalization index and selected services offered by health professionals. METHODS We used data from a cross-sectional parent study performed in Mexico from 2007 to 2009. We analyzed data from 832 women between 35 and 69 years of age with a histopathological diagnosis of breast cancer. This study was performed in hospitals in 5 states. We used frequencies, measures of central tendency, and logistic regression. We used the svy package of STATA statistical software v17. RESULTS Overall, 15.6% of the study population reported that health professionals offered them selected services. The offer of two or more selected services was greater among women living in states with a very high marginalization index (21.8%) than among those living in states with a very low marginalization index (13.8%). Among women living in states with high marginalization, the odds of receiving a selected service offer were 2.03 times higher than those living in states with low marginalization (Odds ratio (OR) = 2.03, 95% CI 1.08-3.83). For women in the highest tertile of the asset index, the odds of receiving a selected service offer were 2.7 times greater than the odds for women in the lowest tertile (OR = 2.66, 95% CI 1.03-6.88). CONCLUSION The prevalence of comprehensive care offered to breast cancer patients is low in Mexico and varies according to the marginalization index and the asset index.
Collapse
Affiliation(s)
- R Aleja Gutiérrez Urzúa
- School of Public Health, National Institute of Public Health, Avenida Universidad No. 655, Colonia Santa María Ahuacatitlán, Cuernavaca, Morelos, 62100, Mexico
| | - Carlos Alfonso Hernández-Girón
- Population Health Research Center, National Institute of Public Health, Avenida Universidad No. 655, Colonia Santa María Ahuacatitlán, Cuernavaca, Morelos, 62100, Mexico
| | - Angélica Ángeles-Llerenas
- Population Health Research Center, National Institute of Public Health, Avenida Universidad No. 655, Colonia Santa María Ahuacatitlán, Cuernavaca, Morelos, 62100, Mexico
| | - Gabriela Torres-Mejía
- Population Health Research Center, National Institute of Public Health, Avenida Universidad No. 655, Colonia Santa María Ahuacatitlán, Cuernavaca, Morelos, 62100, Mexico.
| |
Collapse
|
6
|
Attieh S, Loiselle CG. Cancer Care Team Functioning during COVID-19: A Narrative Literature Review and Synthesis. Curr Oncol 2024; 31:335-349. [PMID: 38248107 PMCID: PMC10814830 DOI: 10.3390/curroncol31010022] [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: 11/28/2023] [Revised: 12/24/2023] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
Amid pandemics, health care teams face unprecedented challenges, requiring significant efforts to sustain optimal functioning and navigate rapid practice changes. It is therefore crucial to identify factors affecting team functioning in these contexts. The present narrative review more specifically summarizes the literature on key elements of cancer teams' functioning during COVID-19. The search strategy involved four main databases (i.e., Medline OVID, EMBASE, PsycINFO, and CINAHL), as well as Google Scholar, from January 2000 to September 2022. Twenty-three publications were found to be relevant. Each was read thoroughly, and its content summarized. Across publications, three key themes emerged: (1) swiftly adopting virtual technology for communication and interprofessional collaboration, (2) promoting team resilience, and (3) encouraging self-care and optimizing team support. Our findings underscore key team functioning elements to address in future pandemics. More research is needed to document the perspectives of broader-based team members (such as patients and lay carers) to inform more comprehensive evidence-based team functioning guidelines.
Collapse
Affiliation(s)
- Samar Attieh
- Department of Experimental Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H4A 3J1, Canada
| | - Carmen G. Loiselle
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H3A 2M7, Canada;
- Department of Oncology, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H4A 3T2, Canada
- Segal Cancer Center, CIUSSS Centre-Ouest, Montreal, QC H3T 1E2, Canada
| |
Collapse
|
7
|
Coutinho LM, Polisseni F. Fertility preservation for women diagnosed with breast cancer: looking beyond the horizon. Women Health 2023; 63:681-683. [PMID: 37822290 DOI: 10.1080/03630242.2023.2261685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
|
8
|
Izzo P, Izzo L, Polistena A, Sibio S, Codacci-Pisanelli M, Crocetti D, Gabriele R, De Intinis C, Izzo S. The management of locally advanced, ulcerated breast cancer in a menopausal woman: a case report. Ann Med Surg (Lond) 2023; 85:5176-5178. [PMID: 37811082 PMCID: PMC10553047 DOI: 10.1097/ms9.0000000000001187] [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: 07/21/2023] [Accepted: 08/07/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction and importance This case report presents the clinical details of a 46-year-old postmenopausal woman who was diagnosed with a locally advanced, ulcerated, hormone receptor-positive, HER2-negative stage 2B lobular carcinoma of the breast. The complexity of the case necessitated a multidisciplinary, personalized approach. Case presentation The patient, a postmenopausal woman, presented with locally advanced lobular carcinoma of the breast. The tumor was of significant size and exhibited ulceration. Given the hormone receptor-positive status of the tumor, a comprehensive treatment plan was formulated, taking into account the patient's overall health and potential tolerance to treatment. Surgical removal of the tumor was performed, followed by adjuvant therapy with aromatase inhibitors. Clinical discussion The complexity of this case highlights the importance of a personalized and patient-centered strategy in managing breast cancer. The patient's menopausal status, tumor characteristics, and potential tolerance to treatment were crucial factors that influenced the treatment plan. The successful outcome of the treatment and the patient's ability to tolerate the therapy underscores the significance of individualized treatment planning. Conclusion This case report emphasizes the necessity for a comprehensive and patient-centered approach to managing complex cases of breast cancer. The findings support the development of personalized therapeutic strategies aimed at improving patient outcomes and quality of life. The successful treatment of the locally advanced, ulcerated lobular carcinoma of the breast in this postmenopausal patient further highlights the importance of considering individual factors and tailoring treatment plans accordingly.
Collapse
Affiliation(s)
- Paolo Izzo
- “Sapienza” University of Rome, Department of Surgery “Pietro Valdoni”, Policlinico “Umberto I”, Rome
| | - Luciano Izzo
- “Sapienza” University of Rome, Department of Surgery “Pietro Valdoni”, Policlinico “Umberto I”, Rome
| | - Andrea Polistena
- “Sapienza” University of Rome, Department of Surgery “Pietro Valdoni”, Policlinico “Umberto I”, Rome
| | - Simone Sibio
- “Sapienza” University of Rome, Department of Surgery “Pietro Valdoni”, Policlinico “Umberto I”, Rome
| | - Massimo Codacci-Pisanelli
- “Sapienza” University of Rome, Department of Surgery “Pietro Valdoni”, Policlinico “Umberto I”, Rome
| | - Daniele Crocetti
- “Sapienza” University of Rome, Department of Surgery “Pietro Valdoni”, Policlinico “Umberto I”, Rome
| | - Raimondo Gabriele
- “Sapienza” University of Rome, Department of Surgery “Pietro Valdoni”, Policlinico “Umberto I”, Rome
| | - Claudia De Intinis
- “Sapienza” University of Rome, Department of Surgery “Pietro Valdoni”, Policlinico “Umberto I”, Rome
| | - Sara Izzo
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Plastic Surgery Unit, Università degli Studi della Campania “Luigi Vanvitelli”, Piazza Luigi Miraglia, Naples, Italy
| |
Collapse
|
9
|
Marrara B, Ibekwe O, Masika M, Attwood K, Gaudioso C, Nwogu C. Using an Adapted Tumor Board Evaluation Tool for Quality Assessment of a Thoracic Multidisciplinary Cancer Conference: A Pilot Study. JCO Clin Cancer Inform 2023; 7:e2300017. [PMID: 37797277 DOI: 10.1200/cci.23.00017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/24/2023] [Accepted: 05/17/2023] [Indexed: 10/07/2023] Open
Abstract
PURPOSE Multidisciplinary cancer conferences (MCCs) are crucial for the management of complex oncology patients. Tools to evaluate MCC performance are needed. The aim of this pilot study was to assess the applicability of an existing validated performance assessment tool to evaluate the quality of thoracic MCCs (T-MCCs). METHODS Data were collected from weekly T-MCCs over a 5-week period using the MCC Performance Assessment Tool and a self-assessment survey. Audio recordings were used to supplement observation notes. Case presentation, discussion duration, decision making contribution, recommendations, and consensus were captured. Quality of information and contribution were rated on a 1-5 scale. The data were analyzed using descriptive statistics to calculate means and composite scores representing overall MCC performance. RESULTS A total of 44 cases were observed at the T-MCC with the mean presentation and discussion time of 6 minutes and 22 seconds. Quality of case history, radiologic and pathological information, and reason for case discussion were rated above average (>3), whereas inclusion of comorbidities and patient views were rated below average. Surgical oncologists had a higher discussion contribution compared with medical and radiation oncologists (3.6 v 2.9 and 2.4, respectively). The overall mean composite score was 55.9 (deemed average) with no cases categorized as poor or excellent. Radiologists and pathologists had mean preparation times of 81.7 and 144.0 minutes, respectively. CONCLUSION This study demonstrated the applicability of a previously validated tool to assess the quality of a T-MCC at an academic comprehensive cancer center. The tool was found to be useful in identifying elements of the T-MCC process that needed improvement.
Collapse
Affiliation(s)
| | | | | | | | | | - Chukwumere Nwogu
- Roswell Park Cancer Institute, Buffalo, NY
- University at Buffalo, Buffalo, NY
| |
Collapse
|
10
|
Tannenbaum MF, Mehta TS, Phillips J, Du L, Mehta RJ, Brook A. Impact of imaging nurse navigation on breast interventions: Direct and closed-loop patient communication and documentation. Clin Imaging 2023; 101:37-43. [PMID: 37295232 DOI: 10.1016/j.clinimag.2023.05.015] [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: 03/29/2023] [Revised: 05/15/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE A breast imaging nurse navigator (NN) was established with the goals to enhance the patient experience after biopsy, improve care timeliness, accuracy, and coordination, facilitate direct communication to patients, and increase care retention within our system. Our aim was to determine the impact of NN on patient care time metrics, communication, documentation, compliance, and care retention at our institution after breast biopsy. METHODS Retrospective review of a six-month period before (5/1/17-10/31/17) and after (5/1/19-10/31/19) establishment of a nurse navigator in our breast imaging department was performed, including 498 patients in the pre-navigation (pre-NN) group and 526 patients in the post-navigation (post-NN) group. Data was gathered from the electronic medical record and collected using REDCap. RESULTS Biopsy pathology results were communicated directly to the patient more often post-NN (71%, 374/526) compared to pre-NN (4%, 21/498) (p < 0.0001), without change in overall time of result communication (p = 0.08). Due to factors outside of imaging, most care time metrics were longer post-NN, including days from biopsy to pathology report (p < 0.001), result communication to initiation of care (p < 0.001), and biopsy to surgery (p < 0.001). There was no difference and high compliance (p = 1) and care retention (p = 0.015) in both groups. There was improved documentation of pathology results, recommendations, and communication post-NN (0/526 vs 10/498, p = 0.001). CONCLUSION Imaging nurse navigation added greatest value by communicating breast biopsy results and recommendations directly to patients and ensuring documentation. Compliance and retention were high in both groups. Factors outside of Radiology influenced time metrics, requiring further investigation of multidisciplinary collaboration.
Collapse
Affiliation(s)
- Melissa F Tannenbaum
- Beth Israel Deaconess Medical Center, Department of Radiology, 330 Brookline Avenue, Boston, MA 02215, United States of America.
| | - Tejas S Mehta
- UMass Memorial Medical Center, Department of Radiology, 55 Lake Avenue North, Worcester, MA 01605, United States of America.
| | - Jordana Phillips
- Boston Medical Center, Department of Radiology, One Boston Medical Center Pl, Boston, MA 02118, United States of America.
| | - Linda Du
- Atrius Health, Department of Radiology, 133 Brookline Ave, Boston, MA 02215, United States of America.
| | - Rashmi J Mehta
- Newton Wellesley Hospital, Department of Radiology, 2014 Washington St, Newton, MA 02462, United States of America. https://twitter.com/RashmiMehtaMD
| | - Alexander Brook
- Beth Israel Deaconess Medical Center, Department of Radiology, 330 Brookline Avenue, Boston, MA 02215, United States of America.
| |
Collapse
|
11
|
Pangarsa EA, Rizky D, Tandarto K, Setiawan B, Santosa D, Hadiyanto JN, Kyana S, Suharti C. The effect of multidisciplinary team on survival rates of women with breast cancer: a systematic review and meta-analysis. Ann Med Surg (Lond) 2023; 85:2940-2948. [PMID: 37363480 PMCID: PMC10289736 DOI: 10.1097/ms9.0000000000000914] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/14/2023] [Indexed: 06/28/2023] Open
Abstract
Breast cancer is quite frequent all around the world. This disease was responsible for an estimated 2.1 million malignancies in 2022, making it the seventh-highest cause of cancer deaths globally. A multidisciplinary team (MDT) care policy was developed in the United Kingdom (UK) in 1995 to enhance the quality of care for cancer patients. The purpose of this systematic review and meta-analysis study is to assess the effects of MDT on breast cancer survival rates. Methods This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020. Systematic search was conducted in several international databases including Google Scholar, PubMed, EBSCOhost, and Proquest from 2012 to 2022. The authors used RevMan 5.4 to do the meta-analysis of the pooled hazard ratio. Newcastle-Ottawa Scale to measure the risk of bias. Newcastle-Ottawa Scale evaluated participant selection, comparability, and reporting of results using eight subscale items. Egger's test funnel plot was used to assess the potential publication bias for this study. Results A total of 1187 studies were identified from research database. The authors found a total of six studies from six different countries (China, the UK, Taiwan, Australia, Africa, and France) included for this study. Based on the meta-analysis of the pooled hazard ratio of the included studies, the authors found that the overall effect size of the study was 0.80 (CI 95%: 0.73-0.88). Conclusions Breast cancer patients who participated in well-organized MDT discussions had a greater survival rate than those who did not.
Collapse
Affiliation(s)
- Eko A. Pangarsa
- Hematology Medical Oncology Division, Department of Internal Medicine, Faculty of Medicine, Diponegoro University/Dr. Kariadi General Hospital Semarang, Indonesia
| | - Daniel Rizky
- Hematology Medical Oncology Division, Department of Internal Medicine, Faculty of Medicine, Diponegoro University/Dr. Kariadi General Hospital Semarang, Indonesia
| | - Kevin Tandarto
- Hematology Medical Oncology Division, Department of Internal Medicine, Faculty of Medicine, Diponegoro University/Dr. Kariadi General Hospital Semarang, Indonesia
| | - Budi Setiawan
- Hematology Medical Oncology Division, Department of Internal Medicine, Faculty of Medicine, Diponegoro University/Dr. Kariadi General Hospital Semarang, Indonesia
| | - Damai Santosa
- Hematology Medical Oncology Division, Department of Internal Medicine, Faculty of Medicine, Diponegoro University/Dr. Kariadi General Hospital Semarang, Indonesia
| | - Jessica N. Hadiyanto
- Department of Internal Medicine, Dr. Kariadi General Hospital/Faculty of Medicine, Diponegoro University, Indonesia
| | - Salma Kyana
- Department of Internal Medicine, Dr. Kariadi General Hospital/Faculty of Medicine, Diponegoro University, Indonesia
| | - Catharina Suharti
- Hematology Medical Oncology Division, Department of Internal Medicine, Faculty of Medicine, Diponegoro University/Dr. Kariadi General Hospital Semarang, Indonesia
| |
Collapse
|
12
|
English K, Alcorn SR, Tran HT, Smith KL, Wilkinson M, Hirose KT, O'Donnell M, Croog V, Wright JL. Adjuvant treatment decisions among adults aged 65 years and older with early-stage hormone receptor positive breast cancer seen in a simple multidisciplinary clinic versus standard consultation. J Geriatr Oncol 2023; 14:101503. [PMID: 37126898 DOI: 10.1016/j.jgo.2023.101503] [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: 09/11/2022] [Revised: 03/15/2023] [Accepted: 04/12/2023] [Indexed: 05/03/2023]
Abstract
INTRODUCTION Randomized studies support de-escalation of adjuvant therapy for a target population of older adults ≥65 years with stage I, estrogen-receptor (ER) positive breast cancer after breast conserving surgery. We sought to evaluate the impact of a simplified multidisciplinary clinic (s-MDC) in this population by comparing treatment patterns and patient perceptions of adjuvant radiation therapy (RT) and hormone therapy (HT) between patients seen in s-MDC vs. standard consultations. MATERIALS AND METHODS Medical records were retrospectively reviewed for patients in the above target population who underwent surgery between August 2020 and May 2022 at our institution. Two cohorts were included: (1) patients seen in s-MDC, and (2) patients seen in standard clinic separately by medical and radiation oncology (non-s-MDC cohort). The non-s-MDC patients declined, could not attend, and/or were not referred to the s-MDC. Patients in the s-MDC cohort were prospectively administered validated questionnaires to evaluate patient reported data including the Decision Autonomy Preference Scale (DAPS), e-Prognosis, and Medical Maximizing-Minimizing Scale (MMS). Chi square, t-tests, and non-parametric equivalents compared demographics, and logistic regression evaluated RT and HT use and survey score outcomes between cohorts. RESULTS A total of 127 patients met inclusion criteria, with 33 s-MDC and 94 non-s-MDC patients. There was no difference between the cohorts in age, margin status, histology, grade, or focality. In the s-MDC cohort there were significantly more patients without sentinel lymph node biopsy (71.3% vs 42.4%, p = 0.003) and mean tumor size was smaller (0.69 vs. 0.96 cm, p < 0.003), and Charlson comborbidity index (CCI) was higher (5.21 vs 4.96, p = 0.038). There was no significant difference in receipt of RT (65% s-MDC vs 77% standard; odds ratio [OR] = 0.55, p = 0.189), HT (78% ss-MDC vs 72% standard; OR = 1.36, p = 0.513), or both (50% s-MDC vs 59% standard; OR = 0.7, p = 0.429). The s-MDC cohort was significantly more likely to undergo accelerated (vs. standard hypofractionated) RT (70% vs 39%; OR = 3.59, p = 0.020). In s-MDC patients with completed questionnaires (n = 33), all whose selected "mostly patient (n=6)" based decision making by DAPS chose RT while all "mostly doctor (n=1)" chose no RT. Based on e-Prognosis, there were lower odds of RT for increasing Schonberg score/ higher 10 yr mortality risk (OR 0.600, p = 0.048). MMS score ≥ 40 ("maximizer") was strongly linked with the use of RT (OR 18.57, p = 0.011). DISCUSSION For adults ≥65 years with early stage, ER positive breast cancer, s-MDC participation was not significantly associated with lower use of adjuvant RT or HT versus standard consultation but was significantly associated with shorter RT courses. DAPS and MMS results indicate that patient treatment preference may be predictable, highlighting an opportunity to tailor consultation discussions and recommendations based on intrinsic patient preferences and individual goals.
Collapse
Affiliation(s)
- Keara English
- The Johns Hopkins Department of Radiation Oncology, 401 North Broadway, Weinberg Building, Suite 1440, Baltimore, MD 21287, United States of America
| | - Sara R Alcorn
- The Johns Hopkins Department of Radiation Oncology, 401 North Broadway, Weinberg Building, Suite 1440, Baltimore, MD 21287, United States of America
| | - Hanh-Tam Tran
- The Johns Hopkins Department of Radiation Oncology, 401 North Broadway, Weinberg Building, Suite 1440, Baltimore, MD 21287, United States of America
| | - Karen Lisa Smith
- The Johns Hopkins Department of Radiation Oncology, 401 North Broadway, Weinberg Building, Suite 1440, Baltimore, MD 21287, United States of America
| | - Mary Wilkinson
- The Johns Hopkins Department of Radiation Oncology, 401 North Broadway, Weinberg Building, Suite 1440, Baltimore, MD 21287, United States of America
| | - Kelly Tadken Hirose
- The Johns Hopkins Department of Radiation Oncology, 401 North Broadway, Weinberg Building, Suite 1440, Baltimore, MD 21287, United States of America
| | - Maureen O'Donnell
- The Johns Hopkins Department of Radiation Oncology, 401 North Broadway, Weinberg Building, Suite 1440, Baltimore, MD 21287, United States of America
| | - Victoria Croog
- The Johns Hopkins Department of Radiation Oncology, 401 North Broadway, Weinberg Building, Suite 1440, Baltimore, MD 21287, United States of America
| | - Jean L Wright
- The Johns Hopkins Department of Radiation Oncology, 401 North Broadway, Weinberg Building, Suite 1440, Baltimore, MD 21287, United States of America.
| |
Collapse
|
13
|
Bò MC, Merlo A, Ligabue MB, Bassi MC, Lusuardi M, Campanini I. Self-managed physical activity in breast cancer survivors: A scoping review. PLoS One 2023; 18:e0284807. [PMID: 37093839 PMCID: PMC10124851 DOI: 10.1371/journal.pone.0284807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/01/2023] [Indexed: 04/25/2023] Open
Abstract
OBJECTIVE Breast cancer survivors (BCS) experience many issues of rehabilitative concern due to the treatments they have undergone. Given the chronicity of these outcomes, the increasing number of survivors, and the positive results obtained by supervised exercise, professionals should consider offering self-managed physical activity (PA) programs to this population. Our aim was to map the currently available evidence about self-care rehabilitation for BCS. METHODS Medline, CINAHL, and Cochrane databases were searched for primary literature. Scoping review methodological frameworks were used to tackle the heterogeneity of the topic. Studies investigating self-managed PA interventions prescribed to adult BCS were included. RESULTS One hundred-eight studies were included, with sample sizes ranging from 6 to 692 patients. Information was systematically collected in tables displaying study design, type of PA, duration and recommended frequency, professional leading the study, type of supervision, initial training, strategies used to help patients integrate self-care into their daily lives, and self-managed PA efficacy. Tables were produced for every oncological side effect that BCS might experience: lymphedema, arthralgia, cancer-related fatigue, a decline in physical parameters, treatment-related cardiotoxicity, peripheral neurotoxicity, and a possible decline in the quality of life. CONCLUSIONS Self-managed PA has the potential to improve BCS oncological issues. Professionals can adopt many strategies to support patients and empower them with long-lasting self-care competencies. This scoping review provided a comprehensive and easy-to-consult overview of self-managed PA interventions for BCS. We also provided recommendations for future primary studies and secondary synthesis.
Collapse
Affiliation(s)
- Maria Chiara Bò
- LAM-Motion Analysis Laboratory, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, San Sebastiano Hospital, Correggio (Reggio Emilia), Italy
- Merlo Bioengineering, Parma, Italy
| | - Andrea Merlo
- LAM-Motion Analysis Laboratory, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, San Sebastiano Hospital, Correggio (Reggio Emilia), Italy
- Merlo Bioengineering, Parma, Italy
| | - Maria Bernadette Ligabue
- Motor Rehabilitation Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, San Sebastiano Hospital, Correggio (Reggio Emilia), Italy
| | - Maria Chiara Bassi
- Medical Library, Azienda USL-IRCCS di Reggio Emilia, Correggio (Reggio Emilia), Italy
| | - Mirco Lusuardi
- Neuromotor and Rehabilitation Department, Azienda USL-IRCCS Reggio Emilia, Correggio (Reggio Emilia), Italy
| | - Isabella Campanini
- LAM-Motion Analysis Laboratory, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, San Sebastiano Hospital, Correggio (Reggio Emilia), Italy
| |
Collapse
|
14
|
Sanchez JI, Doose M, Zeruto C, Chollette V, Gasca N, Verhoeven D, Weaver SJ. Multilevel factors associated with inequities in multidisciplinary cancer consultation. Health Serv Res 2022; 57 Suppl 2:222-234. [PMID: 35491756 PMCID: PMC9670237 DOI: 10.1111/1475-6773.13996] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To assess changes in the prevalence of multidisciplinary cancer consultations (MDCc) over the last decade and examine patient, surgeon, hospital, and neighborhood factors associated with receipt of MDCc among individuals diagnosed with cancer. DATA SOURCE Surveillance, Epidemiology and End Results (SEER)-Medicare data from 2006 to 2016. STUDY DESIGN We used time-series analysis to assess change in MDCc prevalence from 2007 to 2015. We also conducted multilevel logistic regression with random surgeon- and hospital-level effects to assess associations between patient, surgeon, neighborhood, and health care organization-level factors and receipt of MDCc during the cancer treatment planning phase, defined as the 2 months following cancer diagnosis. DATA COLLECTION/EXTRACTION METHODS We identified Medicare beneficiaries >65 years of age with surgically resected breast, colorectal (CRC), or non-small cell lung cancer (NSCLC) stages I-III (n = 103,250). PRINCIPAL FINDINGS From 2007 to 2015, the prevalence of MDCc increased from 35.0% to 61.2%. Overall, MDCc was most common among patients with breast cancer compared to CRC and NSCLC. Cancer patients who were Black, had comorbidities, had dual Medicare-Medicaid coverage, were residing in rural areas or in areas with higher Black and Hispanic neighborhood composition were significantly less likely to have received MDCc. Patients receiving surgery at disproportionate payment-sharing or rural-designated hospitals had 2% (95% CI: -3.55, 0.58) and 17.6% (95% CI: -21.45, 13.70), respectively, less probability of receiving MDCc. Surgeon- and hospital-level effects accounted for 15% of the variance in receipt of MDCc. CONCLUSIONS The practice of MDCc has increased over the last decade, but significant geographical and health care organizational barriers continue to impede equitable access to and delivery of quality care across cancer patient populations. Multilevel and multicomponent interventions that target care coordination, health system, and policy changes may enhance equitable access to and receipt of MDCc.
Collapse
Affiliation(s)
- Janeth I. Sanchez
- Health Systems and Interventions Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population SciencesNational Cancer InstituteRockvilleMarylandUSA
| | - Michelle Doose
- Division of Clinical and Health Services ResearchNational Institute on Minority Health and Health DisparitiesBethesdaMarylandUSA
| | - Chris Zeruto
- Information Management Services, Inc.CalvertonMarylandUSA
| | - Veronica Chollette
- Health Systems and Interventions Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population SciencesNational Cancer InstituteRockvilleMarylandUSA
| | - Natalie Gasca
- School of Public Health, Department of BiostatisticsUniversity of WashingtonSeattleWashingtonUSA
| | - Dana Verhoeven
- Health Systems and Interventions Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population SciencesNational Cancer InstituteRockvilleMarylandUSA
| | - Sallie J. Weaver
- Health Systems and Interventions Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population SciencesNational Cancer InstituteRockvilleMarylandUSA
| |
Collapse
|
15
|
Di Pilla A, Cozzolino MR, Mannocci A, Carini E, Spina F, Castrini F, Grieco A, Messina R, Damiani G, Specchia ML. The Impact of Tumor Boards on Breast Cancer Care: Evidence from a Systematic Literature Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14990. [PMID: 36429708 PMCID: PMC9690234 DOI: 10.3390/ijerph192214990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/03/2022] [Accepted: 11/08/2022] [Indexed: 06/16/2023]
Abstract
Breast cancer is the most common malignancy in women, with a complex clinical path that involves several professionals and that requires a multidisciplinary approach. However, the effectiveness of breast cancer multidisciplinary care and the processes that contribute to its effectiveness have not yet been firmly determined. This study aims to evaluate the impact of multidisciplinary tumor boards on breast cancer care outcomes. A systematic literature review was carried out through Scopus, Web of Science and Pubmed databases. The search was restricted to articles assessing the impact of MTB implementation on breast cancer care. Fourteen studies were included in the review. The most analyzed outcomes were diagnosis, therapy and survival. Four out of four studies showed that, with implementation of an MTB, there was a change in diagnosis, and all reported changes in the treatment plan after MTB implementation. A pooled analysis of three studies reporting results on the outcome "mortality" showed a statistically significant 14% reduction in mortality relative risk for patients enrolled versus not enrolled in an MTB. This study shows that MTB implementation is a valuable approach to deliver appropriate and effective care to patients affected by breast cancer and to improve their outcomes.
Collapse
Affiliation(s)
- Andrea Di Pilla
- Clinical Governance Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | | | - Alice Mannocci
- Faculty of Economics, Università “Universitas Mercatorum”, Piazza Mattei 10, 00186 Rome, Italy
| | | | - Federica Spina
- Department of Maternal, Children and Adult Medical and Surgical Sciences, Università degli Studi di Modena e Reggio Emilia, 41121 Modena, Italy
| | - Francesco Castrini
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Albino Grieco
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Rosaria Messina
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Gianfranco Damiani
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
- Women, Children and Public Health Sciences Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Maria Lucia Specchia
- Clinical Governance Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| |
Collapse
|
16
|
Farhadi DS, Cavagnaro MJ, Orenday-Barraza JM, Avila MJ, Hussein A, Kisana H, Dowell A, Khan N, Strouse IM, Alvarez Reyes A, Ravinsky R, Baaj AA. Do Multidisciplinary Spine Conferences Alter Management or Impact Outcome? World Neurosurg 2022; 166:192-197. [PMID: 35961589 DOI: 10.1016/j.wneu.2022.08.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 08/03/2022] [Accepted: 08/04/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Multidisciplinary spine conferences (MSCs) are a strategy for discussing diagnostic and treatment aspects of patient care. Although they are becoming more common in hospitals, literature investigating how they impact patient care and outcomes is scarce. The aim of this study is to examine the impact of MSCs on surgical management and outcomes in elective spine surgical care. METHODS A systematic review of the literature was conducted to evaluate the impact of MSCs on patient management and outcomes. PubMed and Cochrane databases were searched using combinations and variations of search terms "Spine Conferences," "Multidisciplinary," and "Spine Team." RESULTS The literature search yielded 435 articles, of which 120 were selected for full-text review. Four articles (N = 529 patients) were included. Surgical plans were discussed in 211 patients. The decision was altered to conservative treatment in 70 patients (33.17%) and a different surgical strategy in 34 patients (16.11%). The differences were significant in 2 studies (P < 0.05). A 51% reduction in 30-day complications rates was observed when MSC was implemented in patients with adult complex scoliosis. Other spinal disorders showed a 30-day complication rate between 0% and 14% after MSC. CONCLUSIONS To our knowledge, this is the first systematic review of outcomes of MSCs in elective spine surgery and it confirms that MSCs impact management plan and outcomes. Consistent MSCs that include surgeons and nonsurgeons have the potential to enhance communication between specialists, standardize treatments, improve patient care, and encourage teamwork. More analysis is warranted to determine if patient outcomes are improved with these measures.
Collapse
Affiliation(s)
- Dara S Farhadi
- Department of Neurosurgery, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA.
| | - María José Cavagnaro
- Department of Neurosurgery, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA
| | | | - Mauricio J Avila
- Department of Neurosurgery, University of Arizona College of Medicine-Tucson, Tucson, Arizona, USA
| | - Amna Hussein
- Department of Neurosurgery, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA
| | - Haroon Kisana
- Department of Orthopedic Surgery, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA
| | - Aaron Dowell
- Department of Neurosurgery, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA
| | - Naushaba Khan
- Department of Neurosurgery, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA
| | - Isabel M Strouse
- Department of Neurosurgery, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA
| | - Angelica Alvarez Reyes
- Department of Neurosurgery, University of Arizona College of Medicine-Tucson, Tucson, Arizona, USA
| | - Robert Ravinsky
- Department of Orthopedic Surgery, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA
| | - Ali A Baaj
- Department of Neurosurgery, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA; Department of Orthopedic Surgery, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA
| |
Collapse
|
17
|
Sanna V, Fedele P, Deiana G, Alicicco MG, Ninniri C, Santoro AN, Pazzola A, Fancellu A. Edmonton Symptom Assessment Scale may reduce medical visits in patients undergoing chemotherapy for breast cancer. World J Clin Oncol 2022; 13:577-586. [PMID: 36157162 PMCID: PMC9346425 DOI: 10.5306/wjco.v13.i7.577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 06/05/2022] [Accepted: 06/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Adjuvant chemotherapy is recommended in high-risk breast cancer. However, no universally accepted guidelines exist on pre-chemotherapy assessment. In particular, the number and frequency of medical visits vary according to each institution’s policy. We hypothesised that the Edmonton Symptom Assessment Scale (ESAS) may have a favourable impact on the pre-treatment assessment in candidates for adjuvant chemotherapy.
AIM To investigate whether the ESAS can be used to safely reduce the number of medical visits in women with breast cancer undergoing adjuvant chemotherapy.
METHODS In a retrospectively prospective matched-pair analysis, 100 patients who completed the ESAS questionnaire before administration of adjuvant chemotherapy (ESAS Group) were compared with 100 patients who underwent chemotherapy according to the traditional modality, without ESAS (no-ESAS Group). Patients of the ESAS Group received additional visits before treatment if their ESAS score was > 3. The primary endpoint was the total number of medical visits during the entire duration of the chemotherapy period. The secondary endpoints were the occurrence of severe complications (grade 3-4) and the number of unplanned visits during the chemotherapy period.
RESULTS The study variables did not statistically differ between patients of the ESAS Group and no-ESAS Group (age P = 0.880; breast cancer stage P = 0.56; cancer histology P = 0.415; tumour size P = 0.258; lymph node status P = 0.883; immunohistochemical classification P = 0.754; type of surgery P = 0.157), except for premenopausal status (P = 0.015). The study variables did not statistically differ between patients of the ESAS Group and no-ESAS Group regarding age, cancer stage, histology, tumour size, lymph node status, immunohistochemical classification, and type of surgery. Unplanned visits during the entire duration of chemotherapy were 8 in the ESAS Group and 18 in the no-ESAS Group visits (P = 0.035). Grade 3-4 toxicity did not differ between the study groups (P = 0.652). Forty-eight patients of the ESAS Group received additional visits due to an ESAS score > 3. The mean number of medical visits was 4.38 ± 0.51 in the ESAS Group and 16.18 ± 1.82 in the no-ESAS group (P < 0.001). With multivariate analysis, women of the ESAS group were more likely to undergo additional visits for an ESAS score > 3 if they were aged 60 or older, received a mastectomy, or had tumour stage II/III.
CONCLUSION The ESAS score may safely reduce the number of medical visits in candidates for adjuvant chemotherapy for early breast cancer. Our results suggest that the ESAS score may be used for selecting a group of breast cancer patients for whom it is safe to reduce the number of medical visits in the setting of adjuvant chemotherapy. This may translate into several advantages, such as a more rational utilization of human resources and a possible reduction of coronavirus pandemic infection risk in oncologic patients.
Collapse
Affiliation(s)
- Valeria Sanna
- Unit of Medical Oncology, A.O.U. Sassari, Sassari 07100, Italy
| | - Palma Fedele
- Unit of Medical Oncology, Hospital “D. Camberlingio”, Francavilla Fontana 72100, Brindisi, Italy
| | - Giulia Deiana
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari 07100, Italy
| | | | - Chiara Ninniri
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari 07100, Italy
| | - Anna N Santoro
- Unit of Medical Oncology, Hospital “D. Camberlingio”, Francavilla Fontana 72100, Brindisi, Italy
| | - Antonio Pazzola
- Unit of Medical Oncology, A.O.U. Sassari, Sassari 07100, Italy
| | - Alessandro Fancellu
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari 07100, Italy
| |
Collapse
|
18
|
Bortot L, Targato G, Noto C, Giavarra M, Palmero L, Zara D, Bertoli E, Dri A, Andreetta C, Pascoletti G, Poletto E, Russo S, Seriau L, Mansutti M, Cedolini C, Basile D, Fasola G, Bonotto M, Minisini AM. Multidisciplinary Team Meeting Proposal and Final Therapeutic Choice in Early Breast Cancer: Is There an Agreement? Front Oncol 2022; 12:885992. [PMID: 35747814 PMCID: PMC9209643 DOI: 10.3389/fonc.2022.885992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/12/2022] [Indexed: 11/13/2022] Open
Abstract
Background A multidisciplinary team meeting (MDM) approach in breast cancer (BC) management is a standard of care. One of the roles of MDMs is to identify the best diagnostic and therapeutic strategies for patients (pts) with new diagnosis of early BC. The purpose of this study was to define whether there was an agreement between the planned program (i.e., MDMs-based decision) and that actually applied. In addition, the study explored factors associated with discordance. Methods We conducted a retrospective study of a consecutive series of 291 patients with new diagnosis of early BC, discussed at MDMs at the University Hospital of Udine (Italy), from January 2017 to June 2018. The association between clinico-biological factors and discordance between what was decided during the MDMs and what was consequently applied by the oncologist was explored through uni- and multivariate logistic regression analyses. Results The median age was 62 years (range 27–88 years). Among invasive early BC patients, the most frequent phenotype was luminal A (38%), followed by luminal B (33%), HER2-positive (12%), and triple-negative (5%). In situ carcinoma (DCIS) represented 12% of cases. The median time from MDM discussion to first oncologic examination was 2 weeks. The rate of discordance between MDM-based decision and final choice, during a face-to-face consultation with the oncologist, was 15.8% (46/291). The most frequent reason for changing the MDM-based program was clinical decision (87%). Follow-up was preferred to the chemotherapy (CT) proposed within the MDMs in 15% of cases, and to the endocrine therapy (ET) in 39% of cases (among these, 44.5% had a diagnosis of DCIS). Therapeutic change from sequential CT-ET to ET alone was chosen in 16/46 pts (35%): among these patients, seven had a luminal B disease and six had an HER2-positive disease. On univariate analysis, factors associated with discordance were values of Ki-67 14%–30% (OR 3.91; 95% CI 1.19–12.9), age >70 years (OR 2.44, 95% CI 1.28–4.63), housewife/retired status (OR 2.35, 95% CI 1.14–4.85), polypharmacy (OR 1.95; 95% CI 1.02–3.72), postmenopausal status (OR 4.15; 95% CI 1.58–10.9), and high Charlson Comorbidity Index (OR 1.31; 95% CI 1.09–1.57). The association with marital status, educational level, alcohol and smoke habits, presence of a caregiver, parity, grading, histotype and phenotype, and stage was not statistically significant. On multivariate analysis, only Ki-67 value maintained its statistical significance. Conclusion The results of our study could be useful for enhancing the role of MDMs in the clinical decision-making process in early BC.
Collapse
Affiliation(s)
- Lucia Bortot
- Department of Medicine (DAME), University of Udine, Udine, Italy
- Department of Medical Oncology, Academic Hospital of Udine, Udine, Italy
- *Correspondence: Lucia Bortot,
| | - Giada Targato
- Department of Medicine (DAME), University of Udine, Udine, Italy
- Department of Medical Oncology, Academic Hospital of Udine, Udine, Italy
| | - Claudia Noto
- Department of Medicine (DAME), University of Udine, Udine, Italy
- Department of Medical Oncology, Academic Hospital of Udine, Udine, Italy
| | - Marco Giavarra
- Department of Oncology, Ospedale Santo Spirito, Casale Monferrato, Italy
| | - Lorenza Palmero
- Department of Medicine (DAME), University of Udine, Udine, Italy
- Department of Medical Oncology, Aviano Oncology Reference Center, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Aviano, Italy
| | - Diego Zara
- Department of Medicine (DAME), University of Udine, Udine, Italy
- Department of Medical Oncology, Aviano Oncology Reference Center, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Aviano, Italy
| | - Elisa Bertoli
- Department of Medicine (DAME), University of Udine, Udine, Italy
- Department of Medical Oncology, Aviano Oncology Reference Center, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Aviano, Italy
| | - Arianna Dri
- Department of Medicine (DAME), University of Udine, Udine, Italy
- Department of Medical Oncology, Academic Hospital of Udine, Udine, Italy
| | - Claudia Andreetta
- Department of Medical Oncology, Academic Hospital of Udine, Udine, Italy
| | - Gaetano Pascoletti
- Department of Medical Oncology, Academic Hospital of Udine, Udine, Italy
| | - Elena Poletto
- Department of Medical Oncology, Academic Hospital of Udine, Udine, Italy
| | - Stefania Russo
- Department of Medical Oncology, Academic Hospital of Udine, Udine, Italy
| | - Luca Seriau
- Breast Surgery, Department of Medicine (DAME), University Hospital of Udine, Udine, Italy
| | - Mauro Mansutti
- Department of Medical Oncology, Academic Hospital of Udine, Udine, Italy
| | - Carla Cedolini
- Breast Surgery, Department of Medicine (DAME), University Hospital of Udine, Udine, Italy
| | - Debora Basile
- Department of Medical Oncology, San Giovanni di Dio Hospital, Crotone, Italy
| | - Gianpiero Fasola
- Department of Medical Oncology, Academic Hospital of Udine, Udine, Italy
| | - Marta Bonotto
- Department of Medical Oncology, Academic Hospital of Udine, Udine, Italy
| | | |
Collapse
|
19
|
Barrios C, Sánchez-Vanegas G, Villarreal-Garza C, Ossa A, Lombana MA, Monterrosa-Blanco A, Ferrigno AS, Castro CA. Barriers and facilitators to provide multidisciplinary care for breast cancer patients in five Latin American countries: A descriptive-interpretative qualitative study. LANCET REGIONAL HEALTH. AMERICAS 2022; 11:100254. [PMID: 36778924 PMCID: PMC9904076 DOI: 10.1016/j.lana.2022.100254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background Multidisciplinary care (MDC) remains a cornerstone for breast cancer management as it is associated with improved quality of care and patient outcomes. However, the adoption of MDC practice is heterogeneous and has been poorly explored in Latin America. The objective was to describe barriers and possible facilitators for providing MDC to breast cancer patients in five Latin American countries. Methods A panel of experts with an active clinical practice in Bolivia, Colombia, Ecuador, Mexico, and Uruguay was convened to identify barriers and facilitators to MDC. This study is a qualitative synthesis of a structured discussion regarding the state of MDC in the setting of breast cancer. Findings Experts recognized that most oncology practices in Latin America do not apply a multidisciplinary approach for breast cancer patients. Predominant barriers for MDC are fragmentation of health services, being understaffed, inadequate infrastructure, and geographic disparities. Access to MDC varies widely in the region, with significant heterogeneity documented within countries. MDC practice was described as being more common in the private sector in Ecuador and Uruguay, while it is more widely implemented in public institutions of Colombia and Bolivia. Interpretation Establishing quality MDC remains a challenge for oncology practices in Latin America. Addressing regional issues and identifying specific local needs is warranted to encourage the adoption of an effective multidisciplinary approach and, consequently, improve clinical outcomes. Active involvement of all stakeholders is required to build locally solutions and should involve institutions, health professionals, and patients. Funding Research was funded by Productos Roche S.A.
Collapse
Affiliation(s)
- Carlos Barrios
- Oncoclinicas Group, Oncology Research Center, Hospital São Lucas, PUCRS Latin-American Cooperative Oncology Group (LACOG), Rio Grande do Sul, RS, Brazil
| | - Guillermo Sánchez-Vanegas
- Soluciones Integrales Para la Investigación y la Educación en Salud – SIIES Consultores, Cr 45ª #106ª-20, Bogotá, Cundinamarca, Colombia,Fundación Universtiaria de Ciencias de la Salud-FUCS, Bogotá, Colombia.,Corresponding author.
| | - Cynthia Villarreal-Garza
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, San Pedro Garza García, Nuevo León, México
| | - Andrés Ossa
- Coordinator Breast Cancer Department Hospital General de Medellín, Medellín, Antioquia, Colombia
| | - Milton A. Lombana
- Scientific Medical Head at Comprehensive Cancer Center, Clinica de Occidente, Cali, Valle del Cauca, Colombia
| | - Angélica Monterrosa-Blanco
- Soluciones Integrales Para la Investigación y la Educación en Salud – SIIES Consultores, Cr 45ª #106ª-20, Bogotá, Cundinamarca, Colombia
| | - Ana S. Ferrigno
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, San Pedro Garza García, Nuevo León, México
| | - Carlos Alberto Castro
- Soluciones Integrales Para la Investigación y la Educación en Salud – SIIES Consultores, Cr 45ª #106ª-20, Bogotá, Cundinamarca, Colombia,Fundación Universtiaria de Ciencias de la Salud-FUCS, Bogotá, Colombia
| |
Collapse
|
20
|
Russo M, Boehler-Tatman M, Albright C, David C, Kennedy L, Roberts AW, Shalhub S, Afifi R. Aortic dissection in pregnancy and the postpartum period. Semin Vasc Surg 2022; 35:60-68. [PMID: 35501042 DOI: 10.1053/j.semvascsurg.2022.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/16/2022] [Accepted: 02/16/2022] [Indexed: 01/18/2023]
Abstract
Pregnancy-associated aortic dissection (AD) is a rare event, with an incidence of 0.0004% per pregnancy. The work of the Aortic Dissection Collaborative identified pregnancy-associated AD as a high-priority topic, despite its rarity. The Pregnancy Working Group, which included physicians and patient stakeholders, performed a systematic literature review of pregnancy-associated AD from 1960 to 2021 and identified 6,333 articles through PubMed, OVID MEDLINE, Cochrane, Embase, CINAHL and Web of Science. The inclusion criterion was AD in pregnant populations and exclusion criteria were case reports, conference abstracts, and languages other than English. Assessment of full-text articles for eligibility after removal of duplicates from all databases yielded 68 articles to be included in the final review. Topics included were timing of AD in pregnancy, type of AD, and management considerations of pregnancy-associated AD. The Pregnancy Working Group identified gaps in knowledge and future areas of research for pregnancy-associated AD, including clinical management, mental health outcomes post AD, reproductive and genetic counseling, and contraception after AD. Future collaborative projects could be a multicenter, international registry for all pregnancy-associated AD to refine the risk factors, best practice and management of AD in pregnancy. In addition, future mixed methodology studies may be useful to explore social, mental, and emotional factors related to pregnancy-associated AD and to determine support groups' effect on anxiety and depression related to these events in the pregnancy and postpartum period.
Collapse
Affiliation(s)
- Melissa Russo
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Women and Infants Hospital, Providence, Warren Alpert Medical School of Brown University, Providence, RI
| | | | - Catherine Albright
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Washington Medical Center, Seattle, WA
| | - Carmen David
- Aortic Dissection Collaborative Patient Stakeholder Group, Bedford, TX
| | | | - Aaron W Roberts
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center, Houston, TX
| | - Sherene Shalhub
- Division of Vascular Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA
| | - Rana Afifi
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), 6400 Fannin Street, Suite #2850, Houston, TX 77030.
| | | |
Collapse
|
21
|
Barrios CH. Global challenges in breast cancer detection and treatment. Breast 2022; 62 Suppl 1:S3-S6. [PMID: 35219542 PMCID: PMC9097801 DOI: 10.1016/j.breast.2022.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 02/01/2022] [Accepted: 02/04/2022] [Indexed: 01/03/2023] Open
Abstract
Breast cancer represents an urgent global priority. While this is a universal issue, and as the burden of the disease is increasing globally, current estimates indicate that in the next couple of decades, much of the incidence and mortality related to breast cancer will be seen in underserved populations. The fragile and ill-prepared healthcare systems in low- and middle-income countries (LMIC) need to address this challenge and find solutions with their limited resources. Significant disparities can be identified in stage at presentation as the ability to detect the disease in earlier stages is compromised in these scenarios leading to worse outcomes associated to late diagnoses. Furthermore, access to healthcare in general and to basic surgical, radiotherapy and systemic care is suboptimal additionally limiting treatment results. With a small portion of their budget allocated to healthcare, LMIC need to make the most of their resources prioritizing cost-effective strategies that could offer the best possible results. Countries that invest in women's health do develop into healthier, more educated, and importantly, more productive societies with benefits seen across generations. Finally, recognition of inequities should stimulate a concerted effort engaging all involved stakeholders to find context-adapted solutions to improve healthcare outcomes.
Collapse
Affiliation(s)
- Carlos H Barrios
- Latin American Cooperative Oncology Group (LACOG) - Porto Alegre, Brazil Oncoclinicas Group, Porto Alegre, Brazil.
| |
Collapse
|
22
|
Druel V, Gimenez L, Tachousin P, Boussier N, Bauvin E, Pascale G, Beyne-Rauzy O, Rougé Bugat ME. Adapting patients' oncological treatment through remote participation of general practitioners in multi-disciplinary consultation meetings: A feasibility study. Eur J Gen Pract 2022; 28:15-22. [PMID: 35179084 PMCID: PMC8865098 DOI: 10.1080/13814788.2021.2003775] [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] [Indexed: 12/24/2022] Open
Abstract
Background The general practitioner (GP) is central to managing patients with cancer, whose numbers are increasing worldwide. The GP’s involvement requires better coordination between involved partners, in particular oncologists and GPs. Objectives To conduct a feasibility study of remote participation of GPs in multi-disciplinary consultation meetings (MCMs). We analysed participation, participants’ satisfaction, and their impact on therapeutic decisions. Methods We conducted a feasibility study in the regional cancer centre of Toulouse, France. All patient cases discussed in the MCMs for myelodysplasia from 1 January to 31 March 2016 were included. Cases of patients aged over 18 years, with a diagnosis of myelodysplasia and registered with a GP were included if patients gave informed consent. One investigator collected the data provided by GPs during three telephone or video calls: before, during, and after the MCM, respectively. Results Of 86 patient cases discussed during three months of MCMs, 44 were eligible for GP participation; 27 GPs participated in discussions of 27 patient cases. The GP’s participation in the MCM led to a change in management in five cases, with four times treatment intensifications and once de-intensification. Medical, social, family-related, and psychological domains were discussed with input from the GPs. Overall, all participants were satisfied with the MCMs. Conclusion Remote participation of GPs in MCMs is feasible and may result in adapting oncological and haematological management for patients. This patient-centred approach requires a specific organisation that, when implemented, satisfies the needs of all participants.
Collapse
Affiliation(s)
- Vladimir Druel
- Department of Primary Care, University of Toulouse, Toulouse, France.,Oncology Unit, Auch Hospital, Auch, France.,Paul Sabatier University-Toulouse III, Toulouse, France
| | - Laetitia Gimenez
- Department of Primary Care, University of Toulouse, Toulouse, France.,Paul Sabatier University-Toulouse III, Toulouse, France.,Faculty of Medicine, Inserm U1027, Toulouse, France
| | | | | | - Eric Bauvin
- Onco-Occitanie, Réseau Régional de Cancérologie, Toulouse, France
| | | | - Odile Beyne-Rauzy
- Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Marie-Eve Rougé Bugat
- Department of Primary Care, University of Toulouse, Toulouse, France.,Paul Sabatier University-Toulouse III, Toulouse, France.,Faculty of Medicine, Inserm U1027, Toulouse, France.,Onco-Occitanie, Réseau Régional de Cancérologie, Toulouse, France.,Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| |
Collapse
|
23
|
Karadeniz Cakmak G. Innovative Standards in Oncoplastic Breast Conserving Surgery: From Radical Mastectomy to Extreme Oncoplasty. Breast Care (Basel) 2022; 16:559-573. [PMID: 35087359 DOI: 10.1159/000518992] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/11/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Oncoplastic breast conserving surgery (OBCS), which is the current procedure of choice for eligible BC patients, describes a philosophy that prioritizes oncologic and cosmetic outcomes. However, knowledge gaps regarding training, acceptance, and practice preclude standardization and make it difficult to design algorithmic guidelines to optimize individualized management in the era of precision medicine. SUMMARY The harmony between patient expectations and oncologic goals creates the state of the art of OBCS. Nevertheless, to achieve these goals, multidisciplinary approach is a must. Surgical decisions require a comprehensive evaluation including patient factors, tumor biology, genetics, technical considerations, and adjunct therapies. Moreover, the quality-of-life (QOL) issues should be considered as the highest level of priority with a shared decision making instituted on realistic discussions with the patient. KEY MESSAGES The standardization in OBCS should be initiated via defining a breast surgeon who should gain theorical and practical competence on techniques via national or international educational programs. The algorithmic patient assessment with appropriate documentation before and after surgery should be established. A simple and safe global lexicon should be designed regarding techniques to be proposed and quality metrics to be considered. Additionally, international multicenter prospective trials should be instituted to overcome knowledge gaps. It is evident that OBCS is the perfect union of science with art. Nevertheless, at the very end, the question is not the nature of the surgeon/artist who would be the extremist, the innovator, or the conservative, but the patient's satisfaction, prognosis, and QOL that conclude the cascade of state of the art of OBCS.
Collapse
|
24
|
Guay E, Cordeiro E, Roberts A. Time to treatment and hospital visits for patients undergoing neoadjuvant chemotherapy for breast cancer in a single payer system. J Surg Oncol 2022; 125:824-830. [PMID: 34989410 DOI: 10.1002/jso.26786] [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: 10/28/2021] [Revised: 12/07/2021] [Accepted: 12/18/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND OBJECTIVES Neoadjuvant chemotherapy (NAC) requires coordination of various services to ensure timely and accurate delivery of care. This can result in multiple hospital visits and extend time to treatment (TTT). The primary purpose of our study was to evaluate time to NAC for patients at a regional cancer centre. Healthcare resource use in the form of hospital visits before NAC was also evaluated. METHODS A retrospective chart analysis of patients with invasive breast cancer who underwent NAC between 1 January 2012 and 31 December 2018 was performed. RESULTS Overall, 286 patients underwent NAC. Median TTT was 22 days (range: 2-105). Median number of visits between first consultation and NAC was 5 (range: 0-12). Majority of additional visits were for diagnostic imaging/interventions, with a median number of 4 visits (range: 0-10). Each additional hospital visit increased time to NAC treatment by 14%. CONCLUSIONS Women undergoing NAC require multiple visits before initiating treatment-the majority of these visits are for diagnostic imaging. These results support the need for the coordination of multidisciplinary care and diagnostic imaging for breast cancer patients undergoing NAC to reduce hospital visits, improve the patient experience, and reduce TTT.
Collapse
Affiliation(s)
- Evelyne Guay
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Erin Cordeiro
- Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Amanda Roberts
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
25
|
Chen SH, Chung WP, Huang YC, Kuo YL, Lee KT, Hsu HP, Loh ZJ, Tsai JH, Yang SR, Lee CH. Real-world utilization of the 21-gene assay in taiwanese female patients with early-stage breast cancer: Experience from a single institute. JOURNAL OF CANCER RESEARCH AND PRACTICE 2022. [DOI: 10.4103/2311-3006.355306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
26
|
Ali D, Zeeshan S, Farooqi N, Vohra L. Breast surgery super-specialization: Impact on advanced surgical training and research. Pak J Med Sci 2022; 38:2345-2349. [PMID: 36415238 PMCID: PMC9676618 DOI: 10.12669/pjms.38.8.6045] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 07/18/2022] [Accepted: 09/07/2022] [Indexed: 01/25/2023] Open
Abstract
The earliest records of breast cancer (BC) date back to 3,000 - 2,500 B.C., ever since multiple curative options have been explored. First known wide margin excision was performed around 1st Century AD and a prototype of the modern-day BC surgery, Halsted radical mastectomy, was performed in the 20th Century. BC is the most common cancer in Pakistan accounting for up to 14.5% of the total cancer incidences. Accredited breast surgery fellowships were established in the UK and USA in 2002 and 2003, respectively. In Pakistan, the movement was delayed and the two-year College of Physicians and Surgeons Pakistan (CPSP) accredited breast surgery fellowship program started in 2019. The increasing annual incidence and changes in demands have led to an increased percentage of General Surgery graduates taking up specialty training. PubMed search from 1990 to 2021 showed a rising trend in the number of breast cancer publications from Pakistan; from almost no papers before 1990 to 615 between 2012 to 2021. This remarkable surge in BC-related research can be explained by the commencement of fellowship programs in breast surgery and related fields. An increase in specialist training will yield better results in the management of patients, improve clinical trials and help produce more meaningful publications from the country.
Collapse
Affiliation(s)
- Danish Ali
- Dr. Danish Ali, MBBS. Dean’s Clinical Research Fellow, Aga Khan University Hospital, Karachi, Pakistan
| | - Sana Zeeshan
- Dr. Sana Zeeshan; MBBS, FCPS, FACS. Assistant Professor of Breast Surgery, Aga Khan University Hospital, Karachi, Pakistan,Correspondence: Dr. Sana Zeeshan Assistant Professor, Department of Surgery, Aga Khan University, Stadium Road, Karachi, Pakistan.
| | - Nifasat Farooqi
- Dr. Nifasat Farooqi, MBBS, FCPS. Senior Medical Officer, COVID ICU, Aga Khan University Hospital, Karachi, Pakistan
| | - Lubna Vohra
- Dr. Lubna Vohra, MBBS, FCPS, FACS. Assistant Professor of Breast Surgery, Aga Khan University Hospital, Karachi, Pakistan
| |
Collapse
|
27
|
Hitz F, Ribi K, Grote G, Kolbe M, Schmitz C, Lamb BW, Ruhstaller T, Berchtold P, Sevdalis N. Team functioning across different tumour types: Insights from a Swiss cancer center using qualitative and quantitative methods. Cancer Rep (Hoboken) 2021; 5:e1541. [PMID: 34582132 PMCID: PMC9351662 DOI: 10.1002/cnr2.1541] [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: 05/02/2021] [Revised: 07/18/2021] [Accepted: 08/14/2021] [Indexed: 11/23/2022] Open
Abstract
Background Multidisciplinary care is pivotal in cancer centres and the interaction of all cancer disease specialists in decision making processes is state‐of‐the‐art. Aim To describe differences of MDTMs by tumour type. Methods Twelve multidisciplinary team meetings (MDTMs) with participation of different cancer disease specialists at a tertiary hospital were assessed by an exploratory sequential mixed method approach with interviews, observations and a survey to address the following five topics: organisational structure and supporting technology; leadership; teamwork; decision‐making, perceived value and motivation. Thirteen persons with different tumour specialities and levels of seniority were interviewed. The 12 MDTMs were observed twice by uninvolved persons and evaluated by the participating physicians with a survey. Results There were no systematic differences between MDTMs for different tumour types with the exception of the non‐disease specific type MDTM, which was the only one for which the organisational structure was not driven by an electronic tool. However, several factors could be identified that generally influenced the functioning of the MDTMs. In particular, the quality of decision‐making was highly dependent on the availability of case‐based information and the presence of relevant cancer disease specialists. Leadership and teamwork were rated as important and were comparable across the MDTM. Team participants' motivation and perceived value of MDTMs was high across all meetings. Conclusion MDTM at a single institution did not demonstrate disease specific characteristics. An effective MDTM, irrespective of the tumour type, can be successfully structured by technical means and a chairperson coordinating the interaction of cancer disease specialists to improve the decision‐making process.
Collapse
Affiliation(s)
- Felicitas Hitz
- Oncology Haemtology, Kantonsspital St.Gallen, St.Gallen, Switzerland
| | - Karin Ribi
- International Breast Cancer Study Group, Coordinating Center, Bern, Switzerland
| | - Gudela Grote
- Department of Management, Technology and Economics, ETH Zürich, Zürich, Switzerland
| | - Michaela Kolbe
- Department "Simulationszentrum", University Hospital Zürich, Zürich, Switzerland
| | | | - Benjamin W Lamb
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Cambridge, UK
| | - Thomas Ruhstaller
- Brustzentrum Ostschweiz and University of Basel, St.Gallen, Switzerland
| | | | - Nick Sevdalis
- Centre for Implementation Science, Health Service and Population Research Department, King's College, London, UK
| |
Collapse
|
28
|
The Effects of Multidisciplinary Team Meetings on Clinical Practice for Colorectal, Lung, Prostate and Breast Cancer: A Systematic Review. Cancers (Basel) 2021; 13:cancers13164159. [PMID: 34439312 PMCID: PMC8394238 DOI: 10.3390/cancers13164159] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/29/2021] [Accepted: 08/16/2021] [Indexed: 02/06/2023] Open
Abstract
Simple Summary Multidisciplinary team meetings have increasingly been implemented in cancer care worldwide to ensure timely, accurate and evidence-based diagnosis, and treatment plans. Nowadays, multidisciplinary team meetings are generally considered indispensable. However, they are considered time-consuming and expensive, while the effects of multidisciplinary team meetings are not yet fully understood. The aim of this systematic review is to update and summarize the literature and create an overview of the existing knowledge. Cancer types such as colorectal, lung, prostate and breast cancer with rapidly increasing incidence rates will inevitably impact the workload of clinicians. Understanding the effects of the widely implemented multidisciplinary team meetings in oncology care is fundamental in order to optimize care pathways and allocate resources in the rapidly diversifying landscape of cancer therapies. Abstract Objective: The aim of our systematic review is to identify the effects of multidisciplinary team meetings (MDTM) for lung, breast, colorectal and prostate cancer. Methods: Our systematic review, performed following PRISMA guidelines, included studies examining the impact of MDTMs on treatment decisions, patient and process outcomes. Electronic databases PUBMED, EMBASE, Cochrane Library and Web of Science were searched for articles published between 2000 and 2020. Risk of bias and level of evidence were assessed using the ROBINS-I tool and GRADE scale. Results: 41 of 13,246 articles were selected, evaluating colorectal (21), lung (10), prostate (6) and breast (4) cancer. Results showed that management plans were changed in 1.6–58% of cases after MDTMs. Studies reported a significant impact of MDTMs on surgery type, and a reduction of overall performed surgery after MDTM. Results also suggest that CT and MRI imaging significantly increased after MDTM implementation. Survival rate increased significantly with MDTM discussions according to twelve studies, yet three studies did not show significant differences. Conclusions: Despite heterogeneous data, MDTMs showed a significant impact on management plans, process outcomes and patient outcomes. To further explore the impact of MDTMs on the quality of healthcare, high-quality research is needed.
Collapse
|
29
|
de Belvis AG, Pellegrino R, Castagna C, Morsella A, Pastorino R, Boccia S. Success Factors and Barriers in Combining Personalized Medicine and Patient Centered Care in Breast Cancer. Results from a Systematic Review and Proposal of Conceptual Framework. J Pers Med 2021; 11:654. [PMID: 34357121 PMCID: PMC8306768 DOI: 10.3390/jpm11070654] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/08/2021] [Accepted: 07/11/2021] [Indexed: 02/06/2023] Open
Abstract
Breast Cancer (BC) is the leading cause of death due to cancer in women. Ensuring equitable, quality-assured and effective care has increased the complexity of BC management. This systematic review reports on the state-of-the art of available literature investigating the enactment of personalized treatment and patient-centered care models in BC clinical practice, building a framework for the delivery of personalized BC care within a Patient-Centered model. Databases were searched for articles (from the inception to December 2020) reporting on Patient-Centered or Personalized Medicine BC management models, assessing success factors or limits. Out of 1885 records, 25 studies were included in our analysis. The main success factors include clearly defined roles and responsibilities within a multi-professional collaboration, appropriate training programs and adequate communication strategies and adopting a universal genomic language to improve patients' involvement in the decision-making process. Among detected barriers, delays in the use of genetic testing were linked to the lack of public reimbursement schemes and of clear indications in timing and appropriateness. Overall, both care approaches are complementary and necessary to effectively improve BC patient management. Our framework attempts to bridge the gap in assigning a central role played by shared decision-making, still scarcely investigated in literature.
Collapse
Affiliation(s)
- Antonio Giulio de Belvis
- Department of Life Sciences and Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy; (A.G.d.B.); (A.M.); (R.P.); (S.B.)
- Clinical Pathways and Outcome Evaluation Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Via della Pineta Sacchetti 217, 00168 Rome, Italy
| | - Rossella Pellegrino
- Clinical Pathways and Outcome Evaluation Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Via della Pineta Sacchetti 217, 00168 Rome, Italy
| | - Carolina Castagna
- Department of Life Sciences and Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy; (A.G.d.B.); (A.M.); (R.P.); (S.B.)
| | - Alisha Morsella
- Department of Life Sciences and Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy; (A.G.d.B.); (A.M.); (R.P.); (S.B.)
- Clinical Pathways and Outcome Evaluation Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Via della Pineta Sacchetti 217, 00168 Rome, Italy
| | - Roberta Pastorino
- Department of Life Sciences and Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy; (A.G.d.B.); (A.M.); (R.P.); (S.B.)
| | - Stefania Boccia
- Department of Life Sciences and Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy; (A.G.d.B.); (A.M.); (R.P.); (S.B.)
| |
Collapse
|
30
|
Blasi L, Bordonaro R, Serretta V, Piazza D, Firenze A, Gebbia V. Virtual Clinical and Precision Medicine Tumor Boards, a Cloud-based Platform-mediated Implementation of Multidisciplinary Reviews among Oncology Centers in the Covid-19 Era: an Observational Study Protocol. JMIR Res Protoc 2021; 10:e26220. [PMID: 34387553 PMCID: PMC8437400 DOI: 10.2196/26220] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 04/26/2021] [Accepted: 05/17/2021] [Indexed: 12/24/2022] Open
Abstract
Background Multidisciplinary tumor boards play a pivotal role in the patient-centered clinical management and in the decision-making process to provide best evidence-based, diagnostic, and therapeutic care to patients with cancer. Among the barriers to achieve an efficient multidisciplinary tumor board, lack of time and geographical distance play a major role. Therefore, the elaboration of an efficient virtual multidisciplinary tumor board (VMTB) is a key point to successfully obtain an oncology team and implement a network among health professionals and institutions. This need is stronger than ever during the COVID-19 pandemic. Objective This paper presents a research protocol for an observational study focused on exploring the structuring process and the implementation of a multi-institutional VMTB in Sicily, Italy. Other endpoints include analysis of cooperation between participants, adherence to guidelines, patients’ outcomes, and patient satisfaction. Methods This protocol encompasses a pragmatic, observational, multicenter, noninterventional, prospective trial. The study’s programmed duration is 5 years, with a half-yearly analysis of the primary and secondary objectives’ measurements. Oncology care health professionals from various oncology subspecialties at oncology departments in multiple hospitals (academic and general hospitals as well as tertiary centers and community hospitals) are involved in a nonhierarchic manner. VMTB employs an innovative, virtual, cloud-based platform to share anonymized medical data that are discussed via a videoconferencing system both satisfying security criteria and compliance with the Health Insurance Portability and Accountability Act. Results The protocol is part of a larger research project on communication and multidisciplinary collaboration in oncology units and departments spread in the Sicily region. The results of this study will particularly focus on the organization of VMTBs, involving oncology units present in different hospitals spread in the area, and creating a network to allow best patient care pathways and a hub-and-spoke relationship. The present results will also include data concerning organization skills and pitfalls, barriers, efficiency, number, and types with respect to clinical cases and customer satisfaction. Conclusions VMTB represents a unique opportunity to optimize patient management through a patient-centered approach. An efficient virtualization and data-banking system is potentially time-saving, a source for outcome data, and a detector of possible holes in the hull of clinical pathways. The observations and results from this VMTB study may hopefully be useful to design nonclinical and organizational interventions that enhance multidisciplinary decision-making in oncology. International Registered Report Identifier (IRRID) DERR1-10.2196/26220
Collapse
Affiliation(s)
| | | | | | - Dario Piazza
- GSTU Foundation for Cancer Research, Palermo, IT
| | | | - Vittorio Gebbia
- La Maddalena Cancer Center, via San Lorenzo Colli n. 312d, 90100, Palermo, Italy, palermo, IT
| |
Collapse
|
31
|
Ntalos D, Schoof B, Thiesen DM, Viezens L, Kleinertz H, Rohde H, Both A, Luebke A, Strahl A, Dreimann M, Stangenberg M. Implementation of a multidisciplinary infections conference improves the treatment of spondylodiscitis. Sci Rep 2021; 11:9515. [PMID: 33947939 PMCID: PMC8096947 DOI: 10.1038/s41598-021-89088-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 04/19/2021] [Indexed: 12/17/2022] Open
Abstract
Establishing a multidisciplinary approach regarding the treatment of spondylodiscitis and analyzing its effect compared to a single discipline approach. 361 patients diagnosed with spondylodiscitis were included in this retrospective pre-post intervention study. The treatment strategy was either established by a single discipline approach (n = 149, year 2003–2011) or by a weekly multidisciplinary infections conference (n = 212, year 2013–2018) consisting of at least an orthopedic surgeon, medical microbiologist, infectious disease specialist and pathologist. Recorded data included the surgical and antibiotic strategy, complications leading to operative revision, recovered microorganisms, as well as the total length of hospital and intensive care unit stay. Compared to a single discipline approach, performing the multidisciplinary infections conference led to significant changes in anti-infective and surgical treatment strategies. Patients discussed in the conference showed significantly reduced days of total antibiotic treatment (66 ± 31 vs 104 ± 31, p < 0.001). Moreover, one stage procedures and open transpedicular screw placement were more frequently performed following multidisciplinary discussions, while there were less involved spinal segments in terms of internal fixation as well as an increased use of intervertebral cages instead of autologous bone graft (p < 0.001). Staphylococcus aureus and Staphylococcus epidermidis were the most frequently recovered organisms in both patient groups. No significant difference was found comparing inpatient complications between the two groups or the total in-hospital stay. Implementation of a weekly infections conference is an effective approach to introduce multidisciplinarity into spondylodiscitis management. These conferences significantly altered the treatment plan compared to a single discipline approach. Therefore, we highly recommend the implementation to optimize treatment modalities for patients.
Collapse
Affiliation(s)
- D Ntalos
- Division of Spine Surgery, Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - B Schoof
- Division of Spine Surgery, Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - D M Thiesen
- Division of Spine Surgery, Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - L Viezens
- Division of Spine Surgery, Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - H Kleinertz
- Division of Spine Surgery, Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - H Rohde
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - A Both
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - A Luebke
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - A Strahl
- Division of Orthopedics, Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - M Dreimann
- Division of Spine Surgery, Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - M Stangenberg
- Division of Spine Surgery, Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| |
Collapse
|
32
|
Breast cancer larger than 2.5 cm with tumor-free radioisotope-hot sentinel nodes has higher risk of non-hot axillary lymph node metastasis. Biomed J 2021; 45:396-405. [PMID: 35562283 PMCID: PMC9250121 DOI: 10.1016/j.bj.2021.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 04/25/2021] [Accepted: 04/26/2021] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Sentinel lymph node biopsy (SLNB) is the standard axillary staging approach for early breast cancer with clinically negative axillary involvement. Adequate SLNB should include the removal of not only radioactive tracer-labeled lymph nodes (hot nodes or SLNs) but also suspicious unlabeled nodes (non-hot nodes or non-SLNs). However, the biopsy of non-hot nodes is highly dependent on the surgeons' experiences. This article aims to facilitate the surgeon's decision making by elucidating parameters that correlate with non-hot node metastasis. METHODS From 2013 to 2016, clinically node-negative (cN0) breast cancer patients receiving axillary SLNB using single Tc-99m tracer method at our institute were recruited. Patients were excluded if they had received prior neoadjuvant chemotherapy. Among them, cases that have at least one non-isotope-hot node biopsied were retrospectively reviewed with a particular focus on patients with pathologically negative isotope-hot SLNs. The correlation of clinicopathological data with metastasis to axillary lymph nodes and sentinel lymph nodes was analyzed with the Chi-squared test, Fisher's exact test, and multivariate logistic regression. Receiver operating curve (ROC) was applied for continuous variables that predicted non-hot node metastasis; relapse-free survival (RFS) and locoregional relapse-free survival (LRRFS) were compared by Kaplan-Meier analysis. RESULTS In 632 isotope-hot SLN negative patients, T stage showed a correlation with non-isotope-hot SLN metastasis (p = 0.035, odds ratio (OR) 9.65). Tumors larger than 2.5 cm best predict non-isotope-hot SLN metastasis (area under curve (AUC) = 0.71). With a median follow up of 41.80 months, locoregional relapse-free survival was significantly worse in cases with non-hot node metastasis (66.2% vs. 69.0%, p = 0.001). CONCLUSION In the setting of SLNB using single radioisotope tracer, non-hot node metastasis in cases with negative hot SLN still carries a higher locoregional recurrence rate (13.3%). For early breast cancer larger than 2.5 cm, removal of suspicious non-hot nodes should be included for a precision therapy.
Collapse
|
33
|
Di Leone A, Terribile D, Magno S, Sanchez AM, Scardina L, Mason EJ, D’Archi S, Maggiore C, Rossi C, Di Micco A, Carnevale S, Paris I, Marazzi F, Masiello V, Orlandi A, Palazzo A, Fabi A, Masetti R, Franceschini G. Neoadjuvant Chemotherapy in Breast Cancer: An Advanced Personalized Multidisciplinary Prehabilitation Model (APMP-M) to Optimize Outcomes. J Pers Med 2021; 11:324. [PMID: 33919061 PMCID: PMC8143137 DOI: 10.3390/jpm11050324] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 01/01/2023] Open
Abstract
Neoadjuvant chemotherapy is increasingly being employed in the management of breast cancer patients. Efforts and resources have been devoted over the years to the search for an optimal strategy that can improve outcomes in the neoadjuvant setting. Today, a multidisciplinary approach with the application of evidence-based medicine is considered the gold standard for the improvement of oncological results and patient satisfaction. However, several clinical complications and psychological issues due to various factors can arise during neoadjuvant therapy and undermine outcomes. To ensure that health care needs are adequately addressed, clinicians must consider that women with breast cancer have a high risk of developing "unmet needs" during treatment, and often require a clinical intervention or additional care resources to limit possible complications and psychological issues that can occur during neoadjuvant treatment. This work describes a multidisciplinary model developed at "Fondazione Policlinico Universitario Agostino Gemelli" (FPG) in Rome in an effort to optimize treatment, ease the application of evidence-based medicine, and improve patient quality of life in the neoadjuvant setting. In developing our model, our main goal was to adequately meet patient needs while preventing high levels of distress.
Collapse
Affiliation(s)
- Alba Di Leone
- Multidisciplinary Breast Centre, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (D.T.); (S.M.); (A.M.S.); (L.S.); (E.J.M.); (S.D.); (R.M.); (G.F.)
| | - Daniela Terribile
- Multidisciplinary Breast Centre, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (D.T.); (S.M.); (A.M.S.); (L.S.); (E.J.M.); (S.D.); (R.M.); (G.F.)
| | - Stefano Magno
- Multidisciplinary Breast Centre, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (D.T.); (S.M.); (A.M.S.); (L.S.); (E.J.M.); (S.D.); (R.M.); (G.F.)
| | - Alejandro Martin Sanchez
- Multidisciplinary Breast Centre, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (D.T.); (S.M.); (A.M.S.); (L.S.); (E.J.M.); (S.D.); (R.M.); (G.F.)
| | - Lorenzo Scardina
- Multidisciplinary Breast Centre, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (D.T.); (S.M.); (A.M.S.); (L.S.); (E.J.M.); (S.D.); (R.M.); (G.F.)
| | - Elena Jane Mason
- Multidisciplinary Breast Centre, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (D.T.); (S.M.); (A.M.S.); (L.S.); (E.J.M.); (S.D.); (R.M.); (G.F.)
| | - Sabatino D’Archi
- Multidisciplinary Breast Centre, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (D.T.); (S.M.); (A.M.S.); (L.S.); (E.J.M.); (S.D.); (R.M.); (G.F.)
| | - Claudia Maggiore
- Centre of Integrative Oncology—Multidisciplinary Breast Centre—Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli I RCCS, 00168 Rome, Italy; (C.M.); (C.R.); (A.D.M.)
| | - Cristina Rossi
- Centre of Integrative Oncology—Multidisciplinary Breast Centre—Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli I RCCS, 00168 Rome, Italy; (C.M.); (C.R.); (A.D.M.)
| | - Annalisa Di Micco
- Centre of Integrative Oncology—Multidisciplinary Breast Centre—Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli I RCCS, 00168 Rome, Italy; (C.M.); (C.R.); (A.D.M.)
| | - Stefania Carnevale
- UOS Psicologia Clinica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Ida Paris
- Department of Woman and Child Health and Public Health, Woman Health Area, Fondazione Policlinico Universitario A. Gemelli I RCCS, 00168 Rome, Italy;
| | - Fabio Marazzi
- UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli I RCCS, 00168 Rome, Italy; (F.M.); (V.M.)
| | - Valeria Masiello
- UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli I RCCS, 00168 Rome, Italy; (F.M.); (V.M.)
| | - Armando Orlandi
- Comprehensive Cancer Center, Multidisciplinary Breast Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8, 00168 Rome, Italy; (A.O.); (A.P.)
| | - Antonella Palazzo
- Comprehensive Cancer Center, Multidisciplinary Breast Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8, 00168 Rome, Italy; (A.O.); (A.P.)
| | - Alessandra Fabi
- Medicina di Precisione in Senologia, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Riccardo Masetti
- Multidisciplinary Breast Centre, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (D.T.); (S.M.); (A.M.S.); (L.S.); (E.J.M.); (S.D.); (R.M.); (G.F.)
| | - Gianluca Franceschini
- Multidisciplinary Breast Centre, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (D.T.); (S.M.); (A.M.S.); (L.S.); (E.J.M.); (S.D.); (R.M.); (G.F.)
| |
Collapse
|
34
|
Madekivi V, Boström P, Vahlberg T, Aaltonen R, Salminen E. Characteristics of clinically node negative breast cancer patients needing preoperative MRI. Surg Oncol 2021; 38:101552. [PMID: 33865184 DOI: 10.1016/j.suronc.2021.101552] [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: 12/23/2020] [Accepted: 03/26/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND International guidelines do not recommend magnetic resonance imaging (MRI) for all breast cancer patients at primary diagnostics. This study aimed to understand which patient or tumor characteristics are associated with the use of MRI. The role of MRI among other preoperative imaging methods in clinically node negative breast cancer was studied. MATERIAL AND METHODS Patient and tumor characteristics were analyzed in association with the use of MRI by multivariable logistic regression analysis in 461 patients. Primary tumor size was compared between MRI, mammography (MGR), ultrasound (US) and histopathology by Spearman correlation. The delays in surgery and diagnosis were analyzed among patients with or without MRI, and axillary reoperations were evaluated. RESULTS Age (p < 0.0001), primary operation method (p < 0.0001), tumor histology (p < 0.0001) and HER2 status (p = 0.0064) were associated with the use of MRI. Spearman correlations between tumor size in histopathology and the difference in tumor size between histopathology and imaging methods were 0.52 in MGR, 0.66 in US and 0.36 in MRI (p < 0.0001 for all). A seven-day delay in surgical treatment was observed among patients with MRI compared to patients without MRI (p < 0.0001). Axillary reoperation rates were similar in patients with or without MRI (p = 0.57). CONCLUSION Patient selection through prearranged characterization is important in deciding on optimal candidates for preoperative MRI among breast cancer patients. MRI causes moderate delays in primary breast cancer surgery. Preoperative MRI is useful in the evaluation of tumor size but might be insufficient in detecting lymph node metastases.
Collapse
MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Lobular/diagnostic imaging
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/surgery
- Female
- Follow-Up Studies
- Humans
- Lymph Nodes/diagnostic imaging
- Lymph Nodes/pathology
- Lymph Nodes/surgery
- Lymphatic Metastasis/diagnostic imaging
- Lymphatic Metastasis/pathology
- Magnetic Resonance Imaging/methods
- Mammography/methods
- Middle Aged
- Preoperative Care
- Prognosis
- Ultrasonography/methods
Collapse
Affiliation(s)
- V Madekivi
- Department of Oncology, Turku University Hospital, Finland; University of Turku, Turku, Finland.
| | - P Boström
- University of Turku, Turku, Finland; Department of Pathology, Turku University Hospital, Turku, Finland
| | - T Vahlberg
- Department of Clinical Medicine, Biostatistics, University of Turku, Turku, Finland
| | - R Aaltonen
- University of Turku, Turku, Finland; Department of Surgery, Turku University Hospital, Turku, Finland
| | - E Salminen
- Department of Oncology, Turku University Hospital, Finland; University of Turku, Turku, Finland; Finnish Nuclear and Radiation Safety, Helsinki, Finland
| |
Collapse
|
35
|
Variations in breast cancer surgical treatment and timing: determinants and disparities. Breast Cancer Res Treat 2021; 188:259-272. [PMID: 33689057 PMCID: PMC8233284 DOI: 10.1007/s10549-021-06155-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 02/20/2021] [Indexed: 01/29/2023]
Abstract
PURPOSE To describe clinical and non-clinical factors associated with receipt of breast conserving surgery (BCS) versus mastectomy and time to surgical intervention. METHODS Cross-sectional retrospective study of January 1, 2012 through March 31, 2018 data from the IBM MarketScan Commercial Claims and Encounter and Medicare Supplemental Databases. Area Health Resource Files provided non-clinical characteristics and sociodemographic data. Eligibility: Female sex, claim(s) with ICD-9-CM or ICD-10-CM diagnosis of non-metastatic invasive breast cancer, > 6 months of continuous insurance pre- and post-diagnosis, evidence of BCS or mastectomy following initial ICD9/10 code diagnosis. Logistic and quantile multivariable regression models assessed the association between clinical and non-clinical factors and the outcome of BCS and time to surgery, respectively. RESULTS A total of 53,060 women were included in the study. Compared to mastectomy, BCS was significantly associated with older age (ORs: 1.54 to 2.99, 95% CIs 1.45 to 3.38; ps < .0001) and higher community density of medical genetics (OR: 5.88, 95% CIs 1.38 to 25.00; p = 0.02) or obstetrics and gynecology (OR: 1.13, 95% CI 1.02 to 1.25; p = .02) physicians. Shorter time-to-BCS was associated with living in the South (-2.96, 95% CI -4.39 to -1.33; p < .0001). Longer time-to-BCS was associated with residence in more urban (4.18, 95% CI 0.08 to 8.29; p = 0. 05), educated (9.02, 95% CI 0.13 to 17.91; p = 0.05), or plastic-surgeon-dense (4.62, 95% CI 0.50 to 8.73; p = 0.03) communities. CONCLUSIONS Clinical and non-clinical factors are associated with adoption of BCS and time to treatment, suggesting opportunities to ensure equitable and timely care.
Collapse
|
36
|
Algwaiz G, Salam Y, Bustami R, Ferwana M, Jazieh AR. Do Multidisciplinary Tumor Board Discussions Correlate With Increase in 5-Year Survival? A Meta-Analysis Study. GLOBAL JOURNAL ON QUALITY AND SAFETY IN HEALTHCARE 2021; 4:3-10. [PMID: 37260532 PMCID: PMC10229009 DOI: 10.36401/jqsh-20-23] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 10/20/2020] [Indexed: 06/02/2023]
Abstract
Introduction Due to the complex nature of cancer cases, it is imperative that the involved healthcare providers coordinate the patients care plan in union to reach the best possible outcome in the smoothest and fastest manner. This is what multidisciplinary tumor board (MTB) meetings strive to achieve. Conducting regular MTB meetings requires significant investment of time and finances. It is thus vital to assess the empirical benefits of such practice. Methods A meta-analysis was conducted to evaluate the literature regarding the impact of MTB meetings on patient 5-year survival. Relevant studies were identified by searching Ovid MEDLINE and Embase databases from January 1995 to July 2019. Studies were included if they assessed 5-year survival in cases discussed in MTB meetings and used a comparison group and/or a pretest and posttest design. Results Five articles met the study's inclusion criteria. Quality of studies was affected by selection bias and the use of historic cohorts. The results showed significantly improved 5-year survival in the MTB group compared with the non-MTB groups (odds ratio for 5-year death rate of 0.59, CI 0.45-0.78, p < 0.001). Conclusion This meta-analysis showed that cancer MTB meetings have a significant impact on patients' 5-year survival. This could be because of several reasons, such as less time to treatment initiation, better adherence to guidelines, higher numbers of investigational imaging, lesser surgical complications, and recurrence rates. Future prospective studies are needed to further delineate reasons for improvement of outcome to enhance the benefits of this approach.
Collapse
Affiliation(s)
- Ghada Algwaiz
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Yezan Salam
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Rami Bustami
- Department of Healthcare Management, Alfaisal University, Riyadh, Saudi Arabia
| | - Mazen Ferwana
- Department of Family Medicine, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdul Rahman Jazieh
- Department of Oncology, King Abdulaziz Medical City, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| |
Collapse
|
37
|
Blackwood O, Deb R. Multidisciplinary team approach in breast cancer care: Benefits and challenges. INDIAN J PATHOL MICR 2020; 63:S105-S112. [PMID: 32108641 DOI: 10.4103/ijpm.ijpm_885_19] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The multidisciplinary team approach has been employed internationally for decades, as an attempt to bring collaborative decision-making and concentrate clinical experience from multiple specialties on single patient cases in a systematic fashion. Adoption is not yet worldwide, but is increasing. The role of the histopathologist is central, providing vital information and context to clinical diagnosis and management. Our review summarizes some of the most relevant research on the topic of MDT usage and efficacy in relation to breast cancer, attempting to draw together its advantages and challenges. It is hoped that this review will make a contribution to the current international literature regarding multidisciplinary approaches in breast cancer care.
Collapse
Affiliation(s)
- Owain Blackwood
- Department of Postgraduate Medical Education, Kingæs Mill Hospital, Sherwood Forest Hospitals Foundation Trust, Sutton-in-Ashfield, Nottinghamshire, United Kingdom
| | - Rahul Deb
- Department of Pathology, Royal Derby Hospital, University Hospitals of Derby and Burton, Derby, United Kingdom
| |
Collapse
|
38
|
Yang X, Huang J, Zhu X, Shen K, Zhu J, Chen X. Compliance with multidisciplinary team recommendations and disease outcomes in early breast cancer patients: An analysis of 4501 consecutive patients. Breast 2020; 52:135-145. [PMID: 32512360 PMCID: PMC7375553 DOI: 10.1016/j.breast.2020.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/20/2020] [Accepted: 05/23/2020] [Indexed: 12/24/2022] Open
Abstract
Background Multidisciplinary team (MDT) discussions are widely held to facilitate the diagnosis and treatment of breast cancer, but patient compliance with the MDT recommendations and the impact of compliance on disease outcome are uncertain. Methods We conducted a retrospective review of data from a prospective database of breast cancer patients treated at Shanghai Ruijin Hospital between April 2013 and August 2018. MDT discussions were held for all patients before they started adjuvant therapy. The patients were classified into compliant and non-compliant groups according to whether they received the MDT-recommended regimens. We also analyzed which clinicopathological factors were associated with compliance and prognosis. Results Of 4501 breast cancer patients, 3681 (81.8%) and 820 (18.2%) were included in the compliant and non-compliant groups, respectively. Age >70 years (P < 0.001), invasive ductal carcinoma (P < 0.001), and histological grade III (P = 0.011) were independently associated with higher risk of non-compliance, whereas Ki-67 labeling index ≥14% and history of benign breast disease were independently associated with compliance. Disease-free survival (hazard ratio [HR] 1.813, 95% confidence interval [CI] 1.367–2.405, P < 0.001) and overall survival (HR 2.478, 95% CI 1.431–4.291, P < 0.001) were worse in the non-compliant group. Conclusions Several clinicopathological factors were associated with non-compliance with MDT recommendations for early breast cancer patients. Non-compliance was associated with worse disease outcome. A large consecutive breast cancer cohort with MDT-based treatment recommendation. Factors identified associated with non-compliance with MDT recommendations. A significantly better survival in patients compliant with MDT recommendation.
Collapse
Affiliation(s)
- Xingxia Yang
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Breast, Jiaxing University Affiliated Women and Children Hospital, Jiaxing, Zhejiang, China
| | - Jiahui Huang
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoping Zhu
- Department of Breast, Jiaxing University Affiliated Women and Children Hospital, Jiaxing, Zhejiang, China
| | - Kunwei Shen
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Juanying Zhu
- Department of Breast, Jiaxing University Affiliated Women and Children Hospital, Jiaxing, Zhejiang, China.
| | - Xiaosong Chen
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| |
Collapse
|
39
|
Portelli Tremont JN, Downs-Canner S, Maduekwe U. Delving deeper into disparity: The impact of health literacy on the surgical care of breast cancer patients. Am J Surg 2020; 220:806-810. [PMID: 32444064 DOI: 10.1016/j.amjsurg.2020.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/08/2020] [Accepted: 05/08/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Breast surgical oncology is a unique field that involves complex cancer management and longstanding patient interactions with the healthcare system, making it potentially challenging for patients with low health literacy. The purpose of this review is to summarize the current knowledge regarding health literacy in breast cancer and identify future directions for research and potential intervention in breast surgical oncology. DATA SOURCES A search of relevant literature querying PubMed and Science Direct was performed and included the following keywords: health literacy, breast cancer, breast surgical oncology, surgery, outcomes, prevention, screening, healthcare utilization, chronic disease. CONCLUSIONS Limited health literacy may detrimentally affect understanding and outcomes in breast surgical oncology. Identifying ways providers can improve patient understanding and utilization of health information is important, and surgeons may have a pivotal role. Further studies addressing health literacy in breast surgical oncology is needed in order to better optimize care of patients.
Collapse
Affiliation(s)
- Jaclyn N Portelli Tremont
- University of North Carolina at Chapel Hill, Department of Surgery, Division of Surgical Oncology, 170Manning Drive, CB #7213, 1150 Physicians Office Bldg., Chapel Hill, NC, 27599-7213, USA.
| | - Stephanie Downs-Canner
- University of North Carolina at Chapel Hill, Department of Surgery, Division of Surgical Oncology, 170Manning Drive, CB #7213, 1150 Physicians Office Bldg., Chapel Hill, NC, 27599-7213, USA.
| | - Ugwuji Maduekwe
- University of North Carolina at Chapel Hill, Department of Surgery, Division of Surgical Oncology, 170Manning Drive, CB #7213, 1150 Physicians Office Bldg., Chapel Hill, NC, 27599-7213, USA.
| |
Collapse
|
40
|
Park KU, Selby L, Chen XP, Cochran A, Harzman A, Shen C, Gregory ME. Development of Residents' Self-Efficacy in Multidisciplinary Management of Breast Cancer Survey. J Surg Res 2020; 251:275-280. [PMID: 32197183 DOI: 10.1016/j.jss.2020.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/23/2020] [Accepted: 02/16/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Treating patients with breast cancer is multidisciplinary; however, it is unclear whether surgery residency programs provide sufficient training in multidisciplinary care. Self-efficacy is one way of measuring the adequacy of training. Our goal was to develop a method of assessing self-efficacy in multidisciplinary breast cancer care. METHODS Based on a literature review and subject-matter expert input, we developed a 30-item self-efficacy survey to measure six domains of breast cancer care (genetics, surgery, medical oncology, radiation oncology, pathology, and radiology). We constructed and validated the survey using a seven-step survey development framework. The survey was administered to general surgery residents at a single academic surgical residency. RESULTS Response rate was 66% (n = 31). Internal consistency was strong (Cronbach alpha = 0.92). Self-efficacy was moderate (mean = 3.05) and tended to increase with training (postgraduate year [PGY] 1: mean= 2.37 versus PGY 5: mean= 3.54; P < 0.001), providing evidence for construct validity. Self-efficacy was highest in the surgery (3.56) compared with others (genetics 2.67, medical oncology 3, radiation oncology 2.67, pathology 2.67, and radiology 3.33). This trend was similar across all PGY groups, except for interns, whose self-efficacy in surgery was low. CONCLUSIONS We created a survey to assess self-efficacy in multidisciplinary breast cancer care and provided initial evidence of survey validity. Although self-efficacy in surgery improved with years in training, medical and radiation oncology self-efficacy remained low. As modern breast cancer treatment is highly multidisciplinary, an expanded education program is needed to help trainees incorporate multidisciplinary clinical perspectives.
Collapse
Affiliation(s)
- Ko Un Park
- Division of Surgical Oncology, Department of Surgery, Wexner Medical Center and James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio.
| | - Luke Selby
- Division of Surgical Oncology, Department of Surgery, Wexner Medical Center and James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Xiaodong Phoenix Chen
- Department of Surgery, Wexner Medical Center, The Ohio State University College of Medicine, Columbus, Ohio
| | - Amalia Cochran
- Department of Surgery, Wexner Medical Center, The Ohio State University College of Medicine, Columbus, Ohio
| | - Alan Harzman
- Department of Surgery, Wexner Medical Center, The Ohio State University College of Medicine, Columbus, Ohio
| | - Chengli Shen
- Division of Surgical Oncology, Department of Surgery, Wexner Medical Center and James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Megan E Gregory
- Department of Biomedical Informatics, Wexner Medical Center, The Ohio State University College of Medicine, Columbus, Ohio
| |
Collapse
|
41
|
Liu C, Cheifetz R, Brown C, Nichol A, Speers C, Lohrisch C, McKevitt E. Do surgeons convey all the details? A provincial assessment of operative reporting for breast cancer. Am J Surg 2020; 219:780-784. [PMID: 32145920 DOI: 10.1016/j.amjsurg.2020.02.053] [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: 11/06/2019] [Revised: 02/25/2020] [Accepted: 02/26/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION A breast cancer synoptic operative report was developed using a modified Delphi process METHODS: Data from the British Columbia Cancer Breast Cancer Outcomes Unit (BCOU) was used to analyze the association between the completion of a synoptic operative report and reporting of operative details and The American Society of Breast Surgeons quality indicators. RESULTS 3662 patients had surgery for breast cancer by 185 surgeons. 2281 reports were narrative and 1007 synoptic. Requested surgical details were more commonly reported with synoptic reports for both posterior (96 vs 58%, p < 0.0001) and anterior margins (96 vs 5%, p < 0.0001). This was true for high and low volume surgeons. Quality Indicators were higher in those cases with an associated synoptic report for high and low volume surgeons. CONCLUSION Communication of operative details is improved with synoptic reporting. Investment in platforms to facilitate synoptic reporting could improve patient care through improved multidisciplinary communication.
Collapse
Affiliation(s)
- Claire Liu
- Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada.
| | - Rona Cheifetz
- Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada; Department of Surgical Oncology, British Columbia Cancer Agency, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada.
| | - Carl Brown
- Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada; Department of Surgical Oncology, British Columbia Cancer Agency, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada.
| | - Alan Nichol
- Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada; Department of Radiation Oncology, British Columbia Cancer Agency, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada.
| | - Caroline Speers
- Breast Cancer Outcomes Unit, British Columbia Cancer Agency, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada.
| | - Caroline Lohrisch
- Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada; Department of Medical Oncology, British Columbia Cancer Agency, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada.
| | - Elaine McKevitt
- Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada; Department of Surgical Oncology, British Columbia Cancer Agency, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada.
| |
Collapse
|
42
|
Moser EC, Narayan G. Improving breast cancer care coordination and symptom management by using AI driven predictive toolkits. Breast 2020; 50:25-29. [PMID: 31978814 PMCID: PMC7375673 DOI: 10.1016/j.breast.2019.12.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 12/01/2019] [Accepted: 12/12/2019] [Indexed: 01/29/2023] Open
Abstract
Integrated breast cancer care is complex, marked by multiple hand-offs between primary care and specialists over an extensive period of time. Communication is essential for treatment compliance, lowering error and complication risk, as well as handling co-morbidity. The director role of care, however, becomes often unclear, and patients remain lost across departments. Digital tools can add significant value to care communication but need clarity about the directives to perform in the care team. In effective breast cancer care, multidisciplinary team meetings can drive care planning, create directives and structured data collection. Subsequently, nurse navigators can take the director’s role and become a pivotal determinant for patient care continuity. In the complexity of care, automated AI driven planning can facilitate their tasks, however, human intervention stays needed for psychosocial support and tackling unexpected urgency. Care allocation of patients across centres, is often still done by hand and phone demanding time due to overbooked agenda’s and discontinuous system solutions limited by privacy rules and moreover, competition among providers. Collection of complete outcome information is limited to specific collaborative networks today. With data continuity over time, AI tools can facilitate both care allocation and risk prediction which may unveil non-compliance due to local scarce resources, distance and costs. Applied research is needed to bring AI modelling into clinical practice and drive well-coordinated, patient-centric cancer care in the complex web of modern healthcare today.
Collapse
Affiliation(s)
- E C Moser
- UM-AI Coordinator Research, UM-AI LLC, 8 the Green. Suite #5064, Dover, DE, 19901, USA.
| | - Gayatri Narayan
- UM-AI Coordinator Research, UM-AI LLC, 8 the Green. Suite #5064, Dover, DE, 19901, USA.
| |
Collapse
|