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El-Shabrawi K, Burkhardt V, Becker C. Impact of a Multidisciplinary Head and Neck Tumor Board on Treatment and Survival in Laryngeal Carcinoma. Curr Oncol 2023; 30:10085-10099. [PMID: 38132367 PMCID: PMC10742396 DOI: 10.3390/curroncol30120733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/14/2023] [Accepted: 11/22/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Pretherapeutic discussion in the head and neck tumor board (HNT) has been mandatory at the University Medical Center Freiburg since 01/2015, and it is intended to contribute to a survival benefit through interdisciplinary decision making. Prior to 2015, an optional HNT existed in which mainly advanced tumor stages were discussed. The aim of this study was to determine the effect of a pretherapeutic HNT on treatment and survival in laryngeal cancer. METHODS A retrospective data analysis of 412 laryngeal carcinoma patients treated at the Head and Neck Cancer Center of the University Medical Center Freiburg between 01/2010 and 12/2020 was conducted. Differences regarding TNM status, UICC classification, tumor localization, gender and age at initial diagnosis, recurrence, secondary tumors, therapy, 5-year survival, and 5-year recurrence-free survival (5YSR/5Y-RFS) were assessed for therapy initiation with or without a pretherapeutic HNT. RESULTS In total, 314 patients underwent a pretherapeutic HNT, and 98 received therapy initiation without an HNT. The HNT group showed significantly more advanced T stages and UICC classifications (p < 0.001; p = 0.003) and more frequent primary chemo/radiotherapy (p < 0.001). There was no significant difference regarding 5YSR (43 vs. 47 months, p = 0.96) or 5Y-RFS (48 vs. 52 months, p = 0.16). The time between initial diagnosis and therapy initiation was significantly longer when an HNT was performed (38 vs. 20 days, p = 0.008). CONCLUSIONS The HNT group showed significantly more advanced tumor stages, suggesting that even before it became mandatory, it was frequently used for interdisciplinary case discussion in more complex cases. Due to the small number of T3/4 patients in the non-HNT group, a survival advantage of an HNT cannot be validly demonstrated in our study. However, the HNT led to broader patient counselling regarding their therapy options. At the same time, a significant delay in therapy initiation could be seen, suggesting that workflows between diagnosis, HNT presentation, and therapy initiation should be optimized.
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Affiliation(s)
- Katharina El-Shabrawi
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Medical Centre, University of Freiburg, 79106 Freiburg, Germany
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Joneborg U, Bergamini A, Wallin E, Mangili G, Solheim O, Marquina G, Casado A, Rokkones E, Coulter J, Lok CAR, van Trommel N, Amant F, Bolze PA, Sehouli J, Han S, Kridelka F, Goffin F, Pautier P, Ray-Coquard I, Seckl M. European multidisciplinary tumor boards support cross-border networking and increase treatment options for patients with rare gynecological tumors. Int J Gynecol Cancer 2023; 33:1621-1626. [PMID: 37783481 PMCID: PMC10579460 DOI: 10.1136/ijgc-2023-004599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/24/2023] [Indexed: 10/04/2023] Open
Abstract
OBJECTIVE To evaluate outcomes of European cross-border multidisciplinary tumor boards in terms of participation, adherence to treatment recommendations, and access to novel treatment strategies. METHODS The European reference network for rare gynecological tumors (EURACAN G2 domain) aims to improve the diagnosis, management, and treatment of patients with these cancers. Cross-border multidisciplinary tumor boards were initiated to facilitate intercollegiate clinical discussions across Europe and increase patients' access to specialist treatment recommendations and clinical trials. All G2 healthcare providers were invited to participate in monthly multidisciplinary meetings. Patient data were collected using a standardized form and case summaries were distributed before each meeting. After each tumor board, a meeting summary with treatment recommendations was sent to all participants and the project manager at the coordinating center. The multidisciplinary tumor board format and outcomes were regularly discussed at G2 domain meetings. Anonymized clinical data and treatment recommendations were registered in a prospective database. For this report, clinical data were collected between November 2017 and December 2020 and follow-up data retrieved until May 2021. RESULTS During the 3-year period, 31 multidisciplinary tumor boards were held with participants from 10 countries and 20 centers. 91 individual patients were discussed between one and six times for a total of 109 case discussions. Follow-up data were retrieved from 64 patients and 80 case discussions. Adherence to treatment recommendations was 99%. Multidisciplinary tumor board recommendations resulted in 11 patients getting access to off-label treatment and one patient being enrolled in a clinical trial in another European country. 14/91 patients were recommended for surveillance only when additional treatment had been considered locally. CONCLUSION Cross-border multidisciplinary tumor boards enable networking and clinical collaboration between healthcare professionals in different countries. Surveillance strategies, off-label drug use, and increased participation in clinical trials are possible benefits to patients with rare gynecological tumors.
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Affiliation(s)
- Ulrika Joneborg
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Alice Bergamini
- San Raffaele Hospital Department of Obstetrics and Gynaecology, Milano, Italy
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milano, Italy
| | - Emelie Wallin
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Giorgia Mangili
- San Raffaele Hospital Department of Obstetrics and Gynaecology, Milano, Italy
| | - Olesya Solheim
- Department of Gynecological Oncology, Oslo University Hospital, Oslo, Norway
| | - Gloria Marquina
- Department of Medical Oncology, Hospital Clinico San Carlos, Madrid, Spain
- Department of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Antonio Casado
- Department of Medicine, Complutense University of Madrid, Madrid, Spain
- Department of Medical Oncology, Hospital Clínico San Carlos, Madrid, Spain
| | - Erik Rokkones
- Department of Gynecological Oncology, Oslo University Hospital, Oslo, Norway
| | - John Coulter
- Department of Gynaecological Oncology, Cork University Hospital, Cork, Ireland
| | - Christianne A R Lok
- Department of Gynecologic Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Nienke van Trommel
- Department of Gynecologic Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Frédéric Amant
- Division of Gynecologic Oncology, KU Leuven University Hospitals Leuven, Leuven, Belgium
- Division of Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Pierre-Adrien Bolze
- Hospices Civils de Lyon, Universite Lyon 1 Faculte de Medecine et de Maieutique Lyon-Sud Charles Merieux, Lyon, France
- Department of Gynecological and Oncological Surgery and Obstetrics, Hospital Lyon-South, Lyon, France
| | - Jalid Sehouli
- Department of Gynecology with Center of Oncological Surgery, Charite Medical Faculty Berlin, Berlin, Germany
| | - Sileny Han
- Division of Gynecologic Oncology, KU Leuven University Hospitals Leuven, Leuven, Belgium
| | - Frédéric Kridelka
- Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, Central University Hospital of Liege, Liege, Belgium
| | - Frederic Goffin
- Department of Obstetrics and gynecology, Central University Hospital of Liege, Liege, Belgium
| | - Patricia Pautier
- Gustave Roussy Institute, Villejuif, France
- Paris-Saclay University, Villejuif, France
| | - Isabelle Ray-Coquard
- Centre Leon Berard, Lyon, France
- Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Michael Seckl
- Department of Medical Oncology, Imperial College London - Charing Cross Campus, London, UK
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Agarwal P, Bloom J, Zhou Y, Zhao R, Huang S, Yajima M, Devaiah AK. Socioeconomic disparities in treatment and survival in patients with hypopharyngeal malignancy. Head Neck 2023; 45:2670-2679. [PMID: 37638612 DOI: 10.1002/hed.27492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/26/2023] [Accepted: 08/14/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND This retrospective study utilizes The Surveillance, Epidemiology, and End Results database to investigate socioeconomic factors leading to treatment disparities in hypopharyngeal malignancy. METHODS Treatment was compared to National Cancer Care Network guidelines. Novel analyses, including logistic modeling, allowed survival analysis and identification of socioeconomic variables not previously considered in staging and management guidelines. RESULTS Black and older patients, and residence in low-income areas predict lower likelihood of standard therapy (p < 0.05). Early-stage disease and standard therapy correlate with improved survival (p < 0.001). Medicaid, advanced age, advanced disease, and treatment outside of consensus guidelines correlated with lower survival (p < 0.0001). CONCLUSIONS There are clear socioeconomic factors impacting treatment and survival in hypopharyngeal malignancies. Standard therapy affords superior survival rate. Black, low socioeconomic status, and older patients are less likely to receive standard therapy. Education and language isolation do not predict treatment or survival. Understanding these discrepancies is paramount to palliating disparities in healthcare.
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Affiliation(s)
- Pratima Agarwal
- Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jacob Bloom
- Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
- Boston University School of Medicine, Boston, Massachusetts, USA
| | | | - Runqi Zhao
- Boston University, Boston, Massachusetts, USA
| | - Simu Huang
- Boston University, Boston, Massachusetts, USA
| | | | - Anand K Devaiah
- Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
- Boston University School of Medicine, Boston, Massachusetts, USA
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Ajlan A, Basindwah S, Al Abdulsalam H, Alhothali W, Hussain S, Hassan H, Alomair A, Abdel Warith A, Ibrahim A, Albadr F, Alkhalidi H, Alsaeed E, Orz Y, Alobaid A, Bafaqeeh M, Shaffi Ahamed S, Altewaijri I, Al-habib A, Elwatidy S. Multidisciplinary tumor board behavior consistency in the management of glioblastoma: A multi-center study. Interdisciplinary Neurosurgery 2022; 29:101582. [DOI: 10.1016/j.inat.2022.101582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Vetrugno G, De-Giorgio F, Pascali VL, Oliva A. Border areas in head and neck pathologies: professional liability in the multidisciplinary approach. ACTA ACUST UNITED AC 2021; 41:S166-S172. [PMID: 34060532 PMCID: PMC8172098 DOI: 10.14639/0392-100x-suppl.1-41-2021-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 02/08/2021] [Indexed: 11/23/2022]
Affiliation(s)
- Giuseppe Vetrugno
- Risk Management Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.,Department of Security and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Fabio De-Giorgio
- Department of Security and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy.,Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Vincenzo L Pascali
- Department of Security and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy.,Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Antonio Oliva
- Department of Security and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy.,Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
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