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Stirling RG, Harrison A, Huang J, Lee V, Taverner J, Barnes H. Multidisciplinary meeting review in nonsmall cell lung cancer: a systematic review and meta-analysis. Eur Respir Rev 2024; 33:230157. [PMID: 38719736 PMCID: PMC11078104 DOI: 10.1183/16000617.0157-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 02/23/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Lung cancer diagnosis, staging and treatment may be enhanced by multidisciplinary participation and presentation in multidisciplinary meetings (MDM). We performed a systematic review and meta-analysis to explore literature evidence of clinical impacts of MDM exposure. METHODS A study protocol was registered (PROSPERO identifier CRD42021258069). Randomised controlled trials and observational cohort studies including adults with nonsmall cell lung cancer and who underwent MDM review, compared to no MDM, were included. MEDLINE, CENTRAL, Embase and ClinicalTrials.gov were searched on 31 May 2021. Studies were screened and extracted by two reviewers. Outcomes included time to diagnosis and treatment, histological confirmation, receipt of treatments, clinical trial participation, survival and quality of life. Risk of bias was assessed using the ROBINS-I (Risk of Bias in Non-randomised Studies - of Interventions) tool. RESULTS 2947 citations were identified, and 20 studies were included. MDM presentation significantly increased histological confirmation of diagnosis (OR 3.01, 95% CI 2.30-3.95; p<0.00001) and availability of clinical staging (OR 2.55, 95% CI 1.43-4.56; p=0.002). MDM presentation significantly increased likelihood of receipt of surgery (OR 2.01, 95% CI 1.29-3.12; p=0.002) and reduced the likelihood of receiving no active treatment (OR 0.32, 95% CI 0.21-0.50; p=0.01). MDM presentation was protective of both 1-year survival (OR 3.23, 95% CI 2.85-3.68; p<0.00001) and overall survival (hazard ratio 0.63, 95% CI 0.55-0.72; p<0.00001). DISCUSSION MDM presentation was associated with increased likelihood of histological confirmation of diagnosis, documentation of clinical staging and receipt of surgery. Overall and 1-year survival was better in those presented to an MDM, although there was some clinical heterogeneity in participants and interventions delivered. Further research is required to determine the optimal method of MDM presentation, and address barriers to presentation.
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Affiliation(s)
- Rob G Stirling
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Amelia Harrison
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Australia
| | - Joanna Huang
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Australia
| | - Vera Lee
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - John Taverner
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Australia
| | - Hayley Barnes
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
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Huang RS, Mihalache A, Nafees A, Hasan A, Ye XY, Liu Z, Leighl NB, Raman S. The impact of multidisciplinary cancer conferences on overall survival: a meta-analysis. J Natl Cancer Inst 2024; 116:356-369. [PMID: 38123515 DOI: 10.1093/jnci/djad268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/11/2023] [Accepted: 12/16/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Multidisciplinary cancer conferences consist of regular meetings between diverse specialists working together to share clinical decision making in cancer care. The aim of this study was to systematically review and meta-analyze the effect of multidisciplinary cancer conference intervention on the overall survival of patients with cancer. METHODS A systematic literature search was conducted on Ovid MEDLINE, EMBASE, and the Cochrane Controlled Register of Trials for studies published up to July 2023. Studies reporting on the impact of multidisciplinary cancer conferences on patient overall survival were included. A standard random-effects model with the inverse variance-weighted approach was used to estimate the pooled hazard ratio of mortality (multidisciplinary cancer conference vs non-multidisciplinary cancer conference) across studies, and the heterogeneity was assessed by I2. Publication bias was examined using funnel plots and the Egger test. RESULTS A total of 134 287 patients with cancer from 59 studies were included in our analysis, with 48 467 managed by multidisciplinary cancer conferences and 85 820 in the control arm. Across all cancer types, patients managed by multidisciplinary cancer conferences had an increased overall survival compared with control patients (hazard ratio = 0.67, 95% confidence interval = 0.62 to 0.71, I2 = 84%). Median survival time was 30.2 months in the multidisciplinary cancer conference group and 19.0 months in the control group. In subgroup analysis, a positive effect of the multidisciplinary cancer conference intervention on overall survival was found in breast, colorectal, esophageal, hematologic, hepatocellular, lung, pancreatic, and head and neck cancer. CONCLUSIONS Overall, our meta-analysis found a significant positive effect of multidisciplinary cancer conferences compared with controls. Further studies are needed to establish nuanced guidelines when optimizing multidisciplinary cancer conference integration for treating diverse patient populations.
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Affiliation(s)
- Ryan S Huang
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Andrew Mihalache
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Asad Hasan
- University of British Columbia, Vancouver, BC, Canada
| | - Xiang Y Ye
- Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Zhihui Liu
- Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Natasha B Leighl
- Department of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Srinivas Raman
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
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3
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Arrivi G, Specchia M, Pilozzi E, Rinzivillo M, Caruso D, Santangeli C, Prosperi D, Ascolese AM, Panzuto F, Mazzuca F. Diagnostic and Therapeutic Management of Primary Orbital Neuroendocrine Tumors (NETs): Systematic Literature Review and Clinical Case Presentation. Biomedicines 2024; 12:379. [PMID: 38397981 PMCID: PMC10886459 DOI: 10.3390/biomedicines12020379] [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: 12/01/2023] [Revised: 01/25/2024] [Accepted: 01/30/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND The ocular involvement of neuroendocrine neoplasms (NENs) is uncommon and mainly represented by metastases from gastrointestinal and lung neuroendocrine tumors. Primary orbital NENs are even less common and their diagnostic and therapeutic management is a challenge. METHODS A systematic review of the literature was conducted from 1966 to September 2023 on PubMed to identify articles on orbital NENs and to summarize their clinical-pathological features, diagnosis and therapeutic management. Furthermore, we presented a case of a locally advanced retro-orbital primary neuroendocrine tumor that was referred to the certified Center of Excellence of Sant'Andrea Hospital, La Sapienza University of Rome, Italy. RESULTS The final analysis included 63 records on orbital NENs and 11 records focused on primary orbital NENs. The localization was mostly unilateral and in the right orbit; proptosis or exophthalmos represented the initial symptoms. The diagnostic work-up and therapeutic management was discussed and a diagnostic algorithm for the suspicion of primary orbital NENs was proposed. CONCLUSIONS A multidisciplinary approach is required for the management of primary orbital NENs, emphasizing the importance of early referral to dedicated centers for prompt differential diagnosis, tailored treatment, and an improved quality of life and survival.
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Affiliation(s)
- Giulia Arrivi
- Oncology Unit, Department of Clinical and Molecular Medicine, Sant’Andrea University Hospital, Sapienza University of Rome, Grottarossa Street 1035-1039, 00189 Rome, Italy; (M.S.); (F.M.)
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, PhD School in Translational Medicine and Oncology, Sapienza University of Rome, 00189 Rome, Italy
| | - Monia Specchia
- Oncology Unit, Department of Clinical and Molecular Medicine, Sant’Andrea University Hospital, Sapienza University of Rome, Grottarossa Street 1035-1039, 00189 Rome, Italy; (M.S.); (F.M.)
| | - Emanuela Pilozzi
- Anatomia Patologica Unit, Department of Clinical and Molecular Medicine, Sant’Andrea University Hospital, Sapienza University of Rome, 00189 Rome, Italy;
| | - Maria Rinzivillo
- European Neuroendocrine Tumor Society (ENETS) Center of Excellence, Digestive Disease Unit, Sant’Andrea University Hospital, 00189 Rome, Italy; (M.R.); (F.P.)
| | - Damiano Caruso
- Radiology Unit, Department of Medical Surgical Sciences and Translational Medicine, Sant’Andrea University Hospital, Sapienza University of Rome, 00189 Rome, Italy; (D.C.); (C.S.)
| | - Curzio Santangeli
- Radiology Unit, Department of Medical Surgical Sciences and Translational Medicine, Sant’Andrea University Hospital, Sapienza University of Rome, 00189 Rome, Italy; (D.C.); (C.S.)
| | - Daniela Prosperi
- Nuclear Medicine Unit, Sant’Andrea University Hospital, 00189 Rome, Italy;
| | - Anna Maria Ascolese
- Radiotherapy Oncology Unit, Department of Surgical Medical Sciences and Translational Medicine, Sant’Andrea University Hospital, Sapienza University of Rome, 00189 Rome, Italy;
| | - Francesco Panzuto
- European Neuroendocrine Tumor Society (ENETS) Center of Excellence, Digestive Disease Unit, Sant’Andrea University Hospital, 00189 Rome, Italy; (M.R.); (F.P.)
- European Neuroendocrine Tumor Society (ENETS) Center of Excellence, Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, 00189 Rome, Italy
| | - Federica Mazzuca
- Oncology Unit, Department of Clinical and Molecular Medicine, Sant’Andrea University Hospital, Sapienza University of Rome, Grottarossa Street 1035-1039, 00189 Rome, Italy; (M.S.); (F.M.)
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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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de Oliveira TB, Fontes DMN, Montella TC, Lewgoy J, Dutra C, Miola TM. The Best Supportive Care in Stage III Non-Small-Cell Lung Cancer. Curr Oncol 2023; 31:183-202. [PMID: 38248097 PMCID: PMC10814676 DOI: 10.3390/curroncol31010012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 11/27/2023] [Indexed: 01/23/2024] Open
Abstract
Lung cancer is a major cause of cancer deaths worldwide. Non-small-cell lung cancer (NSCLC) represents most lung cancer cases, and approximately one-third of patients present with stage III disease at diagnosis. As multiple treatment plans can be adopted for these patients depending on tumor size and nodal staging, stage III NSCLC management is challenging. Over the past decades, multidisciplinary teams (MDTs) have been implemented in healthcare services to coordinate actions among the different health care professionals involved in cancer care. The aim of this review was to discuss real-world evidence of the impact of MDTs on stage III NSCLC management, survival, and quality of life. Here, we performed a literature review to investigate the role of nutrition and navigational nursing in NSCLC care and the influence of MDTs in the choice of treatment plans, including immunotherapy consolidation, and in the management of chemotherapy and radiotherapy-related adverse events. We also performed a mapping review to identify gaps in the implementation of cancer care MDTs in healthcare services around the world.
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Affiliation(s)
| | | | | | - Jairo Lewgoy
- Medical Oncology Department, Hospital Mãe de Deus, Porto Alegre 90880-481, Brazil;
| | - Carolina Dutra
- Medical Oncology Department, Clínica Soma, Florianópolis 88020-210, Brazil;
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Zhong X, Zeng X, Zhao L, TaoChen, Min X, He R. Clinicians' knowledge and understanding regarding multidisciplinary treatment implementation: a study in municipal public class III grade A hospitals in Southwest China. BMC MEDICAL EDUCATION 2023; 23:916. [PMID: 38049733 PMCID: PMC10696733 DOI: 10.1186/s12909-023-04891-0] [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: 07/21/2023] [Accepted: 11/21/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Previous studies have highlighted several problems in the implementation of multidisciplinary treatment (MDT) from a managerial perspective. However, no study has addressed these issues from clinicians' perspective. Therefore, this study aimed to identify and address the existing problems in MDT by investigating what clinicians know and think about the implementation of MDT. METHODS A self-designed questionnaire was used to evaluate clinicians' understanding of MDT in municipal public Class III Grade A hospitals in Western China using a cross-sectional questionnaire study. RESULTS Overall, 70.56% of clinicians knew the scope of MDT, and 63.41% knew the process of MDT. Professional title (P = 0.001; OR: 2.984; 95% CI: 1.590-5.603), participated in MDT (P = 0.017; OR: 1.748; 95% CI: 1.103-2.770), and application for MDT (P = 0.000; OR: 2.442; 95% CI: 1.557-3.830) had an impact on clinicians' understanding of the scope of MDT. Professional title (P = 0.002; OR:2.446; 95% CI: 1.399-4.277) and participation in MDT (P = 0.000; OR: 2.414; 95% CI: 1.581-3.684) influenced clinicians' understanding of the scope of MDT. More than 70% of the respondents thought that MDT was important in medical care. However, less than half of the clinicians who had attended MDT were currently satisfied with the results of MDT. CONCLUSION Most clinicians agreed that MDT was crucial in clinical care. However, more than a third of clinicians did not fully understand the scope and process of MDT. Appropriate measures are necessary to improve the quality of MDT. Our study suggests that healthcare administration should strengthen MDT education, especially for new and young clinicians.
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Affiliation(s)
- Xuemin Zhong
- Chengdu Second People's Hospital, Postal Address: No.10 Qingyunnan Street, Jinjiang District, Chengdu, Sichuan, China
| | - Xianbao Zeng
- Women and Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Health Center for Women and Children, Chongqing, China
| | - Longchao Zhao
- Chengdu Second People's Hospital, Postal Address: No.10 Qingyunnan Street, Jinjiang District, Chengdu, Sichuan, China
| | - TaoChen
- Chengdu Second People's Hospital, Postal Address: No.10 Qingyunnan Street, Jinjiang District, Chengdu, Sichuan, China
| | - Xing Min
- Women and Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Health Center for Women and Children, Chongqing, China
| | - Rui He
- Chengdu Second People's Hospital, Postal Address: No.10 Qingyunnan Street, Jinjiang District, Chengdu, Sichuan, China.
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7
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de Castro G, Souza FH, Lima J, Bernardi LP, Teixeira CHA, Prado GF. Does Multidisciplinary Team Management Improve Clinical Outcomes in NSCLC? A Systematic Review With Meta-Analysis. JTO Clin Res Rep 2023; 4:100580. [PMID: 38046377 PMCID: PMC10689272 DOI: 10.1016/j.jtocrr.2023.100580] [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: 04/04/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 12/05/2023] Open
Abstract
Introduction The implementation of multidisciplinary teams (MDTs) has been found to be effective for improving outcomes in oncology. Nevertheless, there is still a dearth of robust literature on patients with NSCLC. The aim of this study was to conduct a systematic review regarding the impact of MDTs on patient with NSCLC outcomes. Methods Databases were systematically searched up to February 2023. Two reviewers independently performed study selection and data extraction. Risk of bias was evaluated using the Newcastle-Ottawa and certainty of evidence by the Grading of Recommendations Assessment, Development and Evaluation approach. Overall survival was the primary outcome. Secondary outcomes included mortality, length of survival, progression-free survival, time from diagnosis to treatment, complete staging, treatment received, and adherence to guidelines. A meta-analysis with a random-effect model was performed. Statistical analysis was performed with the R 3.6.2 package. Results A total of 22 studies were included in the systematic review. Ten outcomes were identified, favoring the MDT group over the non-MDT group. Pooled analysis revealed that patients managed by MDTs had better overall survival (three studies; 38,037 participants; hazard ratio 0.60, 95% confidence interval [CI]: 0.49-0.75, I2 = 78%), shorter treatment time compared with patients in the non-MDT group (six studies; 15,235 participants; mean difference = 12.20 d, 95% CI: 10.76-13.63, I2 = 63%), and higher proportion of complete staging (four studies; 14,925 participants; risk ratio = 1.36, 95% CI: 1.17-1.57, I2 = 89%). Conclusions This meta-analysis revealed that MDT-based patient care was associated with longer overall survival and better quality-of-care-related outcomes.
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Affiliation(s)
- Gilberto de Castro
- Clinical Oncology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
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Chung DH, Zheng M, Bale AE, Vilarinho S. Hepatology Genome Rounds: An interdisciplinary approach to integrate genomic data into clinical practice. J Hepatol 2023; 79:1065-1071. [PMID: 37011712 PMCID: PMC10523901 DOI: 10.1016/j.jhep.2023.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/13/2023] [Accepted: 03/21/2023] [Indexed: 04/05/2023]
Abstract
In the last decade, the utility of whole-exome sequencing in uncovering genetic aetiologies of a variety of liver diseases has been demonstrated. These new diagnoses have guided the management, treatment, and prognostication of previously undiagnosed patients, largely thanks to improved insight into the underlying pathogenesis of their conditions. Despite its clear benefits, the uptake of genetic testing by hepatologists has been limited, in part due to limited prior genetic training and/or opportunities for continuing education. Herein, we show that Hepatology Genome Rounds, an interdisciplinary forum highlighting hepatology cases of clinical interest and educational value, are an important venue for integrating genotypic and phenotypic information to enable accurate diagnosis and appropriate management, dissemination of genomic knowledge within the field of hepatology, and ongoing education to providers and trainees in genomic medicine. We describe our single-centre experience and discuss practical considerations for clinicians interested in launching such a series. We foresee that this format will be adopted at other institutions and by additional specialties, with the aim of further incorporating genomic information into clinical medicine.
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Affiliation(s)
- David H Chung
- Department of Internal Medicine, Section of Digestive Diseases, Yale School of Medicine, New Haven, CT, USA
| | - Melanie Zheng
- Department of Internal Medicine, Section of Digestive Diseases, Yale School of Medicine, New Haven, CT, USA
| | - Allen E Bale
- Department of Genetics, Yale School of Medicine, New Haven, CT, USA
| | - Sílvia Vilarinho
- Department of Internal Medicine, Section of Digestive Diseases, Yale School of Medicine, New Haven, CT, USA; Department of Pathology, Yale School of Medicine, New Haven, CT, USA.
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Marrara B, Ibekwe O, Masika M, Attwood K, Gaudioso C, Nwogu C. Using an Adapted Tumor Board Evaluation Tool for Quality Assessment of a Thoracic Multidisciplinary Cancer Conference: A Pilot Study. JCO Clin Cancer Inform 2023; 7:e2300017. [PMID: 37797277 DOI: 10.1200/cci.23.00017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/24/2023] [Accepted: 05/17/2023] [Indexed: 10/07/2023] Open
Abstract
PURPOSE Multidisciplinary cancer conferences (MCCs) are crucial for the management of complex oncology patients. Tools to evaluate MCC performance are needed. The aim of this pilot study was to assess the applicability of an existing validated performance assessment tool to evaluate the quality of thoracic MCCs (T-MCCs). METHODS Data were collected from weekly T-MCCs over a 5-week period using the MCC Performance Assessment Tool and a self-assessment survey. Audio recordings were used to supplement observation notes. Case presentation, discussion duration, decision making contribution, recommendations, and consensus were captured. Quality of information and contribution were rated on a 1-5 scale. The data were analyzed using descriptive statistics to calculate means and composite scores representing overall MCC performance. RESULTS A total of 44 cases were observed at the T-MCC with the mean presentation and discussion time of 6 minutes and 22 seconds. Quality of case history, radiologic and pathological information, and reason for case discussion were rated above average (>3), whereas inclusion of comorbidities and patient views were rated below average. Surgical oncologists had a higher discussion contribution compared with medical and radiation oncologists (3.6 v 2.9 and 2.4, respectively). The overall mean composite score was 55.9 (deemed average) with no cases categorized as poor or excellent. Radiologists and pathologists had mean preparation times of 81.7 and 144.0 minutes, respectively. CONCLUSION This study demonstrated the applicability of a previously validated tool to assess the quality of a T-MCC at an academic comprehensive cancer center. The tool was found to be useful in identifying elements of the T-MCC process that needed improvement.
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Affiliation(s)
| | | | | | | | | | - Chukwumere Nwogu
- Roswell Park Cancer Institute, Buffalo, NY
- University at Buffalo, Buffalo, NY
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10
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Mäurer M, Staudacher J, Meyer R, Mäurer I, Lazaridis L, Müther M, Huber T, Sommer NP, Fleischmann DF, Käsmann L, Ziegler S, Kropf-Sanchen C, Wikert J, Pietzner K, Holzgreve A, Nestler T, Siech C, Sturm MJ, Sulzer S, Heinrich K, Stahler A. Importance of interdisciplinarity in modern oncology: results of a national intergroup survey of the Young Oncologists United (YOU). J Cancer Res Clin Oncol 2023; 149:10075-10084. [PMID: 37261525 PMCID: PMC10423150 DOI: 10.1007/s00432-023-04937-2] [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: 04/27/2023] [Accepted: 05/24/2023] [Indexed: 06/02/2023]
Abstract
PURPOSE Modern, personalized treatment concepts in oncology require an interdisciplinary and multiprofessional collaboration. In addition to its relevance in patient care, interdisciplinary collaboration is also becoming increasingly important in clinical research as well as medical education and resident training in oncology. METHODS Between November 2021 and March 2022, an online survey was conducted among German early career research groups, represented by Young Oncologists United (YOU). The aim was to identify the status and need for interdisciplinarity at clinic, educational, and research levels. RESULTS A total of 294 participants completed the questionnaire in full. 90.7% of the respondents fully or predominantly agreed with the statement that interdisciplinary work plays a major role in their daily clinical work. 78.9% wished for more interdisciplinary collaboration. Of the 49.7% of participants who have never participated in an interdisciplinary research project, 80.1% said they would like to participate in such a study project in the future. Lack of time resources, too much organizational effort, and possible political conflicts between institutions were identified as factors that make practical implementation difficult. 74.1% declared their willingness to become active in an oncology early career research group. CONCLUSION Interdisciplinary collaboration has become increasingly important in oncology. Networks that span different disciplines could help to promote interdisciplinary research projects among young scientists and improve exchange in professional practice and education with the implication of improved patient care.
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Affiliation(s)
- Matthias Mäurer
- Department of Radiotherapy and Radiation Oncology, University Hospital Jena, Jena, Germany.
| | - Jonas Staudacher
- Department of Gastroenterology, Rheumatology and Infectiology, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Robert Meyer
- Institute of Human Genetics and Genomic Medicine, University Hospital Aachen, Medical Faculty, RWTH Aachen University, Aachen, Germany
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, University Hospital Aachen, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Bonn, Germany
| | - Irina Mäurer
- Department of Neurology, Neurooncology Center, University Hospital Jena, Jena, Germany
| | - Lazaros Lazaridis
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Division of Clinical Neurooncology, University Medicine Essen, University Duisburg-Essen, Essen, Germany
| | - Michael Müther
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Tobias Huber
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Mainz, Germany
| | - Nils P Sommer
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Bonn, Bonn, Germany
| | - Daniel F Fleischmann
- Clinic and Polyclinic for Radiotherapy and Radiooncology, LMU Clinic Munich, LMU Munich, Munich, Germany
| | - Lukas Käsmann
- Clinic and Polyclinic for Radiotherapy and Radiooncology, LMU Clinic Munich, LMU Munich, Munich, Germany
| | - Sonia Ziegler
- Clinic and Polyclinic for Radiation Therapy and Radiooncology, University Medical Center Göttingen, Göttingen, Germany
| | | | - Julia Wikert
- Clinic and Polyclinic for Palliative Medicine, LMU Klinikum München, Munich, Germany
| | - Klaus Pietzner
- Department of Gynecology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Adrien Holzgreve
- Clinic and Polyclinic for Nuclear Medicine, University Hospital Munich, LMU Munich, Munich, Germany
| | - Tim Nestler
- Clinic for Urology, Bundeswehr Central Hospital Koblenz, Koblenz, Germany
| | - Carolin Siech
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Max-Johann Sturm
- Department of Radiotherapy and Radiation Oncology, University Hospital Jena, Jena, Germany
| | - Sabrina Sulzer
- Department of Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center Göttingen, Göttingen, Germany
| | - Kathrin Heinrich
- Medical Clinic and Polyclinic III, University Hospital Munich, LMU Munich, Munich, Germany
| | - Arndt Stahler
- Charité University Medicine, Medical Clinic m. S. Hematology, Oncology and Tumor Immunology, Berlin, Germany
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Imran Hamid U, Modine T, Maessen J, van ‘t Hof A, Sondergaard L, Bleiziffer S, Lancellotti P, Siepe M, Sardari Nia P. Structure of multidisciplinary heart teams, a survey-based heart team study. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2023; 37:7241522. [PMID: 37567588 PMCID: PMC11015317 DOI: 10.1093/icvts/ivad134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/20/2023] [Accepted: 08/09/2023] [Indexed: 08/13/2023]
Abstract
OBJECTIVES Multidisciplinary approach is well established in various disciplines, with evidence highlighting improved patient outcomes. The objective of this survey was to determine the real-world practice of heart teams across Europe. METHODS The survey was drafted after a consensus opinion from the authors. The survey was sent to cardiac surgeons and cardiologists identified through electronic search. The survey link and the information sheet were sent through email followed by survey completion reminders. The survey responses were cumulated and analysed. RESULTS Among 2188 invited clinicians, 220 clinicians from 26 countries took part in the survey (response rate 10%). The completion rate for the survey questions was 85%. A total of 140 (64%) were cardiac surgeons and 80 (36%) were cardiologists. The heart team meeting frequency was weekly according to 104 (55%) respondents. This was conducted face to face according to 139 (73%) of the responses. Eighty-seven (56%) of the respondents reported 10-20% of patients undergoing percutaneous coronary intervention were discussed at the heart team meeting. Seventy-nine (47%) respondents had ad hoc percutaneous coronary intervention institutional guidelines. Fifty-four (32%) respondents reported an audit process for the heart team decisions. CONCLUSIONS This survey suggests that there is marked variability in the infra-structure and execution of heart teams in different institutions. The results of the survey suggest a need to formulate guidelines on the composition and execution of heart teams which may result in an increase in transparency of decision-making within different institutions in reporting and comparing outcomes.
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Affiliation(s)
- Umar Imran Hamid
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
- Department of Cardiac Surgery, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Thomas Modine
- Department of Cardiac Surgery, Lille University Hospital, Lille, France
| | - Jos Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Arnoud van ‘t Hof
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Lars Sondergaard
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Sabine Bleiziffer
- Department of Cardiac Surgery, Heart and Diabetes Center NRW, Bad Oeynhausen, Germany
| | | | - Matthias Siepe
- Department of Cardiac Surgery, Cardiovascular Centre, Inselspital, University of Bern, Switzerland
| | - Peyman Sardari Nia
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
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Giorgi PD, Villa FG, Cenzato M, Capitani D, Antonio DG, Legrenzi S, Puglia F, Picano M, Boeris D, Debernardi A, Schirò GR. Integrated spine trauma team protocol: Combined neurosurgical and orthopedic experience for the management of traumatic spinal injuries. J Neurosci Rural Pract 2023; 14:459-464. [PMID: 37692798 PMCID: PMC10483202 DOI: 10.25259/jnrp_52_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 02/21/2023] [Indexed: 09/12/2023] Open
Abstract
Objectives During the last decades, spine surgery has grown exponentially. In spite of that, it remains a surgical specialty without a well-defined own certification. It is usually carried out, separately, by neurosurgeons and orthopedic surgeons, even if there is an overlapping of competence and skills. Materials and Methods In our hospital, from January 2019, a systematic protocol called integrated spine trauma team protocol (ISTTP) was implemented to improve the management of traumatic spinal injuries in a multidisciplinary way. It is characterized by a specific algorithm from diagnosis to postoperative care. According to the new protocol, orthopedic spinal surgeons and neurosurgeons work together as an integrated spine trauma team. The authors analyzed, retrospectively, the results obtained by comparing patients treated before and after the application of the ISTTP. Results The new protocol allowed a statistically significant reduction in waiting time before surgery and complication rate. Moreover, early discharge of patients was recorded. To the best of our knowledge, this is the first study that described a specific algorithm for a standardized multidisciplinary management of the spinal trauma with combined orthopedic and neurosurgeon expertise. Conclusion Our preliminary results suggest that the application of our ISTTP leads to better results for treating traumatic spinal injury (TSI).
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Affiliation(s)
- Pietro Domenico Giorgi
- Orthopedics and Traumatology Unit, A.S.S.T. Grande Ospedale Metropolitano Niguarda, Italy
| | | | - Marco Cenzato
- Department of Neurosurgery, ASST Niguarda Metropolitan Hospital, Milan, Italy
| | - Dario Capitani
- Orthopedics and Traumatology Unit, A.S.S.T. Grande Ospedale Metropolitano Niguarda, Italy
| | | | - Simona Legrenzi
- Orthopedics and Traumatology Unit, A.S.S.T. Grande Ospedale Metropolitano Niguarda, Italy
| | - Francesco Puglia
- Department of Pediatric Orthopedics and Traumatology, G. Pini Orthopaedic Institute, Milan, Italy
| | - Marco Picano
- Department of Neurosurgery, ASST Niguarda Metropolitan Hospital, Milan, Italy
| | - Davide Boeris
- Department of Neurosurgery, ASST Niguarda Metropolitan Hospital, Milan, Italy
| | - Alberto Debernardi
- Department of Neurosurgery, ASST Niguarda Metropolitan Hospital, Milan, Italy
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13
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Ali SR, Dobbs TD, Jovic M, Hutchings HA, Whitaker IS. Improving the effectiveness of multidisciplinary team meetings on skin cancer: Analysis of the National Cancer Research UK survey responses. J Plast Reconstr Aesthet Surg 2023; 82:141-151. [PMID: 37167715 DOI: 10.1016/j.bjps.2023.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 09/05/2022] [Accepted: 01/29/2023] [Indexed: 03/30/2023]
Abstract
INTRODUCTION Skin cancer is the most common form of cancer in the UK, comprising at least 25% of all new cancer diagnoses. Many patients require referral to the local or specialist skin cancer multidisciplinary team (MDT) for ongoing management. However, national data have shown that Specialist Skin Cancer MDTs are costly and do not currently meet NICE standards for composition and quoracy. Innovative solutions to these problems are therefore warranted. METHODS We performed a secondary comparative analysis of 3563 quantitative responses to two Cancer Research UK commissioned surveys along with subanalysis of 282 skin cancer MDT respondents. RESULTS Good uniformity was observed amongst skin respondents in the belief that risk stratification and prioritization of complex cases were the most important factors compared to other cancer MDT members. The most important priorities for areas requiring change to MDT working deemed by the skin MDT were 1) imaging and pathology results ready for the meeting, 2) time to discuss patients in detail, 3) clear meeting owner in charge, and 4) clear agenda, in advance of the meeting. There was agreement (median Likert score 4) amongst skin MDT respondents that patients should be placed on protocolized treatment pathways. CONCLUSION The responses of skin MDT respondents analyzed in the current study support changes to meeting attendance, preparation, and protocolized streaming. In line with other studies, we support tumor-specific guidance for streamlining MDT discussions. We also encourage stakeholders to adopt an evidence-based approach to test, develop, and reassess changes in this herculean task.
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Affiliation(s)
- Stephen R Ali
- Reconstructive Surgery and Regenerative Medicine Research Centre (ReconRegen), Institute of Life Sciences, Swansea University Medical School, Swansea, UK; Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | - Thomas D Dobbs
- Reconstructive Surgery and Regenerative Medicine Research Centre (ReconRegen), Institute of Life Sciences, Swansea University Medical School, Swansea, UK; Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | - Matthew Jovic
- Reconstructive Surgery and Regenerative Medicine Research Centre (ReconRegen), Institute of Life Sciences, Swansea University Medical School, Swansea, UK
| | - Hayley A Hutchings
- Patient and Population Health and Informatics Research, Swansea University Medical School, Swansea, UK
| | - Iain S Whitaker
- Reconstructive Surgery and Regenerative Medicine Research Centre (ReconRegen), Institute of Life Sciences, Swansea University Medical School, Swansea, UK; Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK.
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Abidi SA, Hoch MJ, Hu R, Sadigh G, Voloschin A, Olson JJ, Shu HKG, Neill SG, Weinberg BD. Using Brain Tumor MRI Structured Reporting to Quantify the Impact of Imaging on Brain Tumor Boards. Tomography 2023; 9:859-870. [PMID: 37104141 PMCID: PMC10146901 DOI: 10.3390/tomography9020070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/06/2023] [Accepted: 04/13/2023] [Indexed: 04/28/2023] Open
Abstract
Multidisciplinary tumor boards (TB) are an essential part of brain tumor care, but quantifying the impact of imaging on patient management is challenging due to treatment complexity and a lack of quantitative outcome measures. This work uses a structured reporting system for classifying brain tumor MRIs, the brain tumor reporting and data system (BT-RADS), in a TB setting to prospectively assess the impact of imaging review on patient management. Published criteria were used to prospectively assign three separate BT-RADS scores (an initial radiology report, secondary TB presenter review, and TB consensus) to brain MRIs reviewed at an adult brain TB. Clinical recommendations at TB were noted and management changes within 90 days after TB were determined by chart review. In total, 212 MRIs in 130 patients (median age = 57 years) were reviewed. Agreement was 82.2% between report and presenter, 79.0% between report and consensus, and 90.1% between presenter and consensus. Rates of management change increased with increasing BT-RADS scores (0-3.1%, 1a-0%, 1b-66.7%, 2-8.3%, 3a-38.5%, 3b-55.9, 3c-92.0%, and 4-95.6%). Of 184 (86.8%) cases with clinical follow-up within 90 days after the tumor board, 155 (84.2%) of the recommendations were implemented. Structured scoring of MRIs provides a quantitative way to assess rates of agreement interpretation alongside how often management changes are recommended and implemented in a TB setting.
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Affiliation(s)
- Syed A Abidi
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, MO 63110, USA
| | - Michael J Hoch
- Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Ranliang Hu
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA 30322, USA
| | - Gelareh Sadigh
- Department of Radiology, University of California-Irvine, Irvine, CA 92868, USA
| | - Alfredo Voloschin
- Department of Neuro-Oncology, Orlando Health Cancer Institute, Orlando, FL 32806, USA
| | - Jeffrey J Olson
- Department of Neurosurgery, Emory University, Atlanta, GA 30322, USA
| | - Hui-Kuo G Shu
- Department of Radiation Oncology, Emory University, Atlanta, GA 30322, USA
| | - Stewart G Neill
- Department of Pathology, Emory University, Atlanta, GA 30322, USA
| | - Brent D Weinberg
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA 30322, USA
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15
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Wolf AJ, Miller PM, Burk JR, Vigness RM, Hollingsworth JW. Ability of single anesthesia for combined robotic-assisted bronchoscopy and surgical lobectomy to reduce time between detection and treatment in stage I non-small cell lung cancer. Proc AMIA Symp 2023; 36:434-438. [PMID: 37334076 PMCID: PMC10269424 DOI: 10.1080/08998280.2023.2193134] [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: 01/16/2023] [Revised: 03/07/2023] [Accepted: 03/15/2023] [Indexed: 06/20/2023] Open
Abstract
Background Background: Early identification, diagnosis, and treatment of lung cancer is associated with improved clinical outcomes. Robotic-assisted bronchoscopy improves the ability to diagnose early stage lung malignancies and, when combined with robotic-assisted lobectomy under single anesthesia, could reduce time from identification to intervention in early stage lung cancer in a select patient population. Methods Methods: A retrospective case-control single-center study compared patients with radiographic stage I non-small cell carcinoma (NSCCA) undergoing robotic navigational bronchoscopy and surgical resection (N = 22) with historical controls (N = 63). The primary outcome was time from initial radiographic identification of a pulmonary nodule to therapeutic intervention. Secondary outcomes included times between identification to biopsy, biopsy to surgery, and procedural complications. Results Results: Patients with suspected stage I NSCCA who received single anesthesia for diagnosis and intervention with robotic-assisted bronchoscopy and robotic-assisted lobectomy had shorter times between identification of a pulmonary nodule and intervention compared to controls (65 vs 116 days, P = 0.005). Cases had lower rates of complications (0% vs 5%) and shorter hospitalizations after surgery (3.6 vs 6.2 days, P = 0.017). Conclusion Conclusion: Our findings support that implementing a multidisciplinary thoracic oncology team and single-anesthesia biopsy-to-surgery approach in management of stage I NSCCA significantly reduced times from identification to intervention, biopsy to intervention, and length of hospital stays in management of lung cancer.
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Affiliation(s)
- Adam J. Wolf
- Texas Christian University Burnett School of Medicine, Fort Worth, Texas
| | - Paige M. Miller
- Texas Christian University Burnett School of Medicine, Fort Worth, Texas
| | - John R. Burk
- Department of Medicine, Texas Christian University Burnett School of Medicine, Fort Worth, Texas
- Department of Pulmonology and Critical Care, Texas Health Harris Methodist Hospital, Fort Worth, Texas
- Texas Pulmonary and Critical Care Consultants LLC, Fort Worth, Texas
| | - Richard M. Vigness
- Department of Thoracic Surgery, Texas Health Harris Methodist Hospital, Fort Worth, Texas
| | - John W. Hollingsworth
- Department of Medicine, Texas Christian University Burnett School of Medicine, Fort Worth, Texas
- Department of Pulmonology and Critical Care, Texas Health Harris Methodist Hospital, Fort Worth, Texas
- Texas Pulmonary and Critical Care Consultants LLC, Fort Worth, Texas
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Blum TG, Morgan RL, Durieux V, Chorostowska-Wynimko J, Baldwin DR, Boyd J, Faivre-Finn C, Galateau-Salle F, Gamarra F, Grigoriu B, Hardavella G, Hauptmann M, Jakobsen E, Jovanovic D, Knaut P, Massard G, McPhelim J, Meert AP, Milroy R, Muhr R, Mutti L, Paesmans M, Powell P, Putora PM, Rawlinson J, Rich AL, Rigau D, de Ruysscher D, Sculier JP, Schepereel A, Subotic D, Van Schil P, Tonia T, Williams C, Berghmans T. European Respiratory Society guideline on various aspects of quality in lung cancer care. Eur Respir J 2023; 61:13993003.03201-2021. [PMID: 36396145 DOI: 10.1183/13993003.03201-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 09/23/2022] [Indexed: 11/18/2022]
Abstract
This European Respiratory Society guideline is dedicated to the provision of good quality recommendations in lung cancer care. All the clinical recommendations contained were based on a comprehensive systematic review and evidence syntheses based on eight PICO (Patients, Intervention, Comparison, Outcomes) questions. The evidence was appraised in compliance with the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Evidence profiles and the GRADE Evidence to Decision frameworks were used to summarise results and to make the decision-making process transparent. A multidisciplinary Task Force panel of lung cancer experts formulated and consented the clinical recommendations following thorough discussions of the systematic review results. In particular, we have made recommendations relating to the following quality improvement measures deemed applicable to routine lung cancer care: 1) avoidance of delay in the diagnostic and therapeutic period, 2) integration of multidisciplinary teams and multidisciplinary consultations, 3) implementation of and adherence to lung cancer guidelines, 4) benefit of higher institutional/individual volume and advanced specialisation in lung cancer surgery and other procedures, 5) need for pathological confirmation of lesions in patients with pulmonary lesions and suspected lung cancer, and histological subtyping and molecular characterisation for actionable targets or response to treatment of confirmed lung cancers, 6) added value of early integration of palliative care teams or specialists, 7) advantage of integrating specific quality improvement measures, and 8) benefit of using patient decision tools. These recommendations should be reconsidered and updated, as appropriate, as new evidence becomes available.
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Affiliation(s)
- Torsten Gerriet Blum
- Department of Pneumology, Lungenklinik Heckeshorn, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - Rebecca L Morgan
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Valérie Durieux
- Bibliothèque des Sciences de la Santé, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Joanna Chorostowska-Wynimko
- Department of Genetics and Clinical Immunology, National Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - David R Baldwin
- Department of Respiratory Medicine, Nottingham University Hospitals, Nottingham, UK
| | | | - Corinne Faivre-Finn
- Division of Cancer Sciences, University of Manchester and The Christie NHS Foundation Trust, Manchester, UK
| | | | | | - Bogdan Grigoriu
- Intensive Care and Oncological Emergencies and Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Georgia Hardavella
- Department of Respiratory Medicine, King's College Hospital London, London, UK
- Department of Respiratory Medicine and Allergy, King's College London, London, UK
| | - Michael Hauptmann
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Neuruppin, Germany
| | - Erik Jakobsen
- Department of Thoracic Surgery, Odense University Hospital, Odense, Denmark
| | | | - Paul Knaut
- Department of Pneumology, Lungenklinik Heckeshorn, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - Gilbert Massard
- Faculty of Science, Technology and Medicine, University of Luxembourg and Department of Thoracic Surgery, Hôpitaux Robert Schuman, Luxembourg, Luxembourg
| | - John McPhelim
- Lung Cancer Nurse Specialist, Hairmyres Hospital, NHS Lanarkshire, East Kilbride, UK
| | - Anne-Pascale Meert
- Intensive Care and Oncological Emergencies and Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Robert Milroy
- Scottish Lung Cancer Forum, Glasgow Royal Infirmary, Glasgow, UK
| | - Riccardo Muhr
- Department of Pneumology, Lungenklinik Heckeshorn, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - Luciano Mutti
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
- SHRO/Temple University, Philadelphia, PA, USA
| | - Marianne Paesmans
- Data Centre, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | | | - Paul Martin Putora
- Departments of Radiation Oncology, Kantonsspital St Gallen, St Gallen and University of Bern, Bern, Switzerland
| | | | - Anna L Rich
- Department of Respiratory Medicine, Nottingham University Hospitals, Nottingham, UK
| | - David Rigau
- Iberoamerican Cochrane Center, Barcelona, Spain
| | - Dirk de Ruysscher
- Maastricht University Medical Center, Department of Radiation Oncology (Maastro Clinic), GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands
- Erasmus Medical Center, Department of Radiation Oncology, Rotterdam, The Netherlands
| | - Jean-Paul Sculier
- Intensive Care and Oncological Emergencies and Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Arnaud Schepereel
- Pulmonary and Thoracic Oncology, Université de Lille, Inserm, CHU Lille, Lille, France
| | - Dragan Subotic
- Clinic for Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Paul Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | | - Thierry Berghmans
- Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Brussels, Belgium
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Braulke F, Kober K, Arndt A, Papendick M, Strauss A, Kramm CM, Thoms KM, König A, Gaedcke J, Gallwas J, Wulf S, Szuszies C, Wulf G, Rödel R, Wolfer S, Malinova V, Overbeck TR, Hinterthaner M, Lotz J, Nauck F, Ernst M, Stadelmann C, Ströbel P, Ellenrieder V, Asendorf T, Rieken S. Optimizing the structure of interdisciplinary tumor boards for effective cancer care. Front Oncol 2023; 13:1072652. [PMID: 37182140 PMCID: PMC10171921 DOI: 10.3389/fonc.2023.1072652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 03/31/2023] [Indexed: 05/16/2023] Open
Abstract
Introduction Multi-professional interdisciplinary tumor boards (ITB) are essential institutions to discuss all newly diagnosed, relapsed or complex cancer patients in a team of specialists to find an optimal cancer care plan for each individual patient with regard to national and international clinical practice guidelines, patient´s preference and comorbidities. In a high-volume cancer center, entity-specific ITBs take place at least once a week discussing a large number of patients. To a high level of expertise and dedication, this also requires an enormous amount of time for physicians, cancer specialists and administrative support colleagues, especially for radiologists, pathologists, medical oncologists and radiation oncologists, who must attend all cancer-specific boards according to certification requirements. Methods In this 15-month prospective German single-center analysis, we examined the established structures of 12 different cancer-specific ITBs at the certified Oncology Center and demonstrate tools helping to optimize processes before, during and after the boards for optimal, time-saving procedures. Results By changing pathways, introducing revised registration protocols and new digital supports we could show that the workload of preparation by radiologists and pathologists could be reduced significantly by 22.9% (p=<0.0001) and 52.7% (p=<0.0001), respectively. Furthermore, two questions were added to all registration forms about the patient´s need for specialized palliative care support that should lead to more awareness and early integration of specialized help. Discussion There are several ways to reduce the workload of all ITB team members while maintaining high quality recommendations and adherence to national and international guidelines.
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Affiliation(s)
- Friederike Braulke
- Comprehensive Cancer Center, University Medical Center Göttingen, Göttingen, Germany
| | - Kathrin Kober
- Comprehensive Cancer Center, University Medical Center Göttingen, Göttingen, Germany
| | - Andreas Arndt
- Comprehensive Cancer Center, University Medical Center Göttingen, Göttingen, Germany
| | - Maximilian Papendick
- Comprehensive Cancer Center, University Medical Center Göttingen, Göttingen, Germany
| | - Arne Strauss
- Department of Urology, University Medical Center Göttingen, Göttingen, Germany
| | - Christof Maria Kramm
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Kai-Martin Thoms
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - Alexander König
- Department of Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center Göttingen, Göttingen, Germany
| | - Jochen Gaedcke
- Department of General, Visceral and Pediatric Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Julia Gallwas
- Department of Gynaecology and Obstetrics, University Medical Center Göttingen, Göttingen, Germany
| | - Svenja Wulf
- Department of Gynaecology and Obstetrics, University Medical Center Göttingen, Göttingen, Germany
| | - Christoph Szuszies
- Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Gerald Wulf
- Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Ralph Rödel
- Department of Otorhinolaryngology, University Medical Center Göttingen, Göttingen, Germany
| | - Susanne Wolfer
- Department of Oral and Maxillofacial Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Vesna Malinova
- Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany
| | - Tobias R. Overbeck
- Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Marc Hinterthaner
- Department of Thoracic and Cardiovascular Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Joachim Lotz
- Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen, Göttingen, Germany
| | - Friedemann Nauck
- Department of Palliative Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Marielle Ernst
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Göttingen, Göttingen, Germany
| | - Christine Stadelmann
- Institute of Neuropathology, University Medical Center Göttingen, Göttingen, Germany
| | - Philipp Ströbel
- Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany
| | - Volker Ellenrieder
- Department of Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center Göttingen, Göttingen, Germany
| | - Thomas Asendorf
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Stefan Rieken
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Göttingen, Germany
- *Correspondence: Stefan Rieken,
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Böcker AH, Gramlich Y, Hoffmann R, Hirche C, Gather A, Grützner PA, Kneser U. Etablierung von interdisziplinären Extremitätenboards: ein wichtiger Beitrag zur Verbesserung der Versorgung von Patienten mit komplexem
Extremitätentrauma. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2022; 160:607-612. [PMID: 36451608 DOI: 10.1055/a-1924-6581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Arne Hendrik Böcker
- Klinik Für Hand, Plastische und Rekonstruktive Chirurgie, Plastische Chirurgie, Schwerbrandverletztenzentrum, BG Klinik Ludwigshafen, Ludwigshafen, Deutschland
| | - Yves Gramlich
- Klinik für Unfallchirurgie und Orthopädie, BG Klinik Frankfurt, Frankfurt am Main, Deutschland
| | - Reinhard Hoffmann
- Klinik für Unfallchirurgie und Orthopädie, BG Klinik Frankfurt, Frankfurt am Main, Deutschland
| | - Christoph Hirche
- Klinik für Plastische-, Hand- und Rekonstruktive Mikrochirurgie, Handtrauma- und Replantationszentrum, BG Klinik Frankfurt, Frankfurt am Main, Deutschland
| | - Andreas Gather
- Klinik für Unfallchirurgie und Orthopädie, BG Klinik Ludwigshafen, Ludwigshafen, Deutschland
| | - Paul Alfred Grützner
- Klinik für Unfallchirurgie und Orthopädie, BG Klinik Ludwigshafen, Ludwigshafen, Deutschland
| | - Ulrich Kneser
- Klinik Für Hand, Plastische und Rekonstruktive Chirurgie, Plastische Chirurgie, Schwerbrandverletztenzentrum, BG Klinik Ludwigshafen, Ludwigshafen, Deutschland
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19
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What is the role of the multidisciplinary team meeting in primary prolapse surgery and are alternative formats acceptable? Int Urogynecol J 2022:10.1007/s00192-022-05345-9. [PMID: 36083507 PMCID: PMC9461398 DOI: 10.1007/s00192-022-05345-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 08/12/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION AND HYPOTHESIS In 2019, the UK National Institute for Health and Care Excellence (NICE) recommended discussion of all primary prolapse cases at a multidisciplinary team (MDT) meeting prior to surgery. However, following the COVID-19 pandemic, face-to-face meetings were suspended. The aim of this study was to evaluate the role of MDT meetings in an observational retrospective review of primary prolapse cases and determine whether alternatives to face-to-face MDT meetings such as virtual and remote paper result in different outcomes. METHODS A total of 100 consecutive patients with primary prolapse, who had already been through face-to-face MDT meetings in 2019, were subjected to remote paper (independent review by team members, who then submit a paper outcome to the MDT meeting chair) and a virtual MDT meeting by the same team (blinded). Outcomes included agree, minor amendment (changing the order of priority of the compartment, changing procedure from + to +/-), major amendment (adding/removing a compartment) and insufficient information. MDT outcomes were compared for remote paper, virtual, and face-to-face MDT options. RESULTS In 88% of cases, face-to-face MDT meetings agreed to proceed unchanged (4% minor amendment, 7% major amendment, 1% insufficient information). This compared with 80% at virtual MDT (5% minor amendment, 11% major amendment, 4% insufficient information) and 74% when conducted by remote paper (5% minor amendment, 15% major amendment, 6% insufficient information). There was no significant difference in outcomes among the MDT meeting formats (Chi-squared 7.73, p=0.26). CONCLUSIONS Multidisciplinary team discussion changes management in a minority of primary prolapse cases. Similar MDT decisions are produced by virtual and remote paper formats, although the latter had the lowest concordance of opinions.
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Staubach P, Veelen K, Zimmer S, Sohn A, Lang BM, Peveling-Oberhag A, Grabbe S, Kaluza-Schilling W, Schwarting A, Wegner J. Multidisziplinarität als Schlüssel zum Erfolg. DIE DERMATOLOGIE 2022; 73:866-871. [PMID: 36069996 PMCID: PMC9592635 DOI: 10.1007/s00105-022-05051-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/27/2022] [Indexed: 11/25/2022]
Abstract
Hintergrund Patienten mit systemischen Autoimmun- und/oder autoinflammatorischen Erkrankungen (AI/AInf) bedürfen in der Regel einer multidisziplinären Zusammenarbeit durch verschiedene Fachrichtungen. Ziel der Arbeit (Fragestellung) Wir evaluierten, ob die Etablierung eines multidisziplinären Boards (sog. Rheumaboard [RB]) zur Optimierung der Versorgung von Patienten mit Psoriasisarthritis (PsA) oder anderen AI/AInf führt. Material und Methoden Es wurden n = 272 Patienten mit AI/AInf eingeschlossen, die in 3 Gruppen eingeteilt wurden; Gruppe 1: 41 Patienten mit oder mit Verdacht auf (V. a.) PsA, von der Dermatologie in der Rheumatologie konsiliarisch avisiert; Gruppe 2: 166 Patienten mit oder mit V. a. PsA, vorstellig in der Dermatologie und im RB; Gruppe 3: 65 Patienten mit anderen AI/AInf, vorstellig in der Dermatologie und im RB. Evaluiert wurde die durchschnittliche Zeit von der initialen Vorstellung bis zur Therapieeinleitung nach erfolgter Beurteilung und Diagnostik durch beide Fachrichtungen. Darüber hinaus wurden die Diagnosesicherung/-bestätigung und die Therapieweiterführung/-optimierung bei allen 3 Gruppen analysiert. Ergebnisse Die durchschnittliche Zeitspanne von der initialen Vorstellung bis zur Therapieeinleitung betrug in Gruppe 1 85 ± 42,24 (5 bis 173) Tage, in Gruppe 2 15 ± 13,09 (0 bis 78) Tage und in Gruppe 3 20 ± 16,71 (1 bis 75) Tage. In Gruppe 2 und 3 konnte die Diagnose schneller gesichert oder bestätigt sowie die Wartezeit auf Diagnostik und Therapie deutlich reduziert werden. Diskussion Durch die Etablierung eines RB zeigt sich eine signifikante Verkürzung der Zeitspanne zwischen Erstvorstellung und Therapieeinleitung und damit eine deutliche Verbesserung des Versorgungsmanagements bei Patienten mit AI/AInf inklusive Diagnosesicherung und Therapieoptimierung. Graphic abstract ![]()
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Affiliation(s)
- Petra Staubach
- Hautklinik und Poliklinik, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
- Universitäres Centrum für Autoimmunität (UCA) Mainz, Universitätsmedizin Mainz, Mainz, Deutschland
| | - Katrin Veelen
- Hautklinik und Poliklinik, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
- Universitäres Centrum für Autoimmunität (UCA) Mainz, Universitätsmedizin Mainz, Mainz, Deutschland
| | - Sebastian Zimmer
- Hautklinik und Poliklinik, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
- Universitäres Centrum für Autoimmunität (UCA) Mainz, Universitätsmedizin Mainz, Mainz, Deutschland
| | - Anna Sohn
- Hautklinik und Poliklinik, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
- Universitäres Centrum für Autoimmunität (UCA) Mainz, Universitätsmedizin Mainz, Mainz, Deutschland
| | - Berenice M Lang
- Hautklinik und Poliklinik, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
- Universitäres Centrum für Autoimmunität (UCA) Mainz, Universitätsmedizin Mainz, Mainz, Deutschland
| | - Adriane Peveling-Oberhag
- Hautklinik und Poliklinik, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
- Universitäres Centrum für Autoimmunität (UCA) Mainz, Universitätsmedizin Mainz, Mainz, Deutschland
| | - Stephan Grabbe
- Hautklinik und Poliklinik, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
- Universitäres Centrum für Autoimmunität (UCA) Mainz, Universitätsmedizin Mainz, Mainz, Deutschland
| | - Wiebke Kaluza-Schilling
- Rheumatologie, Universitätsmedizin Mainz, Mainz, Deutschland
- Universitäres Centrum für Autoimmunität (UCA) Mainz, Universitätsmedizin Mainz, Mainz, Deutschland
| | - Andreas Schwarting
- Rheumatologie, Universitätsmedizin Mainz, Mainz, Deutschland
- Universitäres Centrum für Autoimmunität (UCA) Mainz, Universitätsmedizin Mainz, Mainz, Deutschland
| | - Joanna Wegner
- Hautklinik und Poliklinik, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland.
- Universitäres Centrum für Autoimmunität (UCA) Mainz, Universitätsmedizin Mainz, Mainz, Deutschland.
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21
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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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22
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The Relative Survival Impact of Guideline-Concordant Clinical Staging and Stage-Appropriate Treatment of Potentially Curable Non-Small Cell Lung Cancer. Chest 2022; 162:242-255. [DOI: 10.1016/j.chest.2022.01.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 01/11/2022] [Accepted: 01/18/2022] [Indexed: 12/25/2022] Open
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23
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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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Ichikawa M, Uematsu K, Yano N, Yamada M, Ono T, Kawashiro S, Akamatsu H, Hagiwara Y, Sato H, Nemoto K. Implementation rate and effects of multidisciplinary team meetings on decision making about radiotherapy: an observational study at a single Japanese institution. BMC Med Inform Decis Mak 2022; 22:111. [PMID: 35477440 PMCID: PMC9044833 DOI: 10.1186/s12911-022-01849-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 04/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cancer treatment requires a multidisciplinary approach. Therefore, multidisciplinary team meetings (MDTMs) have been widely used to determine the direction of treatment. However, no standard provisions exist for conducting MDTMs, and recommendations discussed in MDTMs are sometimes not implemented. This study analyzed the indications for radiotherapy discussed and recommended at MDTMs, identified the rate of radiotherapy recommendations for patients that were not implemented, and clarified the reasons at a single academic center in Japan. METHODS This was a cross-sectional study that analyzed the minutes and electronic medical records of cases discussed at MDTMs held between April 2012-March 2017 at Yamagata University Hospital. We categorized how radiotherapy was initially presented at MDTMs, determined the rate of radiotherapy recommendations made through MDTMs, analyzed whether treatment recommendations were subsequently implemented, and examined the causes of non-implementation. We performed a statistical analysis to assess some clinical factors (sex, age, number of multidisciplinary team meetings, and classification of planned treatment) associated with the non-implementation of radiotherapy recommendations from MDTMs. RESULTS A total of 1813 cases were discussed at MDTMs, of which 71% (1293 cases) were presented with treatment plans, including radiotherapy. Further, 66% (1205 cases) were recommended for radiotherapy through the MDTMs. Recommendations from MDTMs were not implemented in 7% (142 cases). The most typical reason for non-implementation was the clinician's opinion (30%), followed by patient preferences (27%) and disease progression (20%). Change in cancer stage and improvement in symptoms were 12% and 4%, respectively. These ratios were similar each year. We could not find the factors associated with the non-implementation of radiotherapy recommendations from MDTMs. CONCLUSIONS MDTMs had a significant effect on the recommendation of radiotherapy for each patient with a tumor. The primary reason for the non-implementation of decisions made at MDTMs was the opinion of clinicians and the patient's preference. These results were similar to previous studies. We need to establish a monitoring system where patients themselves can decide the treatments based on their choices while using the recommendations from MDTMs.
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Affiliation(s)
- Mayumi Ichikawa
- Department of Radiation Oncology, Yamagata University School of Medicine, 2-2-2, Iida-nishi, Yamagata, 990-9585, Japan.
| | - Ken Uematsu
- Department of Radiation Oncology, Yamagata University School of Medicine, 2-2-2, Iida-nishi, Yamagata, 990-9585, Japan
| | - Natsuko Yano
- Department of Radiation Oncology, Yamagata University School of Medicine, 2-2-2, Iida-nishi, Yamagata, 990-9585, Japan
| | - Masayoshi Yamada
- Department of Radiation Oncology, Yamagata University School of Medicine, 2-2-2, Iida-nishi, Yamagata, 990-9585, Japan
| | - Takashi Ono
- Department of Radiation Oncology, Yamagata University School of Medicine, 2-2-2, Iida-nishi, Yamagata, 990-9585, Japan
| | - Shohei Kawashiro
- Department of Radiation Oncology, Yamagata University School of Medicine, 2-2-2, Iida-nishi, Yamagata, 990-9585, Japan
| | - Hiroko Akamatsu
- Department of Radiation Oncology, Yamagata University School of Medicine, 2-2-2, Iida-nishi, Yamagata, 990-9585, Japan
| | - Yasuhito Hagiwara
- Department of Radiation Oncology, Yamagata University School of Medicine, 2-2-2, Iida-nishi, Yamagata, 990-9585, Japan
| | - Hiraku Sato
- Department of Radiation Oncology, Yamagata University School of Medicine, 2-2-2, Iida-nishi, Yamagata, 990-9585, Japan
| | - Kenji Nemoto
- Department of Radiation Oncology, Yamagata University School of Medicine, 2-2-2, Iida-nishi, Yamagata, 990-9585, Japan
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Gaudino S, Giordano C, Magnani F, Cottonaro S, Infante A, Sabatino G, La Rocca G, Della Pepa GM, D’Alessandris QG, Pallini R, Olivi A, Balducci M, Chiesa S, Gessi M, Guadalupi P, Russo R, Schiarelli C, Ausili Cefaro L, Di Lella GM, Colosimo C. Neuro-Oncology Multidisciplinary Tumor Board: The Point of View of the Neuroradiologist. J Pers Med 2022; 12:jpm12020135. [PMID: 35207625 PMCID: PMC8875699 DOI: 10.3390/jpm12020135] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 12/29/2021] [Accepted: 01/10/2022] [Indexed: 02/04/2023] Open
Abstract
Background: The multi-disciplinary tumor board (MTB) is essential to quality cancer care and currently recommended to offer the best personalized clinical approach, but little has been published regarding MTBs in neuro-oncology (nMTBs). The aim of the present paper is to describe our nMTB, to evaluate its impact on clinical management decisions, and to assess the role of neuroradiologists. Methods: The retrospective evaluation of the cases discussed at our nMTB from March 2017 to March 2020. From the electronic records, we extracted epidemiological, clinical and other specific data of nMTB. From the radiological records, we calculated data relating to the number, time for revision, and other specifications of MRI re-evaluation. Statistical analysis was performed. Results: a total of 447 discussions were analyzed, representing 342 patients. The requests for case evaluations came from radiation oncologists (58.8%) and neurosurgeons (40.5%), and were mainly addressed to the neuroradiologist (73.8%). The most frequent questions were about the treatment’s changes (64.4%). The change in patient treatment was reported in 40.5% of cases, 76.8% of these were based on the neuroradiologic assessment. A total of 1514 MRI examinations were re-evaluated, employing approximately 67 h overall. The median of the MRI exams reviewed per patient was 3 (min–max 1–12). Conclusions: Our study supported that the multidisciplinary approach to patient care can be particularly effective in managing brain tumors. A review by an expert neuroradiologist impacts patient management in the context of nMTBs, but has costs in terms of the time and effort spent preparing for it.
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Affiliation(s)
- Simona Gaudino
- Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology, UOC Neuroradiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.G.); (F.M.); (R.R.); (C.S.); (L.A.C.); (G.M.D.L.); (C.C.)
- Correspondence:
| | - Carolina Giordano
- Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology, UOC Neuroradiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.G.); (F.M.); (R.R.); (C.S.); (L.A.C.); (G.M.D.L.); (C.C.)
| | - Francesca Magnani
- Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology, UOC Neuroradiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.G.); (F.M.); (R.R.); (C.S.); (L.A.C.); (G.M.D.L.); (C.C.)
| | - Simone Cottonaro
- Department of Diagnostic, Interventional Radiology, Neuroradiology, Garibaldi Hospital, 95122 Catania, Italy;
| | - Amato Infante
- Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology, UOC Diagnostic Imaging, COVID Center 2, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
| | - Giovanni Sabatino
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (G.S.); (G.L.R.); (G.M.D.P.); (Q.G.D.); (R.P.); (A.O.)
- UOC Neurosurgery, Mater Olbia Hospital, 07026 Olbia, Italy
| | - Giuseppe La Rocca
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (G.S.); (G.L.R.); (G.M.D.P.); (Q.G.D.); (R.P.); (A.O.)
- UOC Neurosurgery, Mater Olbia Hospital, 07026 Olbia, Italy
| | - Giuseppe Maria Della Pepa
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (G.S.); (G.L.R.); (G.M.D.P.); (Q.G.D.); (R.P.); (A.O.)
| | - Quintino Giorgio D’Alessandris
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (G.S.); (G.L.R.); (G.M.D.P.); (Q.G.D.); (R.P.); (A.O.)
| | - Roberto Pallini
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (G.S.); (G.L.R.); (G.M.D.P.); (Q.G.D.); (R.P.); (A.O.)
| | - Alessandro Olivi
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (G.S.); (G.L.R.); (G.M.D.P.); (Q.G.D.); (R.P.); (A.O.)
| | - Mario Balducci
- Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology, UOC Oncological Radiotherapy, Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.B.); (S.C.)
| | - Silvia Chiesa
- Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology, UOC Oncological Radiotherapy, Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.B.); (S.C.)
| | - Marco Gessi
- UOS Neuropathology, UOC Pathology Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
| | | | - Rosellina Russo
- Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology, UOC Neuroradiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.G.); (F.M.); (R.R.); (C.S.); (L.A.C.); (G.M.D.L.); (C.C.)
| | - Chiara Schiarelli
- Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology, UOC Neuroradiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.G.); (F.M.); (R.R.); (C.S.); (L.A.C.); (G.M.D.L.); (C.C.)
| | - Luca Ausili Cefaro
- Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology, UOC Neuroradiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.G.); (F.M.); (R.R.); (C.S.); (L.A.C.); (G.M.D.L.); (C.C.)
| | - Giuseppe Maria Di Lella
- Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology, UOC Neuroradiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.G.); (F.M.); (R.R.); (C.S.); (L.A.C.); (G.M.D.L.); (C.C.)
| | - Cesare Colosimo
- Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology, UOC Neuroradiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.G.); (F.M.); (R.R.); (C.S.); (L.A.C.); (G.M.D.L.); (C.C.)
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Yen CT, Wu WJ, Chen YT, Chang WC, Yang SH, Shen SY, Su J, Chen HY. Surgical resection of brain metastases prolongs overall survival in non-small-cell lung cancer. Am J Cancer Res 2021; 11:6160-6172. [PMID: 35018249 PMCID: PMC8727818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/15/2021] [Indexed: 06/14/2023] Open
Abstract
It remains unclear whether surgical resection of brain metastases prolongs overall survival in patients with non-small-cell lung cancer (NSCLC). A retrospective study was designed to evaluate the benefits of surgical resection for 296 patients with NSCLC and brain metastases. Patients were grouped into those who underwent craniotomy (brain surgery group) and those who did not (non-surgery group). Characteristics, survival, and EGFR mutation status were compared between the two groups. We found that the clinical characteristics were similar between the two groups. However, patients in the brain surgery group had metastases of larger diameters (3.67 cm vs. 2.06 cm, P<0.001) and a lower rate of extracranial metastasis (8.7% vs. 45.5%, P=0.001). Overall survival was significantly longer for those who underwent brain surgery (40.3 months vs. 8.4 months, P<0.001). The adjusted hazard ratio of craniotomy was 0.30 (95% confidence interval [CI], 0.15-0.62). The survival benefit of brain surgery was observed in both EGFR mutation-positive and EGFR mutation-negative sub-populations; the adjusted hazard ratios [aHRs] were 0.34 [95% CI, 0.11-1.00] and 0.26 [95% CI, 0.09-0.73] for EGFR mutation-positive and mutation-negative sub-populations, respectively. We concluded that for patients with NSCLC and brain metastases, surgical resection of brain metastases improved overall survival. This survival benefit was particularly evident in cases with large-sized metastases limited to the brain.
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Affiliation(s)
- Chia-Te Yen
- Chest Division, Department of Internal Medicine, MacKay Memorial HospitalTaipei, Taiwan
| | - Wen-Jui Wu
- Chest Division, Department of Internal Medicine, MacKay Memorial HospitalTaipei, Taiwan
| | - Yen-Ting Chen
- Chest Division, Department of Internal Medicine, MacKay Memorial HospitalTaipei, Taiwan
| | - Wei-Chin Chang
- Department of Pathology, MacKay Memorial HospitalTaipei, Taiwan
- Department of Medicine, MacKay Medical College and MacKay Junior College of Medicine, Nursing, and ManagementTaipei, Taiwan
| | - Sheng-Hsiung Yang
- Chest Division, Department of Internal Medicine, MacKay Memorial HospitalTaipei, Taiwan
| | - Sheng-Yeh Shen
- Chest Division, Department of Internal Medicine, MacKay Memorial HospitalTaipei, Taiwan
| | - Jian Su
- Chest Division, Department of Internal Medicine, MacKay Memorial HospitalTaipei, Taiwan
| | - Hsuan-Yu Chen
- Ph.D. Program for Translational Medicine, National Taiwan UniversityTaipei, Taiwan
- Genome and Systems Biology Degree Program, National Taiwan UniversityTaipei, Taiwan
- Ph.D. Program in Microbial Genomics, National Chung Hsing UniversityTaichung, Taiwan
- Department of Medical Research, Kaohsiung Medical University HospitalKaohsiung, Taiwan
- Institute of Statistical Science, Academia SinicaTaipei, Taiwan
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Lin T, Pham J, Paul E, Conron M, Wright G, Ball D, Mitchell P, Atkin N, Brand M, Zalcberg J, Stirling RG. Impacts of lung cancer multidisciplinary meeting presentation: Drivers and outcomes from a population registry retrospective cohort study. Lung Cancer 2021; 163:69-76. [PMID: 34923204 DOI: 10.1016/j.lungcan.2021.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 11/29/2021] [Accepted: 12/07/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Multidisciplinary Meetings (MDM) are recommended in routine lung cancer care, however its broader impacts demand further evaluation. We assessed the drivers and impacts of MDM presentation in the Victorian Lung Cancer Registry (VLCR). METHODS We examined the effect of MDM presentation on receipt of treatment and survival in VLCR patients diagnosed between 2011 and 2020. We compared patient characteristics, drivers of MDM discussion and survival between the two groups. RESULTS Of 9,628 patients, 5,900 (61.3%) were discussed at MDM, 3,728 (38.7%) were not. In the non-MDM group, a lower proportion received surgery (22.1% vs. 31.2%), radiotherapy (34.2% vs. 44.4%) and chemotherapy (44.7% vs. 49.0%). Patients were less likely to be discussed if ≥80 years (OR 0.73, p < 0.001), of ECOG performance status (PS) 4 (OR 0.23, p < 0.001), clinical stage IV (OR 0.34, p < 0.001) or referred from regional (OR 0.52, p < 0.001) or private hospital (OR 0.18, p < 0.001). MDM-presented patients had better median survival (1.70 vs 0.75 years, p < 0.001) and lower adjusted mortality risk (HR 0.75; 0.71-0.80, p < 0.001), a protective effect consistent across all hospital types. Undocumented PS, histopathology and clinical stage were associated with lower likelihood of MDM discussion and worse mortality. CONCLUSIONS In the VLCR, being male, ≥80 years, of poorer PS, advanced clinical stage and poor clinical characterisation significantly disadvantaged patients in relation to MDM discussion. MDM-discussed patients were more likely to undergo treatment and had a 25% lower risk of mortality. This study supports the use of MDMs in lung cancer and identifies areas of inequity to be addressed.
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Affiliation(s)
- Tiffany Lin
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Australia
| | - Jonathan Pham
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Australia
| | - Eldho Paul
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Matthew Conron
- Department of Respiratory Medicine, St Vincent's Hospital, Melbourne, Australia
| | - Gavin Wright
- Victorian Comprehensive Cancer Centre, Melbourne, Australia
| | - David Ball
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Paul Mitchell
- Olivia Newton-John Cancer and Wellness Centre, Melbourne, Australia
| | - Nicola Atkin
- Parkville Integrated Palliative Care Service, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Margaret Brand
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - John Zalcberg
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Robert G Stirling
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Australia; Department of Medicine, Monash University, Melbourne, Australia.
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Surgical or medical strategy for locally-advanced, stage IIIA/B-N2 non-small cell lung cancer: Reproducibility of decision-making at a multidisciplinary tumor board. Lung Cancer 2021; 163:51-58. [PMID: 34922144 DOI: 10.1016/j.lungcan.2021.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/03/2021] [Accepted: 12/06/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Stage IIIA/B-N2 is a very heterogeneous group of patients and accounts for one third of NSCLC at diagnosis. The best treatment strategy is established at a Multidisciplinary Tumor Board (MTB): surgical resection with neoadjuvant or adjuvant therapy versus definitive chemoradiation with immune checkpoint inhibitors consolidation. Despite the crucial role of MTBs in this complex setting, limited data is available regarding its performances and the reproducibility of the decision-making. METHODS Using a large cohort of IIIA/B-N2 NSCLC patients, we described patient's characteristics and treatment strategies established at the initial MTB: with a "surgical strategy" group, for potentially resectable disease, and a "medical strategy" group for non-resectable patients. A third group consisted of patients who were not eligible for surgery after neoadjuvant treatment and switched from the surgical to the medical strategy. We randomly selected 30 cases (10 in each of the 3 groups) for a blinded re-discussion at a fictive MTB and analyzed the reproducibility and factors associated with treatment decision. RESULTS Ninety-seven IIIA/B-N2 NSCLC patients were enrolled between June 2017 and December 2019. The initial MTB opted for a medical or a surgical strategy in 44% and 56% of patients respectively. We identified histology, tumor size and localization, extent of lymph node involvement and the presence of bulky mediastinal nodes as key decision-making factors. Thirteen patients were not eligible for surgical resection after neoadjuvant therapy and switched for a medical strategy. Overall concordance between the initial decision and the re-discussion was 70%. The kappa correlation coefficient was 0.43. Concordance was higher for patients with limited mediastinal node invasion. Survival did not appear to be impacted by conflicting decisions. CONCLUSIONS Reproducibility of treatment decision-making for stage IIIA/B-N2 NSCLC patients at a MTB is moderate but does not impact survival.
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Mano MS, Çitaku FT, Barach P. Implementing multidisciplinary tumor boards in oncology: a narrative review. Future Oncol 2021; 18:375-384. [PMID: 34787482 DOI: 10.2217/fon-2021-0471] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The healthcare industry compares unfavorably with other ultra-safe industries such as aviation and nuclear power plants, which address complexity by reducing the vulnerability of a single person and promoting teams and strong systems. A multidisciplinary tumor board (MTB) is an evidence-based organizational approach to implementing a more effective concept in oncology practice. Studies addressing the correlation between MTBs and cancer outcomes show promising results, and other potential benefits are also addressed. The objectives of this article are to define and characterize MTBs in modern oncology practice, review the current literature on MTBs effectiveness and address challenges to the implementation and maintenance of MTBs. In this commentary-type narrative review, the authors present their opinions and, whenever possible, substantiate recommendations by citing supportive literature.
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Affiliation(s)
- Max S Mano
- Grupo Oncoclínicas, São Paulo, Brazil.,Academy of Leadership Sciences Switzerland, Switzerland
| | | | - Paul Barach
- Academy of Leadership Sciences Switzerland, Switzerland.,Wayne State University School of Medicine, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201, USA.,Interdisciplinary Research Institute for Health Law & Science, Sigmund Freud University, Vienna, Austria
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Dijkstra S, Kraal KCJM, Tytgat GAM, van Noesel MM, Wijnen MHWA, Hoogerbrugge PM. Use of quality indicators in neuroblastoma treatment: A feasibility assessment. Pediatr Blood Cancer 2021; 68:e28301. [PMID: 32735384 DOI: 10.1002/pbc.28301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 03/15/2020] [Accepted: 03/16/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Quality indicators (QIs) may be used to monitor the quality of neuroblastoma (NBL) care during treatment, in addition to survival and treatment toxicity, which can only be evaluated in the years after treatment. The present study aimed to assess the feasibility of a new set of indicators for the quality of NBL therapy. PROCEDURE Seven QIs have been proposed based on literature and consensus of experts: (a) duration of complete diagnostic work-up, (b) prescription of thyroid prophylaxis before metaiodobenzylguanidine imaging, (c) treatment intensity, (d) use of tumor board meetings, (e) number of outpatient visits and sedation procedures during follow-up, (f) protocolled follow-up, and (g) required apheresis sessions. A retrospective data analysis from October 2014 to November 2017 including all patients with NBL in the centralized Princess Máxima Center in the Netherlands was performed to assess these parameters and determine practicality of measurement. RESULTS A total number of 72 patients (aged between 2 weeks and 15 years) were analyzed. Adherence to all QIs could be determined for all eligible patients using their electronic medical records. Three indicators were compared over time, and an increase in adherence was observed. CONCLUSIONS Assessment of QIs in neuroblastoma treatment is feasible. Seven new QIs were found to be feasible to measure and showed improvement over time for three indicators. Monitoring of these QIs during treatment may provide tools for quality improvement activities and comparisons of treatment quality over time or between centers. Further study is required to investigate their association with long-term outcomes.
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Affiliation(s)
- Suzan Dijkstra
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Kathelijne C J M Kraal
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Godelieve A M Tytgat
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Max M van Noesel
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Marc H W A Wijnen
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Peter M Hoogerbrugge
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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Ray MA, Faris NR, Fehnel C, Derrick A, Smeltzer MP, Meadows-Taylor MB, Ariganjoye F, Pacheco A, Optican R, Tonkin K, Wright J, Fox R, Callahan T, Robbins ET, Walsh W, Lammers P, Satpute S, Osarogiagbon RU. Survival Impact of an Enhanced Multidisciplinary Thoracic Oncology Conference in a Regional Community Health Care System. JTO Clin Res Rep 2021; 2:100203. [PMID: 34590046 PMCID: PMC8474211 DOI: 10.1016/j.jtocrr.2021.100203] [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: 12/21/2020] [Revised: 06/14/2021] [Accepted: 06/24/2021] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION We compared NSCLC treatment and survival within and outside a multidisciplinary model of care from a large community health care system. METHODS We implemented a rigorously benchmarked "enhanced" Multidisciplinary Thoracic Oncology Conference (eMTOC) and used Tumor Registry data (2011-2017) to evaluate guideline-concordant care. Because eMTOC was located in metropolitan Memphis, we separated non-MTOC patient by metropolitan and regional location. We categorized National Comprehensive Cancer Network guideline-concordant treatment as "preferred," or "appropriate" (allowable under certain circumstances). We compared demographic and clinical characteristics across cohorts using chi-square tests and survival using Cox regression, adjusted for multiple testing. We also performed propensity-matched and adjusted survival analyses. RESULTS Of 6259 patients, 14% were in eMTOC, 55% metropolitan non-MTOC, and 31% regional non-MTOC cohorts. eMTOC had the highest rates of African Americans (34% versus 28% versus 22%), stages I to IIIB (63 versus 40 versus 50), urban residents (81 versus 78 versus 20), stage-preferred treatment (66 versus 57 versus 48), guideline-concordant treatment (78 versus 70 versus 63), and lowest percentage of nontreatment (6 versus 21 versus 28); all p values were less than 0.001. Compared with eMTOC, hazard for death was higher in metropolitan (1.5, 95% confidence interval: 1.4-1.7) and regional (1.7, 1.5-1.9) non-MTOC; hazards were higher in regional non-MTOC versus metropolitan (1.1, 1.0-1.2); all p values were less than 0.05 after adjustment. Results were generally similar after propensity analysis with and without adjusting for guideline-concordant treatment. CONCLUSIONS Multidisciplinary NSCLC care planning was associated with significantly higher rates of guideline-concordant care and survival, providing evidence for rigorous implementation of this model of care.
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Affiliation(s)
- Meredith A. Ray
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, Tennessee
| | - Nicholas R. Faris
- Thoracic Oncology Research Group, Baptist Cancer Center, Memphis, Tennessee
| | - Carrie Fehnel
- Thoracic Oncology Research Group, Baptist Cancer Center, Memphis, Tennessee
| | - Anna Derrick
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee
| | - Matthew P. Smeltzer
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, Tennessee
| | | | - Folabi Ariganjoye
- Thoracic Oncology Research Group, Baptist Cancer Center, Memphis, Tennessee
| | - Alicia Pacheco
- Thoracic Oncology Research Group, Baptist Cancer Center, Memphis, Tennessee
| | - Robert Optican
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee
- Mid-South Imaging and Therapeutics, Memphis, Tennessee
| | - Keith Tonkin
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee
- Mid-South Imaging and Therapeutics, Memphis, Tennessee
| | - Jeffrey Wright
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee
- Memphis Lung Physicians, Memphis, Tennessee
| | - Roy Fox
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee
- Mid-South Pulmonary Specialists, Memphis, Tennessee
| | - Thomas Callahan
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee
- Trumbull Laboratories, LLC, Memphis, Tennessee
| | - Edward T. Robbins
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee
| | - William Walsh
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee
| | - Philip Lammers
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee
| | - Shailesh Satpute
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee
| | - Raymond U. Osarogiagbon
- Thoracic Oncology Research Group, Baptist Cancer Center, Memphis, Tennessee
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee
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Gomes MM, Dennie C, Laurie SA, Shamji FM. How to Design and Foster Thoracic Oncology Multidisciplinary Cancer Conferences. Thorac Surg Clin 2021; 31:229-235. [PMID: 34304831 DOI: 10.1016/j.thorsurg.2021.04.007] [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] [Indexed: 11/17/2022]
Abstract
In this chapter, the authors review and discuss the literature on multidisciplinary cancer conferences (MCCs, aka tumor boards), clarifying the terminology, showing the evolution of the field, and providing an evidence-based perspective on positive outcomes, best practices, factors influencing the quality of MCCs, evaluation tools to assess the quality of MCCs, and quality improvement interventions for MCCs. The authors then discuss some perspectives from their MCC and initiatives that they undertook to improve the work of their team and the care that they provide to patients in the area of thoracic oncology.
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Affiliation(s)
- Marcio M Gomes
- Department of Pathology and Laboratory Medicine, Eastern Ontario Regional Laboratory Association, The Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada.
| | - Carole Dennie
- Department of Medical Imaging, The Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada
| | - Scott A Laurie
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre, University of Ottawa, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada
| | - Farid M Shamji
- University of Ottawa, The Ottawa Hospital, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada
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Pan M, Seto T, Yu J, Sidhu M, Kim B, McCormick C, Fang A, Song J, Morse LJ, Peng PD, Chakedis J, Huber R, Schwartz C, Lee JD, Zou Y. Feasibility and Value of Establishing a Community-Based Virtual Multidisciplinary Sarcoma Case Conference. JCO Oncol Pract 2021; 16:e1143-e1150. [PMID: 33049178 DOI: 10.1200/jop.20.00110] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Management of soft tissue and bone sarcoma presents many challenges, both diagnostically and therapeutically, and requires multidisciplinary collaboration; however, such collaboration is often challenging to establish, especially in the community setting. We share our experiences of a virtual multidisciplinary sarcoma case conference (VMSCC). METHODS We conducted retrospective review of the VMSCC data-initially via Webex, now Microsoft Teams-and the surveys of referring physicians to understand the feasibility and value of the VMSCC. RESULTS The VMSCC was established in March 2013 in Kaiser Permanente Northern California with consistent participation of the Departments of Musculoskeletal Oncology (orthopedic oncology), Musculoskeletal Radiology, Pathology, Medical Oncology, Radiation Oncology, Nuclear Medicine, Surgical Oncology, and Genetics. Pediatric Oncology participated ad hoc when pediatric sarcoma cases were presented. Referrals were from multiple specialties and regions, including the Kaiser Permanente Mid-Atlantic and Hawaii regions. From March 2013 to December 2019, 1,585 cases were reviewed encompassing 36 histologic types. More than 300 cases were reviewed per year from 2017 to 2019. Survey results of referring physicians demonstrate that the VMSCC enhanced the confidence of treating physicians, and its recommendations frequently led to treatment changes. CONCLUSION Establishing a valuable community-based VMSCC is feasible. VMSCC recommendations frequently led to treatment changes and improved the confidence of treating physicians.
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Affiliation(s)
- Minggui Pan
- Department of Oncology, Kaiser Permanente Northern California, Santa Clara, CA.,Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Tiffany Seto
- Internal Medicine Residency Program, Kaiser Permanente Northern California, Santa Clara, CA
| | - Jeanette Yu
- Department of Oncology, Kaiser Permanente Northern California, Santa Clara, CA
| | - Manpreet Sidhu
- Department of Oncology, Kaiser Permanente Northern California, Santa Clara, CA
| | - Brian Kim
- Department of Radiology, Kaiser Permanente Northern California, Santa Clara, CA
| | - Craig McCormick
- Department of Radiology, Kaiser Permanente Northern California, Santa Clara, CA
| | - Andrew Fang
- Department of Musculoskeletal Oncology, Kaiser Permanente Northern California, South San Francisco, CA
| | - Joseph Song
- Department of Radiation Oncology, Kaiser Permanente Northern California, South San Francisco, CA
| | - Lee Jae Morse
- Department of Musculoskeletal Oncology, Kaiser Permanente Northern California, South San Francisco, CA
| | - Peter D Peng
- Department of Surgical Oncology, Kaiser Permanente Northern California, Oakland, CA
| | - Jeffery Chakedis
- Department of Surgical Oncology, Kaiser Permanente Northern California, Oakland, CA
| | - Ryan Huber
- Department of Nuclear Medicine, Kaiser Permanente Northern California, Santa Clara, CA
| | - Corey Schwartz
- Department of Oncology, Kaiser Permanente Northern California, Santa Clara, CA
| | - Jason D Lee
- Department of Pathology, Kaiser Permanente Northern California, Santa Clara, CA
| | - Youran Zou
- Department of Pathology, Kaiser Permanente Northern California, Santa Clara, CA
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Pan M, Yu J, Sidhu M, Seto T, Fang A. Impact of a Virtual Multidisciplinary Sarcoma Case Conference on Treatment Plan and Survival in a Large Integrated Healthcare System. JCO Oncol Pract 2021; 17:e1711-e1718. [PMID: 33852341 DOI: 10.1200/op.20.01078] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
PURPOSE Quantifying the impact of a multidisciplinary cancer case conference on patient outcome and care quality remains challenging. PATIENTS AND METHODS We prospectively investigated the impact of our virtual multidisciplinary sarcoma case conference (VMSCC) on treatment plan in patients presented to the VMSCC from July to October 2020 (prospective cohort) and retrospectively in patients with metastatic or locally advanced high-grade soft-tissue sarcoma (STS) reviewed in the VMSCC in 2016 and 2017 (high-grade STS cohort). We also investigated the factors related to the nonadherence to the VMSCC-recommended plan in both cohorts. RESULTS In both cohorts, approximately 28% of the patients were referred to the VMSCC for review without a treatment plan. In significantly more cases, referring physicians outside of the sarcoma group did not have a plan formulated before the VMSCC review compared with the referring physicians within the sarcoma group. In 28.2% (prospective cohort) and 19.5% (high-grade STS cohort) of the patients, VMSCC recommended a different plan. The adherence to the VMSCC-recommended plan was 87.9% and 83.1%, respectively. The causes of the nonadherence were primarily due to disease progression or patient's decision against recommended therapy. The median overall survival for the high-grade STS cohort was 26 months. CONCLUSION VMSCC affected the treatment plan in approximately 50% of the patients in both cohorts. The median overall survival of the patients with high-grade STS reviewed by the VMSCC in our cohort is comparable with the literature.
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Affiliation(s)
- Minggui Pan
- Department of Oncology and Hematology, Kaiser Permanente, Santa Clara, CA.,Division of Research, Kaiser Permanente, Oakland, CA
| | - Jeanette Yu
- Department of Oncology and Hematology, Kaiser Permanente, Oakland, CA
| | - Manpreet Sidhu
- Department of Oncology and Hematology, Kaiser Permanente, Roseville, CA
| | - Tiffany Seto
- Oncology and Hematology Fellowship Program, Kaiser Permanente, San Francisco, CA
| | - Andrew Fang
- Department of Musculoskeletal Oncology, Kaiser Permanente, South San Francisco, CA
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Sardari Nia P, Olsthoorn JR, Heuts S, van Kuijk SMJ, Vainer J, Streukens S, Schalla S, Segers P, Barenbrug P, Crijns HJGM, Maessen JG. Effect of a dedicated mitral heart team compared to a general heart team on survival: a retrospective, comparative, non-randomized interventional cohort study based on prospectively registered data. Eur J Cardiothorac Surg 2021; 60:263-273. [PMID: 33783480 DOI: 10.1093/ejcts/ezab065] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 12/21/2020] [Accepted: 01/13/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Although in both the US and European guidelines the 'heart team approach' is a class I recommendation, supporting evidence is still lacking. Therefore, we sought to provide comparative survival data of patients with mitral valve disease referred to the general and the dedicated heart team. METHODS In this retrospective cohort, patients evaluated for mitral valve disease by a general heart team (2009-2014) and a dedicated mitral valve heart team (2014-2018) were included. Decision-making was recorded prospectively in heart team electronic forms. The end point was overall survival from decision of the heart team. RESULTS In total, 1145 patients were included of whom 641 (56%) were discussed by dedicated heart team and 504 (44%) by general heart team. At 5 years, survival probability was 0.74 [95% confidence interval (CI) 0.68-0.79] for the dedicated heart team group compared to 0.70 (95% CI 0.66-0.74, P = 0.040) for the general heart team. Relative risk of mortality adjusted for EuroSCORE II, treatment groups (surgical, transcatheter and non-intervention), mitral valve pathology (degenerative, functional, rheumatic and others) and 13 other baseline characteristics for patients in the dedicated heart team was 29% lower [hazard ratio (HR) 0.71, 95% CI 0.54-0.95; P = 0.019] than for the general heart team. The adjusted relative risk of mortality was 61% lower for patients following the advice of the heart team (HR 0.39, 95% CI 0.25-0.62; P < 0.001) and 43% lower for patients following the advice of the general heart team (HR 0.57, 95% CI 0.37-0.87; P = 0.010) compared to those who did not follow the advice of the heart team. CONCLUSIONS In this retrospective cohort, patients treated for mitral valve disease based on a dedicated heart team decision have significantly higher survival independent of the allocated treatment, mitral valve pathology and baseline characteristics.
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Affiliation(s)
- Peyman Sardari Nia
- Department of Cardiothoracic Surgery, Maastricht University Medical Center (MUMC+), Maastricht, Netherlands.,Cardiovascular Research Institute (CARIM), Maastricht University, Maastricht, Netherlands
| | - Jules R Olsthoorn
- Department of Cardiothoracic Surgery, Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
| | - Samuel Heuts
- Department of Cardiothoracic Surgery, Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
| | - Jindrich Vainer
- Department of Cardiology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Sebastian Streukens
- Department of Cardiology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Simon Schalla
- Cardiovascular Research Institute (CARIM), Maastricht University, Maastricht, Netherlands.,Department of Cardiology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Patrique Segers
- Department of Cardiothoracic Surgery, Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
| | - Paul Barenbrug
- Department of Cardiothoracic Surgery, Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
| | - Harry J G M Crijns
- Cardiovascular Research Institute (CARIM), Maastricht University, Maastricht, Netherlands.,Department of Cardiology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Jos G Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Center (MUMC+), Maastricht, Netherlands.,Cardiovascular Research Institute (CARIM), Maastricht University, Maastricht, Netherlands
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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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The evolving landscape of biomarker testing for non-small cell lung cancer in Europe. Lung Cancer 2021; 154:161-175. [PMID: 33690091 DOI: 10.1016/j.lungcan.2021.02.026] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/18/2021] [Accepted: 02/21/2021] [Indexed: 12/31/2022]
Abstract
The discovery of oncogenic driver mutations rendering non-small cell lung cancer (NSCLC) targetable by small-molecule inhibitors, and the development of immunotherapies, have revolutionised NSCLC treatment. Today, instead of non-selective chemotherapies, all patients with advanced NSCLC eligible for treatment (and increasing numbers with earlier, less extensive disease) require fast and comprehensive screening of biomarkers for first-line patient selection for targeted therapy, chemotherapy, or immunotherapy (with or without chemotherapy). To avoid unnecessary re-biopsies, biomarker screening before first-line treatment should also include markers that are actionable from second-line onwards; PD-L1 expression testing is also mandatory before initiating treatment. Population differences exist in the frequency of oncogenic driver mutations: EGFR mutations are more frequent in Asia than Europe, whereas the converse is true for KRAS mutations. In addition to approved first-line therapies, a number of emerging therapies are being investigated in clinical trials. Guidelines for biomarker testing vary by country, with the number of actionable targets and the requirement for extensive molecular screening strategies expected to increase. To meet diagnostic demands, rapid screening technologies for single-driver mutations have been implemented. Improvements in DNA- and RNA-based next-generation sequencing technologies enable analysis of a group of genes in one assay; however, turnaround times remain relatively long. Consequently, rapid screening technologies are being implemented alongside next-generation sequencing. Further challenges in the evolving landscape of biomarker testing in NSCLC are actionable primary and secondary resistance mechanisms to targeted therapies. Therefore, comprehensive testing on re-biopsies, collected at the time of disease progression, in combination with testing of circulating tumour DNA may provide important information to guide second- or third-line therapies. Furthermore, longitudinal biomarker testing can provide insights into tumour evolution and heterogeneity during the course of the disease. We summarise best practice strategies for Europe in the changing landscape of biomarker testing at diagnosis and during treatment.
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He H, Yang L, Peng Y, Liu L, Liu L, Xue Q, Gao S. The value of multidisciplinary team (MDT) management in the diagnosis and treatment of primary intrathoracic synovial sarcomas: a single-center experience. J Thorac Dis 2021; 13:600-612. [PMID: 33717533 PMCID: PMC7947479 DOI: 10.21037/jtd-20-2887] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background Synovial sarcoma (SS) is a rare malignant soft tissue tumor. Primary intrathoracic SS is extremely rare, with limited diagnosis and treatment experiences. The aim of our study was to retrospectively study the clinicopathological characteristics, treatment and prognosis of primary intrathoracic SS and the impact of multidisciplinary team (MDT) management in diagnosis and treatment on patient prognosis. Methods The clinical and pathological characteristics, treatment, survival and prognosis of patients with primary intrathoracic SS admitted to the National Cancer Center from January 1999 to December 2018, as well as MDT intervention during diagnosis and treatment, were retrospectively analyzed. Results Thirteen patients were enrolled, including 7 (53.8%) males and 6 (46.3%) females, with primary intrathoracic SS in the lung (8/13, 61.5%), mediastinum (4/13, 30.8%) and pleura (1/13, 7.7%) as confirmed by morphological observation, immunohistochemical (IHC) staining and fluorescence in situ hybridization (FISH). Overall, 10/13 (76.9%) patients underwent surgery, and 6/10 (60.0%) received postoperative adjuvant therapy. Only 23.1% of patients received nonsurgical therapy. The MDT discussed and managed seven patients before and/or after surgery and one patient who did not undergo surgery. The estimated 3- and 5-year overall survival (OS) rates were 50.0% and 30.0%, respectively. Patients who were managed by an MDT had a longer median OS time than those who were not (46.0 vs. 18.0 months). Age (P=0.018), tumor location (P=0.029), and Ki-67 (P=0.020) were found to be significantly related to OS. Conclusions Monophasic morphology and fusion gene characteristics are the main features for the diagnosis of primary intrathoracic SS. MDT management can help obtain accurate diagnoses and provide reasonable therapeutic options.
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Affiliation(s)
- Huayu He
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lin Yang
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yue Peng
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li Liu
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lei Liu
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qi Xue
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shugeng Gao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Algwaiz G, Salam Y, Bustami R, Ferwana M, Jazieh AR. Do Multidisciplinary Tumor Board Discussions Correlate With Increase in 5-Year Survival? A Meta-Analysis Study. GLOBAL JOURNAL ON QUALITY AND SAFETY IN HEALTHCARE 2021; 4:3-10. [PMID: 37260532 PMCID: PMC10229009 DOI: 10.36401/jqsh-20-23] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 10/20/2020] [Indexed: 06/02/2023]
Abstract
Introduction Due to the complex nature of cancer cases, it is imperative that the involved healthcare providers coordinate the patients care plan in union to reach the best possible outcome in the smoothest and fastest manner. This is what multidisciplinary tumor board (MTB) meetings strive to achieve. Conducting regular MTB meetings requires significant investment of time and finances. It is thus vital to assess the empirical benefits of such practice. Methods A meta-analysis was conducted to evaluate the literature regarding the impact of MTB meetings on patient 5-year survival. Relevant studies were identified by searching Ovid MEDLINE and Embase databases from January 1995 to July 2019. Studies were included if they assessed 5-year survival in cases discussed in MTB meetings and used a comparison group and/or a pretest and posttest design. Results Five articles met the study's inclusion criteria. Quality of studies was affected by selection bias and the use of historic cohorts. The results showed significantly improved 5-year survival in the MTB group compared with the non-MTB groups (odds ratio for 5-year death rate of 0.59, CI 0.45-0.78, p < 0.001). Conclusion This meta-analysis showed that cancer MTB meetings have a significant impact on patients' 5-year survival. This could be because of several reasons, such as less time to treatment initiation, better adherence to guidelines, higher numbers of investigational imaging, lesser surgical complications, and recurrence rates. Future prospective studies are needed to further delineate reasons for improvement of outcome to enhance the benefits of this approach.
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Affiliation(s)
- Ghada Algwaiz
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Yezan Salam
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Rami Bustami
- Department of Healthcare Management, Alfaisal University, Riyadh, Saudi Arabia
| | - Mazen Ferwana
- Department of Family Medicine, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdul Rahman Jazieh
- Department of Oncology, King Abdulaziz Medical City, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
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Petrella F, Radice D, Guarize J, Piperno G, Rampinelli C, de Marinis F, Spaggiari L. The Impact of Multidisciplinary Team Meetings on Patient Management in Oncologic Thoracic Surgery: A Single-Center Experience. Cancers (Basel) 2021; 13:E228. [PMID: 33435181 PMCID: PMC7827504 DOI: 10.3390/cancers13020228] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/05/2021] [Accepted: 01/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND the aim of this paper is to quantify multidisciplinary team meeting (MDT) impact on the decisional clinical pathway of thoracic cancer patients, assessing the modification rate of the initial out-patient evaluation. METHODS the impact of MDT was classified as follows: confirmation: same conclusions as out-patient hypothesis; modification: change of out-patient hypothesis; implementation: definition of a clear clinical track/conclusion for patients that did not receive any clinical hypothesis; further exams required: the findings that emerged in the MDT meeting require further exams. RESULTS one thousand consecutive patients evaluated at MDT meetings were enrolled. Clinical settings of patients were: early stage lung cancer (17.4%); locally advanced lung cancer (27.4%); stage IV lung cancer (9.8%); mesothelioma (1%); metastases to the lung from other primary tumors (4%); histologically proven or suspected recurrence from previous lung cancer (15%); solitary pulmonary nodule (19.2%); mediastinal tumors (3.4%); other settings (2.8%). CONCLUSIONS MDT meetings impact patient management in oncologic thoracic surgery by modifying the out-patient clinical hypothesis in 10.6% of cases; the clinical settings with the highest decisional modification rates are "solitary pulmonary nodule" and "proven or suspected recurrence" with modification rates of 14.6% and 13.3%, respectively.
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Affiliation(s)
- Francesco Petrella
- Department of Thoracic Surgery, IRCCS European Institute of Oncology, 20141 Milan, Italy; (J.G.); or (L.S.)
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, 20141 Milan, Italy
| | - Davide Radice
- Department of Biostatistcs, IRCCS European Institute of Oncology, 20141 Milan, Italy;
| | - Juliana Guarize
- Department of Thoracic Surgery, IRCCS European Institute of Oncology, 20141 Milan, Italy; (J.G.); or (L.S.)
| | - Gaia Piperno
- Department of Radiotherapy, IRCCS European Institute of Oncology, 20141 Milan, Italy;
| | - Cristiano Rampinelli
- Department of Radiology, IRCCS European Institute of Oncology, 20141 Milan, Italy;
| | - Filippo de Marinis
- Department of Thoracic Oncology, IRCCS European Institute of Oncology, 20141 Milan, Italy;
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, IRCCS European Institute of Oncology, 20141 Milan, Italy; (J.G.); or (L.S.)
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, 20141 Milan, Italy
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Rajasekaran RB, Whitwell D, Cosker TDA, Gibbons CLMH, Carr A. Will virtual multidisciplinary team meetings become the norm for musculoskeletal oncology care following the COVID-19 pandemic? - experience from a tertiary sarcoma centre. BMC Musculoskelet Disord 2021; 22:18. [PMID: 33402136 PMCID: PMC7784619 DOI: 10.1186/s12891-020-03925-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 12/26/2020] [Indexed: 02/07/2023] Open
Abstract
Background Like with all cancers, multidisciplinary team (MDT) meetings are the norm in bone and soft tissue tumour (BST) management too. Problem in attendance of specialists due to geographical location is the one of the key barriers to effective functioning of MDTs. To overcome this problem, virtual MDTs involving videoconferencing or telemedicine have been proposed, but however this has been seldom used and tested. The COVID-19 pandemic forced the implementation of virtual MDTs in the Oxford sarcoma service in order to maintain normal service provision. We conducted a survey among the participants to evaluate its efficacy. Methods An online questionnaire comprising of 24 questions organised into 4 sections was circulated among all participants of the MDT after completion of 8 virtual MDTs. Opinions were sought comparing virtual MDTs to the conventional face-to-face MDTs on various aspects. A total of 36 responses were received and were evaluated. Results 72.8% were satisfied with the depth of discussion in virtual MDTs and 83.3% felt that the decision-making in diagnosis had not changed following the switch from face-to-face MDTs. About 86% reported to have all essential patient data was available to make decisions and 88.9% were satisfied with the time for discussion of patient issues over virtual platform. Three-fourths of the participants were satisfied (36.1% - highly satisfied; 38.9% - moderately satisfied) with virtual MDTs and 55.6% of them were happy to attend MDTs only by the virtual platform in the future. Regarding future, 77.8% of the participants opined that virtual MDTs would be the future of cancer care and an overwhelming majority (91.7%) felt that the present exercise would serve as a precursor to global MDTs involving specialists from abroad in the future. Conclusion Our study shows that the forced switch to virtual MDTs in sarcoma care following the unprecedented COVID-19 pandemic to be a viable and effective alternative to conventional face-to-face MDTs. With effective and efficient software in place, virtual MDTs would also facilitate in forming extended MDTs in seeking opinions on complex cases from specialists abroad and can expand cancer care globally. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-020-03925-8.
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Affiliation(s)
- Raja Bhaskara Rajasekaran
- The Oxford Bone Tumour & Soft Tissue Sarcoma Service, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, 17, Horwood Close, Headington, Windmill Road, Oxford, OX3 7LD, UK.
| | - Duncan Whitwell
- The Oxford Bone Tumour & Soft Tissue Sarcoma Service, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, 17, Horwood Close, Headington, Windmill Road, Oxford, OX3 7LD, UK
| | - Thomas D A Cosker
- The Oxford Bone Tumour & Soft Tissue Sarcoma Service, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, 17, Horwood Close, Headington, Windmill Road, Oxford, OX3 7LD, UK
| | - Christopher L M H Gibbons
- The Oxford Bone Tumour & Soft Tissue Sarcoma Service, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, 17, Horwood Close, Headington, Windmill Road, Oxford, OX3 7LD, UK
| | - Andrew Carr
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK
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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: 9] [Impact Index Per Article: 2.3] [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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Chang YL, Lin CY, Kang CJ, Liao CT, Chung CF, Yen TC, Peng HL, Chen SC. Association between multidisciplinary team care and the completion of treatment for oral squamous cell carcinoma: A cohort population-based study. Eur J Cancer Care (Engl) 2020; 30:e13367. [PMID: 33174667 DOI: 10.1111/ecc.13367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 08/17/2020] [Accepted: 10/14/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES This study investigates the relationship between multidisciplinary team care (MDTC) and patient completion of their treatment regimen for oral squamous cell carcinoma (OSCC). METHODS We conducted a retrospective cohort study in patients diagnosed with OSCC in Taiwan from 1 January 2016 to 30 June 2018 using a linked cancer registry database. RESULTS Of the 969 OSCC MDTC patients in the study cohort, 6.3% reported incomplete treatment, with 1.3% interrupting ongoing treatment and 5.0% terminating definitive treatment. Patients who had advanced-stage disease, experienced primary cancer recurrence or a secondary cancer, or were treated with surgery combined with chemotherapy, radiotherapy or chemoradiotherapy were more likely to terminate treatment before completion. The major reasons for interruption of ongoing treatment included 'patient or their family considered the patient to be in poor physical condition' and 'difficulty enduring physical discomfort caused by treatment'. The major reason for termination of definitive treatment was 'patient or their families or friends experienced negative treatment effects and worried about the side-effects of treatment'. CONCLUSION Advanced-stage cancer, recurrence or secondary cancer, and surgery combined with chemotherapy, radiotherapy or chemoradiotherapy negatively affected treatment completion. MDTC allows for shared decision-making to determine the optimal treatment.
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Affiliation(s)
- Ya-Lan Chang
- Department of Nursing, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chien-Yu Lin
- Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chung-Jan Kang
- Department of Otorhinolaryngology, Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chun-Ta Liao
- Department of Otorhinolaryngology, Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ching-Fang Chung
- Department of Nursing, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tzu-Chen Yen
- Nuclear Medicine and Molecular Imaging Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Hsi-Ling Peng
- Department of Nursing, Oriental Institute of Technology, Taipei, Taiwan
| | - Shu-Ching Chen
- Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,School of Nursing and Geriatric and Long-Term Care Research Center, College of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan.,School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Hung HY, Tseng YH, Chao HS, Chiu CH, Hsu WH, Hsu HS, Wu YC, Chou TY, Chen CK, Lan KL, Chen YW, Wu YH, Chen YM. Multidisciplinary team discussion results in survival benefit for patients with stage III non-small-cell lung cancer. PLoS One 2020; 15:e0236503. [PMID: 33031375 PMCID: PMC7544080 DOI: 10.1371/journal.pone.0236503] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 07/07/2020] [Indexed: 12/25/2022] Open
Abstract
Background The treatment for stage III non-small cell lung cancer (NSCLC) often involves multi-modality treatment. This retrospective study aimed to evaluate whether multidisciplinary team (MDT) discussion results in better patient survival. Materials and methods MDT discussion was optional before February 2016 and was actively encouraged by the MDT committee beginning February 2016. We reviewed the medical charts and computer records of patients with stage III NSCLC between January 2013 and December 2018. Results A total of 515 patients were included. The median survival of all the patients was 33.9 months (M). The median survival of patients who were treated after MDT discussion was 41.2 M and that of patients treated without MDT discussion was 25.7 M (p = 0.018). The median survival of patients treated before February 2016 was 25.7 M and that of patients treated after February 2016 was 33.9 M (p = 0.003). The median survival of patients with stage IIIA tumors and those with stage IIIB tumors was 39.4 M and 25.7 M, respectively (p = 0.141). Multivariate analysis showed that MDT or not (p<0.001), T staging (p = 0.009), performance status (p<0.001), and surgery (p = 0.016) to be significant prognostic factors. Conclusion The results of the study show that MDT discussion results in survival benefit in patients with stage III NSCLC. The MDT discussion, performance status, and if surgery was performed were independent prognostic factors for patients with stage III NSCLC.
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Affiliation(s)
- Hsiu-Ying Hung
- Nursing Department, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yen-Han Tseng
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China (R.O.C)
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Heng-Sheng Chao
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China (R.O.C)
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Chao-Hua Chiu
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China (R.O.C)
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Wen-Hu Hsu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
| | - Han-Shui Hsu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
| | - Yu-Chung Wu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
| | - Teh-Ying Chou
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Division of Molecular Pathology, Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
| | - Chun-Ku Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
| | - Keng-Li Lan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Wei Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yuan-Hung Wu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yuh-Min Chen
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China (R.O.C)
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Taipei Cancer Center, Taipei Medical University, Taipei, Taiwan, R.O.C
- * E-mail:
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45
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Tsai CH, Hsieh HF, Lai TW, Kung PT, Kuo WY, Tsai WC. Effect of multidisciplinary team care on the risk of recurrence in breast cancer patients: A national matched cohort study. Breast 2020; 53:68-76. [PMID: 32652461 PMCID: PMC7375674 DOI: 10.1016/j.breast.2020.07.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 07/01/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Cancer has been the leading cause of death in the past decade in Taiwan, with breast cancer being the most common type of cancer in females. Very few studies looked at the risk of recurrence in patients who received multidisciplinary team (MDT) care. We analyzed the influence of MDT on the risk of recurrence and death in breast cancer patients. METHOD In this retrospective study, we included newly diagnosed patients from 2004 to 2010. The study included 9,266 breast cancer patients who were enrolled in MDT care and 9,266 patients who were not. The study used log-rank test to analyze patients' characteristics, hospital characteristics, cancer staging, and treatment methods to compare the recurrence rates in MDT care and non-MDT care participants. We used Cox proportional hazards model to examine the effect of MDT and associated factors on the risk of recurrence and mortality of breast cancer patients. RESULTS Relative risk of recurrence was lower for patients who received MDT care than for patients who did not (HR, 0.84; 95%CI: 0.70-0.99) after matching. The mortality risk for breast cancer patients with relapse was 8.48 times (95%CI: 7.53-9.54) than that for patients without relapse. CONCLUSIONS The relative risk of recurrence and death was significantly lower for breast cancer patients who received MDT care than for those who did not. We suggest that MDT care be implanted in the National Health Policy settings of breast cancer patients.
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Affiliation(s)
- Chang-Hung Tsai
- Miao-Li General Hospital, Ministry of Health and Welfare, Taiwan, ROC; Department of Health Services Administration, China Medical University, Taichung, Taiwan, ROC; Department of Public Health, China Medical University, Taichung, Taiwan, ROC
| | | | - Ting-Wei Lai
- Management Center, China Medical University Hospital, Taichung, Taiwan, ROC
| | - Pei-Tseng Kung
- Department of Healthcare Administration, Asia University, Taichung, Taiwan, ROC; Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan, ROC
| | - Wei-Yin Kuo
- Department of Health Services Administration, China Medical University, Taichung, Taiwan, ROC
| | - Wen-Chen Tsai
- Department of Health Services Administration, China Medical University, Taichung, Taiwan, ROC.
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Pan M, Seto T, Yu J, Sidhu M, Kim B, McCormick C, Fang A, Song J, Morse LJ, Peng PD, Chakedis J, Huber R, Schwartz C, Lee JD, Zou Y. Feasibility and Value of Establishing a Community-Based Virtual Multidisciplinary Sarcoma Case Conference. JCO Oncol Pract 2020; 16:e1143-e1150. [PMID: 33049178 DOI: 10.1200/op.20.00110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2020] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Management of soft tissue and bone sarcoma presents many challenges, both diagnostically and therapeutically, and requires multidisciplinary collaboration; however, such collaboration is often challenging to establish, especially in the community setting. We share our experiences of a virtual multidisciplinary sarcoma case conference (VMSCC). METHODS We conducted retrospective review of the VMSCC data-initially via Webex, now Microsoft Teams-and the surveys of referring physicians to understand the feasibility and value of the VMSCC. RESULTS The VMSCC was established in March 2013 in Kaiser Permanente Northern California with consistent participation of the Departments of Musculoskeletal Oncology (orthopedic oncology), Musculoskeletal Radiology, Pathology, Medical Oncology, Radiation Oncology, Nuclear Medicine, Surgical Oncology, and Genetics. Pediatric Oncology participated ad hoc when pediatric sarcoma cases were presented. Referrals were from multiple specialties and regions, including the Kaiser Permanente Mid-Atlantic and Hawaii regions. From March 2013 to December 2019, 1,585 cases were reviewed encompassing 36 histologic types. More than 300 cases were reviewed per year from 2017 to 2019. Survey results of referring physicians demonstrate that the VMSCC enhanced the confidence of treating physicians, and its recommendations frequently led to treatment changes. CONCLUSION Establishing a valuable community-based VMSCC is feasible. VMSCC recommendations frequently led to treatment changes and improved the confidence of treating physicians.
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Affiliation(s)
- Minggui Pan
- Department of Oncology, Kaiser Permanente Northern California, Santa Clara, CA
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Tiffany Seto
- Internal Medicine Residency Program, Kaiser Permanente Northern California, Santa Clara, CA
| | - Jeanette Yu
- Department of Oncology, Kaiser Permanente Northern California, Santa Clara, CA
| | - Manpreet Sidhu
- Department of Oncology, Kaiser Permanente Northern California, Santa Clara, CA
| | - Brian Kim
- Department of Radiology, Kaiser Permanente Northern California, Santa Clara, CA
| | - Craig McCormick
- Department of Radiology, Kaiser Permanente Northern California, Santa Clara, CA
| | - Andrew Fang
- Department of Musculoskeletal Oncology, Kaiser Permanente Northern California, South San Francisco, CA
| | - Joseph Song
- Department of Radiation Oncology, Kaiser Permanente Northern California, South San Francisco, CA
| | - Lee Jae Morse
- Department of Musculoskeletal Oncology, Kaiser Permanente Northern California, South San Francisco, CA
| | - Peter D Peng
- Department of Surgical Oncology, Kaiser Permanente Northern California, Oakland, CA
| | - Jeffery Chakedis
- Department of Surgical Oncology, Kaiser Permanente Northern California, Oakland, CA
| | - Ryan Huber
- Department of Nuclear Medicine, Kaiser Permanente Northern California, Santa Clara, CA
| | - Corey Schwartz
- Department of Oncology, Kaiser Permanente Northern California, Santa Clara, CA
| | - Jason D Lee
- Department of Pathology, Kaiser Permanente Northern California, Santa Clara, CA
| | - Youran Zou
- Department of Pathology, Kaiser Permanente Northern California, Santa Clara, CA
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Habermann TM, Khurana A, Lentz R, Schmitz JJ, von Bormann AG, Young JR, Hunt CH, Christofferson SN, Nowakowski GS, McCullough KB, Horna P, Wood AJ, Macon WR, Kurtin PJ, Lester SC, Stafford SL, Chamarthy U, Khan F, Ansell SM, King RL. Analysis and impact of a multidisciplinary lymphoma virtual tumor board. Leuk Lymphoma 2020; 61:3351-3359. [PMID: 32967496 DOI: 10.1080/10428194.2020.1817432] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The aim is to prospectively evaluate the impact of a multidisciplinary lymphoma virtual tumor board. The utility of multi-site interactive lymphoma-specific tumor boards has not been reported. The Mayo Clinic Lymphoma Tumor Board is a component of the International Mayo Clinic Care Network (MCCN). The format includes the clinical case presentation, presentation of radiology and hematopathology findings by the appropriate subspecialist, proposed treatment options, review of the literature pertinent to the case, pharmacy contributions, and discussion followed by recommendations. Three hundred and nine consecutive highly selected real-time cases with a diagnosis of lymphoma were presented at the Mayo Clinic Lymphoma Tumor Board from January 2014 to June 2018 and decisions were prospectively tracked to assess its impact on the treatment decisions. A total of 309 cases were prospectively evaluated. One hundred and forty (45.3%) cases had some changes made or recommended. The total changes suggested were 179, as some cases had more than one recommendation. There were 93 (30%) clinical management recommendations, 45 (14.6%) additional testing recommendations, 29 (9.4%) pathology changes, and 6 (1.9%) radiology changes. In an electronic evaluation process, 93% of the responders reported an improvement in knowledge and competence, and 100% recommended no change in format of the board. A multidisciplinary lymphoma tumor board approach was found to have a meaningful impact on lymphoma patients while enhancing interdisciplinary interactions and education for multiple levels of the clinical care team.
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Affiliation(s)
- Thomas M Habermann
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Arushi Khurana
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ruth Lentz
- Division of Hematology, Department of Nursing, Mayo Clinic, Rochester, MN, USA
| | - John J Schmitz
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Jason R Young
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | - Pedro Horna
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Adam J Wood
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - William R Macon
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Paul J Kurtin
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Scott C Lester
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Scott L Stafford
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Ushrasree Chamarthy
- Department of Medical Oncology and Hematology, Sparrow Cancer Center, Lansing, MI, USA
| | - Faraz Khan
- Department of Hematology-Oncology, American Hospital Dubai, Dubai, United Arab Emirates
| | - Stephen M Ansell
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Rebecca L King
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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Nemesure B, Albano D, Bilfinger T. Lung cancer recurrence and mortality outcomes over a 10-year period using a multidisciplinary team approach. Cancer Epidemiol 2020; 68:101804. [PMID: 32896806 DOI: 10.1016/j.canep.2020.101804] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/03/2020] [Accepted: 08/21/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Longitudinal data are limited regarding the impact of a multidisciplinary team (MDT) approach on patient outcomes among those diagnosed with lung cancer. The purpose of this study is to 1) compare 1- and 3-year recurrence and mortality rates among patients receiving a MDT vs. standard model of care; and 2) assess trends in these proportions over a 10-year period. METHODS This investigation included 2044 lung cancer cases reported to the Stony Brook Cancer Registry between 2006 and 2015. Patients were stratified into 2 groups, those participating in Stony Brook's Lung Cancer Evaluation Center's (LCEC) MDT Program (n = 1179) and those receiving a standard model of care (n = 865). 1- and 3-year stage-stratified recurrence and mortality rates are reported. Logistic regression analyses are performed and linear by linear associations are used to assess trends over time. RESULTS A higher proportion of patients in the MDT program (LCEC) remained disease-free at 1-year compared those receiving standard care (80.0 % vs 62.3 %, p < 0.01). There were no significant changes in mortality over the 10-year observation period in either group, however the rates were significantly lower among LCEC vs non-LCEC cases after adjusting for possible confounders (OR = 0.68 (0.51,0.90) at 1-year; OR = 0.50 (0.36, 0.70) at 3-years). Recurrence was also lower at 3-years in the MDT group (OR = 0.51 (0.32, 0.79)). CONCLUSIONS This study suggests that a comprehensive MDT program for lung cancer yields improved patient outcomes compared to the standard model of care and this approach may help to decrease rates of disease recurrence and mortality.
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Affiliation(s)
- Barbara Nemesure
- Department of Family, Population and Preventive Medicine, Stony Brook Medicine, 100 Nicolls Road - HSC Level 3, Stony Brook, NY 11794-8036, United States.
| | - Denise Albano
- Department of Surgery, Stony Brook Medicine, 100 Nicolls Road - HSC Level 19, Stony Brook, NY 11794-8191, United States.
| | - Thomas Bilfinger
- Department of Surgery, Stony Brook Medicine, 100 Nicolls Road - HSC Level 19, Stony Brook, NY 11794-8191, United States.
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Neuro-oncology Multidisciplinary Clinic and Improvements in Patient Outcome. Am J Clin Oncol 2020; 43:798-801. [PMID: 32841962 DOI: 10.1097/coc.0000000000000751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Neuro-oncology care is becoming increasingly complex and patients often see multiple specialists. Multidisciplinary clinic (MDC) is a patient-centric option to allow multiple specialists to be involved where patients see multiple providers on the same day. OBJECTIVE The objective of this study was to evaluate the role of a neuro-oncology MDC on patient outcomes. MATERIALS AND METHODS Retrospective study was performed on consecutive patients who received radiosurgery for central nervous system (CNS) disease. We evaluated patients 2 years before and 2 years after the implementation of a MDC. RESULTS A total of 351 patients were analyzed, 163 patients before MDC and 188 after implementation of MDC. Before MDC the median follow-up was dependent on which department ordered follow-up radiographic imaging. This discrepancy decreased after the MDC. Overall survival for patients with CNS metastatic disease improved in the MDC cohort (median survival of 248 before MDC and 315 d after, P<0.027). CONCLUSION We found that neuro-oncology MDC improved follow-up across disciplines and improved overall survival for patients with CNS metastatic disease.
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50
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Heinke MY, Vinod SK. A review on the impact of lung cancer multidisciplinary care on patient outcomes. Transl Lung Cancer Res 2020; 9:1639-1653. [PMID: 32953538 PMCID: PMC7481642 DOI: 10.21037/tlcr.2019.11.03] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
International guidelines recommend a multidisciplinary approach to the management of lung cancer due to the complexity of both patients and their disease and the multiple treatment options available. This care can be provided through patient discussion at multidisciplinary meetings where relevant medical and allied health staff formulate a consensus management plan taking all factors into consideration. This model can be extended further to include multidisciplinary clinics where the patient is present for assessment and discussion. However, conducting regular multidisciplinary meetings or clinics has significant time, resource and financial costs and therefore, it is important to assess the impact of multidisciplinary care. We aimed to review published evidence, from 2000 to 2019, to evaluate the impact of multidisciplinary care on lung cancer outcomes. There were 29 studies found, 11 evaluating multidisciplinary clinics, 14 studying multidisciplinary meetings and four where the model of care was not defined. There was only one randomised trial and three prospective studies, the remainder being retrospective studies. Despite limitations in trial design and confounding factors, overall, multidisciplinary care in lung cancer was associated with improvements in patient outcomes, in particular improved survival for all stages of lung cancer. Lung cancer patients managed in a multidisciplinary setting were more likely to receive active treatment and had improved utilisation of all treatment modalities: surgery, radiotherapy and chemotherapy. In addition, the treatment recommendations were more likely to be consistent with lung cancer management guidelines. These improved outcomes support the recommendations for a multidisciplinary approach to lung cancer care.
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Affiliation(s)
- Monique Y Heinke
- Liverpool and Macarthur Cancer Therapy Centre, Liverpool, NSW, Australia
| | - Shalini K Vinod
- Liverpool and Macarthur Cancer Therapy Centre, Liverpool, NSW, Australia.,South Western Sydney Clinical School, University of New South Wales, NSW, Australia
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