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Lacaud M, Leclerc A, Marguet F, Faisant M, Lesueur P, El Ouazzani H, Di Fiore F, Hanzen C, Emery E, Langlois O, Fontanilles M. Impact of Covid-19 pandemic on neuro-oncology multidisciplinary tumor board in the pre-vaccine era: the Normandy experience. Neurochirurgie 2023; 69:101429. [PMID: 36870566 PMCID: PMC9979624 DOI: 10.1016/j.neuchi.2023.101429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 02/21/2023] [Accepted: 02/25/2023] [Indexed: 03/06/2023]
Abstract
INTRODUCTION The COVID19 pandemic had a strong impact on the healthcare system, particularly in oncology. Brain tumor are usually revealed by acute and life threatening symptoms. We wanted to evaluate the possible consequences of the COVID19 pandemic in 2020 on the activity of neuro-oncology multidisciplinary tumor board in a Normandy region (France). METHODS A descriptive, retrospective, multicenter study was conducted in the four referent centers (two universitary hospitals and two cancer centers). The main objective was to compare the average number of neuro-oncology patients presented per multidisciplinary tumor board per week between a pre-COVID19 reference period (period 1 from December 2018 to December 2019) and the pre-vaccination period (period 2 from December 2019 to November 2020). RESULTS Across Normandy, 1540 cases were presented in neuro-oncology multidisciplinary tumor board in 2019 and 2020. No difference was observed between period 1 and 2: respectively 9.8 per week versus 10.7, P=0.36. The number of cases per week also did not significantly differ during the lockdown periods: 9.1/week versus 10.4 during the non-lockdown periods, P=0.26. The only difference observed was a higher proportion of tumor resection during the lockdown periods: 81.4% (n=79/174) versus 64.5% (n=408/1366), P=0.001. CONCLUSION The pre-vaccination era of the COVID19 pandemic did not impact the activity of neuro-oncology multidisciplinary tumor board in the Normandy region. The possible consequences in terms of public health (excess mortality) due to this tumor location should now be investigated.
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Affiliation(s)
- M Lacaud
- Le Havre Hospital, Unit of Medical Oncology and Hematology, Le Havre, France; Rouen University Hospital, Department of Urology, Rouen, France
| | - A Leclerc
- Caen University Hospital, Department of Neurosurgery, Caen, France
| | - F Marguet
- Univ Rouen Normandie, Inserm U1245 Brain And Cancer Genomics, Department of Pathology, CHU de Rouen, 76000 Rouen, France
| | - M Faisant
- Caen University Hospital, Department of Pathology, Caen, France
| | - P Lesueur
- Cancer Centre François-Baclesse, Radiation Oncology Department, Caen, France; Centre Guillaume le Conquérant, Radiation Oncology Department, Le Havre, France; ISTCT UMR6030-CNRS, CEA, Université de Caen-Normandie, Équipe CERVOxy, Caen, France
| | - H El Ouazzani
- Le Havre Hospital, Clinical Research Unit, Le Havre, France
| | - F Di Fiore
- Rouen University Hospital, Department of Hepatogastroenterology, Rouen, France; Univ Rouen Normandie, Inserm U1245 Brain And Cancer Genomics, Normandy Centre for Genomic and Personalized Medicine, IRON group, 76000 Rouen, France
| | - C Hanzen
- Cancer Centre Henri-Becquerel, Radiotherapy Department, Rouen, France
| | - E Emery
- Caen University Hospital, Department of Neurosurgery, Caen, France
| | - O Langlois
- Rouen University Hospital, Department of Neurosurgery, Rouen, France
| | - M Fontanilles
- Le Havre Hospital, Unit of Medical Oncology and Hematology, Le Havre, France; Univ Rouen Normandie, Inserm U1245 Brain And Cancer Genomics, Normandy Centre for Genomic and Personalized Medicine, IRON group, 76000 Rouen, France; Cancer Centre Henri-Becquerel, Department of Medical Oncology, Rouen, France.
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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: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [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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Gosset M, Gal J, Schiappa R, Dejode M, Fouché Y, Alazet F, Roux E, Delpech Y, Barranger E. [Impact of COVID-19 pandemic on breast and gynecologic cancers management. Experience of the Surgery Department in the Nice Anticancer Center]. Bull Cancer 2020; 108:3-11. [PMID: 33358012 PMCID: PMC7690308 DOI: 10.1016/j.bulcan.2020.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/28/2020] [Accepted: 10/02/2020] [Indexed: 12/15/2022]
Abstract
Introduction Durant la pandémie de COVID-19, les mesures de confinement et les recommandations des sociétés savantes de cancérologie ont pu impacter le recours aux soins des patients. Méthodes Cette étude rétrospective unicentrique comparaît le nombre et les caractéristiques des patientes reçues pour une première consultation pour une tumeur du sein ou gynécologique entre la période du confinement et une période contrôle, ainsi que les délais de prise en charge et les traitements proposés. Résultats Durant le confinement, 91 patientes ont été vues pour une demande de prise en charge, contre 159 durant la période contrôle, soit une baisse de 43,5 %. Les patientes étaient plus âgées (62,9 contre 60,9 ans), sans que cette différence soit significative (p = 0,339). Le stade tumoral n’était pas modifié. En sénologie, le délai entre la biopsie et la première consultation a été allongé de 5,5 jours (différence non significative). Parmi les 51 patientes ayant une indication opératoire durant le confinement, 16 (31,4 %) ont été reportées après la levée du confinement. Malgré tout, le délai entre la consultation et le début des traitements n’a pas été impacté. Nous n’avons pas non plus mis en évidence de modification statistiquement significative des pratiques. Discussion Au plus fort de la pandémie, les bénéfices et les risques du traitement du cancer ont dû être évalués en permanence, face au risque d’exposition au SARS-CoV-2. L’évaluation des pratiques en oncologie est essentielle pour comprendre le réel impact de cette pandémie, et se préparer à d’éventuelles crises futures.
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Affiliation(s)
- Marie Gosset
- Université Côte d'Azur, centre Antoine-Lacassagne, département de chirurgie sénologique et onco-gynécologique, 33, avenue de Valombrose, 06189 Nice cedex, France.
| | - Jocelyn Gal
- Université Côte d'Azur, centre Antoine-Lacassagne, département d'épidémiologie, de biostatistiques et des données de santé (DEBDS), 33, avenue de Valombrose, 06189 Nice cedex, France
| | - Renaud Schiappa
- Université Côte d'Azur, centre Antoine-Lacassagne, département d'épidémiologie, de biostatistiques et des données de santé (DEBDS), 33, avenue de Valombrose, 06189 Nice cedex, France
| | - Magali Dejode
- Université Côte d'Azur, centre Antoine-Lacassagne, département de chirurgie sénologique et onco-gynécologique, 33, avenue de Valombrose, 06189 Nice cedex, France
| | - Yves Fouché
- Université Côte d'Azur, centre Antoine-Lacassagne, département de chirurgie sénologique et onco-gynécologique, 33, avenue de Valombrose, 06189 Nice cedex, France
| | - Fanny Alazet
- Université Côte d'Azur, centre Antoine-Lacassagne, département de chirurgie sénologique et onco-gynécologique, 33, avenue de Valombrose, 06189 Nice cedex, France
| | - Emilie Roux
- Université Côte d'Azur, centre Antoine-Lacassagne, département de chirurgie sénologique et onco-gynécologique, 33, avenue de Valombrose, 06189 Nice cedex, France
| | - Yann Delpech
- Université Côte d'Azur, centre Antoine-Lacassagne, département de chirurgie sénologique et onco-gynécologique, 33, avenue de Valombrose, 06189 Nice cedex, France
| | - Emmanuel Barranger
- Université Côte d'Azur, centre Antoine-Lacassagne, département de chirurgie sénologique et onco-gynécologique, 33, avenue de Valombrose, 06189 Nice cedex, France
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Tuech JJ, Gangloff A, Di Fiore F, Benyoucef A, Michel P, Schwarz L. The Day after Tomorrow: How Should We Address Health System Organization to Treat Cancer Patients after the Peak of the COVID-19 Epidemic? Oncology 2020; 98:827-835. [PMID: 32683373 PMCID: PMC7445382 DOI: 10.1159/000509650] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/23/2020] [Indexed: 12/28/2022]
Abstract
On March 11, 2020, the WHO director general declared COVID-19 a pandemic. This pandemic evolves in successive phases, i.e., phase 1 (the start phase), phase 2 (“the storm”), and phase 3 (the recession). To date, oncology and surgery groups have only given instructions for addressing phases 1 and 2. To prevent excess cancer mortality, health care systems (HCS) need to be restructured. Our aim is to detail the specificities of each epidemic phase and discuss several methods of organization to optimize cancer patient flow during the COVID-19 pandemic, particularly during phase 3. Hospitals must be reorganized in order to create a cancer hub that is free of infection, allowing for the safe treatment of patients. Hospital structures are different, but all allow for the creation of virus-free areas. Screening programs are critical and need to be applied to all people entering the virus-free zone, including health care workers. Some reorganization proposals are internal to a hospital, while others require interhospital collaboration. The heterogeneity and complexity of HCS will make interhospital management difficult. The ministry of health has an important role in managing the cancer crisis. Cancer management should be declared a priority. Oncological and surgical societies must coordinate their efforts to facilitate this prioritization. The anticipation of oncological management during phase 3 of the pandemic is necessary because it requires a complete readjustment of HCS. This adaptation should allow for the continuation of cancer care to prevent excess cancer mortality, as the virus will still be present for a currently undetermined period of time.
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Affiliation(s)
- Jean-Jacques Tuech
- Department of Digestive Surgery, Rouen University Hospital, Rouen, France, .,UNIROUEN, UMR 1245 INSERM, Rouen University Hospital, Department of Genomic and Personalized Medicine in Cancer and Neurological Disorders, Normandie University, Rouen, France,
| | - Alice Gangloff
- Department of Digestive Oncology, Rouen University Hospital, Rouen, France
| | - Frederic Di Fiore
- UNIROUEN, UMR 1245 INSERM, Rouen University Hospital, Department of Genomic and Personalized Medicine in Cancer and Neurological Disorders, Normandie University, Rouen, France.,Department of Digestive Oncology, Rouen University Hospital, Rouen, France
| | - Ahmed Benyoucef
- Radiotherapy Department, Centre de Lutte Contre le Cancer Henri-Bequerel, Rouen, France
| | - Pierre Michel
- UNIROUEN, UMR 1245 INSERM, Rouen University Hospital, Department of Genomic and Personalized Medicine in Cancer and Neurological Disorders, Normandie University, Rouen, France.,Department of Digestive Oncology, Rouen University Hospital, Rouen, France
| | - Lilian Schwarz
- Department of Digestive Surgery, Rouen University Hospital, Rouen, France.,UNIROUEN, UMR 1245 INSERM, Rouen University Hospital, Department of Genomic and Personalized Medicine in Cancer and Neurological Disorders, Normandie University, Rouen, France
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