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Lamprell K, Chittajallu R, Arnolda G, Easpaig BNG, Delaney GP, Liauw W, Olver I, Braithwaite J. Multidisciplinary team meeting Chairs' attitudes and perceived facilitators, barriers and ideal improvements to meeting functionality: A qualitative study. Asia Pac J Clin Oncol 2024; 20:537-545. [PMID: 38757440 DOI: 10.1111/ajco.14077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/17/2024] [Accepted: 05/02/2024] [Indexed: 05/18/2024]
Abstract
AIM Oncology care provision by multidisciplinary teams (MDTs) is widely acknowledged as best practice. Formal team meetings, led by chairpersons, coordinate decisions on diagnosis, staging, treatment planning, and review. This study addresses a gap in meeting Chairs' perspectives on factors affecting functionality across the meeting cycle, from pre-meeting patient list triage to post-meeting dissemination of recommendations. METHODS Semi-structured interviews were conducted in person with Chairs within two urban geographical regions in New South Wales, Australia as part of a larger project. Though the population of oncology MDT Chairs in Australia is small, the richness and depth of data from nine Chairs were considered to be valuable knowledge in support of extant literature on meeting functionality. An integrated deductive-inductive approach was applied to data analysis. RESULTS Perceived facilitators, barriers, and ideals relating to pre-meeting, in-meeting, and post-meeting functionality were identified across five pre-determined analytic categories: the team; meeting infrastructure; meeting organization and logistics; patient-centered clinical decision-making, and; team governance. Key barriers included inadequate information technology, limited support staff, and lack of dedicated time for Chair duties. Corresponding facilitators included robust Information Technology infrastructure and support, provision of clinically knowledgeable MDT meeting coordinators, and formal employment recognition of Chairs' responsibilities and skill sets. CONCLUSION Chairs across various tumor streams develop workarounds to overcome barriers and ensure quality meeting outcomes. With more robust support they could enhance value by sharing evidence, conducting audits, and engaging in research. The findings highlight the need for healthcare systems to support tumor stream clinical networks by allocating greater resources to prioritize multidisciplinary meetings and cancer care decision-making.
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Affiliation(s)
- Klay Lamprell
- Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Renuka Chittajallu
- Medical Oncology, Riverina Cancer Care Centre, Wagga Wagga, Australia
- Medical Oncology, GenesisCare, Kingswood, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Bróna Nic Giolla Easpaig
- Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
- School of Nursing, Charles Darwin University, Darwin, Australia
| | - Geoff P Delaney
- South-Western Sydney Clinical School, University of New South Wales, Sydney, Australia
- Radiation Oncology, Liverpool Hospital, Liverpool, Australia
| | - Winston Liauw
- St. George Cancer Care Centre, St. George Hospital, Kogarah, Australia
- St. George Hospital Clinical School, University of New South Wales, Sydney, Australia
| | - Ian Olver
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
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Daye D, Parker R, Tripathi S, Cox M, Brito Orama S, Valentin L, Bridge CP, Uppot RN. CASCADE: Context-Aware Data-Driven AI for Streamlined Multidisciplinary Tumor Board Recommendations in Oncology. Cancers (Basel) 2024; 16:1975. [PMID: 38893096 PMCID: PMC11171258 DOI: 10.3390/cancers16111975] [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: 05/06/2024] [Revised: 05/18/2024] [Accepted: 05/22/2024] [Indexed: 06/21/2024] Open
Abstract
This study addresses the potential of machine learning in predicting treatment recommendations for patients with hepatocellular carcinoma (HCC). Using an IRB-approved retrospective study of patients discussed at a multidisciplinary tumor board, clinical and imaging variables were extracted and used in a gradient-boosting machine learning algorithm, XGBoost. The algorithm's performance was assessed using confusion matrix metrics and the area under the Receiver Operating Characteristics (ROC) curve. The study included 140 patients (mean age 67.7 ± 8.9 years), and the algorithm was found to be predictive of all eight treatment recommendations made by the board. The model's predictions were more accurate than those based on published therapeutic guidelines by ESMO and NCCN. The study concludes that a machine learning model incorporating clinical and imaging variables can predict treatment recommendations made by an expert multidisciplinary tumor board, potentially aiding clinical decision-making in settings lacking subspecialty expertise.
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Affiliation(s)
- Dania Daye
- Massachusetts General Hospital, Boston, MA 02114, USA; (S.T.); (M.C.); (L.V.); (C.P.B.); (R.N.U.)
- Harvard Medical School, Boston, MA 02115, USA;
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA 02129, USA
| | | | - Satvik Tripathi
- Massachusetts General Hospital, Boston, MA 02114, USA; (S.T.); (M.C.); (L.V.); (C.P.B.); (R.N.U.)
- Harvard Medical School, Boston, MA 02115, USA;
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA 02129, USA
| | - Meredith Cox
- Massachusetts General Hospital, Boston, MA 02114, USA; (S.T.); (M.C.); (L.V.); (C.P.B.); (R.N.U.)
- Harvard Medical School, Boston, MA 02115, USA;
| | | | - Leonardo Valentin
- Massachusetts General Hospital, Boston, MA 02114, USA; (S.T.); (M.C.); (L.V.); (C.P.B.); (R.N.U.)
- Professional Hospital Guaynabo, Guaynabo 00971, Puerto Rico
| | - Christopher P. Bridge
- Massachusetts General Hospital, Boston, MA 02114, USA; (S.T.); (M.C.); (L.V.); (C.P.B.); (R.N.U.)
- Harvard Medical School, Boston, MA 02115, USA;
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA 02129, USA
| | - Raul N. Uppot
- Massachusetts General Hospital, Boston, MA 02114, USA; (S.T.); (M.C.); (L.V.); (C.P.B.); (R.N.U.)
- Harvard Medical School, Boston, MA 02115, USA;
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Sugiyama A, Okumiya H, Fujimoto K, Utsunomiya K, Shimomura Y, Sanuki M, Kume K, Yano T, Kagawa R, Bando H. Integrated Electronic Health Record of Multidisciplinary Professionals Throughout the Cancer Care Pathway: A Pilot Study Exploring Patient-Centered Information in Breast Cancer Patients. J Multidiscip Healthc 2024; 17:2069-2081. [PMID: 38736534 PMCID: PMC11088412 DOI: 10.2147/jmdh.s455281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 04/20/2024] [Indexed: 05/14/2024] Open
Abstract
Purpose The aim of this pilot study was to first aggregate and then integrate the medical records of various healthcare professionals involved with breast cancer patients to reveal if and how patient-centered information is documented in multidisciplinary cancer care. Patients and Methods We aggregated 20 types of medical records from various healthcare professionals such as physicians, nurses and allied healthcare professionals (AHPs) throughout three breast cancer patients' care pathways in a department of breast surgery at a university hospital. Purposeful sampling was used, and three cases were examined. The number of integrated type of records was 14, 14, 17 in case 1, 2 and 3, respectively. We manually annotated and analyzed them exploratively using a thematic analysis. The tags were produced using both a deductive template approach and a data-driven inductive approach. All records were then given tags. We defined patient-centered information related tags and biomedical information related tags and then analyzed for if and how patient-centered information was documented. Results The number of patient-centered information related tags accounted for 30%, 30% and 20% of the total in case 1, 2 and 3, respectively. In all cases, patient-centered information was distributed across various medical records. The Progress Note written by doctors provided much of the patient-centered information, while other records contained information not described elsewhere in the Progress Notes. The records of nurses and AHPs included more patient-centered information than the doctors' notes. Each piece of patient-centered information was documented in fragments providing from each of the healthcare professionals' viewpoints. Conclusion The documented information throughout the breast cancer care pathway in the cases examined was dominated by biomedical information. However, our findings suggest that integrating fragmented patient-centered information from various healthcare professionals' medical records produces holistic patient-centered information from multiple perspectives and thus may facilitate an enhanced multidisciplinary patient-centered care.
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Affiliation(s)
- Atsuko Sugiyama
- R&D Planning Office, Canon Medical Systems Corporation, Otawara, Tochigi, Japan
- Research and Development Center, Canon Medical Systems Corporation, Otawara, Tochigi, Japan
- Graduate School of Biomedical Engineering, Tohoku University, Sendai, Miyagi, Japan
| | - Hayato Okumiya
- R&D Planning Office, Canon Medical Systems Corporation, Otawara, Tochigi, Japan
| | - Katsuhiko Fujimoto
- R&D Planning Office, Canon Medical Systems Corporation, Otawara, Tochigi, Japan
| | - Kazuki Utsunomiya
- R&D Planning Office, Canon Medical Systems Corporation, Otawara, Tochigi, Japan
| | - Yuka Shimomura
- Research and Development Center, Canon Medical Systems Corporation, Otawara, Tochigi, Japan
| | - Masaru Sanuki
- Laboratory of Mathematical Informatics in Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Keitaro Kume
- Laboratory of Mathematical Informatics in Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Takahiro Yano
- Laboratory of Mathematical Informatics in Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Rina Kagawa
- Department of Biomedical Informatics and Management, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Hiroko Bando
- Department of Breast-Thyroid-Endocrine Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Law NLW, Hong LW, Tan SSN, Foo CJ, Lee D, Voon PJ. Barriers And Challenges Of Multidisciplinary Teams In Oncology Management: A Scoping Review Protocol. BMJ Open 2024; 14:e079559. [PMID: 38341218 PMCID: PMC10862282 DOI: 10.1136/bmjopen-2023-079559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/19/2024] [Indexed: 02/12/2024] Open
Abstract
INTRODUCTION Multidisciplinary teams (MDTs) are integral to oncology management, involving specialised healthcare professionals who collaborate to develop individualised treatment plans for patients. However, as cancer care grows more complex, MDTs must continually adapt to better address patient needs. This scoping review will explore barriers and challenges MDTs have encountered in the past decade; and propose strategies for optimising their utilisation to overcome these obstacles and improve patient care. METHODS AND ANALYSIS The scoping review will follow Arksey and O'Malley's framework and begin with a literature search using keywords in electronic databases such as PubMed/MEDLINE, Scopus and PsychINFO, covering the period from January 2013 to December 2022 and limited to English language publications. Four independent reviewers will screen titles and abstracts based on predefined inclusion criteria, followed by full-text review of selected titles. Relevant references cited in the publications will also be examined. A Preferred Reporting Items for Systematic reviews and Meta-Analyses flow diagram will be utilised to illustrate the methodology. Data from selected publications will be extracted, analysed, and categorised for further analysis. ETHICS AND DISSEMINATION The results of the scoping review will provide a comprehensive overview of the barriers and challenges encountered by oncology MDTs over the past decade. These findings will contribute to the existing literature and provide insights into areas that require improvement in the functioning of MDTs in oncology management. The results will be disseminated through publication in a scientific journal, which will help to share the findings with the wider healthcare community and facilitate further research and discussion in this field. TRIAL REGISTRATION DETAILS The protocol for this scoping review is registered with Open Science Framework, available at DOI 10.17605/OSF.IO/R3Y8U.
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Affiliation(s)
- Nicholas Lee Wei Law
- Department of Radiotherapy, Oncology and Palliative Care, Sarawak General Hospital, Ministry of Health Malaysia, Jalan Hospital, 93586, Kuching, Sarawak, Malaysia
| | - Lai Wei Hong
- Clinical Research Centre, Sarawak General Hospital, Ministry of Health Malaysia, Jalan Hospital, 93586, Kuching, Sarawak, Malaysia
| | - Shirley Siang Ning Tan
- Clinical Research Centre, Sarawak General Hospital, Ministry of Health Malaysia, Jalan Hospital, 93586, Kuching, Sarawak, Malaysia
- Department of Pharmacy, Sarawak General Hospital, Ministry of Health Malaysia, Jalan Hospital, 93586, Kuching, Sarawak, Malaysia
| | - Chuan Jie Foo
- Department of Radiotherapy, Oncology and Palliative Care, Sarawak General Hospital, Ministry of Health Malaysia, Jalan Hospital, 93586, Kuching, Sarawak, Malaysia
| | - Daniel Lee
- Department of Radiotherapy, Oncology and Palliative Care, Sarawak General Hospital, Ministry of Health Malaysia, Jalan Hospital, 93586, Kuching, Sarawak, Malaysia
| | - Pei Jye Voon
- Department of Radiotherapy, Oncology and Palliative Care, Sarawak General Hospital, Ministry of Health Malaysia, Jalan Hospital, 93586, Kuching, Sarawak, Malaysia
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Kočo L, Siebers CCN, Schlooz M, Meeuwis C, Oldenburg HSA, Prokop M, Mann RM. The Facilitators and Barriers of the Implementation of a Clinical Decision Support System for Breast Cancer Multidisciplinary Team Meetings-An Interview Study. Cancers (Basel) 2024; 16:401. [PMID: 38254891 PMCID: PMC10813995 DOI: 10.3390/cancers16020401] [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: 12/07/2023] [Revised: 01/07/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND AI-driven clinical decision support systems (CDSSs) hold promise for multidisciplinary team meetings (MDTMs). This study aimed to uncover the hurdles and aids in implementing CDSSs during breast cancer MDTMs. METHODS Twenty-four core team members from three hospitals engaged in semi-structured interviews, revealing a collective interest in experiencing CDSS workflows in clinical practice. All interviews were audio recorded, transcribed verbatim and analyzed anonymously. A standardized approach, 'the framework method', was used to create an analytical framework for data analysis, which was performed by two independent researchers. RESULTS Positive aspects included improved data visualization, time-saving features, automated trial matching, and enhanced documentation transparency. However, challenges emerged, primarily concerning data connectivity, guideline updates, the accuracy of AI-driven suggestions, and the risk of losing human involvement in decision making. Despite the complexities involved in CDSS development and integration, clinicians demonstrated enthusiasm to explore its potential benefits. CONCLUSIONS Acknowledging the multifaceted nature of this challenge, insights into the barriers and facilitators identified in this study offer a potential roadmap for smoother future implementations. Understanding these factors could pave the way for more effective utilization of CDSSs in breast cancer MDTMs, enhancing patient care through informed decision making.
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Affiliation(s)
- Lejla Kočo
- Department of Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Carmen C. N. Siebers
- Department of Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Margrethe Schlooz
- Department of Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Carla Meeuwis
- Department of Radiology, Rijnstate, Wagnerlaan 55, 6815 AD Arnhem, The Netherlands;
| | - Hester S. A. Oldenburg
- Department of Surgery, The Netherlands Cancer Institute (Antoni van Leeuwenhoek), Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Mathias Prokop
- Department of Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Ritse M. Mann
- Department of Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
- Department of Surgery, The Netherlands Cancer Institute (Antoni van Leeuwenhoek), Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
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Bouleftour W, Mondiere-Wichurski A, Fournel P, Reboul Q. COVID-19 Outbreak Impact on Cancer Multidisciplinary Team Meetings. A Multicenter French Experience. Cancer Invest 2024; 42:4-11. [PMID: 38317281 DOI: 10.1080/07357907.2024.2311856] [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: 12/05/2022] [Accepted: 01/25/2024] [Indexed: 02/07/2024]
Abstract
Multidisciplinary team meeting (MDT) became a standard of care in cancer management. The COVID-19 epidemic induced unprecedented pressure on the health system. The impact of this health crisis on MDTs held within a regional French health structures was analyzed. A decrease in the total number of records discussed in hematological, digestive, thoracic, gynecological and genitourinary MDTs was observed following the 1st wave of the COVID-19 pandemic. This decrease was generally maintained during the 2nd and 3rd wave. MDTs activity back in order from the 4th wave. The COVID-19 pandemic has challenged MDTs settings. The implementation of virtual technologies offers an opportunity to improve MDTs organization.
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Affiliation(s)
- Wafa Bouleftour
- Department of Medical Oncology, North Hospital, University Hospital of Saint-Etienne, Saint-Etienne, France
| | | | - Pierre Fournel
- Department of Medical Oncology, North Hospital, University Hospital of Saint-Etienne, Saint-Etienne, France
- Cancerology Coordination Center, Oncoloire of Department Loire and Northern Ardeche, France Saint-Etienne
| | - Quentin Reboul
- Cancerology Coordination Center, Oncoloire of Department Loire and Northern Ardeche, France Saint-Etienne
- Surgical Mutual Clinic, Saint-Etienne, France
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Taroeno-Hariadi KW, Herdini C, Briliant AS, Husodoputro HK, Dhamiyati W, Indrasari SR, Lestari SP, Widyastuti Y, Puspitaningtyas H, Rahmasari R, Rachmawati IN, Purwanto I, Setyawan NH, Ekaputra E, Hutajulu SH, Dwidanarti SR, Kurniawan T, Meidania L, Yanuarta SE, Hardianti MS, Kurnianda J. Multidisciplinary Team Meeting in the Core of Nasopharyngeal Cancer Management Improved Quality of Care and Survival of Patients. Health Serv Insights 2023; 16:11786329231204757. [PMID: 37850152 PMCID: PMC10578065 DOI: 10.1177/11786329231204757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 09/14/2023] [Indexed: 10/19/2023] Open
Abstract
Nasopharyngeal cancer (NPC) cases are often diagnosed in advanced stages. The complexity of clinical management for advanced-stage NPC requires thorough communication and shared decisions between medical professionals and allied teams. Incorporating a multidisciplinary team meeting (MDTM) for newly diagnosed NPC patients was chosen to facilitate collaboration and communication between physicians. This retrospective study aimed to compare the quality of care, clinical responses and survival between NPC patients treated with and without MDTM. Data on clinical responses, assessment visits, date of progression and death with progression-free survival (PFS), overall survival (OS), and hazard ratio (HR) were collected and analyzed with 95% confidence interval (CI) and significance set as P < .05. There were 87 of 178 NPC patients treated with MDTM. Revisions of diagnosis and stage occurred in 5.7% and 52.9% of cases during the MDTM. More clinical responses were achieved by patients treated with MDTM (69.0%vs 32.0%, P < .00). NPC patients who received MDTM treatment recommendation had a lower risk for progression (median PFS 59.89 months vs 12.68 months; HR 0.267, 95% CI: 0.17-0.40, P < .00) and mortality (median OS was not reached vs 13.44 months; HR 0.134, 95% CI: 0.08-0.24, P < .00) compared to patients without MDTM. Incorporating the MDTM approach into NPC management improves patients' clinical responses and survival.
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Affiliation(s)
- Kartika W Taroeno-Hariadi
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Camelia Herdini
- Department of Ear, Nose and Throat, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Aulia S Briliant
- Department of Pathology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Henry K Husodoputro
- Division of Radiodiagnosis, Department of Radiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Wigati Dhamiyati
- Division of Radiotherapy, Department of Radiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Sagung Rai Indrasari
- Department of Ear, Nose and Throat, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Setiyani P Lestari
- Department of Pathology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | | | | | - Risa Rahmasari
- Tulip Cancer Clinic, Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | | | - Ibnu Purwanto
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Nurhuda H Setyawan
- Division of Radiodiagnosis, Department of Radiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Ericko Ekaputra
- Division of Radiotherapy, Department of Radiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Susanna H Hutajulu
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Sri R Dwidanarti
- Division of Radiotherapy, Department of Radiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Torana Kurniawan
- Division of Radiotherapy, Department of Radiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Lidya Meidania
- Division of Radiotherapy, Department of Radiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Seize E Yanuarta
- Division of Radiotherapy, Department of Radiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Mardiah S Hardianti
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Johan Kurnianda
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
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Vernooij JEM, Boerlage RM, Doggen CJM, Preckel B, Dirksen CD, van Leeuwen BL, Spruit RJ, Festen S, van der Wal-Huisman H, van Basten JP, Kalkman CJ, Koning NJ. Is a preoperative multidisciplinary team meeting (cost)effective to improve outcome for high-risk adult patients undergoing noncardiac surgery: the PREPARATION study-a multicenter stepped-wedge cluster randomized trial. Trials 2023; 24:660. [PMID: 37821994 PMCID: PMC10568883 DOI: 10.1186/s13063-023-07685-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 09/28/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND As a result of increased life expectancy and improved care for patients suffering from chronic disease, the number of patients with multimorbidity requiring surgical intervention is increasing. For complex surgical patients, it is essential to balance the potential benefits of surgical treatment against the risk of permanent loss of functional capacity and quality of life due to complications. European and US guidelines on perioperative care recommend preoperative multidisciplinary team (MDT) discussions for high-risk noncardiac surgical patients. However, the evidence underlying benefits from preoperative MDT meetings with all relevant perioperative specialties present is limited. The current study aims to investigate the effect of implementation of preoperative MDT discussions for high-risk patients undergoing noncardiac surgery on serious adverse events. METHODS/DESIGN PREPARATION is a stepped-wedge cluster randomized trial in 14 Dutch hospitals without currently established preoperative MDT meeting. The intervention, preoperative MDT meetings, will be implemented sequentially with seven blocks of 2 hospitals switching from control (preoperative screening as usual) to the intervention every 3 months. Each hospital will be randomized to one of seven blocks. We aim to include 1200 patients. The primary outcome is the incidence of serious adverse events at 6 months. Secondary outcomes include (cost)effectiveness, functional outcome, and quality of life for up to 12 months. DISCUSSION PREPARATION is the first study to assess the effectiveness of a preoperative MDT meeting for high-risk noncardiac surgical patients in the presence of an anesthesiologist. If the results suggest that preoperative MDT discussions for high-risk patients are (cost)-effective, the current study facilitates implementation of preoperative MDT meetings in clinical practice. TRIAL REGISTRATION ClinicalTrials.gov NCT05703230. Registered on 11/09/2022.
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Affiliation(s)
- Jacqueline E M Vernooij
- Department of Anesthesiology, Rijnstate Hospital, Arnhem, The Netherlands.
- Department of Anesthesiology, University Medical Centre Utrecht, Utrecht, The Netherlands.
| | - Romijn M Boerlage
- Department of Anesthesiology, Rijnstate Hospital, Arnhem, The Netherlands
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschedé, The Netherlands
- Clinical Research Center, Rijnstate Hospital, Arnhem, The Netherlands
- Department of Anesthesiology, Amsterdam UMC Location AMC, Amsterdam Public Health, Quality of Care, Amsterdam Cardiovascular Science, Diabetes & Metabolism, Amsterdam, The Netherlands
| | - Carine J M Doggen
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschedé, The Netherlands
- Clinical Research Center, Rijnstate Hospital, Arnhem, The Netherlands
| | - Benedikt Preckel
- Department of Anesthesiology, Amsterdam UMC Location AMC, Amsterdam Public Health, Quality of Care, Amsterdam Cardiovascular Science, Diabetes & Metabolism, Amsterdam, The Netherlands
| | - Carmen D Dirksen
- Care and Public Health Research Institute, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Barbara L van Leeuwen
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Rutger J Spruit
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Suzanne Festen
- University Center for Geriatric Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Hanneke van der Wal-Huisman
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jean P van Basten
- Department of Urology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Cor J Kalkman
- Department of Anesthesiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Nick J Koning
- Department of Anesthesiology, Rijnstate Hospital, Arnhem, The Netherlands
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9
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Chau BL, LaGuardia JS, Kim S, Zhang SC, Pletcher E, Sanford NN, Raldow AC, Singer L, Gong J, Padda SK, Kamrava M, Cohen T, Mitra D, Atkins KM. Association of Parental Status and Gender With Burden of Multidisciplinary Tumor Boards Among Oncology Physicians. JAMA Netw Open 2023; 6:e2340663. [PMID: 37906191 PMCID: PMC10618838 DOI: 10.1001/jamanetworkopen.2023.40663] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/19/2023] [Indexed: 11/02/2023] Open
Abstract
Importance Tumor boards are integral to the care of patients with cancer. However, data investigating the burden of tumor boards on physicians are limited. Objective To investigate what physician-related and tumor board-related factors are associated with higher tumor board burden among oncology physicians. Design, Setting, and Participants Tumor board burden was assessed by a cross-sectional convenience survey posted on social media and by email to Cedars-Sinai Medical Center cancer physicians between March 3 and April 3, 2022. Tumor board start times were independently collected by email from 22 top cancer centers. Main Outcomes and Measures Tumor board burden was measured on a 4-point scale (1, not at all burdensome; 2, slightly burdensome; 3, moderately burdensome; and 4, very burdensome). Univariable and multivariable probabilistic index (PI) models were performed. Results Surveys were completed by 111 physicians (median age, 42 years [IQR, 36-50 years]; 58 women [52.3%]; 60 non-Hispanic White [54.1%]). On multivariable analysis, factors associated with higher probability of tumor board burden included radiology or pathology specialty (PI, 0.68; 95% CI, 0.54-0.79; P = .02), attending 3 or more hours per week of tumor boards (PI, 0.68; 95% CI, 0.58-0.76; P < .001), and having 2 or more children (PI, 0.65; 95% CI, 0.52-0.77; P = .03). Early or late tumor boards (before 8 am or at 5 pm or after) were considered very burdensome by 33 respondents (29.7%). Parents frequently reported a negative burden on childcare (43 of 77 [55.8%]) and family dynamics (49 of 77 [63.6%]). On multivariable analysis, a higher level of burden from early or late tumor boards was independently associated with identifying as a woman (PI, 0.69; 95% CI, 0.57-0.78; P = .003) and having children (PI, 0.75; 95% CI, 0.62-0.84; P < .001). Independent assessment of 358 tumor boards from 22 institutions revealed the most common start time was before 8 am (88 [24.6%]). Conclusions and Relevance This survey study of tumor board burden suggests that identifying as a woman or parent was independently associated with a higher level of burden from early or late tumor boards. The burden of early or late tumor boards on childcare and family dynamics was commonly reported by parents. Having 2 or more children, attending 3 or more hours per week of tumor boards, and radiology or pathology specialty were associated with a significantly higher tumor board burden overall. Future strategies should aim to decrease the disparate burden on parents and women.
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Affiliation(s)
- Brittney L. Chau
- Department of Medicine, New York Medical College, New York, New York
| | - Jonnby S. LaGuardia
- Department of Medicine, University of Rochester Medical Center, Rochester, New York
| | - Sungjin Kim
- Biostatistics Research Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - Samuel C. Zhang
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Eric Pletcher
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Nina N. Sanford
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas
| | - Ann C. Raldow
- Department of Radiation Oncology, University of California Los Angeles Medical Center, Los Angeles
| | - Lisa Singer
- Department of Radiation Oncology, University of California San Francisco Medical Center, San Francisco
| | - Jun Gong
- Department of Medicine, Division of Medical Oncology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Sukhmani K. Padda
- Department of Medicine, Division of Medical Oncology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Mitchell Kamrava
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Tara Cohen
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Devarati Mitra
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Katelyn M. Atkins
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California
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10
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Stella GM, Lettieri S, Piloni D, Ferrarotti I, Perrotta F, Corsico AG, Bortolotto C. Smart Sensors and Microtechnologies in the Precision Medicine Approach against Lung Cancer. Pharmaceuticals (Basel) 2023; 16:1042. [PMID: 37513953 PMCID: PMC10385174 DOI: 10.3390/ph16071042] [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: 06/08/2023] [Revised: 06/23/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND AND RATIONALE The therapeutic interventions against lung cancer are currently based on a fully personalized approach to the disease with considerable improvement of patients' outcome. Alongside continuous scientific progresses and research investments, massive technologic efforts, innovative challenges, and consolidated achievements together with research investments are at the bases of the engineering and manufacturing revolution that allows a significant gain in clinical setting. AIM AND METHODS The scope of this review is thus to focus, rather than on the biologic traits, on the analysis of the precision sensors and novel generation materials, as semiconductors, which are below the clinical development of personalized diagnosis and treatment. In this perspective, a careful revision and analysis of the state of the art of the literature and experimental knowledge is presented. RESULTS Novel materials are being used in the development of personalized diagnosis and treatment for lung cancer. Among them, semiconductors are used to analyze volatile cancer compounds and allow early disease diagnosis. Moreover, they can be used to generate MEMS which have found an application in advanced imaging techniques as well as in drug delivery devices. CONCLUSIONS Overall, these issues represent critical issues only partially known and generally underestimated by the clinical community. These novel micro-technology-based biosensing devices, based on the use of molecules at atomic concentrations, are crucial for clinical innovation since they have allowed the recent significant advances in cancer biology deciphering as well as in disease detection and therapy. There is an urgent need to create a stronger dialogue between technologists, basic researchers, and clinicians to address all scientific and manufacturing efforts towards a real improvement in patients' outcome. Here, great attention is focused on their application against lung cancer, from their exploitations in translational research to their application in diagnosis and treatment development, to ensure early diagnosis and better clinical outcomes.
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Affiliation(s)
- Giulia Maria Stella
- Department of Internal Medicine and Medical Therapeutics, University of Pavia Medical School, 27100 Pavia, Italy
- Cardiothoracic and Vascular Department, Unit of Respiratory Diseases, IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Sara Lettieri
- Department of Internal Medicine and Medical Therapeutics, University of Pavia Medical School, 27100 Pavia, Italy
- Cardiothoracic and Vascular Department, Unit of Respiratory Diseases, IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Davide Piloni
- Department of Internal Medicine and Medical Therapeutics, University of Pavia Medical School, 27100 Pavia, Italy
- Cardiothoracic and Vascular Department, Unit of Respiratory Diseases, IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Ilaria Ferrarotti
- Department of Internal Medicine and Medical Therapeutics, University of Pavia Medical School, 27100 Pavia, Italy
- Cardiothoracic and Vascular Department, Unit of Respiratory Diseases, IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Fabio Perrotta
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", 80131 Napoli, Italy
- U.O.C. Clinica Pneumologica "L. Vanvitelli", A.O. dei Colli, Ospedale Monaldi, 80131 Napoli, Italy
| | - Angelo Guido Corsico
- Department of Internal Medicine and Medical Therapeutics, University of Pavia Medical School, 27100 Pavia, Italy
- Cardiothoracic and Vascular Department, Unit of Respiratory Diseases, IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Chandra Bortolotto
- Department of Clinical-Surgical, Diagnostic and Paediatric Sciences, University of Pavia Medical School, 27100 Pavia, Italy
- Department of Diagnostic Services and Imaging, Unit of Radiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
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11
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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.
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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
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12
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Vignot S, Guyader G, Salomon V, Vella P, Yoldjian I, Maison P, Ratignier-Carbonneil C. Clinical Trial Authorisation: A Final Look Back to Better Appraise the New European Regulation. Rev Recent Clin Trials 2023; 18:167-171. [PMID: 36959158 PMCID: PMC10514496 DOI: 10.2174/1574887118666230320124012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/18/2023] [Accepted: 01/26/2023] [Indexed: 03/25/2023]
Abstract
The implementation of the new European Clinical Trial Regulation on 31 January 2022, is a major step to promote clinical research in Europe. The French National Agency for Medicines and Health Products Safety (ANSM) proposes to share some key aspects of the preparation for the application of the Regulation initiated in 2017 and to discuss shared indicators that should be considered to monitor clinical trials opportunities on a territory with regards to access to innovation for patients and attractiveness for sponsors. New criteria based on the time from the first request for authorisation to the first inclusion could be of particular interest to appraise the implementation of the European Clinical Trial Regulation.
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Affiliation(s)
- Stéphane Vignot
- Agence Nationale de Sécurité du Médicament et des Produits de Santé, Boulevard Anatole France, 93200, Saint Denis, Grand Paris, France
| | - Gaëlle Guyader
- Agence Nationale de Sécurité du Médicament et des Produits de Santé, Boulevard Anatole France, 93200, Saint Denis, Grand Paris, France
| | - Valérie Salomon
- Agence Nationale de Sécurité du Médicament et des Produits de Santé, Boulevard Anatole France, 93200, Saint Denis, Grand Paris, France
| | - Philippe Vella
- Agence Nationale de Sécurité du Médicament et des Produits de Santé, Boulevard Anatole France, 93200, Saint Denis, Grand Paris, France
| | - Isabelle Yoldjian
- Agence Nationale de Sécurité du Médicament et des Produits de Santé, Boulevard Anatole France, 93200, Saint Denis, Grand Paris, France
| | - Patrick Maison
- Agence Nationale de Sécurité du Médicament et des Produits de Santé, Boulevard Anatole France, 93200, Saint Denis, Grand Paris, France
| | - Christelle Ratignier-Carbonneil
- Agence Nationale de Sécurité du Médicament et des Produits de Santé, Boulevard Anatole France, 93200, Saint Denis, Grand Paris, France
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13
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Abd Al Rahman E, Intan Raihana Ruhaiyem N, Bouchahma M, Imran Musa K. Framework for a Computer-Aided Treatment Prediction (CATP) System for Breast Cancer. INTELLIGENT AUTOMATION & SOFT COMPUTING 2023; 36:3007-3028. [DOI: 10.32604/iasc.2023.032580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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14
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Specchia ML, Di Pilla A, Gambacorta MA, Filippella A, Beccia F, Farina S, Meldolesi E, Lanza C, Bellantone RDA, Valentini V, Tortora G. An IT Platform Supporting Rectal Cancer Tumor Board Activities: Implementation Process and Impact Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15808. [PMID: 36497903 PMCID: PMC9736877 DOI: 10.3390/ijerph192315808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/22/2022] [Accepted: 11/25/2022] [Indexed: 06/17/2023]
Abstract
Colorectal cancer (RC) is the third most common cancer, with an increasing incidence in recent years. Digital health solutions supporting multidisciplinary tumor boards (MTBs) could improve positive outcomes for RC patients. This paper describes the implementation process of a digital solution within the RC-MTB and its impact analysis in the context of the Fondazione Policlinico 'A. Gemelli' in Italy. Adopting a two-phase methodological approach, the first phase qualitatively describes each phase of the implementation of the IT platform, while the second phase quantitatively describes the analysis of the impact of the IT platform. Descriptive and inferential analyses were performed for all variables, with a p-value < 0.05 being considered statistically significant. The implementation of the platform allowed more healthcare professionals to attend meetings and resulted in a decrease in patients sent to the RC-MTB for re-staging and further diagnostic investigations and an increase in patients sent to the RC-MTB for treatment strategies. The results could be attributed to the facilitated access to the platform remotely for specialists, partly compensating for the restrictions imposed by the COVID-19 pandemic, as well as to the integration of the platform into the hospital's IT system. Furthermore, the early involvement of healthcare professionals in the process of customizing the platform to the specific needs of the RC-MTB may have facilitated its use and contributed to the encouraging quantitative results.
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Affiliation(s)
- Maria Lucia Specchia
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Andrea Di Pilla
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Maria Antonietta Gambacorta
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Alessandro Filippella
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Flavia Beccia
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Sara Farina
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Elisa Meldolesi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Chiara Lanza
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Rocco Domenico Alfonso Bellantone
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Vincenzo Valentini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Giampaolo Tortora
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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15
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Cheng AL, Snider EM, Prather H, Dougherty NL, Wilcher-Roberts M, Hunt DM. Provider-Perceived Value of Interprofessional Team Meetings as a Core Element of a Lifestyle Medicine Program: A Mixed-Methods Analysis of One Center’s Experience. Am J Lifestyle Med 2022. [DOI: 10.1177/15598276221135539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Interprofessional care improves outcomes for medically complex patients and may be a valuable addition to standard lifestyle medicine practice, but implementation barriers exist. The purpose of this study was to explore the key features, perceived impact, and implementation considerations related to holding interprofessional team meetings as part of an intensive lifestyle medicine program. In this mixed-methods study, focus groups were conducted with 15 lifestyle medicine clinicians from various healthcare disciplines who had participated in interprofessional team meetings. Quantitative descriptive statistics of the meeting minutes were also calculated. Clinician-perceived benefits from participating in interprofessional team meetings included increased acquisition of knowledge, access to other clinicians, collaborative decision-making, patient satisfaction, and achievement of patient-centered goals. Participants described the importance of preparing an agenda for the interprofessional team meetings in advance, but a major implementation challenge was the time required to prepare for and conduct the meetings. Commitment and financial support by organization and program leadership were reported as key facilitators to implementing the meetings. Clinicians perceive significant value from incorporation of interprofessional team meetings into an intensive lifestyle medicine program, but successful implementation of meetings requires investment from all levels within a healthcare system.
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Affiliation(s)
- Abby L. Cheng
- Department of Orthopaedic Surgery, Division of Physical Medicine and Rehabilitation, Washington University in St Louis School of Medicine, St Louis, MO, USA (ALC, DMH); Brown School Evaluation Center, Brown School at Washington University in St Louis, St Louis, MO, USA (EMS, NLD, MWR); Kirksville College of Osteopathic Medicine, A. T. Still University, Kirksville, MO, USA (EMS); Department of Physical Medicine and Rehabilitation, Weill Cornell Medical College, New York, NY, USA (HP)
| | - Elsa M. Snider
- Department of Orthopaedic Surgery, Division of Physical Medicine and Rehabilitation, Washington University in St Louis School of Medicine, St Louis, MO, USA (ALC, DMH); Brown School Evaluation Center, Brown School at Washington University in St Louis, St Louis, MO, USA (EMS, NLD, MWR); Kirksville College of Osteopathic Medicine, A. T. Still University, Kirksville, MO, USA (EMS); Department of Physical Medicine and Rehabilitation, Weill Cornell Medical College, New York, NY, USA (HP)
| | - Heidi Prather
- Department of Orthopaedic Surgery, Division of Physical Medicine and Rehabilitation, Washington University in St Louis School of Medicine, St Louis, MO, USA (ALC, DMH); Brown School Evaluation Center, Brown School at Washington University in St Louis, St Louis, MO, USA (EMS, NLD, MWR); Kirksville College of Osteopathic Medicine, A. T. Still University, Kirksville, MO, USA (EMS); Department of Physical Medicine and Rehabilitation, Weill Cornell Medical College, New York, NY, USA (HP)
| | - Nikole L. Dougherty
- Department of Orthopaedic Surgery, Division of Physical Medicine and Rehabilitation, Washington University in St Louis School of Medicine, St Louis, MO, USA (ALC, DMH); Brown School Evaluation Center, Brown School at Washington University in St Louis, St Louis, MO, USA (EMS, NLD, MWR); Kirksville College of Osteopathic Medicine, A. T. Still University, Kirksville, MO, USA (EMS); Department of Physical Medicine and Rehabilitation, Weill Cornell Medical College, New York, NY, USA (HP)
| | - Myisha Wilcher-Roberts
- Department of Orthopaedic Surgery, Division of Physical Medicine and Rehabilitation, Washington University in St Louis School of Medicine, St Louis, MO, USA (ALC, DMH); Brown School Evaluation Center, Brown School at Washington University in St Louis, St Louis, MO, USA (EMS, NLD, MWR); Kirksville College of Osteopathic Medicine, A. T. Still University, Kirksville, MO, USA (EMS); Department of Physical Medicine and Rehabilitation, Weill Cornell Medical College, New York, NY, USA (HP)
| | - Devyani M. Hunt
- Department of Orthopaedic Surgery, Division of Physical Medicine and Rehabilitation, Washington University in St Louis School of Medicine, St Louis, MO, USA (ALC, DMH); Brown School Evaluation Center, Brown School at Washington University in St Louis, St Louis, MO, USA (EMS, NLD, MWR); Kirksville College of Osteopathic Medicine, A. T. Still University, Kirksville, MO, USA (EMS); Department of Physical Medicine and Rehabilitation, Weill Cornell Medical College, New York, NY, USA (HP)
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16
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Luo H, Wang T, Xiao L, Wang C, Yi H. Multiple disciplinary team management of rare primary splenic malignancy: Two case reports. World J Clin Cases 2022; 10:10535-10542. [PMID: 36312480 PMCID: PMC9602245 DOI: 10.12998/wjcc.v10.i29.10535] [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: 07/20/2021] [Revised: 11/27/2021] [Accepted: 09/01/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Malignant splenic tumors are rare but fatal, presenting a challenge in diagnosis and management involving hematology, oncology, and general surgery. By contrast, diagnosing and treating other common malignant tumors (such as lung and gastrointestinal cancer) offers multiple strategies for chemotherapy, radiotherapy, targeted therapy, and immunotherapy with the prospect of a cure. With various specialists involved in clinical multiple disciplinary team (MDT) discussion, personal bias can be minimized. It can also ignite important discussion which can benefit not only one patient but many patients.
CASE SUMMARY Here, we report on the MDT diagnosis and management of the malignant splenic tumors littoral cell angiosarcoma and histiocytic sarcoma. Although only two cases of rare primary splenic malignancy are presented, MDT is a novel means of rare disease treatment.
CONCLUSION To benefit patients, imaging analysis, safe operation, precise pathology examination, and individualized therapeutic treatment strategies are required. The involvement of various specialists in a clinical MDT discussion minimizes personal bias and can create important ideas to benefit all patients.
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Affiliation(s)
- Hao Luo
- Department of General Surgery Center, General Hospital of Western Theater, Chengdu 610083, Sichuan Province, China
| | - Tao Wang
- Department of General Surgery Center, General Hospital of Western Theater, Chengdu 610083, Sichuan Province, China
| | - Le Xiao
- Department of General Surgery Center, General Hospital of Western Theater, Chengdu 610083, Sichuan Province, China
| | - Chao Wang
- Department of Pathology, General Hospital of Western Theater, Chengdu 610083, Sichuan Province, China
| | - Hai Yi
- Department of Hematology, General Hospital of Western Theater, Chengdu 610083, Sichuan Province, China
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17
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He YG, Huang XB, Li YM, Li J, Peng XH, Huang W, Tang YC, Zheng L. Efficacy and safety of laparoscopic radical resection following neoadjuvant therapy for pancreatic ductal adenocarcinoma: A retrospective study. World J Gastrointest Oncol 2022; 14:1785-1797. [PMID: 36187398 PMCID: PMC9516639 DOI: 10.4251/wjgo.v14.i9.1785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/16/2022] [Accepted: 08/16/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Multiple studies have demonstrated that neoadjuvant chemotherapy (NACT) can prolong the overall survival of pancreatic ductal adenocarcinoma (PDAC) patients. However, most studies have focused on open surgery following NACT.
AIM To investigate the efficacy and safety of laparoscopic radical resection following NACT for PDAC.
METHODS We retrospectively analyzed the clinical data of 15 patients with pathologically confirmed PDAC who received NACT followed by laparoscopic radical surgery in our hospital from December 2019 to April 2022. All patients underwent abdominal contrast-enhanced computed tomography (CT) and positron emission tomography-CT before surgery to accurately assess tumor stage and exclude distant metastasis.
RESULTS All 15 patients with pancreatic cancer were successfully converted to surgical resection after NACT, including 8 patients with pancreatic head cancer and 7 patients with pancreatic body and tail cancer. Among them, 13 patients received the nab-paclitaxel plus gemcitabine regimen (gemcitabine 1000 mg/m2 plus nab-paclitaxel 125 mg/m2 on days 1, 8, and 15 every 4 wk) and 2 patients received the modified FOLFIRINOX regimen (intravenous oxaliplatin 68 mg/m2, irinotecan 135 mg/m2, and leucovorin 400 mg/m2 on day 1 and fluorouracil 400 mg/m2 on day 1, followed by 46-h continuous infusion of fluorouracil 2400 mg/m2). After each treatment cycle, abdominal CT, tumor markers, and circulating tumor cell counts were reviewed to evaluate the treatment efficacy. All 15 patients achieved partial remission. The surgical procedures included laparoscopic pancreaticoduodenectomy (LPD, n = 8) and laparoscopic radical antegrade modular pancreatosplenectomy (L-RAMPS, n = 7). None of them were converted to a laparotomy. One patient with pancreatic head carcinoma was found to have portal vein involvement during the operation, and LPD combined with vascular resection and reconstruction was performed. The amount of blood loss and operation times of L-RAMPS vs LPD were 435.71 ± 32.37 mL vs 343.75 ± 145.01 mL and 272.52 ± 49.14 min vs 444.38 ± 68.63 min, respectively. The number of dissected lymph nodes was 16.87 ± 4.10, and 3 patients had positive lymph nodes. One patient developed grade B postoperative pancreatic fistula (POPF) after L-RAMPS, and one patient experienced jaundice after LPD. None of the patients died after surgery. As of April 2022, progressive disease was noted in 4 patients, 2 patients had liver metastasis, and one had both liver metastasis and lymph node metastasis and died during the follow-up period.
CONCLUSION Laparoscopic radical resection of PDAC after NACT is safe and effective if it is performed by a surgeon with rich experience in LPD and in a large center of pancreatic surgery.
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Affiliation(s)
- Yong-Gang He
- Department of Hepatobiliary, The Second Affiliated Hospital of Army Medical University, Chongqing 400037, China
| | - Xiao-Bing Huang
- Department of Hepatobiliary, The Second Affiliated Hospital of Army Medical University, Chongqing 400037, China
| | - Yu-Ming Li
- Department of Hepatobiliary, The Second Affiliated Hospital of Army Medical University, Chongqing 400037, China
| | - Jing Li
- Department of Hepatobiliary, The Second Affiliated Hospital of Army Medical University, Chongqing 400037, China
| | - Xue-Hui Peng
- Department of Hepatobiliary, The Second Affiliated Hospital of Army Medical University, Chongqing 400037, China
| | - Wen Huang
- Department of Hepatobiliary, The Second Affiliated Hospital of Army Medical University, Chongqing 400037, China
| | - Yi-Chen Tang
- Department of Hepatobiliary, The Second Affiliated Hospital of Army Medical University, Chongqing 400037, China
| | - Lu Zheng
- Department of Hepatobiliary, The Second Affiliated Hospital of Army Medical University, Chongqing 400037, China
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Bertolaccini L, Mohamed S, Bardoni C, Lo Iacono G, Mazzella A, Guarize J, Spaggiari L. The Interdisciplinary Management of Lung Cancer in the European Community. J Clin Med 2022; 11:jcm11154326. [PMID: 35893419 PMCID: PMC9332145 DOI: 10.3390/jcm11154326] [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: 06/28/2022] [Revised: 07/16/2022] [Accepted: 07/20/2022] [Indexed: 02/01/2023] Open
Abstract
Lung cancer continues to be the largest cause of cancer-related mortality among men and women globally, accounting for around 27% of all cancer-related deaths. Recent advances in lung cancer medicines, particularly for non-small-cell lung cancer (NSCLC), have increased the need for multidisciplinary disease care, thereby enhancing patient outcomes and quality of life. Different studies in the European community have evaluated the impact of multidisciplinary care on outcomes for lung cancer patients, including its impact on survival, adherence to guideline treatment, utilization of all treatment modalities, timeliness of treatment, patient satisfaction, quality of life, and referral to palliative care. This publication will examine the roles and duties of all multidisciplinary members and the influence of multidisciplinary care on lung cancer outcomes in Europe. Multidisciplinary treatment is the foundation of lung cancer treatment. The optimal setting for interdisciplinary collaboration between specialists with complementary functions is multidisciplinary meetings. Multidisciplinary care in lung cancer facilitates the delivery of a high-quality service, which may improve lung cancer patients’ survival, utilization of all treatment modalities, adherence to guideline management, and quality of life, despite the fact that only limited observational data have demonstrated these results. To confirm the relationship between multidisciplinary treatment and improved lung cancer patient outcomes, however, further research is required.
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Affiliation(s)
- Luca Bertolaccini
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (S.M.); (C.B.); (G.L.I.); (A.M.); (L.S.)
- Correspondence: ; Tel.: +39-02-57489665; Fax: +39-02-56562994
| | - Shehab Mohamed
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (S.M.); (C.B.); (G.L.I.); (A.M.); (L.S.)
| | - Claudia Bardoni
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (S.M.); (C.B.); (G.L.I.); (A.M.); (L.S.)
| | - Giorgio Lo Iacono
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (S.M.); (C.B.); (G.L.I.); (A.M.); (L.S.)
| | - Antonio Mazzella
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (S.M.); (C.B.); (G.L.I.); (A.M.); (L.S.)
| | - Juliana Guarize
- Unit of Interventional Pulmonology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy;
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (S.M.); (C.B.); (G.L.I.); (A.M.); (L.S.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20141 Milan, Italy
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Karabatić S, Šajnić A, Pleština S, Jakopović M, Kurtović B. Croatian National Cancer Patient Experience Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148285. [PMID: 35886137 PMCID: PMC9323016 DOI: 10.3390/ijerph19148285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/01/2022] [Accepted: 07/05/2022] [Indexed: 11/23/2022]
Abstract
Background: Cancer patients’ experiences of the healthcare system, care, and treatment are increasingly viewed as important in order to inform and improve quality of care, patient safety, and treatment efficacy. Understanding patient experience is a key step in moving toward patient-centred care. The aims of this study were to determine the experience of cancer patients in Central and Eastern European countries and to identify the needs and perspectives of oncological patients during the cancer treatment. In this paper, results from Croatia are presented. Methods: A sixty-nine item online survey was translated by native-language participating countries. Only registered members (subjects with confirmed cancer diagnosis) of the national patient oncology associations in each participating country were allowed to access and complete the online questionnaire (n = 16,458). Data were collected between October 2018 to February 2019. The Croatian Coalition of Health Associations enabled the authors of this paper to use the collected data from a sample of the Croatian participants (n = 2460) for the purposes of publication. Results: Two-thirds (67.3%) of the respondents reported satisfaction with the length of time needed for getting tests done. Bad news was delivered sensitively to 52.97% of the participants, and 52.76% received a cancer treatment plan. During the hospitalisation, 45.93% responded that they did not find someone from the hospital staff whom they could talk to about their worries and fears, and 57.48% were not given any contact information in case of concerns about their condition or treatment following the discharge. Regarding the patients’ preferences, needs, and values, 60.81% of the respondents felt that the greatest improvement would be to perform all services in one place, and 55.28% felt that improvement would be achieved through a multidisciplinary team coordinated by one person. Conclusions: The study reveals domains that need to be addressed in the overall Croatian healthcare system for oncology patients. Based on the obtained data, we can conclude that there is a large need for improvement in patient experience on the oncology pathway.
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Affiliation(s)
- Sandra Karabatić
- Department for Respiratory Diseases Jordanovac, University Hospital Centre Zagreb, 10000 Zagreb, Croatia; (A.Š.); (S.P.); (M.J.)
- Croatian Association of Patients with Lung Cancer and Other Respiratory Disease Jedra, 10000 Zagreb, Croatia
- Correspondence:
| | - Andreja Šajnić
- Department for Respiratory Diseases Jordanovac, University Hospital Centre Zagreb, 10000 Zagreb, Croatia; (A.Š.); (S.P.); (M.J.)
| | - Sanja Pleština
- Department for Respiratory Diseases Jordanovac, University Hospital Centre Zagreb, 10000 Zagreb, Croatia; (A.Š.); (S.P.); (M.J.)
- School of Medicine, University of Rijeka, 51000 Rijeka, Croatia
| | - Marko Jakopović
- Department for Respiratory Diseases Jordanovac, University Hospital Centre Zagreb, 10000 Zagreb, Croatia; (A.Š.); (S.P.); (M.J.)
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Biljana Kurtović
- Department of Nursing, University of Applied Health Sciences, 10000 Zagreb, Croatia;
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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.
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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
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Ekhator C, Kesari S, Tadipatri R, Fonkem E, Grewal J. The Emergence of Virtual Tumor Boards in Neuro-Oncology: Opportunities and Challenges. Cureus 2022; 14:e25682. [PMID: 35677741 PMCID: PMC9169580 DOI: 10.7759/cureus.25682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2022] [Indexed: 11/17/2022] Open
Abstract
Background Virtual tumor board (VTB) platforms are an important aspect of cancer management. They enable easier access to a multidisciplinary team of experts. To deliver high-quality cancer care, it is necessary to coordinate numerous therapies and providers, share technical knowledge, and maintain open lines of communication among all professionals involved. The VTB is an essential tool in the diagnosis and treatment of brain cancer. For patients with glioma and brain metastases, multidisciplinary tumor board guidelines should guide diagnosis and therapy throughout the course of the illness. VTBs are an emerging resource across various cancer care networks in the United States. Methodology We performed a systematic search of all VTBs incorporating a platform designed for this specific role. We reviewed the records of the Genomet VTB, the Medical University of South Carolina (MUSC) VTB, and Xcures VTB. Summary data examined included the year of launch, demographics, characteristics of cases, average response time, advantages, and how they handle protected health information. Results Overall, 30% of VTBs examined were launched in 2017. All had a Health Insurance Portability and Accountability Act-compliant online environment. On a review of Xcures records, the median age of the female patients was 57 years and the median age of the male patients was 55 years. The data showed that 44% (4.4 out of every 10 patients) with a confirmed treatment chose the VTB integrated option. Overall, 76% of patients in the Xcures registry had primary central nervous system tumors, with at least 556 patients in the tumor registry which included 46% glioblastoma cases (96% primary, 4% secondary). In the MUSC VTB project, 112 thoracic tumor cases and nine neuro-oncology cases were reviewed. The tumor board met weekly, and the average response time was within 24 hours of case review and presentation. The Genomet VTB de-identifies all patient information; this is a virtual platform primarily focused on neuro-oncology cases. Cases involved a median of five specialists most commonly neuro-oncologists, neurosurgeons, radiation oncologists, molecular pathologists, and neuroradiologists. The case review revealed an age range of six months to 84 years (mean age = 44.5 years), with 69.6% males and 30.4% females, 43.5% glioblastomas, 8.7% adenocarcinomas, and 8.7% infratentorial tumors. The average response time observed in all cases was ≤24 hours. Conclusions VTBs allow for quicker expert analysis of cases. This has resulted in an accelerated number of cases reviewed with a shortened communication time. More studies are needed to gain additional insights into user engagement metrics.
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Brown GTF, Bekker HL, Young AL. Quality and efficacy of Multidisciplinary Team (MDT) quality assessment tools and discussion checklists: a systematic review. BMC Cancer 2022; 22:286. [PMID: 35300636 PMCID: PMC8928609 DOI: 10.1186/s12885-022-09369-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 02/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background MDT discussion is the gold standard for cancer care in the UK. With the incidence of cancer on the rise, demand for MDT discussion is increasing. The need for efficiency, whilst maintaining high standards, is therefore clear. Paper-based MDT quality assessment tools and discussion checklists may represent a practical method of monitoring and improving MDT practice. This reviews aims to describe and appraise these tools, as well as consider their value to quality improvement. Methods Medline, EMBASE and PsycInfo were searched using pre-defined terms. The PRISMA model was followed throughout. Studies were included if they described the development of a relevant tool, or if an element of the methodology further informed tool quality assessment. To investigate efficacy, studies using a tool as a method of quality improvement in MDT practice were also included. Study quality was appraised using the COSMIN risk of bias checklist or the Newcastle-Ottawa scale, depending on study type. Results The search returned 7930 results. 18 studies were included. In total 7 tools were identified. Overall, methodological quality in tool development was adequate to very good for assessed aspects of validity and reliability. Clinician feedback was positive. In one study, the introduction of a discussion checklist improved MDT ability to reach a decision from 82.2 to 92.7%. Improvement was also noted in the quality of information presented and the quality of teamwork. Conclusions Several tools for assessment and guidance of MDTs are available. Although limited, current evidence indicates sufficient rigour in their development and their potential for quality improvement. Trial registration PROSPERO ID: CRD42021234326. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09369-8.
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Affiliation(s)
- George T F Brown
- Department of Pancreatic Surgery, St James's University Hospital, Leeds, UK
| | - Hilary L Bekker
- Leeds Unit of Complex Intervention Development, School of Medicine, University of Leeds, Leeds, UK.,Research Centre for Patient Involvement, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Alastair L Young
- Department of Pancreatic Surgery, St James's University Hospital, Leeds, UK.
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Ebben KCWJ, Hendriks MP, Markus L, Kos M, De Hingh IHJT, Oddens JR, Rothbarth J, De wilt H, Strobbe LJA, Bessems M, Mellema CT, Siesling S, Verbeek XAAM. Using Guideline-Based Clinical Decision Support in Oncological Multidisciplinary Team Meetings: A Prospective, Multicenter Concordance Study. Int J Qual Health Care 2022; 34:6523785. [PMID: 35137091 PMCID: PMC8934031 DOI: 10.1093/intqhc/mzac007] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 01/21/2022] [Accepted: 02/07/2022] [Indexed: 11/14/2022] Open
Abstract
Background Multidisciplinary team meetings formulate guideline-based individual treatment plans based on patient and disease characteristics and motivate reasons for deviation. Clinical decision trees could support multidisciplinary teams to adhere more accurately to guidelines. Every clinical decision tree is tailored to a specific decision moment in a care pathway and is composed of patient and disease characteristics leading to a guideline recommendation. Objective This study investigated (1) the concordance between multidisciplinary team and clinical decision tree recommendations and (2) the completeness of patient and disease characteristics available during multidisciplinary team meetings to apply clinical decision trees such that it results in a guideline recommendation. Methods This prospective, multicenter, observational concordance study evaluated 17 selected clinical decision trees, based on the prevailing Dutch guidelines for breast, colorectal and prostate cancers. In cases with sufficient data, concordance between multidisciplinary team and clinical decision tree recommendations was classified as concordant, conditional concordant (multidisciplinary team specified a prerequisite for the recommendation) and non-concordant. Results Fifty-nine multidisciplinary team meetings were attended in 8 different hospitals, and 355 cases were included. For 296 cases (83.4%), all patient data were available for providing an unconditional clinical decision tree recommendation. In 59 cases (16.6%), insufficient data were available resulting in provisional clinical decision tree recommendations. From the 296 successfully generated clinical decision tree recommendations, the multidisciplinary team recommendations were concordant in 249 (84.1%) cases, conditional concordant in 24 (8.1%) cases and non-concordant in 23 (7.8%) cases of which in 7 (2.4%) cases the reason for deviation from the clinical decision tree generated guideline recommendation was not motivated. Conclusion The observed concordance of recommendations between multidisciplinary teams and clinical decision trees and data completeness during multidisciplinary team meetings in this study indicate a potential role for implementation of clinical decision trees to support multidisciplinary team decision-making.
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Affiliation(s)
- Kees C W J Ebben
- Address reprint requests to: Kees C.W.J. Ebben, Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Godebaldkwartier 419, Utrecht 3511 DT, The Netherlands. Tel: +31 6 1179 0131; E-mail:
| | | | - Lieke Markus
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - Milan Kos
- Department of Medical Oncology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, Amsterdam 1105AZ, Noord-Holland, The Netherlands
| | - Ignace H J T De Hingh
- Department of Surgical Oncology, Catharina Hospital, Michelangelolaan 2, Eindhoven 5623EJ, The Netherlands
| | - Jorg R Oddens
- Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, Amsterdam 1105AZ, Noord-Holland, The Netherlands
| | - Joost Rothbarth
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Doctor Molewaterplein 40, Rotterdam 3015GD, The Netherlands
| | - Hans De wilt
- Department of Surgical Oncology, Radboud University Medical Center, Geert Grooteplein Zuid 10, Nijmegen 6525GA, The Netherlands
| | - Luc J A Strobbe
- Department of Surgical Oncology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, Nijmegen 6532SZ, The Netherlands
| | - Maud Bessems
- Department of Surgical Oncology, Jeroen Bosch Hospital, Henri Dunantstraat 1, ‘s-Hertogenbosch 5223 GZ, The Netherlands
| | - Carsten T Mellema
- Department of Urology, Spaarne Hospital, Boerhavelaan 22, Haarlem 2035RC, The Netherlands
| | - Sabine Siesling
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
- Department of Health Technology and Services Research, Technical Medical Center, University of Twente, Hallenweg 5, Enschede 7522NH, Overijssel, The Netherlands
| | - Xander A A M Verbeek
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
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van Huizen LS, Dijkstra PU, van der Werf S, Ahaus K, Roodenburg JL. Benefits and drawbacks of videoconferencing for collaborating multidisciplinary teams in regional oncology networks: a scoping review. BMJ Open 2021; 11:e050139. [PMID: 34887273 PMCID: PMC8662582 DOI: 10.1136/bmjopen-2021-050139] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 11/12/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Various forms of videoconferenced collaborations exist in oncology care. In regional oncology networks, multidisciplinary teams (MDTs) are essential in coordinating care in their region. There is no recent overview of the benefits and drawbacks of videoconferenced collaborations in oncology care networks. This scoping review presents an overview of videoconferencing (VC) in oncology care and summarises its benefits and drawbacks regarding decision-making and care coordination. DESIGN We searched MEDLINE, Embase, CINAHL (nursing and allied health) and the Cochrane Library from inception to October 2020 for studies that included VC use in discussing treatment plans and coordinating care in oncology networks between teams at different sites. Two reviewers performed data extraction and thematic analyses. RESULTS Fifty studies were included. Six types of collaboration between teams using VC in oncology care were distinguished, ranging from MDTs collaborating with similar teams or with national or international experts to interactions between palliative care nurses and experts in that field. Patient benefits were less travel for diagnosis, better coordination of care, better access to scarce facilities and treatment in their own community. Benefits for healthcare professionals were optimised treatment plans through multidisciplinary discussion of complex cases, an ability to inform all healthcare professionals simultaneously, enhanced care coordination, less travel and continued medical education. VC added to the regular workload in preparing for discussions and increased administrative preparation. DISCUSSION Benefits and drawbacks for collaborating teams were tied to general VC use. VC enabled better use of staff time and reduced the time spent travelling. VC equipment costs and lack of reimbursement were implementation barriers. CONCLUSION VC is highly useful for various types of collaboration in oncology networks and improves decision-making over treatment plans and care coordination, with substantial benefits for patients and specialists. Drawbacks are additional time related to administrative preparation.
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Affiliation(s)
- Lidia S van Huizen
- Quality and Safety, University Medical Centre Groningen, Groningen, The Netherlands
- Oral and Maxillofacial Surgery, University Medical Centre Groningen, Groningen, The Netherlands
| | - Pieter U Dijkstra
- Center for Rehabilitation, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Sjoukje van der Werf
- Central Medical Library, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Kees Ahaus
- Erasmus School of Health Policy and Management, Department of Health Services Management and Organization, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Jan Ln Roodenburg
- Oral and Maxillofacial Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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Guirado M, Sanchez-Hernandez A, Pijuan L, Teixido C, Gómez-Caamaño A, Cilleruelo-Ramos Á. Quality indicators and excellence requirements for a multidisciplinary lung cancer tumor board by the Spanish Lung Cancer Group. Clin Transl Oncol 2021; 24:446-459. [PMID: 34665437 PMCID: PMC8525055 DOI: 10.1007/s12094-021-02712-8] [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: 08/03/2021] [Accepted: 09/18/2021] [Indexed: 12/24/2022]
Abstract
Multidisciplinary care is needed to decide the best therapeutic approach and to provide optimal care to patients with lung cancer (LC). Multidisciplinary teams (MDTs) are optimal strategies for the management of patients with LC and have been associated with better outcomes, such as an increase in quality of life and survival. The Spanish Lung Cancer Group has promoted this review about the current situation of the existing national LC-MDTs, which also offers a set of excellence requirements and quality indicators to achieve the best care in any patient with LC. Time and sufficient resources; leadership; administrative and institutional support; and recording of activity are key factors for the success of LC-MDTs. A set of excellence requirements in terms of staff, resources and organization of the LC-MDT have been proposed. At last, a list of quality indicators has been agreed to achieve and measure the performance of current LC-MDTs.
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Affiliation(s)
- M Guirado
- Medical Oncology Department, Hospital General Universitario de Elche, 03203, Elche, Spain
| | - A Sanchez-Hernandez
- Medical Oncology Department, Consorcio Hospitalario Provincial de Castellón, 12002, Castellón de la Plana, Spain
| | - L Pijuan
- Pathology Department, Bellvitge University Hospital, 08907, L'Hospitalet de Llobregat, Spain
| | - C Teixido
- Thoracic Oncology Unit, Department of Pathology, IDIBAPS, Hospital Clinic of Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain.
| | - A Gómez-Caamaño
- Department of Radiation Oncology, Hospital Clínico Universitario Santiago de Compostela, 15706, Santiago de Compostela, Spain
| | - Á Cilleruelo-Ramos
- Thoracic Surgery Department, Hospital Clínico Universitario Valladolid, 47005, Valladolid, Spain
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Borgstrom E, Cohn S, Driessen A, Martin J, Yardley S. Multidisciplinary team meetings in palliative care: an ethnographic study. BMJ Support Palliat Care 2021:bmjspcare-2021-003267. [PMID: 34593385 DOI: 10.1136/bmjspcare-2021-003267] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/11/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Multidisciplinary team meetings are a regular feature in the provision of palliative care, involving a range of professionals. Yet, their purpose and best format are not necessarily well understood or documented. This article describes how hospital and community-based palliative care multidisciplinary team meetings operate to elucidate some of their main values and offer an opportunity to share examples of good practice. METHODS Ethnographic observations of over 70 multidisciplinary team meetings between May 2018 and January 2020 in hospital and community palliative care settings in intercity London. These observations were part of a larger study examining palliative care processes. Fieldnotes were thematically analysed. RESULTS This article analyses how the meetings operated in terms of their setup, participants and general order of business. Meetings provided a space where patients, families and professionals could be cared for through regular discussions of service provision. CONCLUSIONS Meetings served a variety of functions. Alongside discussing the more technical, clinical and practical aspects that are formally recognised aspects of the meetings, an additional core value was enabling affectual aspects of dealing with people who are dying to be acknowledged and processed collectively. Insight into how the meetings are structured and operate offer input for future practice.
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Affiliation(s)
- Erica Borgstrom
- School of Health, Wellbeing and Social Care, The Open University, Milton Keynes, Buckinghamshire, UK
| | - Simon Cohn
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, London, UK
| | - Annelieke Driessen
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, London, UK
| | - Jonathan Martin
- Central and North West London NHS Foundation Trust, London, UK
- University College London Hospitals NHS Foundation Trust, London, London, UK
| | - Sarah Yardley
- Central and North West London NHS Foundation Trust, London, UK
- Marie Curie Palliative Care Research Department, University College London, London, UK
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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.
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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
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The use a virtual interactive system to enhance gynecologic oncology multi-disciplinary care in Zambia. J Cancer Policy 2021; 29:100298. [DOI: 10.1016/j.jcpo.2021.100298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 07/14/2021] [Indexed: 11/21/2022]
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Hammer RD, Fowler D, Sheets LR, Siadimas A, Guo C, Prime MS. Digital Tumor Board Solutions Have Significant Impact on Case Preparation. JCO Clin Cancer Inform 2021; 4:757-768. [PMID: 32816529 PMCID: PMC7469605 DOI: 10.1200/cci.20.00029] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Multidisciplinary tumor boards (TBs) are the gold standard for decision-making in cancer care. Variability in preparation, conduction, and impact is widely reported. The benefit of digital technologies to support TBs is unknown. This study evaluated the impact of the NAVIFY Tumor Board solution (NTB) on TB preparation time across multiple user groups in 4 cancer categories: breast, GI, head and neck (ie, ear, nose, and throat, or ENT), and hematopathology. METHODS This prospective study evaluated TB preparation time in multiple phases pre- and post-NTB implementation at an academic health care center. TB preparation times were recorded for multiple weeks using a digital time tracker. RESULTS Preparation times for 59 breast, 61 GI, 36 ENT, and 71 hematopathology cancer TBs comparing a pre-NTB phase to 3 phases of NTB implementation were evaluated between February 2018 and July 2019. NTB resulted in significant reductions in overall preparation time (30%) across 3 TBs pre-NTB compared with the final post-NTB implementation phase. In the breast TB, NTB reduced overall preparation time by 28%, with a 76% decrease in standard deviation (SD). In the GI TB, a 23% reduction in average preparation time was observed for all users, with a 48% decrease in SD. In the ENT TB, a 33% reduction in average preparation time was observed for all users, with a 73% decrease in SD. The hematopathology TB, which was the cocreation partner and initial adopter of the solution, showed variable results. CONCLUSION This study showed a significant impact of a digital solution on time preparation for TBs across multiple users and different TBs, reflecting the generalizability of the NTB. Adoption of such a solution could improve the efficiency of TBs and have a direct economic impact on hospitals.
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Affiliation(s)
- Richard D Hammer
- Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, MO
| | | | | | | | - Chaohui Guo
- Roche Diagnostics Information Solutions, Basel, Switzerland
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The role of specialist nurses in delivering effective care in a tertiary sarcoma referral service. J Clin Orthop Trauma 2021; 20:101501. [PMID: 34307019 PMCID: PMC8281648 DOI: 10.1016/j.jcot.2021.101501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 07/06/2021] [Accepted: 07/06/2021] [Indexed: 12/13/2022] Open
Abstract
Musculoskeletal sarcomas are rare cancers with an incidence of less than 1% of all cancers. Management of these tumors requires multidisciplinary care comprising of numerous specialists. Critical decisions following collaborative discussion among treating specialists followed by timely communication and starting prompt treatment are vital in delivering care in such rare sarcomas. While musculoskeletal surgeons, radiologists, and clinical oncologists are well known, the role of specialist nurses has been less described. They form a vital pillar in any tertiary sarcoma service by assisting in collaborative care, having consultations in nurse-led clinics, offering psychological support, imparting details of treatment to patient and helping in palliative care. This narrative review focuses on the role of trained specialist nurses in a tertiary sarcoma service and gives insight into their vital role in delivering timely, coordinated, effective care.
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Schellenberger B, Diekmann A, Heuser C, Gambashidze N, Ernstmann N, Ansmann L. Decision-Making in Multidisciplinary Tumor Boards in Breast Cancer Care - An Observational Study. J Multidiscip Healthc 2021; 14:1275-1284. [PMID: 34103928 PMCID: PMC8179814 DOI: 10.2147/jmdh.s300061] [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: 01/01/2021] [Accepted: 03/16/2021] [Indexed: 12/16/2022] Open
Abstract
Purpose Healthcare providers decide on recommendations for further treatment of patients with cancer in multidisciplinary tumor boards (MTBs). As such, communicative processes during MTBs are assumed to influence decision-making and, thereby, treatment planning. The aim of this exploratory study is to gain insights into decision-making during MTBs. Methods Case discussions from MTBs in breast cancer centers in North Rhine-Westphalia, Germany, were observed and audiotaped. The transcripts of the audio recordings were analyzed by procedures of conversation analysis. Results Based on 38 case discussions from 15 MTBs in four breast cancer centers, an action scheme for decision-making in MTBs in breast cancer care was developed. In addition, the conversational practices used by the participants during interactions were analyzed. Conclusion Analysis indicated that conventions in MTBs were observed during individual phases of decision-making but not for the entire process. Although exchanging multidisciplinary knowledge is an essential aspect of MTBs, this exchange does not always seem to occur in practice. The extent to which recommendations are derived from consensus during MTBs remains unclear. Thus, the study suggests developing standards for communication during MTBs to optimize decision-making and, thus, the quality of recommendation.
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Affiliation(s)
- Barbara Schellenberger
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, Germany
| | - Annika Diekmann
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, Germany
| | - Christian Heuser
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, Germany
| | | | - Nicole Ernstmann
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, Germany.,Institute for Patient Safety, University Hospital Bonn, Bonn, Germany
| | - Lena Ansmann
- Division for Organizational Health Services Research, Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
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Soo KC, Al Jajeh I, Quah R, Seah HKB, Soon S, Walker E. Virtual Multidisciplinary Review of a Complex Case Using a Digital Clinical Decision Support Tool to Improve Workflow Efficiency. J Multidiscip Healthc 2021; 14:1149-1158. [PMID: 34045862 PMCID: PMC8147890 DOI: 10.2147/jmdh.s307470] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/30/2021] [Indexed: 11/23/2022] Open
Abstract
Objective Integration of distinct clinical perspectives in multi-disciplinary tumor board meetings is critical to determine optimal patient care. Digital tools can support the data consolidation needed for meeting preparation and data sharing during complex case reviews. In this paper, we assessed the value of a clinical decision support tool on workflow efficiency and conducting a complex case review of a dermatofibrosarcoma protuberans (DFSP) tumor. Methods Case presentation was performed by each unique clinical specialty that had relevant information about the patient; an oncologist, a pathologist, and a radiologist. Virtual discussion was completed online with case presentation and documentation with NAVIFY Tumor Board. Workflow efficiency assessment was done through interviews and observation of the # of steps across different team members involved in preparing and conducting cancer multidisciplinary team (MDT) meetings before and after the implementation of the NAVIFY Tumor Board solution. Results Case review consisted of surgical and therapeutic intervention history, distinct histological and sequencing patterns representative of DFSP, with radiological review to determine areas for surgical intervention. Consolidation of clinical input led to a recommendation of a formal external hemipelvectomy with potential chemotherapy. Workflow assessment demonstrated a 46% total reduction in the # of steps for meeting preparation (from 69 to 37), with specific changes based on role: data manager (33 to 15), pathologist (26 to 13), radiologist (no change), and logistics (5 to 4). There was a 31% total reduction in the # of steps for conducting the meeting (from 51 to 35). Conclusion Utilizing a digital clinical decision support tool helped to consolidate patient data and improved case presentation through workflow efficiency. This allowed for improved interdisciplinary discussion on a complex DFSP case and supported the determination of a clinical decision.
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Affiliation(s)
- Khee Chee Soo
- General Surgery Department, Farrer Park Hospital, Singapore
| | - Issam Al Jajeh
- Department of Pathology, Farrer Park Hospital, Singapore
| | - Raymond Quah
- Department of Diagnostic Radiology, Farrer Park Hospital, Singapore
| | | | - Sharon Soon
- Roche Diagnostics Asia Pacific, Ltd, Singapore
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Chofor N, Bopda P, Bücker R, Ivo A, Okonkwo E, Joel K, Tung Z, Ige T, Wirtz H, Ngwa W. Mobilising stakeholders to improve access to state-of-the-art radiotherapy in low- and middle-income countries. Ecancermedicalscience 2021; 15:1227. [PMID: 34158831 PMCID: PMC8183652 DOI: 10.3332/ecancer.2021.1227] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Indexed: 12/24/2022] Open
Abstract
In an ongoing effort to improve access to state-of-the-art radiotherapy in low- and middle-income countries (LMICs), a joint symposium was organised by the non-governmental, non-profit organisation Medical physicists in diaspora for Africa e.V. (MephidA e.V.) in collaboration with the Germany-based Cameroon-German medical doctor’s association (Camfomedics e.V.) and the Harvard-based Global Health Catalyst summit. The goal of the symposium was to discuss the technical and structural challenges faced in African LMIC settings, re-evaluate strategies to overcome the shortfall of radiotherapy services and ameliorate the situation. The meeting brought together industry partners, including radiotherapy machine vendors and dosimetry solution providers, alongside public health, oncology and medical physics experts. This paper summarises the deliberations and recommendations based on the ongoing efforts including the use of information and communication technologies towards the provision of expert knowledge and telemedicine, the use of solar energy to avoid power outages and the use of high-end technology for enhanced quality assurance. We also present the experiences on the first linac installation at the Rwanda Military Hospital, the challenges faced in this LMIC as well as the patient’s demography, reflecting the reality in most sub-Saharan LMICs.
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Affiliation(s)
| | - Pierre Bopda
- Strahlentherapie Agaplesion Diakonieklinikum Rotenburg, Elise-Averdieck-Str. 17, 27356 Rotenburg, Germany
| | - Rebecca Bücker
- Strahlentherapie Klinikum Lippe GmbH, Rintelner Straße 85, 32657 Lemgo, Germany
| | - Azeh Ivo
- Onkologische Praxis und Tagesklinik, Ahstr. 2, 45879 Gelsenkirchen, Germany
| | - Ernest Okonkwo
- Strahlentherapie Ortenau Klinikum, Weingartenstr. 70, 77654 Offenburg, Germany
| | - Kra Joel
- Radiotherapy Department, Military Hospital, PO Box 3377, Kigali, Rwanda
| | - Zanzem Tung
- Zentrum für Strahlentherapie und Radioonkologie, Mozartstraße 30, 26655 Westerstede, Germany
| | - Taofeeq Ige
- Medical Physics Department, National Hospital Abuja, Abuja, FCT 900001, Nigeria.,University of Abuja, Abuja, Nigeria
| | - Holger Wirtz
- Strahlentherapie Singen-Friedrichshafen, Virchowstraße 10b D-78224 Singen/Hohentwiel, Germany
| | - Wilfred Ngwa
- Harvard Medical School, Brigham and Women's Hospital, Dana Farber Cancer Institute, Boston, MA 02115, USA.,University of Massachusetts Lowell, Boston, MA 02115, USA
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Foo JC, Jawin V, Yap TY, Ahmad Bahuri NF, Ganesan D, Mun KS, Loh J, Azman RR, Gottardo NG, Qaddoumi I, Moreira DC, Rajagopal R. Conduct of neuro-oncology multidisciplinary team meetings and closing the "gaps" in the clinical management of childhood central nervous system tumors in a middle-income country. Childs Nerv Syst 2021; 37:1573-1580. [PMID: 33580355 DOI: 10.1007/s00381-021-05080-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/06/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Multidisciplinary team meetings (MDTMs) are essential in the clinical management of pediatric central nervous system (CNS) tumors. Evaluations of the impact of MDTMs on childhood CNS tumors and clinicians' perspectives on their effectiveness are scarce. METHODS We retrospectively reviewed the clinical data of pediatric patients (aged <18 years) with CNS tumors diagnosed and treated in the Pediatric Hematology-Oncology Division at the University Malaya Medical Center from 2008 to 2019. We also conducted a web-based survey of the core members of the multidisciplinary team to evaluate the impact of the MDTMs. RESULTS During the pre-MDTM era (2008-2012), 29 CNS tumors were diagnosed and treated, and during the MDTM era (2014-2019), 49 CNS tumors were diagnosed and treated. The interval for histologic diagnosis was significantly shorter during the MDTM era (p=0.04), but the interval from diagnosis to chemotherapy or radiotherapy and the 5-year overall survival of the 78 patients did not improve (62.1% ± 9.0% vs. 68.8% ± 9.1%; p=0.184). However, the 5-year overall survival of patients with medulloblastoma or rare tumors significantly improved in the MDTM era (p=0.01). Key factors that contributed to delayed treatment and poor outcomes were postoperative complications, the facility's lack of infrastructure, poor parental education about early treatment, cultural beliefs in alternative medicine, and infection during chemotherapy. Eighteen clinicians responded to the survey; they felt that the MDTMs were beneficial in decision-making and enhanced the continuity of coordinated care. CONCLUSION MDTMs significantly reduced the diagnostic interval and improved the overall outcomes. However, delayed treatment remains a major challenge that requires further attention.
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Affiliation(s)
- Jen Chun Foo
- Division of Hematology-Oncology, Department of Pediatrics, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Vida Jawin
- Division of Hematology-Oncology, Department of Pediatrics, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Tsiao Yi Yap
- Division of Hematology-Oncology, Department of Pediatrics, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Nor Faizal Ahmad Bahuri
- Division of Neuro-Surgery, Department of Surgery, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Dharmendra Ganesan
- Division of Neuro-Surgery, Department of Surgery, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Kein Seong Mun
- Department of Pathology, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Jasmin Loh
- Department of Clinical Radiation Oncology, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Raja Rizal Azman
- Department of Radiology, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Nicholas G Gottardo
- Department of Pediatric and Adolescent Clinical Hematology and Oncology, Perth Children's Hospital, Nedlands, Australia
| | - Ibrahim Qaddoumi
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Daniel C Moreira
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Revathi Rajagopal
- Division of Hematology-Oncology, Department of Pediatrics, University Malaya Medical Center, Kuala Lumpur, Malaysia.
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Evans L, Liu Y, Donovan B, Kwan T, Byth K, Harnett P. Improving Cancer MDT performance in Western Sydney - three years' experience. BMC Health Serv Res 2021; 21:203. [PMID: 33676492 PMCID: PMC7937192 DOI: 10.1186/s12913-021-06203-y] [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: 02/22/2021] [Indexed: 11/22/2022] Open
Abstract
Background While multidisciplinary teams (MDTs) are now considered an essential part of cancer care decision-making, how they perform varies widely. The authors hypothesised that a comprehensive, multipronged improvement program, and associated annual member survey, could strengthen MDT performance across a whole cancer service. Methods The study comprised the introduction of a structured program, the Tumour Program Strengthening Initiative (TPSI) linked with an annual survey of member’s perceptions of their performance. Three iterations of the survey have been completed (2017, 2018 and 2019). Generalised estimating equations (GEEs) were used to test for a difference in the proportion of positive survey responses between 2017 and 2019 adjusted for team clustering. Results Twelve teams participated in TPSI. One hundred twenty-nine, 118 and 146 members completed the survey in 2017, 2018 and 2019, respectively. Of the 17 questions that were asked in all three years, nine showed significant improvement and, of these, five were highly significant. Documenting consensus, developing Terms of Reference (TORs), establishing referral criteria and referring to clinical practice guidelines showed most improvement. Questions related to patient considerations, professional development and quality improvement (QI) activities showed no significant change. Conclusions TPSI resulted in sustained and significant improvement. The MDT survey not only allowed MDT members to identify their strengths and weaknesses but also provided insights for management to flag priority areas for further support. Overall program improvement reflected the strengthening of the weakest teams as well as further improvement in highly performing MDTs. Importantly, the initiative has the potential to achieve behaviour change amongst clinicians. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06203-y.
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Affiliation(s)
- Lynleigh Evans
- Sydney West - Translational Cancer Research Centre, Western Sydney Local Health District, PO Box 533 Wentworthville, Sydney, NSW, 2145, Australia.
| | - Yiren Liu
- Tumour Program Strengthening Initiative innovation manager (2019), Western Sydney Local Health District, Sydney, Australia
| | - Brendan Donovan
- Tumour Program Strengthening Initiative innovation manager (2018), Western Sydney Local Health District, Sydney, Australia
| | - Terence Kwan
- Faculty of Engineering and IT, University of Sydney, Sydney, Australia
| | - Karen Byth
- Research and Education Network, Western Sydney Local Health District, Sydney, Australia
| | - Paul Harnett
- Sydney West - Translational Cancer Research Centre, Western Sydney Local Health District, PO Box 533 Wentworthville, Sydney, NSW, 2145, Australia
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Foucan AS, Grosclaude P, Bousser V, Bauvin E, Smith D, Andre-Fardeau C, Daubisse-Marliac L, Mathoulin-Pelissier S, Amadeo B, Coureau G. Management of colon cancer patients: A comprehensive analysis of the absence of multidisciplinary team meetings in two French departments. Clin Res Hepatol Gastroenterol 2021; 45:101413. [PMID: 32359832 DOI: 10.1016/j.clinre.2020.02.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 01/28/2020] [Accepted: 02/26/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND The care management of colorectal cancers has evolved, particularly since the implementation of multidisciplinary team meetings (MDTm). The aim of this study was to identify factors associated with the non-presentation of colon cancer patients in MDTm (no-MDTm) and to assess the association between no-MDTm and the diagnostic and therapeutic care management, in two areas in France, in 2010. METHODS Patients over 18 years diagnosed for invasive colon cancer in Gironde and Tarn during 2010 were included from the cancer registries of these two departments. We used five indicators to evaluate the care management of colon cancer patients (about diagnosis, treatment and selection of patients for chemotherapy). RESULTS No-MDTm patients were more likely to die early after diagnosis (OR=2.94, 95% CI=[1.52-5.66]). Elderly patients and those living in more disadvantaged areas were less often presented in MDTm (OR≥85years=2.10, 95% CI=[1.06-4.18]; OREDIQ4-Q5=1.96, 95% CI=[1.23-3.14]). After adjusting for patient-related variables (age, comorbidities, deprivation) and tumor (stage at diagnosis), we found that thoracic CT scan was less often performed among no-MDTm patients (OR=0.40, 95% CI=[0.24-0.65]). There was no association between the absence of MDTm and the therapeutic care management indicators. CONCLUSION In conclusion, therapeutic care management was not associated with the absence of MDTm but with patient and tumor characteristics, including age, comorbidities and level of deprivation, that influence the non-presentation in MDTm.
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Affiliation(s)
- Anne-Sophie Foucan
- Gironde General Cancer Registry, 33000 Bordeaux, France; Inserm Bordeaux Population Health, Research Center U1219, Epicene Team, university of Bordeaux, 33000 Bordeaux, France.
| | - Pascale Grosclaude
- Claudius Regaud Institute, Regional Cancer Center, IUCT-O, Tarn Cancer Registry, 31059 Toulouse, France; LEASP, Inserm U1027, university of Toulouse III, 31000 Toulouse, France
| | | | - Eric Bauvin
- LEASP, Inserm U1027, university of Toulouse III, 31000 Toulouse, France; Occitanie Regional Cancer network (Onco-Occitanie), 31059 Toulouse, France
| | - Denis Smith
- University hospital of Haut-Lévêque, 33000 Bordeaux, France
| | | | - Laetitia Daubisse-Marliac
- Claudius Regaud Institute, Regional Cancer Center, IUCT-O, Tarn Cancer Registry, 31059 Toulouse, France; LEASP, Inserm U1027, university of Toulouse III, 31000 Toulouse, France
| | - Simone Mathoulin-Pelissier
- Inserm Bordeaux Population Health, Research Center U1219, Epicene Team, university of Bordeaux, 33000 Bordeaux, France; Inserm CIC1401, Clinical and Epidemiological Research Unit, Bergonie Institute, Comprehensive Cancer Center, 33000 Bordeaux, France
| | - Brice Amadeo
- Gironde General Cancer Registry, 33000 Bordeaux, France; Inserm Bordeaux Population Health, Research Center U1219, Epicene Team, university of Bordeaux, 33000 Bordeaux, France
| | - Gaëlle Coureau
- Gironde General Cancer Registry, 33000 Bordeaux, France; Inserm Bordeaux Population Health, Research Center U1219, Epicene Team, university of Bordeaux, 33000 Bordeaux, France; Medical Information Service, Public Health Department, university Bordeaux hospital, 33000 Bordeaux, France
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van Huizen LS, Dijkstra PU, Hemmer PH, van Etten B, Buis CI, Olsder L, van Vilsteren FG, Ahaus K(CB, Roodenburg JL. Reorganizing the Multidisciplinary Team Meetings in a Tertiary Centre for Gastro-Intestinal Oncology Adds Value to the Internal and Regional Care Pathways. A Mixed Method Evaluation. Int J Integr Care 2021; 21:8. [PMID: 33664641 PMCID: PMC7908930 DOI: 10.5334/ijic.5526] [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: 04/24/2020] [Accepted: 01/19/2021] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION The reorganisation of the structure of a Gastro-Intestinal Oncology Multidisciplinary Team Meeting (GIO-MDTM) in a tertiary centre with three care pathways is evaluated on added value. METHODS In a mixed method investigation, process indicators such as throughput times were analysed and stakeholders were interviewed regarding benefits and drawbacks of the reorganisation and current MDTM functioning. RESULTS For the hepatobiliary care pathway, the time to treatment plan increased, but the time to start treatment reduced significantly. The percentage of patients treated within the Dutch standard of 63 days increased for the three care pathways. From the interviews, three themes emerged: added value of MDTMs, focus on planning integrated care and awareness of possible improvements. DISCUSSION The importance of evaluating interventions in oncology care pathways is shown, including detecting unexpected drawbacks. The evaluation provides insight into complex dynamics of the care pathways and contributes with recommendations on functioning of an MDTM. CONCLUSIONS Throughput times are only partly determined by oncology care pathway management, but have influence on the functioning of MDTMs. Process indicator information can help to reflect on integration of care in the region, resulting in an increase of patients treated within the Dutch standard.
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Affiliation(s)
- Lidia S. van Huizen
- University of Groningen, University Medical Center Groningen, Department of Oral and Maxillofacial Surgery, Groningen, The Netherlands
- University of Groningen, University Medical Center Groningen, Department of Quality and Patient Safety, Groningen, The Netherlands
- Kerteza, a Worldwide Consultancy and Training Institute for Healthcare Organizations, Kasterlee, Belgium
| | - Pieter U. Dijkstra
- University of Groningen, University Medical Center Groningen, Department of Oral and Maxillofacial Surgery, Groningen, The Netherlands
- University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Groningen, The Netherlands
| | - Patrick H.J. Hemmer
- University of Groningen, University Medical Center Groningen, Department of Surgery, Groningen, The Netherlands
| | - Boudewijn van Etten
- University of Groningen, University Medical Center Groningen, Department of Surgery, Groningen, The Netherlands
| | - Carlijn I. Buis
- University of Groningen, University Medical Center Groningen, Department of Surgery, Groningen, The Netherlands
| | - Linde Olsder
- University of Groningen, University Medical Center Groningen, Department of Surgery, Groningen, The Netherlands
| | - Frederike G.I. van Vilsteren
- University of Groningen, University Medical Center Groningen, Department of Gastroenterology and Hepatology, Groningen, The Netherlands
| | - Kees (C.)T. B. Ahaus
- University of Groningen, University Medical Center Groningen, Department of Quality and Patient Safety, Groningen, The Netherlands
- Erasmus University Rotterdam, Erasmus School of Health Policy & Management, Rotterdam, The Netherlands
| | - Jan L.N. Roodenburg
- University of Groningen, University Medical Center Groningen, Department of Oral and Maxillofacial Surgery, Groningen, The Netherlands
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Saqlain F, Shalhout SZ, Flaherty KT, Emerick KS, Miller DM. REDCap-Based Operational Tool to Guide Care Coordination in a Multidisciplinary Cutaneous Oncology Clinic. JCO Oncol Pract 2021; 17:527-533. [PMID: 33492980 DOI: 10.1200/op.20.00673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The multidisciplinary team is the primary means for delivery of complex cancer care in the United States. Considerable variability exists in how multidisciplinary teams operate across the landscape of oncology, including variation in represented specialties and specifics of the shared medical decision-making process. Here, we describe operations of a multidisciplinary clinic focused on the management of nonmelanoma skin cancer, formed as a joint effort between departments at the Massachusetts General Hospital and Massachusetts Eye and Ear Infirmary. We describe deployment of a flexible Web-based operational tool created on the Research Electronic Data Capture platform to facilitate provider coordination and tracking and visualization of the patient census, offering a new perspective on optimization of the multidisciplinary workflow. To help promote further discussion, we have made the data dictionary for the operational tool and R code for the accompanying data visualization dashboard freely available online for download and customization.
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Affiliation(s)
| | - Sophia Z Shalhout
- Harvard Medical School, Boston, MA.,Department of Medicine, Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA.,Mass General Cancer Center, Massachusetts General Hospital, Boston, MA
| | - Keith T Flaherty
- Harvard Medical School, Boston, MA.,Department of Medicine, Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA.,Mass General Cancer Center, Massachusetts General Hospital, Boston, MA
| | - Kevin S Emerick
- Harvard Medical School, Boston, MA.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA.,Department of Otolaryngology, Harvard Medical School, Boston, MA
| | - David M Miller
- Harvard Medical School, Boston, MA.,Department of Medicine, Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA.,Mass General Cancer Center, Massachusetts General Hospital, Boston, MA.,Department of Dermatology, Massachusetts General Hospital, Boston, MA
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39
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Hardavella G, Frille A, Theochari C, Keramida E, Bellou E, Fotineas A, Bracka I, Pappa L, Zagana V, Palamiotou M, Demertzis P, Karampinis I. Multidisciplinary care models for patients with lung cancer. Breathe (Sheff) 2020; 16:200076. [PMID: 33664831 PMCID: PMC7910033 DOI: 10.1183/20734735.0076-2020] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 01/20/2021] [Indexed: 12/24/2022] Open
Abstract
Multidisciplinary care is the cornerstone of lung cancer treatment in the developed world, even though there is a relative lack of consistent evidence that this care model improves outcomes. In this review, we present the available literature regarding how to set up and run an efficient multidisciplinary care model for lung cancer patients with emphasis on team members' roles and responsibilities. Moreover, we present some limited evidence about multidisciplinary care and its impact on lung cancer outcomes and survival. This review provides simple guidance on setting up and running a multidisciplinary service for lung cancer patients. It highlights the importance of defined roles and responsibilities for team members. It also presents concise information based on the literature regarding the impact of multidisciplinary care in lung cancer outcomes (e.g. survival of patients undergoing lung cancer surgery).
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Affiliation(s)
- Georgia Hardavella
- 9th Dept of Respiratory Medicine, "Sotiria" Athens' Chest Diseases Hospital, Athens, Greece
| | - Armin Frille
- Dept of Respiratory Medicine, University of Leipzig, Leipzig, Germany
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, University Medical Center Leipzig, Leipzig, Germany
| | - Christina Theochari
- 9th Dept of Respiratory Medicine, "Sotiria" Athens' Chest Diseases Hospital, Athens, Greece
| | - Elli Keramida
- 9th Dept of Respiratory Medicine, "Sotiria" Athens' Chest Diseases Hospital, Athens, Greece
| | - Elena Bellou
- 9th Dept of Respiratory Medicine, "Sotiria" Athens' Chest Diseases Hospital, Athens, Greece
| | - Andreas Fotineas
- Radiation Oncology Dept, IASO Maternity Hospital, Athens, Greece
| | - Irma Bracka
- 9th Dept of Respiratory Medicine, "Sotiria" Athens' Chest Diseases Hospital, Athens, Greece
| | - Loukia Pappa
- 9th Dept of Respiratory Medicine, "Sotiria" Athens' Chest Diseases Hospital, Athens, Greece
| | - Vaia Zagana
- Dept of Nursing, "Sotiria" Athens' Chest Diseases Hospital, Athens, Greece
| | - Maria Palamiotou
- Dept of Nursing, "Sotiria" Athens' Chest Diseases Hospital, Athens, Greece
| | - Panagiotis Demertzis
- 9th Dept of Respiratory Medicine, "Sotiria" Athens' Chest Diseases Hospital, Athens, Greece
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40
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Graetz DE, Chen Y, Devidas M, Antillon-Klussmann F, Fu L, Quintero K, Fuentes-Alabi SL, Gassant PY, Kaye EC, Baker JN, Rodriguez Galindo C, Mack JW. Interdisciplinary care of pediatric oncology patients in Central America and the Caribbean. Cancer 2020; 127:2579-2586. [PMID: 33237591 DOI: 10.1002/cncr.33339] [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: 08/31/2020] [Revised: 10/12/2020] [Accepted: 10/27/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Interdisciplinary teamwork supports high-quality cancer care and effective utilization of limited resources. This study purposed to examine the value, structure, process, and effectiveness of interdisciplinary care (IDC) among pediatric oncology providers in low-income and middle-income countries in Central America and the Caribbean. METHODS A cross-sectional survey was disseminated to pediatric oncology providers at 5 centers participating in the Pediatric Hematology-Oncology Association of Central America. The survey included previously validated items and novel questions assessing the value (importance), structure (multidisciplinary meeting attendance), process (team climate), and effectiveness (job satisfaction, quality of care and communication) of IDC. RESULTS The survey was completed by 174 providers, including 22 oncologists, 9 pathologists, 9 radiologists, 5 radiation oncologists, 12 surgeons, 35 subspecialists, 60 nurses, 20 psychosocial providers, and 2 other staff. Participants agreed that IDC benefits team members (95%) and patients (96%). IDC structure and processes varied across the region. Multidisciplinary meeting attendance differed by center (P = .005) and discipline (P < .0001). Participants who frequently attended multidisciplinary meetings reported a more positive team climate (P = .0003). Team climate was positively associated with job satisfaction (P < .001). In multivariable analyses, team climate was predictive of an improved perception of communication between professionals (P < .0001), with families (P < .0001), and with patients (P = .0005), as well as with quality of the care environment (P = .006) and overall care quality (P < .0001). CONCLUSIONS Nearly all surveyed participants valued IDC, and the structure and processes supporting IDC varied by center. Associations between a collaborative professional climate, job satisfaction, and the perception of quality care encourage continued investigation and prioritization of IDC in these settings.
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Affiliation(s)
- Dylan E Graetz
- Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee.,Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Yichen Chen
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Meenakshi Devidas
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Federico Antillon-Klussmann
- National Unit of Pediatric Oncology, Francisco Marroquin University School of Medicine, Guatemala City, Guatemala
| | - Ligia Fu
- Pediatric Hematology and Oncology Unit, Tegucigalpa School Hospital, Tegucigalpa, Honduras
| | - Karina Quintero
- Pediatric Oncology Unit, Dr Jose Renan Esquivel Children's Hospital, Panama City, Panama
| | - Soad L Fuentes-Alabi
- Department of Oncology, Benjamin Bloom National Children's Hospital, El Salvador City, El Salvador
| | | | - Erica C Kaye
- Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee.,Division of Palliative and End of Life Care, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Justin N Baker
- Division of Palliative and End of Life Care, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Carlos Rodriguez Galindo
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Jennifer W Mack
- Pediatric Oncology/Oncology, Dana Farber Cancer Institute and Boston Children's Hospital, Boston, Massachusetts
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Wihl J, Rosell L, Bendahl PO, De Mattos CBR, Kinhult S, Lindell G, von Steyern FV, Nilbert M. Leadership perspectives in multidisciplinary team meetings; observational assessment based on the ATLAS instrument in cancer care. Cancer Treat Res Commun 2020; 25:100231. [PMID: 33157512 DOI: 10.1016/j.ctarc.2020.100231] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 10/12/2020] [Accepted: 10/26/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVES High-quality leadership and chairing skills are central components in team performance during multidisciplinary team (MDT) meetings. We hypothesized that the recently developed A Tumor Leadership Assessment inStrument (ATLAS) could provide relevant information to support more detailed insights into MDT chairing and leadership aspects of relevance for team feedback and targeted improvements. MATERIALS AND METHODS The observational assessment instrument ATLAS rates chairing and leadership skills during MDT meetings in 12 predefined domains that include e.g. time management, case prioritization, team involvement, discussion climate and clarity of treatment recommendations. We used ATLAS to prospectively assess 33 MDT meetings in neuro-oncology, sarcoma and hepatobiliary cancer. RESULTS The aspects time management, effective case prioritization and provision of clear treatment plans were found to be well-functioning, whereas facilitatation of case discussions, encouragment of team member contributions, keeping the meeting focused and ability to summarize case discussions showed variable and partly weak results. CONCLUSION We conclude that the ATLAS instrument effectively captures various aspects of MDT leadership and chairing skills. It may thereby provide relevant information to prioritize initiatives that support and develop effective teamwork and decision-making during MDT meetings.
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Affiliation(s)
- Jessica Wihl
- Institute of Clinical Sciences, Division of Oncology, Lund University, Sweden; Regional Cancer Centre South, Region Skåne, Lund, Sweden; Department of Oncology and Hematology, Skåne University Hospital, Lund, Sweden.
| | - Linn Rosell
- Institute of Clinical Sciences, Division of Oncology, Lund University, Sweden; Regional Cancer Centre South, Region Skåne, Lund, Sweden.
| | - Pär-Ola Bendahl
- Institute of Clinical Sciences, Division of Oncology, Lund University, Sweden
| | | | - Sara Kinhult
- Department of Oncology and Hematology, Skåne University Hospital, Lund, Sweden
| | - Gert Lindell
- Department of Surgery, Skåne University Hospital, Lund, Sweden
| | | | - Mef Nilbert
- Institute of Clinical Sciences, Division of Oncology, Lund University, Sweden; Clinical Research Centre, Hvidovre Hospital and Copenhagen University, Copenhagen, Denmark; Danish Cancer Society Research Centre, Copenhagen, Denmark.
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42
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Affiliation(s)
- Julian Yeoh
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Philip MacCarthy
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, UK
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Ferraioli D, Bally O, Meeus P, Benayoun D, Bakrin N, De Saint Hilaire P, Beal Ardisson D, Provençal J, Barletta H, Mousseau M, Chauleur C, Verbaere S, Knibiehly A, Fuso L, Charreton A, Devouassoux-Shisheboran M, Chopin N, Glehen O, Labrosse-Canat H, Farsi F, Ray-Coquard I. Impact of multidisciplinary tumour board in the management of ovarian carcinoma in the first-line setting. Exhaustive analysis from the Rhone-Alpes region. Eur J Cancer Care (Engl) 2020; 29:e13313. [PMID: 32894629 DOI: 10.1111/ecc.13313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 06/18/2020] [Accepted: 08/07/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Epithelial ovarian cancer (EOC) is a poor prognosis disease partly linked to diagnosis at an advanced stage. The quality of care management is a factor that needs to be explored, more specifically optimal organisation of first-line treatment. METHODS A retrospective study, dealing with all patients diagnosed within the Rhone-Alpes region with initial diagnosis EOC in 2012, was performed. The aim was to describe the impact of multidisciplinary tumour boards (MTB) in the organisation of care and the consequence on the patient's outcomes. RESULTS 271 EOC were analysed. 206 patients had an advanced EOC. Median progression-free survival (PFS) is 17.8 months (CI95%, 14.6-21.2) for AOC. 157 patients (57.9%) had a front-line surgery versus 114 patients (42.1%) interval debulking surgery. PFS for AOC patients with no residual disease is 24.3 months compared with 15.3 months for patients with residual disease (p = .01). No macroscopic residual disease is more frequent in the patients discussed before surgery in MTB compared with patients not submitted before surgery (73% vs. 56.2%, p < .001). CONCLUSION These results highlight the heterogeneity of medical practices in terms of front-line surgery versus interval surgery, in the administration of neoadjuvant chemotherapy and in the setting of MTB discussion.
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Affiliation(s)
- Domenico Ferraioli
- Gynecology Department, Leon Berard Cancer Center, Lyon, France.,Department of Internal Medicine, University of Genoa and IRCCS AOU San Martino-IST, Genoa, Italy
| | - Olivia Bally
- Oncology Department, Private Hospital Jean Mermoz, Lyon, France
| | - Pierre Meeus
- Surgical Department, Leon Berard Cancer Center, Lyon, France
| | - David Benayoun
- Oncology Department, University Hospital of Lyon, Lyon, France
| | - Naoual Bakrin
- Surgical Department, University Hospital of Lyon, Lyon, France
| | | | | | | | - Hugues Barletta
- Surgical Department, Private Hospital Drome Ardeche, Valence, France
| | - Mireille Mousseau
- Surgical Department, University Hospital of Grenoble, Grenoble, France
| | - Céline Chauleur
- Oncology Department, Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Sylvain Verbaere
- Surgical Department, Private Hospital of Saint-Etienne, Saint-Etienne, France
| | - Alain Knibiehly
- Surgical Department, Hospital of Montelimar, Montelimar, France
| | - Luca Fuso
- Gynecology Oncology Department, Ordine Mauriziano Hospital, Turin, Italy
| | | | | | - Nicolas Chopin
- Gynecology Department, Leon Berard Cancer Center, Lyon, France
| | - Olivier Glehen
- Surgical Department, University Hospital of Lyon, Lyon, France
| | | | - Fadila Farsi
- Regional Network of Cancer (ONCO AuRA), Lyon, France
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Clinical questions on rehabilitation in cancer patients with skeletal metastasis: a content analysis of the multidisciplinary tumor board records. Support Care Cancer 2020; 29:2015-2020. [PMID: 32844315 DOI: 10.1007/s00520-020-05696-3] [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: 05/19/2020] [Accepted: 08/19/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE Cancer rehabilitation addresses the functional needs of patients who have various impairments. Disease control is a critical oncological consideration, while physical intervention increased weights of importance in several situations. To identify the clinical status that necessitates active physical intervention in cancer patients with skeletal metastasis, we performed a content analysis in the multidisciplinary tumor board (MDTB) records. METHODS From January 2017 to September 2019, the MDTB discussed 168 consecutive patients with skeletal metastasis. We reviewed the MDTB records and asked responsible physicians to frame clinical questions. Based on these data, we identified the predictor valuables with the association to rehabilitation-related clinical questions using univariate and multivariate analyses. Moreover, we investigated a predictor of the change in Barthel index (BI) scores using univariate analyses. RESULTS Rehabilitation-related questions arose more frequently in older patients (p = 0.011), in patients with slow-growth vs. rapid-growth tumor (p = 0.002), and in patients with skeletal-related events (p = 0.001) at MDTB. The tumor growth speed was associated with the change in BI scores, as slower-growth tumors had the benefit of BI gains (p = 0.017). CONCLUSIONS Regarding rehabilitation in patients with skeletal metastasis, we should pay attention to three parameters: occurrence of skeletal events, patient age, and growth speed of tumors. Rehabilitation-related questions may reflect patients' functional needs that occur more frequently in patients with pathological fractures or neurological symptoms, older patients, and patients with slow-growth tumors.
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Rankin NM, Fradgley EA, Barnes DJ. Implementation of lung cancer multidisciplinary teams: a review of evidence-practice gaps. Transl Lung Cancer Res 2020; 9:1667-1679. [PMID: 32953540 PMCID: PMC7481625 DOI: 10.21037/tlcr.2019.11.32] [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] [Indexed: 12/11/2022]
Abstract
Multidisciplinary care (MDC) is considered best practice in lung cancer care. Health care services have made significant investments in MDC through the establishment of multidisciplinary team (MDT) meetings. This investment is likely to be sustained in future. It is imperative that MDT meetings are efficient, effective, and sufficiently nimble to introduce new innovations to enable best practice. In this article, we consider the ‘evidence-practice gaps’ in the implementation of lung cancer MDC. These gaps were derived from the recurrent limitations outlined in existing studies and reviews. We address the contributions that implementation science and quality improvement can make to bridge these gaps by increasing translation and improving the uptake of innovations by teams.
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Affiliation(s)
- Nicole M Rankin
- Faculty of Medicine and Health Sciences, University of Sydney, Camperdown, New South Wales, Australia
| | - Elizabeth A Fradgley
- University of Newcastle Priority Research Centre for Cancer Research, Innovation and Translation, Callaghan, New South Wales, Australia.,University of Newcastle Priority Research Centre for Health Behaviour, Callaghan, New South Wales, Australia.,School of Medicine & Public Health, University Drive, Callaghan, New South Wales, Australia
| | - David J Barnes
- Faculty of Medicine and Health Sciences, University of Sydney, Camperdown, New South Wales, Australia.,Sydney Local Health District, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
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47
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Bouaud J, Pelayo S, Lamy JB, Prebet C, Ngo C, Teixeira L, Guézennec G, Séroussi B. Implementation of an ontological reasoning to support the guideline-based management of primary breast cancer patients in the DESIREE project. Artif Intell Med 2020; 108:101922. [DOI: 10.1016/j.artmed.2020.101922] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/25/2020] [Accepted: 07/01/2020] [Indexed: 10/23/2022]
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Liam CK, Liam YS, Poh ME, Wong CK. Accuracy of lung cancer staging in the multidisciplinary team setting. Transl Lung Cancer Res 2020; 9:1654-1666. [PMID: 32953539 PMCID: PMC7481640 DOI: 10.21037/tlcr.2019.11.28] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Accurate staging of lung cancer is of utmost importance in determining the stage-appropriate treatment and prognosis. Imaging tests which include contrast-enhanced computed tomography (CT) examination of the chest to include the liver and adrenal glands and 18-fluoro-2 deoxyglucose positron emission tomography (PET)/CT scan facilitate the initial tumor node metastasis (TNM) staging of the disease and provide guidance on the optimal biopsy site and biopsy method. The diagnostic and staging approach should be tailored to the individual patient according to risk, benefit, patient preferences, and available expertise. Diagnosis and staging should preferably be accomplished with a single procedure or the least number of invasive procedures if more than one is needed. Ideally, centers managing lung cancer patients should have a multidisciplinary thoracic oncology board prescribing personalized evidence-based management tailored to each individual patient. Multidisciplinary team (MDT) meetings provide a platform for key experts from various disciplines to contribute specific advice on the management of each individual patient. As assessment of mediastinal lymph node involvement is an important component of lung cancer staging, optimal mediastinal staging can be achieved with a variety of techniques that can be discussed and performed by the various specialists in the MDT. Despite a relative paucity of quality evidence that MDT contributes to improvements in lung cancer survival outcomes, this approach has evolved to become the standard of care in many centers around the world. Thoracic MDT has resulted in more focused and timely investigations for histopathologic diagnosis and disease staging which translate into earlier treatment initiation. Moreover, there is increasing evidence that MDT care facilitates and allows access to investigations that lead to improved accuracy of tumor and nodal staging. However, there is still a paucity of evidence on the accuracy of lung cancer staging in the MDT setting.
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Affiliation(s)
- Chong-Kin Liam
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yong-Sheng Liam
- Clinical Investigation Centre, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Mau-Ern Poh
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chee-Kuan Wong
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Keller DS, Berho M, Perez RO, Wexner SD, Chand M. The multidisciplinary management of rectal cancer. Nat Rev Gastroenterol Hepatol 2020; 17:414-429. [PMID: 32203400 DOI: 10.1038/s41575-020-0275-y] [Citation(s) in RCA: 139] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/07/2020] [Indexed: 02/07/2023]
Abstract
Rectal cancer treatment has evolved during the past 40 years with the use of a standardized surgical technique for tumour resection: total mesorectal excision. A dramatic reduction in local recurrence rates and improved survival outcomes have been achieved as consequences of a better understanding of the surgical oncology of rectal cancer, and the advent of adjuvant and neoadjuvant treatments to compliment surgery have paved the way for a multidisciplinary approach to disease management. Further improvements in imaging techniques and the ability to identify prognostic factors such as tumour regression, extramural venous invasion and threatened margins have introduced the concept of decision-making based on preoperative staging information. Modern treatment strategies are underpinned by accurate high-resolution imaging guiding both neoadjuvant therapy and precision surgery, followed by meticulous pathological scrutiny identifying the important prognostic factors for adjuvant chemotherapy. Included in these strategies are organ-sparing approaches and watch-and-wait strategies in selected patients. These pathways rely on the close working of interlinked disciplines within a multidisciplinary team. Such multidisciplinary forums are becoming standard in the treatment of rectal cancer across the UK, Europe and, more recently, the USA. This Review examines the essential components of modern-day management of rectal cancer through a multidisciplinary team approach, providing information that is essential for any practising colorectal surgeon to guide the best patient care.
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Affiliation(s)
- Deborah S Keller
- Department of Surgery, New York-Presbyterian, Columbia University Medical Centre, New York, NY, USA
| | - Mariana Berho
- Department of Pathology and Laboratory Medicine, Cleveland Clinic Florida, Weston, Florida, USA
| | | | - Steven D Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida, USA
| | - Manish Chand
- Wellcome EPSRC Centre for Interventional and Surgical Sciences (WEISS); University College London, London, UK.
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Dawson C, Roe J, Starmer H, Brady G, Nund R, Coffey M, Govender R, Patterson JM, Nankivell P, Topping A, Sharma N, Parmar S, Elkington C, Merrit M, Stanbury D, Pracy P. Patient advocacy in head and neck cancer: Realities, challenges and the role of the multi‐disciplinary team. Clin Otolaryngol 2020; 45:437-444. [DOI: 10.1111/coa.13508] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 01/12/2020] [Indexed: 12/17/2022]
Affiliation(s)
| | - Justin Roe
- Department of Speech & Language Therapy The Royal Marsden NHS Foundation Trust London UK
- Department of Surgery and Cancer Imperial College Healthcare NHS Trust London UK
- National Centre for Airway ReconstructionImperial College Healthcare Trust London UK
| | - Heather Starmer
- Department of Otolaryngology and Head and Neck Cancer Speech and Swallowing Rehabilitation Stanford Cancer Center CA USA
| | - Grainne Brady
- Department of Speech and Language Therapy The Royal Marsden NHS Foundation Trust London UK
| | - Rebecca Nund
- School of Health and Rehabilitation Sciences The University of Queensland Brisbane Qld. Australia
| | | | - Roganie Govender
- University College London Hospital NHS Foundation Trust London UK
| | | | | | | | - Neil Sharma
- Queen Elizabeth Hospital Birmingham Birmingham UK
| | - Sat Parmar
- Queen Elizabeth Hospital Birmingham Birmingham UK
| | | | | | | | - Paul Pracy
- Queen Elizabeth Hospital Birmingham Birmingham UK
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