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Puente J, Algaba Arrea F, Buisán Rueda Ó, Castellano Gauna D, Durán I, Fernández Ávila JJ, Gómez-Iturriaga A, Parada Blázquez MJ, Pérez Fentes D, Sancho Pardo G, Vallejo Casas JA, Gratal P, Pardo MT, Guillem Porta V. Criteria and indicators to evaluate quality of care in genitourinary tumour boards. Clin Transl Oncol 2024:10.1007/s12094-024-03381-z. [PMID: 38341809 DOI: 10.1007/s12094-024-03381-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 12/31/2023] [Indexed: 02/13/2024]
Abstract
PURPOSE Genitourinary (GU) multidisciplinary tumour boards (GUMTBs) are key components of patient care, as they might lead to changes in treatment plan, improved survival, and increased adherence to guidelines. However, there are no guidelines on how GUMTBs should operate or how to assess their quality of performance. METHODS A systematic literature review was conducted to identify criteria and indicators to evaluate quality in GUMTBs. A scientific committee-comprising 12 GU cancer specialists from seven disciplines-proposed a list of criteria and developed indicators, evaluated in two rounds of Delphi method. Appropriateness and utility of indicators were scored using a 9-point Likert scale. Consensus was defined as at least two-thirds of Delphi respondents selecting a score sub-category that encompassed the median score of the group. RESULTS Forty-five criteria were selected to evaluate the quality of GUMTBs covering five dimensions: organisation, personnel, protocol and documentation, resources, and interaction with patients. Then, 33 indicators were developed and evaluated in the first round of Delphi, leading to a selection of 26 indicators in two dimensions: function, governance and resources, and GUMTB sessions. In the second round, consensus was reached on the appropriateness of all 26 indicators and on the utility of 24 of them. Index cards for criteria and indicators were developed to be used in clinical practice. CONCLUSIONS Criteria and indicators were developed to evaluate the quality of GUMTBs, aiming to serve as a guide to improve quality of care and health outcomes in patients with GU cancer.
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Affiliation(s)
- Javier Puente
- Servicio de Oncología Médica, Hospital Universitario Clínico San Carlos, Madrid, Spain.
- Fundación ECO (Excelencia y Calidad de La Oncología), Madrid, Spain.
| | | | - Óscar Buisán Rueda
- Servicio de Urología, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Daniel Castellano Gauna
- Fundación ECO (Excelencia y Calidad de La Oncología), Madrid, Spain
- Servicio de Oncología Médica, Hospital Universitario, 12 de Octubre, Madrid, Spain
| | - Ignacio Durán
- Fundación ECO (Excelencia y Calidad de La Oncología), Madrid, Spain
- Servicio de Oncología Médica, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Juan José Fernández Ávila
- Servicio de Farmacia Hospitalaria, Hospital Clínico Universitario Virgen de La Arrixaca, Murcia, Spain
| | - Alfonso Gómez-Iturriaga
- Servicio de Oncología Radioterápica, Hospital Universitario de Cruces, Instituto de Investigación Sanitaria Biobizkaia, Vizcaya, Spain
| | | | - Daniel Pérez Fentes
- Servicio de Urología, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - Gemma Sancho Pardo
- Servicio de Oncología Radioterápica, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
| | | | - Paula Gratal
- Fundación ECO (Excelencia y Calidad de La Oncología), Madrid, Spain
| | | | - Vicente Guillem Porta
- Fundación ECO (Excelencia y Calidad de La Oncología), Madrid, Spain
- Servicio de Oncología Médica, Hospital Vithas 9 de Octubre, Valencia, Spain
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Guillem Porta V, Camps C, Climent Durán MÁ, Gallardo E, González Del Alba A, Lázaro-Quintela M, Méndez Vidal MJ, Pinto Marín Á, Puente J, Antón-Rodríguez C, Caballero-Martínez F, Campos-Lucas FJ, Lugo I, Rogado Á, Durán I. Measures to evaluate quality of care in renal cancer: results of a Delphi study in Spain. Clin Transl Oncol 2021; 24:495-502. [PMID: 34482526 DOI: 10.1007/s12094-021-02703-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/24/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To review current measures for renal cancer care and develop a comprehensive and updated list of measures for their practical use in Spain. METHODS The study was developed by Fundación ECO, a Spanish foundation aiming to improve oncology quality of care. A systematic literature review was carried out to identify measures and knowledge gaps. A scientific committee composed of nine experts reviewed the literature findings and added measures. A preliminary list of 42 measures was evaluated with the Delphi method to gather feedback from 47 medical oncology experts in Spain. Experts scored the appropriateness of the measures and ranked their priority in two consecutive online surveys. The scientific committee reviewed the Delphi results and developed the measures. A technical group from Universidad Francisco de Vitoria conducted and oversaw the Delphi method. RESULTS The Delphi method led to consensus on all 42 measures. The scientific committee used a prioritisation matrix to select 25 of these measures for evaluating quality of care in renal cancer. These measures regarded structure, process, and outcome and covered general management, diagnosis, treatment, follow-up, and evaluation of health outcomes. Easy-to-use index cards were developed for all 25 measures, including their definition, formula, acceptable level of attainment, and rationale. CONCLUSIONS This manuscript aims to provide healthcare professionals with expert- and evidence-based measures that are useful for evaluating quality of care in renal cancer in Spain and cover all aspects and stages.
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Affiliation(s)
- Vicente Guillem Porta
- Fundación ECO (Excelencia Y Calidad de La Oncología), Madrid, Spain. .,Medical Oncology Department, Servicio de Oncología Médica, Instituto Valenciano de Oncología, Carrer del Professor Beltrán Báguena, 8, 46009, València, Spain.
| | - Carlos Camps
- Fundación ECO (Excelencia Y Calidad de La Oncología), Madrid, Spain.,Medical Oncology Department, Hospital General de Valencia, CIBERONC, València, Spain
| | - Miguel Ángel Climent Durán
- Fundación ECO (Excelencia Y Calidad de La Oncología), Madrid, Spain.,Medical Oncology Department, Servicio de Oncología Médica, Instituto Valenciano de Oncología, Carrer del Professor Beltrán Báguena, 8, 46009, València, Spain
| | - Enrique Gallardo
- Oncology Department, Parc Taulí Hospital Universitari. Institut d'Investigació I Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Aránzazu González Del Alba
- Fundación ECO (Excelencia Y Calidad de La Oncología), Madrid, Spain.,Medical Oncology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Martín Lázaro-Quintela
- Fundación ECO (Excelencia Y Calidad de La Oncología), Madrid, Spain.,Medical Oncology Department, Complexo Hospitalario Universitario de Vigo, Vigo, Spain.,Oncology Translational Research Group (ONCOINVES), Galicia Sur Health Research Institute, Vigo, Spain
| | - María José Méndez Vidal
- Medical Oncology Department, Maimonides Institute for Biomedical Research of Córdoba, Hospital Reina Sofía, Córdoba, Spain
| | - Álvaro Pinto Marín
- Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Javier Puente
- Fundación ECO (Excelencia Y Calidad de La Oncología), Madrid, Spain.,Medical Oncology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), CIBERONC, Madrid, Spain
| | - Cristina Antón-Rodríguez
- Unidad de apoyo a La Investigación, Facultad de Medicina, Universidad Francisco de Vitoria, Madrid, Spain
| | | | - Francisco J Campos-Lucas
- Unidad de Consultoría E Investigación en Salud, Facultad de Medicina, Universidad Francisco de Vitoria, Madrid, Spain
| | - Ilse Lugo
- Fundación ECO (Excelencia Y Calidad de La Oncología), Madrid, Spain
| | - Álvaro Rogado
- Fundación ECO (Excelencia Y Calidad de La Oncología), Madrid, Spain
| | - Ignacio Durán
- Fundación ECO (Excelencia Y Calidad de La Oncología), Madrid, Spain.,Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain
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Guillem Porta V, Anton A, Aranda E, Carrato A, Constenla M, Cruz-Hernández JJ, Diaz Rubio E, Garcia-Foncillas J, Gascon P, Lopez R, Caballero F, Monge D, Garcia de Leonardo C, Campos FJ, Camps C. The future of precision medicine, strengths and weaknesses: An expert position paper. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e18879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Antonio Anton
- Hospital Universitario Miguel Servet, Servicio de Oncología, Zaragoza, Spain
| | - Enrique Aranda
- Reina Sofía Hospital, University of Cordoba, Maimonides Institute of Biomedical Research, Spanish Cancer Network, Instituto de Salud Carlos III, Cordoba, Spain
| | | | | | - Juan J. Cruz-Hernández
- Complejo Asistencial Universitario de Salamanca, Oncology Department, Head of Department, Salamanca, Spain
| | - Eduardo Diaz Rubio
- Hospital Clinico Universitario San Carlos, IdISSC, CIBERONC, Madrid, Spain
| | | | | | | | | | - Diana Monge
- Francisco de Vitoria University, Madrid, Spain
| | | | | | - Carlos Camps
- Laboratorio de Oncología Molecular, FIHGUV; CIBERONC; Servicio de Oncología Médica, HGUV; Departament de Medicina, Universitat de València, Valencia, Spain
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Blanquisett AH, Vicent CH, Gregori JG, Zotano ÁG, Porta VG, Simón AR. Breast cancer in pregnancy: an institutional experience. Ecancermedicalscience 2015; 9:551. [PMID: 26284115 PMCID: PMC4531131 DOI: 10.3332/ecancer.2015.551] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Indexed: 12/04/2022] Open
Abstract
Background Breast cancer is one of the most common cancers diagnosed during pregnancy. Pregnancy-associated breast cancer (PABC) is defined as breast cancer diagnosed during pregnancy or within 12 months of delivery. Nowadays PABC can be safely diagnosed, staged, and treated during pregnancy with good outcomes for both the mother and the fetus. Recent studies suggest that prognosis of women diagnosed during postpartum seems to be worse. In order to gain a better understanding of the PABC, we reviewed our centre’s experience. Patients and methods We assessed the clinicopathological parameters, evolution, and outcome of patients treated in the Fundación Instituto Valenciano de Oncología of Valencia, Spain, from October 1990 to October 2013, and compared the results of patients diagnosed during pregnancy (group ‘A’) and patients diagnosed within one year of delivery (group ‘B’). Of 12,000 cases of breast cancer registered in our database, 35 cases of PABC were identified. We included 11 patients in group ‘A’ and 24 in group ‘B’. Results In our group the median age was 35 years (range 29–42), of which ten (28%) patients had family history (first grade) of breast cancer, four patients were BRCA 1 mutation carriers. Axillary node compromise was found in 19 patients (53.5%), 24 patients were stage II or III at diagnosis (68.5%), 22 (62.8%) were ER positive, and nine (25.7%) were HER-2 positive. In group A (n = 11), five patients diagnosed before 18th week decided that a therapeutic abortion be performed before treatment, two patients were treated during pregnancy, one with chemotherapy without treatment associated complications during delivery. Four women diagnosed after 28th week decided to delay the treatment until delivery. After a follow up of 172 months, the relapse free survival (RFS) was 69% at five years and 45% at ten years. Overall survival (OS) at five years was 90.8% and 74.2% at ten years for all patients. For group ‘A’ OS was higher with 90% at five years versus 80% in group ‘B’. The differences between the groups were not statistically significant p = 0.368. Conclusion In our experience, there is a higher OS in patients diagnosed during pregnancy suggesting a better prognosis for this group of women but the difference between the groups is not statistically significant. Our study is limited because of our small sample.
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Affiliation(s)
| | - Carmen Herrero Vicent
- Department of Medical Oncology, Fundación Instituto Valenciano de Oncología, Valencia 46009, Spain
| | - Joaquín Gavilá Gregori
- Department of Medical Oncology, Fundación Instituto Valenciano de Oncología, Valencia 46009, Spain
| | - Ángel Guerrero Zotano
- Department of Medical Oncology, Fundación Instituto Valenciano de Oncología, Valencia 46009, Spain
| | - Vicente Guillem Porta
- Department of Medical Oncology, Fundación Instituto Valenciano de Oncología, Valencia 46009, Spain
| | - Amparo Ruiz Simón
- Department of Medical Oncology, Fundación Instituto Valenciano de Oncología, Valencia 46009, Spain
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Gianni L, Baselga J, Eiermann W, Guillem Porta V, Semiglazov V, Lluch A, Zambetti M, Sabadell D, Raab G, Llombart Cussac A, Bozhok A, Martinez-Agulló A, Greco M, Byakhov M, Lopez Lopez JJ, Mansutti M, Valagussa P, Bonadonna G. Feasibility and tolerability of sequential doxorubicin/paclitaxel followed by cyclophosphamide, methotrexate, and fluorouracil and its effects on tumor response as preoperative therapy. Clin Cancer Res 2006; 11:8715-21. [PMID: 16361558 DOI: 10.1158/1078-0432.ccr-05-0539] [Citation(s) in RCA: 131] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The European Cooperative Trial in Operable breast cancer (ECTO) randomly tested whether efficacy of adjuvant doxorubicin followed by i.v. cyclophosphamide, methotrexate, and fluorouracil (CMF; doxorubicin-->CMF, arm A) could be improved by adding paclitaxel (doxorubicin/paclitaxel-->CMF) as adjuvant (arm B) or primary systemic therapy (PST, arm C). We report here feasibility, tolerability, locoregional antitumor activity, and breast conservation rate. METHODS A total of 1,355 women entered the study. Feasibility and safety were compared in arm A versus arms B plus C. Surgical findings were compared in arms A plus B versus arm C. RESULTS Grade 3 or 4 National Cancer Institute toxicities were low (<5%) in all arms. Neuropathy was more frequent in the paclitaxel-containing arms (grade 2, 20.5% versus 5.0%; grade 3, 1.3% versus 0.2%). At 31 months of follow-up, asymptomatic drop of left ventricular ejection fraction was similar in all arms, whereas symptomatic cardiotoxicity was recorded in three patients (0.5%) in A and in three patients (0.3%) in B plus C. PST induced clinical complete plus partial remission in 78%, with an in-breast pathologic complete response rate of 23% and an in-breast plus axilla pathologic complete response rate of 20%. In the multivariate analysis, only estrogen receptor (ER) status was significantly associated with pathologic complete response (odds ratio for ER negative, 5.77; 95% confidence interval, 3.49-9.52; P<0.0001). PTS induced a significant axillary downstaging (P<0.001), and breast sparing surgery was feasible in 65% versus 34% (P<0.001). CONCLUSIONS Doxorubicin/paclitaxel-->CMF is feasible, safe, and well tolerated. Given as PST, it is markedly active, allowing for breast-sparing surgery in a large fraction of patients.
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Affiliation(s)
- Luca Gianni
- Istituto Nazionale Tumori, Milan, Italy, and Hospital Vall d'Hebron, Barcelona, Spain.
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