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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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2
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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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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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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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5
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Braulke F, Kober K, Rieken S, Brand T, Hartz T, Seipke S, Asendorf T, Haier J. Adherence to interdisciplinary tumor board recommendations as an expression of quality-assured patient care: results of a bicentric German analysis. J Cancer Res Clin Oncol 2023; 149:14775-14784. [PMID: 37592032 PMCID: PMC10602985 DOI: 10.1007/s00432-023-05253-5] [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: 06/15/2023] [Accepted: 08/04/2023] [Indexed: 08/19/2023]
Abstract
PURPOSE Interdisciplinary tumor boards (ITBs) represent a central part of standard cancer care defining a guidelines-guided treatment plan adapted to the patient's capabilities, comorbidities and wishes in a multi-professional team. The implementation rate of ITB recommendations can be monitored by structured adherence analyses. But (inter)national definitions how to measure the level of implementation are missing. Here, we present results of 4 years of ITB adherence analyses in a bicentric German Comprehensive Cancer Center (CCC). METHODS Between 2018 and 2021, for at least 1 month, the implementation rate of recommendations of 8 different ITBs of 2 CCC sites was evaluated manually according to harmonized criteria between both sites regarding the degree of implementation of ITB's recommendations. RESULTS In total, 1104 cases were analyzed (65% male, 35% female). Mean distance from patient's home to the CCC was 57 km (range 0.8-560.6 km). For 949 cases (86%) with known follow-up, the adherence rate was 91.9% (95% CI 0.9; 0.935). In 8.1%, ITB decisions were not implemented due to medical reasons (45.4%), patient's wish (35.1%) and unknown reasons (19.5%). Logistic regression revealed neither age (OR = 0.998, p = 0.90), nor gender (OR = 0.98, p = 0.92) or the distance from patient's home to the CCC (OR = 1.001, p = 0.54) were significantly associated with ITB adherence. CONCLUSION ITB adherences analyses can serve as a quality management tool to monitor the implementation rate of ITB recommendations and to stay in contact with practitioners, other hospitals and state cancer registries to share data and resources in accordance with data protection requirements for continuously improvement of quality management and patient care.
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Affiliation(s)
- Friederike Braulke
- Comprehensive Cancer Center, University Medical Center Göttingen, von-Bar-Str. 2/4, 37075, Göttingen, Germany.
| | - Kathrin Kober
- Comprehensive Cancer Center, University Medical Center Göttingen, von-Bar-Str. 2/4, 37075, Göttingen, Germany
| | - Stefan Rieken
- Department of Radiation Therapy and Radiooncology, University Medical Center Göttingen, Göttingen, Germany
| | - Tonia Brand
- Klinisches Krebsregister Niedersachsen, Hannover, Germany
| | - Tobias Hartz
- Klinisches Krebsregister Niedersachsen, Hannover, Germany
| | - Stefanie Seipke
- Comprehensive Cancer Center Hannover, Hannover Medical School, Hannover, Germany
| | - Thomas Asendorf
- Institute of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Jörg Haier
- Comprehensive Cancer Center Hannover, Hannover Medical School, Hannover, Germany
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6
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Walter J, Moeller C, Resuli B, Kauffmann-Guerrero D, Manapov F, Dinkel J, Neumann J, Kovacs J, Schneider C, Huber RM, Tufman A. Guideline adherence of tumor board recommendations in lung cancer and transfer into clinical practice. J Cancer Res Clin Oncol 2023; 149:11679-11688. [PMID: 37402967 PMCID: PMC10465379 DOI: 10.1007/s00432-023-05025-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/26/2023] [Indexed: 07/06/2023]
Abstract
PURPOSE Evaluating patients and treatment decisions in a multidisciplinary tumor board has led to better quality of care and longer survival in cancer patients. The aim of this study was to evaluate tumor board recommendations for thoracic oncology patients regarding guideline adherence and transferal of recommendations into clinical practice. METHODS We evaluated tumor board recommendations of the thoracic oncology tumor board at Ludwig-Maximilians University (LMU) Hospital Munich between 2014 and 2016. We compared patient characteristics between guideline-adherent and non-guideline-adherent recommendations, as well as between transferred and non-transferred recommendations. We used multivariate logistic regression models to evaluate factors associated with guideline adherence. RESULTS Over 90% of recommendations by the tumor board were either adherent to the guidelines (75.5%) or over fulfilling guidelines (15.6%). Almost 90% of recommendations were transferred to clinical practice. If a recommendation was not according to the guidelines, the reason was mostly associated with the general condition (age, Charlson comorbidity index, ECOG) of the patient or due to the patients' request. Surprisingly, sex also had a significant influence on the guideline adherence of recommendations, with females being more likely to get recommendations not according to the guidelines. CONCLUSION In conclusion, the results of this study are promising, as the guideline adherence of recommendations as well as the transferal of recommendations into clinical practice were high. In the future, a special focus should be put on fragile patients as well as female patients.
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Affiliation(s)
- Julia Walter
- Department of Medicine V-Pneumology, University Hospital, Ludwig-Maximilians-University Hospital (LMU) Munich, Munich, Germany.
- German Center for Lung Research (DZL), Giessen, Germany.
| | - Caroline Moeller
- Department of Medicine V-Pneumology, University Hospital, Ludwig-Maximilians-University Hospital (LMU) Munich, Munich, Germany
| | - Blerina Resuli
- Department of Medicine V-Pneumology, University Hospital, Ludwig-Maximilians-University Hospital (LMU) Munich, Munich, Germany
| | - Diego Kauffmann-Guerrero
- Department of Medicine V-Pneumology, University Hospital, Ludwig-Maximilians-University Hospital (LMU) Munich, Munich, Germany
- German Center for Lung Research (DZL), Giessen, Germany
| | - Farkhad Manapov
- German Center for Lung Research (DZL), Giessen, Germany
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Julien Dinkel
- German Center for Lung Research (DZL), Giessen, Germany
- Department of Radiology, Asklepios Clinic Gauting, Gauting, Germany
| | - Jens Neumann
- Institute of Pathology, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Julia Kovacs
- German Center for Lung Research (DZL), Giessen, Germany
- Department of Thoracic Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Christian Schneider
- German Center for Lung Research (DZL), Giessen, Germany
- Department of Thoracic Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Rudolf M Huber
- Department of Medicine V-Pneumology, University Hospital, Ludwig-Maximilians-University Hospital (LMU) Munich, Munich, Germany
- German Center for Lung Research (DZL), Giessen, Germany
| | - Amanda Tufman
- Department of Medicine V-Pneumology, University Hospital, Ludwig-Maximilians-University Hospital (LMU) Munich, Munich, Germany
- German Center for Lung Research (DZL), Giessen, Germany
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7
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Moghanaki D, Lisberg A, Oh S, Lee JM. Unresectable Stage III NSCLC Should Not be Treated With Neoadjuvant Therapy and Re-Evaluated for Resection. J Thorac Oncol 2023; 18:1129-1133. [PMID: 37599046 DOI: 10.1016/j.jtho.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/06/2023] [Accepted: 06/11/2023] [Indexed: 08/22/2023]
Affiliation(s)
- Drew Moghanaki
- Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
| | - Aaron Lisberg
- Division of Hematology and Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Scott Oh
- Section of Interventional Pulmonology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Jay Moon Lee
- Division of Thoracic Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
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8
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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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9
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Naessens C, Laloze J, Leobon S, Gauthier T, Lacorre A, Monteil J, Venat L, Deluche E. Physician compliance with multidisciplinary tumor board recommendations for managing gynecological cancers. Future Oncol 2023; 19:897-908. [PMID: 37232140 DOI: 10.2217/fon-2022-1183] [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: 05/27/2023] Open
Abstract
Aims: Evaluation of compliance with gynecological multidisciplinary tumor board (MTB) recommendations and its impact. Patients & methods: All patient records discussed in our MTB from 2018 to 2020 were analyzed. Results: We analyzed 437 MTB recommendations concerning 166 patients. Each patient was discussed an average of 2.6 (1.0-4.2) times. Of the 789 decisions, the decision was not followed 102 times (12.9%), corresponding to 85 MTB meetings (19.5%). Of these, 72 recommendations concerned therapeutic changes (70.5%), and 30 concerned non-therapeutic changes (29.5%). Of these 85 MTB decisions, 60 (71%) led to a new MTB submission. Noncompliance with MTB decisions decreased the overall survival (46 vs 138 months; p = 0.003). Conclusion: Improving compliance with MTB decisions is crucial to enhance patient outcomes.
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Affiliation(s)
- Clara Naessens
- Radiation Therapy Department, Limoges University Hospital, Limoges, 87000, France
| | - Jerome Laloze
- Reconstructive Surgery Department, Limoges University Hospital, Limoges, 87000, France
| | - Sophie Leobon
- Medical Oncology Department, Limoges University Hospital, Limoges, 87000, France
| | - Tristan Gauthier
- Gynecological Department, Limoges University Hospital, Limoges, 87000, France
| | - Aymeline Lacorre
- Gynecological Department, Limoges University Hospital, Limoges, 87000, France
| | - Jacques Monteil
- Nuclear Medicine Department, Limoges University Hospital, Limoges, 87000, France
| | - Laurence Venat
- Medical Oncology Department, Limoges University Hospital, Limoges, 87000, France
| | - Elise Deluche
- Medical Oncology Department, Limoges University Hospital, Limoges, 87000, France
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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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11
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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: 3] [Impact Index Per Article: 3.0] [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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Abstract
The sudden contrast dye shortage, precipitated by a temporary forced closure of healthcare plant, has limited the supply of iodinated contrast media to Australia. Furthering the impact of the coronavirus disease 2019 pandemic, this new crisis has increased burden on the radiology system. Lessons from the strategies applied during the shortage should be used as building blocks as safeguards for the future. A pragmatic approach to education and training is required in an ever-changing environment. Our relationships between medical specialties and manufacturers are paramount to maintaining an effective workflow. An ongoing commitment to a strong workforce will be the backbone to overcome another challenge in these uncertain times.
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Affiliation(s)
- Christiaan Yu
- Department of Respiratory Medicine, Alfred Health, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne Australia
- * Correspondence: Christiaan Yu, Respiratory and Sleep Consultant, Department of Respiratory Medicine, 55 Commercial Road, Melbourne VIC 3004, Australia (e-mail: )
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13
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Rodríguez-Reinado C, Delgado-Parrilla A, Alguacil J. Breast Cancer Treatment in Integrated Care Process in Andalusia: The Challenge of Multidisciplinarity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12728. [PMID: 36232027 PMCID: PMC9566388 DOI: 10.3390/ijerph191912728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/30/2022] [Accepted: 10/02/2022] [Indexed: 06/16/2023]
Abstract
Despite the increasing trend in the incidence of breast cancer in recent decades, mortality has decreased in developed countries. The general objective of the study is to analyse the functioning and organisation of the care process for breast cancer treatment in Andalusia (Spain) in order to identify possible barriers and facilitators that may be affecting its effectiveness and, therefore, the survival of the disease. A qualitative method was adopted based on 19 semi-structured interviews with health professionals from different specialities in two Andalusian provinces: Huelva (mortality rate higher than the national average) and Granada (mortality rate similar to the national average). Results show the existence of barriers (seasonal delays, low frequency of multidisciplinary meetings, lack of human and technical resources, difficulties in accessing treatment in certain populations, etc.) and facilitators (creation of multidisciplinary units and committees for breast pathology, standardisation of treatments, assignment of professionals with preferential attention to breast pathology, etc.) in the care process of breast cancer treatment. The combination of these barriers can have an impact on the accessibility, quality, and efficacy of the treatment, and in the long term, on survival from the disease.
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Affiliation(s)
- Carmen Rodríguez-Reinado
- Clinical, Environmental and Social Transformation Epidemiology Research Group, Department of Sociology, Social Work and Public Health, University of Huelva, 21007 Huelva, Spain
| | - Ana Delgado-Parrilla
- Clinical, Environmental and Social Transformation Epidemiology Research Group, Department of Sociology, Social Work and Public Health, University of Huelva, 21007 Huelva, Spain
| | - Juan Alguacil
- Clinical, Environmental and Social Transformation Epidemiology Research Group, Department of Sociology, Social Work and Public Health, University of Huelva, 21007 Huelva, Spain
- Centro de Investigación en Recursos Naturales, Salud y Medio Ambiente (RENSMA), University of Huelva, 21071 Huelva, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
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14
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Gutt R, Shapiro RH, Lee SP, Faricy-Anderson K, Hoffman-Hogg L, Solanki AA, Moses E, Dawson GA, Kelly MD. Consensus Statement Supporting the Presence of Onsite Radiation Oncology Departments at VHA Medical Centers. Fed Pract 2022; 39:S8-S11. [PMID: 36426112 PMCID: PMC9662312 DOI: 10.12788/fp.0308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Although multiple studies demonstrate that radiotherapy is underused worldwide, the impact that onsite radiation oncology at medical centers has on the use of radiotherapy is poorly studied. The Veterans Health Administration (VHA) Palliative Radiotherapy Taskforce has evaluated the impact of onsite radiation therapy on the use of palliative radiation and has made recommendations based on these findings. OBSERVATIONS Radiation consults and treatment occur in a more timely manner at VHA centers with onsite radiation therapy compared with VHA centers without onsite radiation oncology. Referring practitioners with onsite radiation oncology less frequently report difficulty contacting a radiation oncologist (0% vs 20%, respectively; P = .006) and patient travel (28% vs 71%, respectively; P < .001) as barriers to referral for palliative radiotherapy. Facilities with onsite radiation oncology are more likely to have multidisciplinary tumor boards (31% vs 3%, respectively; P = .11) and are more likely to be influenced by radiation oncology recommendations at tumor boards (69% vs 44%, respectively; P = .02). CONCLUSIONS The VHA Palliative Radiotherapy Taskforce recommends the optimization of the use of radiotherapy within the VHA. Radiation oncology services should be maintained where present in the VHA, with consideration for expansion of services to additional facilities. Telehealth should be used to expedite consults and treatment. Hypofractionation should be used, when appropriate, to ease travel burden. Options for transportation services and onsite housing or hospitalization should be understood by treating physicians and offered to patients to mitigate barriers related to travel.
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Affiliation(s)
| | - Ronald H. Shapiro
- Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana
| | - Steve P. Lee
- Veterans Affairs Long Beach Healthcare System, California
| | | | - Lori Hoffman-Hogg
- Veterans Health Administration, National Center for Health Promotion and Disease Prevention, Durham, North Carolina
- Veterans Health Administration, Office of Nursing Services, Washington, DC
| | - Abhishek A. Solanki
- Edward Hines, Jr Veterans Affairs Hospital, Hines, Illinois
- Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois
| | - Edwinette Moses
- Hunter Holmes Mcguire Veterans Affairs Medical Center, Richmond, Virginia
| | - George A. Dawson
- US Department of Veterans Affairs, Specialty Care Program Office, National Radiation Oncology Program, Washington, DC
| | - Maria D. Kelly
- US Department of Veterans Affairs, Specialty Care Program Office, National Radiation Oncology Program, Washington, DC
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15
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Fang R, Liao H, Mardani A. How to aggregate uncertain and incomplete cognitive evaluation information in lung cancer treatment plan selection? A method based on Dempster-Shafer theory. Inf Sci (N Y) 2022. [DOI: 10.1016/j.ins.2022.04.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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16
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Walraven JEW, van der Hel OL, van der Hoeven JJM, Lemmens VEPP, Verhoeven RHA, Desar IME. Factors influencing the quality and functioning of oncological multidisciplinary team meetings: results of a systematic review. BMC Health Serv Res 2022; 22:829. [PMID: 35761282 PMCID: PMC9238082 DOI: 10.1186/s12913-022-08112-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/20/2022] [Indexed: 12/01/2022] Open
Abstract
Background Discussing patients with cancer in a multidisciplinary team meeting (MDTM) is customary in cancer care worldwide and requires a significant investment in terms of funding and time. Efficient collaboration and communication between healthcare providers in all the specialisms involved is therefore crucial. However, evidence-based criteria that can guarantee high-quality functioning on the part of MDTMs are lacking. In this systematic review, we examine the factors influencing the MDTMs’ efficiency, functioning and quality, and offer recommendations for improvement. Methods Relevant studies were identified by searching Medline, EMBASE, and PsycINFO databases (01–01-1990 to 09–11-2021), using different descriptions of ‘MDTM’ and ‘neoplasm’ as search terms. Inclusion criteria were: quality of MDTM, functioning of MDTM, framework and execution of MDTM, decision-making process, education, patient advocacy, patient involvement and evaluation tools. Full text assessment was performed by two individual authors and checked by a third author. Results Seventy-four articles met the inclusion criteria and five themes were identified: 1) MDTM characteristics and logistics, 2) team culture, 3) decision making, 4) education, and 5) evaluation and data collection. The quality of MDTMs improves when the meeting is scheduled, structured, prepared and attended by all core members, guided by a qualified chairperson and supported by an administrator. An appropriate amount of time per case needs to be established and streamlining of cases (i.e. discussing a predefined selection of cases rather than discussing every case) might be a way to achieve this. Patient centeredness contributes to correct diagnosis and decision making. While physicians are cautious about patients participating in their own MDTM, the majority of patients report feeling better informed without experiencing increased anxiety. Attendance at MDTMs results in closer working relationships between physicians and provides some medico-legal protection. To ensure well-functioning MDTMs in the future, junior physicians should play a prominent role in the decision-making process. Several evaluation tools have been developed to assess the functioning of MDTMs. Conclusions MDTMs would benefit from a more structured meeting, attendance of core members and especially the attending physician, streamlining of cases and structured evaluation. Patient centeredness, personal competences of MDTM participants and education are not given sufficient attention.
Supplementary information The online version contains supplementary material available at 10.1186/s12913-022-08112-0.
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17
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Zandee WT, Merola E, Poczkaj K, de Mestier L, Klümpen HJ, Geboes K, de Herder WW, Munir A. Evaluation of multidisciplinary team decisions in neuroendocrine neoplasms: Impact of expert centres. Eur J Cancer Care (Engl) 2022; 31:e13639. [PMID: 35735226 DOI: 10.1111/ecc.13639] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/10/2022] [Accepted: 06/06/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the impact of multidisciplinary team (MDT) meetings on the management of patients with neuroendocrine neoplasms (NENs). METHODS All newly referred gastro-entero-pancreatic (GEP)-NEN patients discussed from 1 April to 1 October 2017 in the MDT of seven European expert centres were prospectively included. The impact on patients' management was defined as a change in diagnosis, grade, stage or treatment. RESULTS A total of 292 patients were included, mainly small intestinal (siNENs) (32%) and pancreatic NENs (28%), with distant metastases in 51%. Patients had received prior surgery in 43% of cases and prior medical treatment in 32%. A significant change occurred in 61% of NENs: 7% changes in diagnosis, 8% in grade and 16% in stage. The MDT recommended a new treatment for 51% of patients, mainly surgery (9%) or somatostatin analogues (20%). A significant change was most frequently observed in patients with Stage IV disease (hazard ratio [HR] 3.6, 95% confidence interval [CI]: 1.9-6.9 vs. Stage I) and G2 NENs (vs. G1, HR 2.1 95% CI: 1.2-3.8). CONCLUSION NEN-dedicated MDT discussion in expert centres yields significant management changes in over 60% of patients and thus represents the gold standard for the management of these patients.
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Affiliation(s)
- Wouter T Zandee
- Department of Internal Medicine, Sector of Endocrinology Erasmus MC, Rotterdam, The Netherlands.,Department of Internal Medicine, Division of Endocrinology, University of Groningen, University Medical Centre Groningen, The Netherlands
| | - Elettra Merola
- Department of Medicine 1, Division of Endocrinology, Friedrich-Alexander University, Erlangen-Nuremberg, Erlangen, Germany.,Department of Gastroenterology, Azienda Provinciale Servizi Sanitari (APSS), Trento, Italy
| | - Karolina Poczkaj
- Department of Endocrinology and Neuroendocrine Tumours, Medical University of Silesia, Katowice, Poland
| | - Louis de Mestier
- Department of Gastroenterology and Pancreatology, Beaujon Hospital (APHP) and Paris 7 University, Clichy, France
| | - Heinz-Josef Klümpen
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Karen Geboes
- Department of Gastroenterology, University Hospital Ghent, Ghent, Belgium
| | - Wouter W de Herder
- Department of Internal Medicine, Sector of Endocrinology Erasmus MC, Rotterdam, The Netherlands
| | - Alia Munir
- Department of Endocrinology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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18
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Lim M, Qureshi MM, Boyd G, Hirsch AE. Effect of Radiation Treatment at a High-Volume Center on Outcomes in Intermediate-Risk Prostate Cancer: An Analysis of the National Cancer Database. Urology 2022; 165:242-249. [PMID: 35182584 DOI: 10.1016/j.urology.2022.01.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/21/2021] [Accepted: 01/09/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the effect of radiation treatment at a high-volume center on overall survival in men with intermediate-risk prostate cancer. METHODS From 2004-2015, 430,347 patients with intermediate-risk prostate cancer were identified in the NCDB. Radiation case volume (RCV) of each hospital was calculated based on number of patients treated. After excluding certain patients including those with metastatic disease, our final analysis population included 116,091 intermediate-risk prostate cancer patients receiving radiation therapy (RT) or radiation with androgen deprivation therapy (RT+ADT). Characteristics analyzed include age, race, distance to treatment facility, Charlson-Deyo Score (CDS), and socioeconomic factors. Primary outcome was overall survival (OS). 5-year survival rates were estimated using the Kaplan-Meier method. Adjusted hazard ratios (HR) with 95% confidence intervals (CI) were computed using multivariate analysis (MVA). Cox regression and propensity score-matched (PSM) analysis was performed. RESULTS Median follow up was 63.5 months and estimated 5-year OS was 90.1% at high RCV centers and 88.2% at low RCV centers (p<0.0001). Treatment at high RCV facility was associated with significantly lower mortality compared to treatment at a low RCV facility on MVA and PSM analysis. The survival benefit of treatment at a high RCV facility remained when high RCV facilities were defined as those above the 80th, 90th, and 95th percentile in patient volume (p<0.05). CONCLUSIONS Treatment at a high radiation case volume facility is associated with improved OS in patients with radiation-treated intermediate-risk prostate cancer. This survival benefit is important to consider when choosing a treatment center for radiation therapy.
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Affiliation(s)
- Mir Lim
- Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, MA.
| | - Muhammad M Qureshi
- Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, MA
| | - Graham Boyd
- Harvard Radiation Oncology Program, Boston, MA
| | - Ariel E Hirsch
- Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, MA
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19
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Rendell VR, Ricker MM, Winslow ER. Deconstructing the Meaning of Multidisciplinary Cancer Care: A mixed-method study of patients and providers. ONCOLOGY ISSUES 2022; 37:52-64. [PMID: 36845883 PMCID: PMC9957188 DOI: 10.1080/10463356.2021.2008592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Victoria R Rendell
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisc
| | - Melissa M Ricker
- Department of Family Medicine and Community Health at the University of Wisconsin School of Medicine and Public Health, Madison, Wisc
| | - Emily R Winslow
- Georgetown University, Medstar Georgetown Transplant Institute, D.C
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20
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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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21
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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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22
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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: 10] [Impact Index Per Article: 3.3] [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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The Effects of Multidisciplinary Team Meetings on Clinical Practice for Colorectal, Lung, Prostate and Breast Cancer: A Systematic Review. Cancers (Basel) 2021; 13:cancers13164159. [PMID: 34439312 PMCID: PMC8394238 DOI: 10.3390/cancers13164159] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/29/2021] [Accepted: 08/16/2021] [Indexed: 02/06/2023] Open
Abstract
Simple Summary Multidisciplinary team meetings have increasingly been implemented in cancer care worldwide to ensure timely, accurate and evidence-based diagnosis, and treatment plans. Nowadays, multidisciplinary team meetings are generally considered indispensable. However, they are considered time-consuming and expensive, while the effects of multidisciplinary team meetings are not yet fully understood. The aim of this systematic review is to update and summarize the literature and create an overview of the existing knowledge. Cancer types such as colorectal, lung, prostate and breast cancer with rapidly increasing incidence rates will inevitably impact the workload of clinicians. Understanding the effects of the widely implemented multidisciplinary team meetings in oncology care is fundamental in order to optimize care pathways and allocate resources in the rapidly diversifying landscape of cancer therapies. Abstract Objective: The aim of our systematic review is to identify the effects of multidisciplinary team meetings (MDTM) for lung, breast, colorectal and prostate cancer. Methods: Our systematic review, performed following PRISMA guidelines, included studies examining the impact of MDTMs on treatment decisions, patient and process outcomes. Electronic databases PUBMED, EMBASE, Cochrane Library and Web of Science were searched for articles published between 2000 and 2020. Risk of bias and level of evidence were assessed using the ROBINS-I tool and GRADE scale. Results: 41 of 13,246 articles were selected, evaluating colorectal (21), lung (10), prostate (6) and breast (4) cancer. Results showed that management plans were changed in 1.6–58% of cases after MDTMs. Studies reported a significant impact of MDTMs on surgery type, and a reduction of overall performed surgery after MDTM. Results also suggest that CT and MRI imaging significantly increased after MDTM implementation. Survival rate increased significantly with MDTM discussions according to twelve studies, yet three studies did not show significant differences. Conclusions: Despite heterogeneous data, MDTMs showed a significant impact on management plans, process outcomes and patient outcomes. To further explore the impact of MDTMs on the quality of healthcare, high-quality research is needed.
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Tchelebi LT, Shen B, Wang M, Gusani NJ, Walter V, Abrams R, Verma V, Zaorsky NG. Impact of radiation therapy facility volume on survival in patients with cancer. Cancer 2021; 127:4081-4090. [PMID: 34398470 DOI: 10.1002/cncr.33777] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 05/07/2021] [Accepted: 06/07/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND This study examined whether radiation therapy facility volumes correlate with survival after curative intent treatment of solid tumors. METHODS The National Cancer Database was queried for patients with solid tumors treated with curative-intent radiation therapy from 2004-2013. Facilities were stratified into 4 volume categories: low, intermediate, high, and very high. Primary cancer sites were divided into neoadjuvant, adjuvant, or definitive radiation subgroups. Kaplan-Meier curves of 5-year postradiation survival probability, stratified by facility volume, were generated with log-rank tests for group comparisons. Cox proportional hazard models were used to evaluate the effect of facility volume on survival, adjusted for multiple covariates. RESULTS There were 253,422 patients treated at 1289 facilities: 6231 received neoadjuvant radiation, 147,980 received adjuvant radiation, and 99,211 received definitive radiation without surgery. Among patients receiving neoadjuvant radiation, survival correlated with facility volume for patients with rectal cancer (hazard ratio [HR], 0.75; 95% CI, 0.6-0.94; P = .01). For cancers of the breast and uterus, patients receiving adjuvant radiation at very high-volume facilities (vs low volume) had improved survival (HR, 0.83; 95% CI, 0.77-0.90; P < .001 and HR, 0.77, 95% CI, 0.62-0.97; P = .03, respectively). For patients receiving definitive radiation for prostate, non-small cell lung, pancreas, and head and neck cancer, there was an improvement in survival for patients treated at very high-volume centers (P < .05). CONCLUSIONS For select cancer patients, treatment with curative radiation at higher volume facilities is associated with improved survival. In particular, patients receiving radiation therapy in the definitive setting without surgery may benefit most from treatment at high-volume centers.
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Affiliation(s)
- Leila T Tchelebi
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, Pennsylvania
| | - Biyi Shen
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Ming Wang
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Niraj J Gusani
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania.,Department of Surgery, Penn State College of Medicine, Hershey, Pennsylvania
| | - Vonn Walter
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania.,Department of Biochemistry and Molecular Biology, Penn State College of Medicine, Hershey, Pennsylvania
| | - Ross Abrams
- Department of Radiation Oncology, Sharett Cancer Institute, Hadassah Medical Center, Ein Kerem Jerusalem, Israel
| | - Vivek Verma
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Nicholas G Zaorsky
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, Pennsylvania.,Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
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26
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Foo JC, Jawin V, Yap TY, Ahmad Bahuri NF, Ganesan D, Mun KS, Loh J, Azman RR, Gottardo NG, Qaddoumi I, Moreira DC, Rajagopal R. Conduct of neuro-oncology multidisciplinary team meetings and closing the "gaps" in the clinical management of childhood central nervous system tumors in a middle-income country. Childs Nerv Syst 2021; 37:1573-1580. [PMID: 33580355 DOI: 10.1007/s00381-021-05080-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/06/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Multidisciplinary team meetings (MDTMs) are essential in the clinical management of pediatric central nervous system (CNS) tumors. Evaluations of the impact of MDTMs on childhood CNS tumors and clinicians' perspectives on their effectiveness are scarce. METHODS We retrospectively reviewed the clinical data of pediatric patients (aged <18 years) with CNS tumors diagnosed and treated in the Pediatric Hematology-Oncology Division at the University Malaya Medical Center from 2008 to 2019. We also conducted a web-based survey of the core members of the multidisciplinary team to evaluate the impact of the MDTMs. RESULTS During the pre-MDTM era (2008-2012), 29 CNS tumors were diagnosed and treated, and during the MDTM era (2014-2019), 49 CNS tumors were diagnosed and treated. The interval for histologic diagnosis was significantly shorter during the MDTM era (p=0.04), but the interval from diagnosis to chemotherapy or radiotherapy and the 5-year overall survival of the 78 patients did not improve (62.1% ± 9.0% vs. 68.8% ± 9.1%; p=0.184). However, the 5-year overall survival of patients with medulloblastoma or rare tumors significantly improved in the MDTM era (p=0.01). Key factors that contributed to delayed treatment and poor outcomes were postoperative complications, the facility's lack of infrastructure, poor parental education about early treatment, cultural beliefs in alternative medicine, and infection during chemotherapy. Eighteen clinicians responded to the survey; they felt that the MDTMs were beneficial in decision-making and enhanced the continuity of coordinated care. CONCLUSION MDTMs significantly reduced the diagnostic interval and improved the overall outcomes. However, delayed treatment remains a major challenge that requires further attention.
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Affiliation(s)
- Jen Chun Foo
- Division of Hematology-Oncology, Department of Pediatrics, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Vida Jawin
- Division of Hematology-Oncology, Department of Pediatrics, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Tsiao Yi Yap
- Division of Hematology-Oncology, Department of Pediatrics, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Nor Faizal Ahmad Bahuri
- Division of Neuro-Surgery, Department of Surgery, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Dharmendra Ganesan
- Division of Neuro-Surgery, Department of Surgery, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Kein Seong Mun
- Department of Pathology, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Jasmin Loh
- Department of Clinical Radiation Oncology, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Raja Rizal Azman
- Department of Radiology, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Nicholas G Gottardo
- Department of Pediatric and Adolescent Clinical Hematology and Oncology, Perth Children's Hospital, Nedlands, Australia
| | - Ibrahim Qaddoumi
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Daniel C Moreira
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Revathi Rajagopal
- Division of Hematology-Oncology, Department of Pediatrics, University Malaya Medical Center, Kuala Lumpur, Malaysia.
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27
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Basendowah M, Awlia AM, Alamoudi HA, Ali Kanawi HM, Saleem A, Malibary N, Hijazi H, Alfawaz M, Alzahrani AH. Impact of optional multidisciplinary tumor board meeting on the mortality of patients with gastrointestinal cancer: A retrospective observational study. Cancer Rep (Hoboken) 2021; 4:e1373. [PMID: 33739628 PMCID: PMC8388160 DOI: 10.1002/cnr2.1373] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/17/2021] [Accepted: 02/21/2021] [Indexed: 12/24/2022] Open
Abstract
Background Multidisciplinary tumor board meetings (MDTs) have shown a positive effect on patient care and play a role in the planning of care. However, there is limited evidence of the association between MDTs and patient mortality and in‐hospital morbidity for mixed cases of gastrointestinal (GI) cancer. Aim To evaluate the influence of optional MDTs on care of patients with cancer to determine potential associations between MDTs and patient mortality and morbidity. Methods and results This was a retrospective observational study at the referral center of King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia. Among all adult patients diagnosed with GI cancer from January 2017 to June 2019, 130 patients were included. We categorized patients into two groups: 66 in the control group (non‐MDT) and 64 in the MDT group. The main outcome measure was overall mortality, measured by survival analysis. The follow‐up was 100% complete. Four patients in the MDT group and 13 in the non‐MDT group died (P = .04). The median follow‐up duration was 294 days (interquartile range [IQR], 140‐434) in the non‐MDT group compared with 176 days (IQR, 103‐466) in the MDT group (P = .20). There were no differences in intensive care unit or hospital length‐of‐stay or admission rates. The overall mortality at 2 years was 13% (95% confidence interval [CI], 0.06‐0.66) in the MDT group and 38% (95% CI, 0.10‐0.39) in the non‐MDT group (P = .08). The MDT group showed a 72% (adjusted hazard ratio [HR], 0.28; 95% CI, 0.08‐0.90; P = .03) decrease in mortality over time compared with the non‐MDT group. Conclusions MDTs were associated with decreased mortality over time. Thus, MDTs have a positive influence on patient care by improving survival and should be incorporated into care.
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Affiliation(s)
- Mohammed Basendowah
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Alaa M Awlia
- Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Hanin A Alamoudi
- Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Hala M Ali Kanawi
- Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Abdulaziz Saleem
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Nadim Malibary
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Hussam Hijazi
- Radiology Department, Radiation Oncology Unit, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Mohammed Alfawaz
- Department of Medicine, University of Jeddah, Jeddah, Kingdom of Saudi Arabia
| | - Anas H Alzahrani
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.,Clinical Research Education Program, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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28
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Gaudioso C, Sykes A, Whalen PE, Attwood KM, Masika MM, Demmy TL, Dexter EU, Hennon MW, Picone AL, Yendamuri SS, Nwogu CE. Impact of a Thoracic Multidisciplinary Conference on Lung Cancer Outcomes. Ann Thorac Surg 2021; 113:392-398. [PMID: 33744217 DOI: 10.1016/j.athoracsur.2021.03.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 02/14/2021] [Accepted: 03/09/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND With the complexity of cancer treatment rising, the role of multidisciplinary conferences (MDCs) in making diagnostic and treatment decisions has become critical. The aim of this study was to evaluate the impact of a thoracic MDC (T-MDC) on lung cancer care quality and survival. METHODS Lung cancer cases over 7 years were identified from the Roswell Park cancer registry system. The survival rates and treatment plans of 300 patients presented at the MDC were compared to 300 matched patients. The National Comprehensive Cancer Network (NCCN) guidelines were used to define the standard of care. The compliance of care plans with NCCN guidelines was summarized using counts and percentages, with comparisons made using Fisher's exact test. Survival outcomes were summarized using Kaplan-Meier methods. RESULTS There was improvement in median overall survival (36.9 versus 19.3 months; p<0.001) and cancer specific survival (48 versus 28.1 months; p<0.001) for lung cancer patients discussed at the T-MDC compared to controls. These differences were statistically significant in patients with stages III/IV, but not in patients with stages I/II disease. The NCCN guidelines compliance rate of treatment plans improved from 80% to 94% (p<0.001) following MDC discussion. 123 of 300 (41%) patients had treatment plan changes recommended by the MDC. CONCLUSIONS Our results suggest that lung cancer patients have a survival benefit from MDC discussion compared to controls. Patients with advanced disease (stages III and IV) benefited the most. Further research is necessary to understand the precise mechanisms that drive these results.
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Affiliation(s)
- Carmelo Gaudioso
- Department of Biostatistics & Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | | | - Philip E Whalen
- Department of Biostatistics & Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Kristopher M Attwood
- Department of Biostatistics & Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Martin M Masika
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Todd L Demmy
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA; Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, SUNY Buffalo, NY
| | - Elisabeth U Dexter
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA; Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, SUNY Buffalo, NY
| | - Mark W Hennon
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA; Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, SUNY Buffalo, NY
| | - Anthony L Picone
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA; Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, SUNY Buffalo, NY
| | - Saikrishna S Yendamuri
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA; Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, SUNY Buffalo, NY
| | - Chukwumere E Nwogu
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA; Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, SUNY Buffalo, NY.
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Artioli G, Besutti G, Cassetti T, Sereni G, Zizzo M, Bonacini S, Carlinfante G, Panebianco M, Cavazza A, Pinto C, Sassatelli R, Pattacini P, Giorgi Rossi P. Impact of multidisciplinary approach and radiologic review on surgical outcome and overall survival of patients with pancreatic cancer: a retrospective cohort study. TUMORI JOURNAL 2021; 108:147-156. [PMID: 33719770 DOI: 10.1177/0300891621999092] [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] [Indexed: 11/15/2022]
Abstract
AIM To evaluate the impact of multidisciplinary team case discussion including computed tomography (CT) radiologic review on surgical outcome and overall survival (OS) of patients with pancreatic ductal adenocarcinoma (PDAC). METHODS Patients with PDAC evaluated in 2008-2011 and 2013-2016 (before and after multidisciplinary team introduction), aged <85 years and staged I-III, were included. Surgical failures and 2-year OS were compared in these periods. Available CT scans of preintervention period (2008-2011) cases were reviewed by two radiologists in consensus, assigning a resectability judgment to evaluate in how many cases a different recommendation would be achieved. RESULTS A total of 316 patients (49.3% female, age 71±10 years) were included: 132 in 2008-2011 and 184 in 2013-2016. The proportion of patients who underwent upfront surgery was similar in the two periods (51% vs 47% in 2008-2011 vs 2013-2016). Neoadjuvant referral increased from 7% to 21% and surgical resection was excluded for 42% patients in 2008-2011 vs 33% in 2013-2016 (p = 0.002). Adjusting by age, sex, and stage, surgical failures slightly decreased in 2013-2016 (odds ratio 0.89, 95% confidence interval 0.53-1.51); the decrease was stronger when therapeutic choice complied with CT indications (odds ratio 0.76, 95% confidence interval 0.36-1.63); in both cases, the decrease could be due to chance. After correction for age, sex, and stage, the hazard ratio of 2013-2016 for OS was 0.83 (95% confidence interval 0.64-1.09). In 33/114 (29%) patients, CT retrospective review produced a change in resectability judgment. CONCLUSION Although differences could be due to chance or generic improvement, the consistency between process and outcome indicators suggests that multidisciplinary team approach with radiologic review may improve outcomes.
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Affiliation(s)
- Giulia Artioli
- Radiology Unit, Department of Imaging and Laboratory Medicine, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giulia Besutti
- Radiology Unit, Department of Imaging and Laboratory Medicine, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Tiziana Cassetti
- Gastroenterology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giuliana Sereni
- Gastroenterology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Maurizio Zizzo
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy.,Oncological Surgery Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Stefano Bonacini
- Oncological Surgery Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Gabriele Carlinfante
- Pathology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Michele Panebianco
- Oncology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Alberto Cavazza
- Pathology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Carmine Pinto
- Oncology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Romano Sassatelli
- Gastroenterology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Pierpaolo Pattacini
- Radiology Unit, Department of Imaging and Laboratory Medicine, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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30
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van Huizen LS, Dijkstra PU, Hemmer PH, van Etten B, Buis CI, Olsder L, van Vilsteren FG, Ahaus K(CB, Roodenburg JL. Reorganizing the Multidisciplinary Team Meetings in a Tertiary Centre for Gastro-Intestinal Oncology Adds Value to the Internal and Regional Care Pathways. A Mixed Method Evaluation. Int J Integr Care 2021; 21:8. [PMID: 33664641 PMCID: PMC7908930 DOI: 10.5334/ijic.5526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 01/19/2021] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION The reorganisation of the structure of a Gastro-Intestinal Oncology Multidisciplinary Team Meeting (GIO-MDTM) in a tertiary centre with three care pathways is evaluated on added value. METHODS In a mixed method investigation, process indicators such as throughput times were analysed and stakeholders were interviewed regarding benefits and drawbacks of the reorganisation and current MDTM functioning. RESULTS For the hepatobiliary care pathway, the time to treatment plan increased, but the time to start treatment reduced significantly. The percentage of patients treated within the Dutch standard of 63 days increased for the three care pathways. From the interviews, three themes emerged: added value of MDTMs, focus on planning integrated care and awareness of possible improvements. DISCUSSION The importance of evaluating interventions in oncology care pathways is shown, including detecting unexpected drawbacks. The evaluation provides insight into complex dynamics of the care pathways and contributes with recommendations on functioning of an MDTM. CONCLUSIONS Throughput times are only partly determined by oncology care pathway management, but have influence on the functioning of MDTMs. Process indicator information can help to reflect on integration of care in the region, resulting in an increase of patients treated within the Dutch standard.
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Affiliation(s)
- Lidia S. van Huizen
- University of Groningen, University Medical Center Groningen, Department of Oral and Maxillofacial Surgery, Groningen, The Netherlands
- University of Groningen, University Medical Center Groningen, Department of Quality and Patient Safety, Groningen, The Netherlands
- Kerteza, a Worldwide Consultancy and Training Institute for Healthcare Organizations, Kasterlee, Belgium
| | - Pieter U. Dijkstra
- University of Groningen, University Medical Center Groningen, Department of Oral and Maxillofacial Surgery, Groningen, The Netherlands
- University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Groningen, The Netherlands
| | - Patrick H.J. Hemmer
- University of Groningen, University Medical Center Groningen, Department of Surgery, Groningen, The Netherlands
| | - Boudewijn van Etten
- University of Groningen, University Medical Center Groningen, Department of Surgery, Groningen, The Netherlands
| | - Carlijn I. Buis
- University of Groningen, University Medical Center Groningen, Department of Surgery, Groningen, The Netherlands
| | - Linde Olsder
- University of Groningen, University Medical Center Groningen, Department of Surgery, Groningen, The Netherlands
| | - Frederike G.I. van Vilsteren
- University of Groningen, University Medical Center Groningen, Department of Gastroenterology and Hepatology, Groningen, The Netherlands
| | - Kees (C.)T. B. Ahaus
- University of Groningen, University Medical Center Groningen, Department of Quality and Patient Safety, Groningen, The Netherlands
- Erasmus University Rotterdam, Erasmus School of Health Policy & Management, Rotterdam, The Netherlands
| | - Jan L.N. Roodenburg
- University of Groningen, University Medical Center Groningen, Department of Oral and Maxillofacial Surgery, Groningen, The Netherlands
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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: 6] [Impact Index Per Article: 2.0] [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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Sridharan K, Paul E, Stirling RG, Li C. Impacts of multidisciplinary meeting case discussion on palliative care referral and end-of-life care in lung cancer: a retrospective observational study. Intern Med J 2021; 51:1450-1456. [PMID: 33463032 DOI: 10.1111/imj.15215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 12/17/2020] [Accepted: 12/23/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Multidisciplinary meeting (MDM) discussion and early palliative care are recommended in lung cancer management. The literature is unclear whether MDM discussion leads to early palliative care and improved end-of-life care. AIMS To evaluate impacts of discussion at an Australian lung MDM on palliative care referral, and MDM and early palliative care on aggressive end-of-life care. METHODS A retrospective, cross-sectional study was conducted of 352 patients diagnosed with primary lung cancer from 2017 to 2019 at the Alfred Hospital, Melbourne. The primary question was whether MDM discussion influenced palliative care referrals. Secondary questions were whether MDM discussion and early palliative care reduced aggressive treatment (chemotherapy, hospitalisation, emergency department visits, intensive care admission and in-hospital death) during the last 30 days of life. Multivariable logistic regression was used to determine independent association between MDM discussion and palliative care referral. RESULTS MDM discussion did not independently impact palliative care referral. There was reduced likelihood of MDM presentation in patients with metastatic disease (P < 0.0001) and poorer performance status (P = 0.025), and higher likelihood of palliative care referral in these patients (both P < 0.001). MDM discussion reduced end-of-life intensive care unit (ICU) admission in patients with metastatic disease (P = 0.04). A palliative care referral-to-death interval of ≥30 days was associated with reduced hospitalisation at the end of life (P < 0.0001) and hospital deaths (P = 0.001). CONCLUSION Discussion at lung MDM did not increase palliative care referral, but did reduce ICU admission among metastatic patients at the end of life. Longer palliative care referral-to-death interval was associated with reduced aggressive end-of-life care. Further research is needed in these areas.
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Affiliation(s)
- Krita Sridharan
- Department of Palliative Care, Alfred Health, Melbourne, Victoria, Australia
| | - Eldho Paul
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Robert G Stirling
- Department of Respiratory Medicine, Alfred Health, Melbourne, Victoria, Australia.,Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Chi Li
- Department of Palliative Care, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
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Hansen CC, Egleston B, Leachman BK, Churilla TM, DeMora L, Ebersole B, Bauman JR, Liu JC, Ridge JA, Galloway TJ. Patterns of Multidisciplinary Care of Head and Neck Squamous Cell Carcinoma in Medicare Patients. JAMA Otolaryngol Head Neck Surg 2020; 146:1136-1146. [PMID: 33090191 PMCID: PMC7582229 DOI: 10.1001/jamaoto.2020.3496] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Importance Multidisciplinary care (MDC) yields proven benefits for patients with cancer, although it may be underused in the complex management of head and neck squamous cell carcinoma (HNSCC). Objective To characterize the patterns of MDC in the treatment of HNSCC among elderly patients in the US. Design, Setting, and Participants This nationwide, population-based, retrospective cohort study used Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data from January 1, 1991, to December 31, 2011, to identify patients 66 years or older diagnosed with head and neck cancer and determine the dates of diagnosis, oncology consultations, treatment initiation, and speech therapy evaluation in addition to MDC completion. Multidisciplinary care was defined in a stage-dependent manner: localized disease necessitated consultations with radiation and surgical oncologists, and advanced-stage disease also included a medical oncology consultation, all before definitive treatment. Data were analyzed between December 2016 and September 2020. Main Outcomes and Measures Rates of MDC across all subsites of head and neck cancer as measured by the presence of an evaluation for each oncologist on the MDC team and its effect on treatment initiation. Results This cohort study assessed 28 293 patients with HNSCC (mean [SD] age, 75.1 [6.6] years; 67% male; 87% White) from the SEER-Medicare linked database. The HNSCC subsites included larynx (40%), oral cavity (30%), oropharynx (21%), hypopharynx (7%), and nasopharynx (2%). Overall, the practice of MDC significantly increased over time, from 24% in 1991 to 52% in 2011 (P < .001). For patients with localized (stage 0-II) tumors, 60% received care in the multidisciplinary setting, whereas 28% of those with advanced-stage disease did. A total of 18 181 patients (64%) were treated with initial definitive nonsurgical therapy across all stages. Regardless of stage and subsite, few patients (2%) underwent evaluation by a speech-language pathologist before definitive therapy. Multidisciplinary care prolonged the time to initiation of definitive treatment by 11 days for localized disease and 10 days for advanced disease. Conclusions and Relevance This cohort study found that most elderly patients with localized HNSCC received MDC, whereas few patients with advanced-stage disease received such care, although a significant proportion received adjuvant therapy. Multidisciplinary care may prolong time to initiation of definitive treatment with an uncertain impact. Consultation with a speech-language pathologist before definitive therapy was rare.
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Affiliation(s)
- Chase C. Hansen
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Brian Egleston
- Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Brooke K. Leachman
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Thomas M. Churilla
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Lyudmila DeMora
- Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Barbara Ebersole
- Department of Otolaryngology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Jessica R. Bauman
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Jeffrey C. Liu
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - John A. Ridge
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Thomas J. Galloway
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
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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: 14] [Impact Index Per Article: 3.5] [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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Alkasbi J, Mortuaire G, Rysman B, Nicot R, Chevalier D, Mouawad F. Match between therapeutic proposal in multidisciplinary tumor board and actual treatment in head and neck cancer. Eur Ann Otorhinolaryngol Head Neck Dis 2020; 138:247-252. [PMID: 33257266 DOI: 10.1016/j.anorl.2020.11.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES There are few published studies evaluating the quality and outcome of multidisciplinary tumor board (MDTB) decisions. The aim of the present study was to evaluate adherence to MDTB recommendations in head and neck cancer and to document reasons in case of discordance. MATERIAL AND METHODS We included all patients with newly diagnosed head and neck cancer presented in our MDTB meetings between January 1st and December 31st, 2018, whatever the tumor site, histology type and TNM classification. MDTB recommendations were compared to actual treatment. Discordance was defined as treatment partially or entirely different from the treatment decision recorded in the MDTB minutes. RESULTS Board decisions were made for 344 new patients. Complete treatment concordance rate was 91.6% (315/344 patients), with deviation in 29 patients. Reasons for deviation were complications of treatment in 10 cases, patient refusal in 8, and physician's decision in 4 cases. Five patients died before therapy initiation. Mean interval from board discussion to treatment was 21 days, and depended on type of treatment (range, 1 to 74 days). CONCLUSION This study shows the importance of evaluating concordance between the protocol proposed in the MDTB and the treatment actually received, to identify factors for deviation and remedy them when possible.
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Affiliation(s)
- J Alkasbi
- Service d'ORL et de Chirurgie Cervico-Faciale, Hôpital Huriez, CHU de Lille, Université de Lille, rue Michel Polonovski, 59037 Lille cedex, France
| | - G Mortuaire
- Service d'ORL et de Chirurgie Cervico-Faciale, Hôpital Huriez, CHU de Lille, Université de Lille, rue Michel Polonovski, 59037 Lille cedex, France
| | - B Rysman
- Service d'ORL et de Chirurgie Cervico-Faciale, Hôpital Huriez, CHU de Lille, Université de Lille, rue Michel Polonovski, 59037 Lille cedex, France
| | - R Nicot
- Service de Stomatologie et de Chirurgie Maxillo-Faciale, Hôpital Roger Salengro, CHU de Lille, Université de Lille, Rue Michel Polonovski, 59037 Lille cedex, France
| | - D Chevalier
- Service d'ORL et de Chirurgie Cervico-Faciale, Hôpital Huriez, CHU de Lille, Université de Lille, rue Michel Polonovski, 59037 Lille cedex, France
| | - F Mouawad
- Service d'ORL et de Chirurgie Cervico-Faciale, Hôpital Huriez, CHU de Lille, Université de Lille, rue Michel Polonovski, 59037 Lille cedex, France; Inserm U 908, Lille Science and Technology University, UFR de Biologie - SN3, 59655 Villeneuve d'Ascq, France.
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36
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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: 24] [Impact Index Per Article: 6.0] [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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37
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Affiliation(s)
- Emily Stone
- Department of Thoracic Medicine, St Vincent's Hospital Sydney, Kinghorn Cancer Centre, University of Sydney, Sydney, New South Wales, Australia
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38
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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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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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40
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Rankin NM, Fradgley EA, Barnes DJ. Implementation of lung cancer multidisciplinary teams: a review of evidence-practice gaps. Transl Lung Cancer Res 2020; 9:1667-1679. [PMID: 32953540 PMCID: PMC7481625 DOI: 10.21037/tlcr.2019.11.32] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Multidisciplinary care (MDC) is considered best practice in lung cancer care. Health care services have made significant investments in MDC through the establishment of multidisciplinary team (MDT) meetings. This investment is likely to be sustained in future. It is imperative that MDT meetings are efficient, effective, and sufficiently nimble to introduce new innovations to enable best practice. In this article, we consider the ‘evidence-practice gaps’ in the implementation of lung cancer MDC. These gaps were derived from the recurrent limitations outlined in existing studies and reviews. We address the contributions that implementation science and quality improvement can make to bridge these gaps by increasing translation and improving the uptake of innovations by teams.
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Affiliation(s)
- Nicole M Rankin
- Faculty of Medicine and Health Sciences, University of Sydney, Camperdown, New South Wales, Australia
| | - Elizabeth A Fradgley
- University of Newcastle Priority Research Centre for Cancer Research, Innovation and Translation, Callaghan, New South Wales, Australia.,University of Newcastle Priority Research Centre for Health Behaviour, Callaghan, New South Wales, Australia.,School of Medicine & Public Health, University Drive, Callaghan, New South Wales, Australia
| | - David J Barnes
- Faculty of Medicine and Health Sciences, University of Sydney, Camperdown, New South Wales, Australia.,Sydney Local Health District, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
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41
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Stone E, Rankin N, Currow D, Fong KM, Phillips JL, Shaw T. Optimizing lung cancer MDT data for maximum clinical impact-a scoping literature review. Transl Lung Cancer Res 2020; 9:1629-1638. [PMID: 32953537 PMCID: PMC7481624 DOI: 10.21037/tlcr.2020.01.02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Multidisciplinary care in is widely recommended as best practice for lung cancer in many countries and jurisdictions. A number of studies suggest multidisciplinary care benefits patient outcomes, with analyses based on a range of data sources including national, state and local registries as well as multidisciplinary team meeting (MDT)-based data collections, often focused on different questions depending on data sources. MDT data collection and linkage are not standardized and not routine although data collection and feedback are specifically recommended by at least one statutory body. We performed a scoping review of current evidence for lung cancer MDT data collection and analysis, to identify discrete strategies through illustrative examples and to make recommendations for future approaches. Thirteen studies were identified that presented lung cancer MDT-related clinical outcomes, three included MDTs from multiple tumour streams while 10 studies focussed on lung cancer MDT meetings. Eleven studies measured the effect of MDT discussion on clinical outcomes of which eight were positive. Data sources included MDT records (3 studies), medical or hospital records (3 studies), institutional registries (5 studies) and state or national administrative datasets (6 studies), with some overlap. Examples of studies based on different data sources (local MDT, institutional registry, national registry) exemplified the different types of clinical research questions appropriate for each data source. While MDT data collection is not well-defined, the importance of clinical audit and data feedback and the potential for real-time analysis to improve outcomes deserve further investigation. Optimized datasets and linkage strategies are likely to maximize benefits for patients.
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Affiliation(s)
- Emily Stone
- Department of Thoracic Medicine, St Vincent's Hospital Sydney, Kinghorn Cancer Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Nicole Rankin
- Research in Implementation Science and e-Health (RISe), Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - David Currow
- IMPACCT, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Kwun M Fong
- UQ Thoracic Research Centre and The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, QLD, Australia
| | - Jane L Phillips
- IMPACCT, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Tim Shaw
- Director of Research in Implementation Science and eHealth Group (RISe), Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
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Abstract
Lung cancer is the most common cause of cancer mortality globally. A vast majority of lung cancer cases are diagnosed at advanced stages. Management of advanced lung cancer requires several diagnostic and therapeutic procedures provided by various specialists. To optimise the entire diagnostic and therapeutic process, a concept of care provided simultaneously by a multidisciplinary team (MDT) has been developed and implemented in specialised centres worldwide. Observational studies suggest that integrated and coordinated care increases adherence to clinical guidelines, significantly shortens the interval from diagnosis to treatment, and may increase survival and quality of life (QoL). Prospective studies are warranted to assess the real impact of MDT on treatment outcomes and to further refine this approach.
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Affiliation(s)
- Anna Kowalczyk
- Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Jacek Jassem
- Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland
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43
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Vermeulen BD, Bruggeman L, Bac DJ, Schrauwen RWM, Epping LSM, Scheffer RCH, Tan ACITL, Groenen MJM, Verhoeven RHA, Siersema PD. Impact of multidisciplinary tumor board discussion on palliation of patients with esophageal or gastro-esophageal junction cancer: a population-based study. Acta Oncol 2020; 59:410-416. [PMID: 32067535 DOI: 10.1080/0284186x.2020.1725240] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background: The Dutch guidelines for esophageal and gastro-esophageal junction (GEJ) cancer recommend discussion of patients by a multidisciplinary tumor board (MDT). Despite this recommendation, one previous study in the Netherlands suggested that therapeutic guidance was missing for palliative care of patients with esophageal cancer. The aim of the current study was therefore to assess the impact of an MDT discussion on initial palliative treatment and outcome of patients with esophageal or GEJ cancer.Material and methods: The population-based Netherlands Cancer Registry was used to identify patients treated for esophageal or GEJ cancer with palliative intent between 2010 and 2017 in 7 hospitals. We compared patients discussed by the MDT with patients not discussed by the MDT in a multivariate analysis. Primary outcome was type of initial palliative treatment. Secondary outcome was overall survival.Results: A total of 389/948 (41%) patients with esophageal or GEJ cancer were discussed by the MDT before initial palliative treatment. MDT discussion compared to non-MDT discussion was associated with more patients treated with palliative intent external beam radiotherapy (38% vs. 21%, OR 2.7 [95% CI 1.8-3.9]) and systemic therapy (30% vs. 23%, OR 1.6 [95% CI 1.0-2.5]), and fewer patients treated with stent placement (4% vs. 12%, OR 0.3 [95% CI 0.1-0.6]) and best supportive care alone (12% vs. 33%, OR 0.2 [95% CI 0.1-0.3]). MDT discussion was also associated with improved survival (169 days vs. 107 days, HR 1.3 [95% CI 1.1-1.6]).Conclusion: Our study shows that MDT discussion of patients with esophageal or GEJ cancer resulted in more patients treated with initial palliative radiotherapy and chemotherapy compared with patients not discussed by the MDT. Moreover, MDT discussion may have a positive effect on survival, highlighting the importance of MDT meetings at all stages of treatment.
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Affiliation(s)
- Bram D. Vermeulen
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lukas Bruggeman
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dirk J. Bac
- Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede, The Netherlands
| | - Ruud W. M. Schrauwen
- Department of Gastroenterology and Hepatology, Bernhoven Hospital, Uden, The Netherlands
| | - Ludger S. M. Epping
- Department of Gastroenterology and Hepatology, Maasziekenhuis Pantein, Boxmeer, The Netherlands
| | - Robert C. H. Scheffer
- Department of Gastroenterology and Hepatology, Jeroen Bosch Hospital, ‘s-Hertogenbosch, The Netherlands
| | - Adriaan C. I. T. L. Tan
- Department of Gastroenterology and Hepatology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Marcel J. M. Groenen
- Department of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Rob H. A. Verhoeven
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
- Department of Surgery, Radboud university medical center, Nijmegen, The Netherlands
| | - Peter D. Siersema
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
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Devitt B, Philip J, Singh M, McLachlan SA. Understanding Patients' Attitudes Toward Cancer Multidisciplinary Meetings: A Mixed Methods Study. JCO Oncol Pract 2020; 16:e175-e182. [PMID: 32045550 DOI: 10.1200/jop.19.00274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Multidisciplinary cancer meetings (MDMs) are an integral component of quality care; however, little research exists regarding patients' views on this model of care. We aimed to explore and understand the attitudes of patients toward MDMs. METHODS A mixed methods exploratory design was used. Qualitative data from patients with a current or previous diagnosis of cancer were collected and analyzed using a grounded theory approach. Results informed the development of a questionnaire survey that was administered to patients with a current or previous diagnosis of cancer. Results were analyzed using descriptive statistics. RESULTS Nine patients participated in 3 focus groups, and 152 patients (response rate, 90%) completed the questionnaire. Patients were strongly supportive of MDMs and thought that all patients with cancer should be routinely discussed. More than 90% of surveyed patients believed MDMs were reassuring, meant all treatment modalities were considered, and led to evidence-based treatment recommendations. Patients wanted MDMs to focus on medical treatment planning rather than psychosocial issues, and 87% regarded the meeting as confidential. Patients described a preference for doctor-led decision making, and most (84%) wanted MDM treatment decisions to be discussed with them in a subsequent consultation, with 73% of patients also wanting this in a written format. CONCLUSION Patients strongly endorse MDMs as a means to develop an evidence-based, medical treatment plan agreed to by consensus. They want to be purposely informed of the meeting and its outcomes. Results from this study can help inform future guidelines on the conduct of MDMs.
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Affiliation(s)
- Bianca Devitt
- Department of Oncology, Eastern Health, Box Hill, Victoria, Australia.,Eastern Health Clinical School, Monash University, Victoria, Australia
| | - Jennifer Philip
- Department of Medicine, Eastern Hill Clinical School, University of Melbourne, Melbourne, Victoria, Australia.,Palliative Care Service, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Madhu Singh
- Department of Oncology, Barwon Health, Geelong, Victoria, Australia
| | - Sue-Anne McLachlan
- Department of Medicine, Eastern Hill Clinical School, University of Melbourne, Melbourne, Victoria, Australia.,Department of Oncology, St Vincent's Hospital, Melbourne, Victoria, Australia
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Wales KE, Saxena A, Gray TG. Evidence for the urogynaecology multidisciplinary team meeting: evaluation from a secondary care perspective. Int Urogynecol J 2019; 31:1181-1189. [PMID: 31813032 DOI: 10.1007/s00192-019-04154-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/10/2019] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Urogynaecology multidisciplinary team (MDT) meetings to discuss management plans prior to invasive treatments for urinary incontinence have been recommended by guidelines in the UK since 2013. Evidence for MDT discussion in urogynaecology is lacking, with only two published studies. The aim of this study was to evaluate the cases discussed at a secondary care urogynaecology MDT meeting, to establish types of clinical problems discussed, assess the outcomes of the MDT meeting and compare this with existing evidence for MDT meetings in urogynaecology. METHODS A retrospective review of meeting minutes and all case notes for patients discussed at 12 MDT meetings over 13 months was carried out. Data collected included attendance from different staff groups, reasons for referral, outcome of discussions, and changes to management plans. RESULTS A total of 123 cases were discussed over 12 meetings, 7 members of staff attended each meeting on average. 63% of cases were referred for discussion of a primary problem. The majority of patients were referred for discussion of management of urinary incontinence prior to invasive procedures (57%). The agreed MDT plan corresponded with proposed management in 67% of cases, with changes to management plan in 31% of cases. CONCLUSION Refinements to management plans in this study highlight the importance of MDT input in urogynaecology care and mirror the findings of two previous studies. Evidence for improved outcomes and the cost-effectiveness of MDTs is lacking and is an area for future research. Expanded national guidance for urogynaecology MDTs is likely to require local and regional restructuring of these in the UK.
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Affiliation(s)
- Keren E Wales
- Sheffield Teaching Hospitals NHS Foundation Trust, c/o Tricia Kenyon, Level 4, Jessop Wing, Tree Root Walk, Sheffield, S10 2SF, UK.,The Rotherham Foundation NHS Trust, Rotherham, UK
| | | | - Thomas G Gray
- Sheffield Teaching Hospitals NHS Foundation Trust, c/o Tricia Kenyon, Level 4, Jessop Wing, Tree Root Walk, Sheffield, S10 2SF, UK.
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Gambazzi F, Frey LD, Bruehlmeier M, Janthur WD, Heuberger J, Spirig A, Williams R, Zweifel R, Boerner B, Tini GM, Irani S. Image analysis in posttreatment non-small cell lung cancer surveillance: specialists' interpretations reviewed by the thoracic multidisciplinary tumor board. Multidiscip Respir Med 2019; 14:34. [PMID: 31827794 PMCID: PMC6891985 DOI: 10.1186/s40248-019-0198-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 09/23/2019] [Indexed: 11/10/2022] Open
Abstract
Background Data show that the initial specialist’s image interpretation and final multidisciplinary tumor board (MTB) assessment can vary substantially in the pretherapeutic cancer setting. The aim of this post hoc analysis was to investigate the concordance of the specialist’s and MTB’s image interpretations in patients undergoing systematic posttreatment lung cancer image surveillance. Methods In the initial prospective study, lung cancer patients who had received curative-intent treatment were randomly assigned to undergo either contrast-enhanced computed tomography (CE-CT) or integrated 18F-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT). Imaging was performed every 6 months for 2 years, and all imaging studies were finally assessed by our MTB. This post hoc analysis assessed differences between the initial specialist’s image interpretation and the final MTB’s image interpretation. Results In 89 patients, 266 imaging studies (129 PET-CT, 137 CE-CT) were analyzed. In 87.2% (88.4, 86.1%) of the studies, complete concordance was found. Out of the 12.8% (11.6, 13.9%) with discordant results, 7.5% (6.9, 8.0%) had implications for alterations in patient management (major disagreements). Twenty major disagreements were detected in 17 study patients. Retrospectively, in eight out of these 17 (47%) patients, in contrast to the MTB’s view, the specialist’s interpretation was more appropriate, whereas in nine out of 17 patients (53%), the MTB’s interpretation was more accurate. Conclusions In an experienced MTB, the agreement between imaging specialists and the rest of the MTB with regard to the interpretation of images is high in a setting of posttreatment lung cancer image surveillance. It seems that in cases of disagreements, the rates of more accurate interpretation are well balanced between imaging specialists and the MTB. Trial registration ISRCTN16281786, Date 23. February 2017.
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Affiliation(s)
- Franco Gambazzi
- 1Clinic of Thoracic Surgery, Cantonal Hospital Aarau, Tellstrasse, CH-5001 Aarau, Switzerland
| | - Lukas D Frey
- 2Institute of Nuclear Medicine and PET-Center, Cantonal Hospital Aarau, Tellstrasse, CH-5001 Aarau, Switzerland
| | - Matthias Bruehlmeier
- 2Institute of Nuclear Medicine and PET-Center, Cantonal Hospital Aarau, Tellstrasse, CH-5001 Aarau, Switzerland
| | - Wolf-Dieter Janthur
- 3Clinic of Oncology, Cantonal Hospital Aarau, Tellstrasse, CH-5001 Aarau, Switzerland
| | - Juerg Heuberger
- 4Clinic of Radio-Oncology, Cantonal Hospital Aarau, Tellstrasse, CH-5001 Aarau, Switzerland
| | - Andres Spirig
- 5Department of Radiology, Cantonal Hospital Aarau, Tellstrasse, CH-5001 Aarau, Switzerland
| | - Richard Williams
- 5Department of Radiology, Cantonal Hospital Aarau, Tellstrasse, CH-5001 Aarau, Switzerland
| | - Roland Zweifel
- 6Institute of Pathology, Cantonal Hospital Aarau, Tellstrasse, CH-5001 Aarau, Switzerland
| | - Bettina Boerner
- 7Clinic of Pulmonary and Sleep Medicine, Cantonal Hospital Aarau, Tellstrasse, CH-5001 Aarau, Switzerland
| | - Gabrielo M Tini
- 7Clinic of Pulmonary and Sleep Medicine, Cantonal Hospital Aarau, Tellstrasse, CH-5001 Aarau, Switzerland
| | - Sarosh Irani
- 7Clinic of Pulmonary and Sleep Medicine, Cantonal Hospital Aarau, Tellstrasse, CH-5001 Aarau, Switzerland
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Scott R, Hawarden A, Russell B, Edmondson RJ. Decision-Making in Gynaecological Oncology Multidisciplinary Team Meetings: A Cross-Sectional, Observational Study of Ovarian Cancer Cases. Oncol Res Treat 2019; 43:70-77. [PMID: 31743932 DOI: 10.1159/000504260] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 10/16/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Multidisciplinary team (MDT) meetings are widely used across the UK to provide expert decisions and improve cancer outcomes. However, little is known about the underlying mechanisms of MDT decision-making. We investigated how decisions are made regarding the management of advanced ovarian cancer in gynaecological oncology MDT meetings. METHODS A cross-sectional observational study was performed, focussing on 41/ 223 MDT case discussions across six hospitals. The validated MDT-MODe tool was adapted to increase relevance to gynaecological oncology. Case information and contributions from seven disciplines were rated on a five-point Likert scale. Spearman's correlation investigated relationships between factors and an exploratory factor analysis examined the underlying structure of MDT discussion. RESULTS Forty-one MDT decisions were made for patients with FIGO Stage III/IV ovarian cancer. MDT case discussions were structured by four factors: "Clinical Presentation," "Patient Factors," "Chair's Direction" and "Input from Other Specialties." Nurses were often quiet but facilitated discussion of patient factors. Junior doctors were not involved in MDT decision-making. CONCLUSIONS The decision-making process in MDT meetings is driven by four underlying factors, the most significant of which represents patient history, tumour markers, images and radiologist input. Patient factors were underrepresented, and nurses should be empowered to overcome this.
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Affiliation(s)
- Rebecca Scott
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St Mary's Hospital, Manchester, United Kingdom
| | - Amy Hawarden
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St Mary's Hospital, Manchester, United Kingdom
- Department of Obstetrics and Gynaecology, Manchester Academic Health Science Centre, St Mary's Hospital, Central Manchester NHS Foundation Trust, Manchester, United Kingdom
| | - Bryn Russell
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St Mary's Hospital, Manchester, United Kingdom
| | - Richard J Edmondson
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St Mary's Hospital, Manchester, United Kingdom,
- Department of Obstetrics and Gynaecology, Manchester Academic Health Science Centre, St Mary's Hospital, Central Manchester NHS Foundation Trust, Manchester, United Kingdom,
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Stone E, Rankin NM, Vinod SK, Nagarajah M, Donnelly C, Currow DC, Fong KM, Phillips JL, Shaw T. Clinical impact of data feedback at lung cancer multidisciplinary team meetings: A mixed methods study. Asia Pac J Clin Oncol 2019; 16:45-55. [PMID: 31721458 DOI: 10.1111/ajco.13278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 10/04/2019] [Indexed: 12/24/2022]
Abstract
AIM Multidisciplinary team (MDT) meetings can facilitate optimal lung cancer care, yet details of structured data collection and feedback remain sparse. This study aimed to investigate data collection and the impact of feedback to lung cancer MDTs. METHODS A mixed-methods study using pre and post-test surveys, semistructured interviews, and observation to evaluate data collection and response to modeled data feedback in three Australian lung cancer MDTs at different locations and development stage (site A: outer metropolitan, established; site B, outer metropolitan, new; and site C, inner metropolitan, established). RESULTS MDT attendees (range 13-25) discussed 5-8 cases per meeting. All sites collected data prospectively (80% prepopulated) into local oncology medical information systems. The pretest survey had 17 respondents in total (88% clinicians). At sites A and C, 100% of respondents noted regular data audits, occasional at site B. Regular audit data included number of cases, stage, final diagnosis, and time to diagnosis and treatment. The post-test survey had 25 respondents in total, all clinicians. The majority (88-96%) of respondents found modeled data easy to interpret, relevant to clinical practice and the MDT, and welcomed future regular data presentations (as rated on a 5-point Likert scale mean weighted average 4.5 where > 4 demonstrates agreement). Semistructured interviews identified five major themes for MDTs: current practice, attitudes, enablers, barriers, and benefits for the MDT. CONCLUSIONS MDT teams exhibited positive responses to modeled data feedback. Key characteristics of MDT data were identified and may assist with future team research and development.
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Affiliation(s)
- Emily Stone
- Department of Thoracic Medicine, St Vincent's Hospital Sydney, Kinghorn Cancer Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Nicole M Rankin
- Research in Implementation Science and e-Health (RISe), Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Shalini K Vinod
- Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW South Western Sydney Clinical School, UNSW, Sydney, New South Wales, Australia
| | - Mohan Nagarajah
- Department of Respiratory and Sleep Medicine, Blacktown Hospital, Western Sydney University, Sydney, New South Wales, Australia
| | - Candice Donnelly
- Research in Implementation Science and e-Health (RISe), Faculty of Health Sciences, Charles Perkins Centre, University of Sydney and Sydney West Translational Cancer Research Centre, Sydney, New South Wales, Australia
| | - David C Currow
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Kwun M Fong
- University of Queensland Thoracic Research Centre and The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Jane L Phillips
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Tim Shaw
- Director of Research in Implementation Science and e-Health (RISe), Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
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van Huizen LS, Dijkstra P, Halmos GB, van den Hoek JGM, van der Laan KT, Wijers OB, Ahaus K, de Visscher JGAM, Roodenburg J. Does multidisciplinary videoconferencing between a head-and-neck cancer centre and its partner hospital add value to their patient care and decision-making? A mixed-method evaluation. BMJ Open 2019; 9:e028609. [PMID: 31699717 PMCID: PMC6858233 DOI: 10.1136/bmjopen-2018-028609] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 07/26/2019] [Accepted: 10/11/2019] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Given the difficulties in diagnosing and treating head-and-neck cancer, care is centralised in the Netherlands in eight head-and-neck cancer centres and six satellite regional hospitals as preferred partners. A requirement is that all patients of the partner should be discussed in a multidisciplinary team meeting (MDT) with the head-and-neck centre as part of a Dutch health policy rule. In this mixed-method study, we evaluate the value that the video-conferenced MDT adds to the MDTs in the care pathway, quantitative regarding recommendations given and qualitative in terms of benefits for the teams and the patient. DESIGN A sequential mixed-method study. SETTING One oncology centre and its partner in the Northern part of the Netherlands. PARTICIPANTS Head-and-neck cancer specialists presenting patient cases during video-conferenced MDT over a period of 6 months. Semistructured interviews held with six medical specialists, three from the centre and three from the partner. PRIMARY AND SECONDARY OUTCOME MEASURES Percentage of cases in which recommendations were given on diagnostic and/or therapeutic plans during video-conferenced MDT. RESULTS In eight of the 336 patient cases presented (2%), specialists offered recommendations to the collaborating team (three given from centre to partner and five from partner to centre). Recommendations mainly consisted of alternative diagnostic modalities or treatment plans for a specific patient. Interviews revealed that specialists perceive added value in discussing complex cases because the other team offered a fresh perspective by hearing the case 'as new'. The teams recognise the importance of keeping their medical viewpoints aligned, but the requirement (that the partner should discuss all patients) was seen as outdated. CONCLUSIONS The added value of the video-conferenced MDT is small considering patient care, but the specialists recognised that it is important to keep their medical viewpoints aligned and that their patients benefit from the discussions on complex cases.
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Affiliation(s)
- Lidia S van Huizen
- Quality and Patient Safety, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Pieter Dijkstra
- Centre for Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gyorgy B Halmos
- Ear, Nose and Throat, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Johanna G M van den Hoek
- Radiotherapy, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Oda B Wijers
- Radiotherapeutic Institute Friesland, Leeuwarden, The Netherlands
| | - Kees Ahaus
- Erasmus School of Health Policy & Management, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
| | - Jan G A M de Visscher
- Oral and Maxillofacial Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
- Oral and Maxillofacial Surgery/Oral Pathology, Free University Medical Center, Amsterdam, The Netherlands
| | - Jan Roodenburg
- Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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50
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Walraven J, Desar I, Hoeven van der J, Aben K, Hillegersberg van R, Rasch C, Lemmens V, Verhoeven R. Analysis of 105.000 patients with cancer: have they been discussed in oncologic multidisciplinary team meetings? A nationwide population-based study in the Netherlands. Eur J Cancer 2019; 121:85-93. [DOI: 10.1016/j.ejca.2019.08.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/14/2019] [Accepted: 08/14/2019] [Indexed: 12/24/2022]
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