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Kuan EC, Wang EW, Adappa ND, Beswick DM, London NR, Su SY, Wang MB, Abuzeid WM, Alexiev B, Alt JA, Antognoni P, Alonso-Basanta M, Batra PS, Bhayani M, Bell D, Bernal-Sprekelsen M, Betz CS, Blay JY, Bleier BS, Bonilla-Velez J, Callejas C, Carrau RL, Casiano RR, Castelnuovo P, Chandra RK, Chatzinakis V, Chen SB, Chiu AG, Choby G, Chowdhury NI, Citardi MJ, Cohen MA, Dagan R, Dalfino G, Dallan I, Dassi CS, de Almeida J, Dei Tos AP, DelGaudio JM, Ebert CS, El-Sayed IH, Eloy JA, Evans JJ, Fang CH, Farrell NF, Ferrari M, Fischbein N, Folbe A, Fokkens WJ, Fox MG, Lund VJ, Gallia GL, Gardner PA, Geltzeiler M, Georgalas C, Getz AE, Govindaraj S, Gray ST, Grayson JW, Gross BA, Grube JG, Guo R, Ha PK, Halderman AA, Hanna EY, Harvey RJ, Hernandez SC, Holtzman AL, Hopkins C, Huang Z, Huang Z, Humphreys IM, Hwang PH, Iloreta AM, Ishii M, Ivan ME, Jafari A, Kennedy DW, Khan M, Kimple AJ, Kingdom TT, Knisely A, Kuo YJ, Lal D, Lamarre ED, Lan MY, Le H, Lechner M, Lee NY, Lee JK, Lee VH, Levine CG, Lin JC, Lin DT, Lobo BC, Locke T, Luong AU, Magliocca KR, Markovic SN, Matnjani G, McKean EL, Meço C, Mendenhall WM, Michel L, Na'ara S, Nicolai P, Nuss DW, Nyquist GG, Oakley GM, Omura K, Orlandi RR, Otori N, Papagiannopoulos P, Patel ZM, Pfister DG, Phan J, Psaltis AJ, Rabinowitz MR, Ramanathan M, Rimmer R, Rosen MR, Sanusi O, Sargi ZB, Schafhausen P, Schlosser RJ, Sedaghat AR, Senior BA, Shrivastava R, Sindwani R, Smith TL, Smith KA, Snyderman CH, Solares CA, Sreenath SB, Stamm A, Stölzel K, Sumer B, Surda P, Tajudeen BA, Thompson LDR, Thorp BD, Tong CCL, Tsang RK, Turner JH, Turri-Zanoni M, Udager AM, van Zele T, VanKoevering K, Welch KC, Wise SK, Witterick IJ, Won TB, Wong SN, Woodworth BA, Wormald PJ, Yao WC, Yeh CF, Zhou B, Palmer JN. International Consensus Statement on Allergy and Rhinology: Sinonasal Tumors. Int Forum Allergy Rhinol 2024; 14:149-608. [PMID: 37658764 DOI: 10.1002/alr.23262] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 08/21/2023] [Accepted: 08/24/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Sinonasal neoplasms, whether benign and malignant, pose a significant challenge to clinicians and represent a model area for multidisciplinary collaboration in order to optimize patient care. The International Consensus Statement on Allergy and Rhinology: Sinonasal Tumors (ICSNT) aims to summarize the best available evidence and presents 48 thematic and histopathology-based topics spanning the field. METHODS In accordance with prior International Consensus Statement on Allergy and Rhinology documents, ICSNT assigned each topic as an Evidence-Based Review with Recommendations, Evidence-Based Review, and Literature Review based on the level of evidence. An international group of multidisciplinary author teams were assembled for the topic reviews using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses format, and completed sections underwent a thorough and iterative consensus-building process. The final document underwent rigorous synthesis and review prior to publication. RESULTS The ICSNT document consists of four major sections: general principles, benign neoplasms and lesions, malignant neoplasms, and quality of life and surveillance. It covers 48 conceptual and/or histopathology-based topics relevant to sinonasal neoplasms and masses. Topics with a high level of evidence provided specific recommendations, while other areas summarized the current state of evidence. A final section highlights research opportunities and future directions, contributing to advancing knowledge and community intervention. CONCLUSION As an embodiment of the multidisciplinary and collaborative model of care in sinonasal neoplasms and masses, ICSNT was designed as a comprehensive, international, and multidisciplinary collaborative endeavor. Its primary objective is to summarize the existing evidence in the field of sinonasal neoplasms and masses.
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Affiliation(s)
- Edward C Kuan
- Departments of Otolaryngology-Head and Neck Surgery and Neurological Surgery, University of California, Irvine, Orange, California, USA
| | - Eric W Wang
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Nithin D Adappa
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daniel M Beswick
- Department of Otolaryngology-Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Nyall R London
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Sinonasal and Skull Base Tumor Program, Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Shirley Y Su
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Marilene B Wang
- Department of Otolaryngology-Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Waleed M Abuzeid
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Borislav Alexiev
- Department of Pathology, Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Jeremiah A Alt
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Paolo Antognoni
- Division of Radiation Oncology, University of Insubria, ASST Sette Laghi Hospital, Varese, Italy
| | - Michelle Alonso-Basanta
- Department of Radiation Oncology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Pete S Batra
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Mihir Bhayani
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Diana Bell
- Department of Pathology, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Manuel Bernal-Sprekelsen
- Otorhinolaryngology Department, Surgery and Medical-Surgical Specialties Department, Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Christian S Betz
- Department of Otorhinolaryngology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jean-Yves Blay
- Department of Medical Oncology, Centre Léon Bérard, UNICANCER, Université Claude Bernard Lyon I, Lyon, France
| | - Benjamin S Bleier
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Juliana Bonilla-Velez
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Claudio Callejas
- Department of Otolaryngology, Pontificia Universidad Católica de Chile, Santiago, Chile
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Ricardo L Carrau
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Roy R Casiano
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Paolo Castelnuovo
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi Hospital, Varese, Italy
| | - Rakesh K Chandra
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Simon B Chen
- Department of Pathology, Stanford University, Stanford, California, USA
| | - Alexander G Chiu
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Garret Choby
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Naweed I Chowdhury
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Martin J Citardi
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Marc A Cohen
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Roi Dagan
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Gianluca Dalfino
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi Hospital, Varese, Italy
| | - Iacopo Dallan
- Department of Otolaryngology-Head and Neck Surgery, Pisa University Hospital, Pisa, Italy
| | | | - John de Almeida
- Department of Otolaryngology-Head and Neck Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Angelo P Dei Tos
- Section of Pathology, Department of Medicine, University of Padua, Padua, Italy
| | - John M DelGaudio
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Charles S Ebert
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ivan H El-Sayed
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - James J Evans
- Department of Neurological Surgery and Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Christina H Fang
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, New York, USA
| | - Nyssa F Farrell
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Marco Ferrari
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
| | - Nancy Fischbein
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Adam Folbe
- Department of Otolaryngology-Head and Neck Surgery, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - Wytske J Fokkens
- Department of Otorhinolaryngology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Meha G Fox
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | | | - Gary L Gallia
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Paul A Gardner
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Mathew Geltzeiler
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Christos Georgalas
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Nicosia Medical School, Nicosia, Cyprus
| | - Anne E Getz
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, Colorado, USA
| | - Satish Govindaraj
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Stacey T Gray
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Jessica W Grayson
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Bradley A Gross
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jordon G Grube
- Department of Otolaryngology-Head and Neck Surgery, Albany Medical Center, Albany, New York, USA
| | - Ruifeng Guo
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Patrick K Ha
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Ashleigh A Halderman
- Department of Otolaryngology-Head and Neck Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ehab Y Hanna
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Richard J Harvey
- Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of South Wales, Sydney, New South Wales, Australia
| | - Stephen C Hernandez
- Department of Otolaryngology-Head and Neck Surgery, LSU Health Sciences Center, New Orleans, Louisiana, USA
| | - Adam L Holtzman
- Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Claire Hopkins
- Department of Otolaryngology-Head and Neck Surgery, Guys and St Thomas' Hospital, London, UK
| | - Zhigang Huang
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology-Head and Neck Surgery, Ministry of Education, Beijing, China
| | - Zhenxiao Huang
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology-Head and Neck Surgery, Ministry of Education, Beijing, China
| | - Ian M Humphreys
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Peter H Hwang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Alfred M Iloreta
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Masaru Ishii
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael E Ivan
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Aria Jafari
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - David W Kennedy
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mohemmed Khan
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Adam J Kimple
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Todd T Kingdom
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, Colorado, USA
| | - Anna Knisely
- Department of Otolaryngology, Head and Neck Surgery, Swedish Medical Center, Seattle, Washington, USA
| | - Ying-Ju Kuo
- Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Devyani Lal
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric D Lamarre
- Head and Neck Institute, Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ming-Ying Lan
- Department of Otorhinolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hien Le
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Matt Lechner
- UCL Division of Surgery and Interventional Science and UCL Cancer Institute, University College London, London, UK
| | - Nancy Y Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jivianne K Lee
- Department of Head and Neck Surgery, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Victor H Lee
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Corinna G Levine
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jin-Ching Lin
- Department of Radiation Oncology, Changhua Christian Hospital, Changhua, Taiwan
| | - Derrick T Lin
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Brian C Lobo
- Department of Otolaryngology-Head and Neck Surgery, University of Florida, Gainesville, Florida, USA
| | - Tran Locke
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Amber U Luong
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Kelly R Magliocca
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Svetomir N Markovic
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Gesa Matnjani
- Department of Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Erin L McKean
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Cem Meço
- Department of Otorhinolaryngology, Head and Neck Surgery, Ankara University Medical School, Ankara, Turkey
- Department of Otorhinolaryngology Head and Neck Surgery, Salzburg Paracelsus Medical University, Salzburg, Austria
| | - William M Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Loren Michel
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Shorook Na'ara
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Piero Nicolai
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
| | - Daniel W Nuss
- Department of Otolaryngology-Head and Neck Surgery, LSU Health Sciences Center, New Orleans, Louisiana, USA
| | - Gurston G Nyquist
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Gretchen M Oakley
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Kazuhiro Omura
- Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan
| | - Richard R Orlandi
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Nobuyoshi Otori
- Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan
| | - Peter Papagiannopoulos
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Zara M Patel
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - David G Pfister
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jack Phan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Alkis J Psaltis
- Department of Otolaryngology-Head and Neck Surgery, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Mindy R Rabinowitz
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Murugappan Ramanathan
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ryan Rimmer
- Department of Otolaryngology-Head and Neck Surgery, Yale University, New Haven, Connecticut, USA
| | - Marc R Rosen
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Olabisi Sanusi
- Department of Neurosurgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Zoukaa B Sargi
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Philippe Schafhausen
- Department of Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ahmad R Sedaghat
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Brent A Senior
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Raj Shrivastava
- Department of Neurosurgery and Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Raj Sindwani
- Head and Neck Institute, Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Timothy L Smith
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Kristine A Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Carl H Snyderman
- Departments of Otolaryngology-Head and Neck Surgery and Neurological Surgery, University of California, Irvine, Orange, California, USA
| | - C Arturo Solares
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Satyan B Sreenath
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, Indiana, USA
| | - Aldo Stamm
- São Paulo ENT Center (COF), Edmundo Vasconcelos Complex, São Paulo, Brazil
| | - Katharina Stölzel
- Department of Otorhinolaryngology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Baran Sumer
- Department of Otolaryngology-Head and Neck Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Pavol Surda
- Department of Otolaryngology-Head and Neck Surgery, Guys and St Thomas' Hospital, London, UK
| | - Bobby A Tajudeen
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Brian D Thorp
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Charles C L Tong
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Raymond K Tsang
- Department of Otolaryngology-Head and Neck Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Justin H Turner
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mario Turri-Zanoni
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi Hospital, Varese, Italy
| | - Aaron M Udager
- Department of Pathology, Michigan Center for Translational Pathology, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Thibaut van Zele
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - Kyle VanKoevering
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Kevin C Welch
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sarah K Wise
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ian J Witterick
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Tae-Bin Won
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Stephanie N Wong
- Division of Otorhinolaryngology, Department of Surgery, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Bradford A Woodworth
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Peter-John Wormald
- Department of Otolaryngology-Head and Neck Surgery, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - William C Yao
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Chien-Fu Yeh
- Department of Otorhinolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Bing Zhou
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology-Head and Neck Surgery, Ministry of Education, Beijing, China
| | - James N Palmer
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Tzelnick S, Soroka HP, Tasnim N, Gilbert RW, Irish JC, Goldstein DP, Brown D, Gullane P, Chepeha DB, Yao CMKL, Sahovaler A, Witterick IJ, Monteiro E, Davies J, Huang SH, O'Sullivan B, Hahn E, Hosni A, Razak AA, Gupta AA, de Almeida JR. The impact of surgical resection margins on outcomes for adults with head and neck osteosarcomas: A Canadian sarcoma research and Clinical Collaboration (CanSaRCC) study. Oral Oncol 2023; 145:106495. [PMID: 37478572 DOI: 10.1016/j.oraloncology.2023.106495] [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: 07/02/2023] [Accepted: 07/04/2023] [Indexed: 07/23/2023]
Abstract
OBJECTIVE The aim of the study is to describe the factors that influence outcome in adults with head and neck osteosarcoma (HNO) with a specific focus on the margin status. METHODS Patients with a diagnosis of HNO between the years 1996-2021 were reviewed from the Canadian Sarcoma Research and Clinical Collaboration (CanSaRCC) Database. Baseline characteristics, pathology, treatment, and outcomes were analyzed. Univariable (UVA) and multivariable (MVA) Cox regression models were performed. 5-year locoregional control rate and overall survival (OS) were estimated using Kaplan-Meier method and Log-Rank test. RESULTS Of 50 patients with a median age of 40 years (range 16-80), 27 (54%) were male. HNO commonly involved the mandible (n = 21, 42%) followed by maxilla (n = 15, 30%). Thirteen (33.3%) had low-intermediate grade and 26 (66.6%) had high grade tumors. Three patients (6%) had negative resection margins (>5 mm), 24 (48%) had close margins (1-5 mm), 15 (30%) had positive margins (<1mm) and 7 (16%) had unknown margin status. In total, 39 (78%) received chemotherapy - 22 (44%) received neoadjuvant chemotherapy while 17 (34%) received adjuvant chemotherapy. A total of 12 (24%) patients received radiotherapy, of whom 8 (16%) had adjuvant and 3 (6%) had neo-adjuvant. Median follow-up time was 6.3 years (range 0.26-24.9). Disease recurred in 21 patients (42%), of whom 15 (30%) had local recurrence only, 4 (8%) had distant metastasis, and 2 (4%) had both local and distant recurrence. 5-year locoregional control rate and OS was 62% and 79.2% respectively. Resection margins <3 mm was associated with lower 5 years OS and locoregional control rate (Log-Rank p = 0.02, p = 0.01 respectively). CONCLUSION Osteosarcomas of the head and neck are rare and local recurrence remains a concern. Surgical resection with negative resection margins may improve survival, and a 3 mm resection margin threshold may optimize survival. Radiotherapy and/or chemotherapy should be considered in a multidisciplinary setting based on risk-features.
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Affiliation(s)
- Sharon Tzelnick
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Hospital, University of Toronto, Ontario, Canada
| | - Hagit Peretz Soroka
- Department of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Ontario, Canada; CanSaRCC, Princess Margaret Cancer Center, Ontario, Canada
| | - Najifah Tasnim
- CanSaRCC, Princess Margaret Cancer Center, Ontario, Canada
| | - Ralph W Gilbert
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Hospital, University of Toronto, Ontario, Canada
| | - Jonathan C Irish
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Hospital, University of Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - David P Goldstein
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Hospital, University of Toronto, Ontario, Canada
| | - Dale Brown
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Hospital, University of Toronto, Ontario, Canada
| | - Patrick Gullane
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Hospital, University of Toronto, Ontario, Canada
| | - Douglas B Chepeha
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Hospital, University of Toronto, Ontario, Canada
| | - Christopher M K L Yao
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Hospital, University of Toronto, Ontario, Canada
| | - Axel Sahovaler
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Hospital, University of Toronto, Ontario, Canada
| | - Ian J Witterick
- Department of Otolaryngology-Head and Neck Surgery, Mt Sinai Hospital, Toronto, Ontario, Canada
| | - Eric Monteiro
- Department of Otolaryngology-Head and Neck Surgery, Mt Sinai Hospital, Toronto, Ontario, Canada
| | - Joel Davies
- Department of Otolaryngology-Head and Neck Surgery, Mt Sinai Hospital, Toronto, Ontario, Canada
| | - Shao Hui Huang
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Ontario, Canada
| | - Brian O'Sullivan
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Ontario, Canada
| | - Ezra Hahn
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Ontario, Canada
| | - Ali Hosni
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Ontario, Canada
| | - Albiruni Abdul Razak
- Department of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Ontario, Canada; Department of Medical Oncology, Mount Sinai Hospital, University of Toronto, Ontario, Canada
| | - Abha A Gupta
- Division of Hematology/Oncology, Hospital for Sick Children, University of Toronto, Ontario, Canada; Department of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Ontario, Canada; CanSaRCC, Princess Margaret Cancer Center, Ontario, Canada
| | - John R de Almeida
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Hospital, University of Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
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3
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Fu G, Chazen RS, Monteiro E, Vescan A, Freeman JL, Witterick IJ, MacMillan C. Facilitation of Definitive Cancer Diagnosis With Quantitative Molecular Assays of BRAF V600E and TERT Promoter Variants in Patients With Thyroid Nodules. JAMA Netw Open 2023; 6:e2323500. [PMID: 37505499 PMCID: PMC10383015 DOI: 10.1001/jamanetworkopen.2023.23500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
Importance Molecular testing of the presence of pathogenic genomic variants in a tumor without quantifying the variant allele fraction (VAF) does not differentiate the variation extent among tumors, often resulting in an inconclusive diagnosis because of interpatient variability. Objective To examine the association between the quantification of VAFs of BRAF V600E and TERT promoter variants and a definitive cancer diagnosis of thyroid tumors. Design, Setting, and Participants This diagnostic study analyzed a cohort of 378 surgically resected thyroid tumors with a maximum dimension of 1 cm or larger between March 15, 2016, and March 16, 2020, and a separate cohort of 217 residual thyroid fine-needle aspiration (FNA) biopsy specimens obtained from January 22, 2020, to March 2, 2021, at Mount Sinai Hospital, Toronto, Ontario, Canada. Data analysis was conducted between February 1, 2021, and February 1, 2023. Exposures Quantitative VAF assays of BRAF V600E and TERT promoter variants (C228T and C250T) were performed by digital polymerase chain reaction molecular assays. Main Outcomes and Measures The VAFs of BRAF V600E and TERT promoter variants were correlated with tumor histologic diagnoses and histopathologic features to delineate the association of VAF assays with tumor malignancy. The receiver operating characteristic curve analysis, sensitivity, specificity, positive predictive value, negative predictive value, and logistic regression analysis based on follow-up histopathologic types were used to determine the diagnostic utility of the quantitative molecular assays. Results A total of 595 specimens, including 378 surgically resected thyroid tumors and 217 thyroid nodule FNA biopsy specimens, were collected from 580 patients (436 [75.2%] female with a mean [SD] age of 50 [16] years and 144 [24.8%] male with a mean [SD] age of 55 [14] years). Sensitive VAF assays of 378 thyroid tumors revealed the presence of the BRAF V600E variant in 162 tumors (42.9%), with 26 (16.0%) at a low VAF of 1% or less and 136 (84.0%) at a high VAF of greater than 1%, and the presence of TERT promoter variants in 49 tumors (13.0%), including 45 C228T variants (91.8%), 15 (33.3%) of which were quantified as having a low VAF (≤1%) and 30 (66.7%) as having a high VAF (>1%), and 4 C250T variants (8.2%) with VAFs between 40.0% and 47.0%. All tumors detected with BRAF V600E and/or TERT promoter variants, whether at low or high VAFs, received a definitive cancer diagnosis. Further analysis delineated a significant association between high VAFs of either variant individually or different VAF levels for both variants in coexistence and aggressive histopathologic features of tumors. Excluding low VAFs assisted in identifying patients at an intermediate-to-high risk of recurrence (odds ratio, 5.3; 95% CI, 1.9-14.6; P = .001). The VAF assays on the residual FNA biopsy specimens showed a high agreement to those on surgical tissues (κ = 0.793, P < .001) and stratified malignancy in 40 of 183 indeterminate FNA cases (21.9%), with a sensitivity of 93.8% (95% CI, 67.7%-99.7%), specificity of 90.0% (95% CI, 75.4%-96.7%), positive predictive value of 78.9% (95% CI, 53.9%-93.0%), and negative predictive value of 97.3% (95% CI, 84.2%-99.9%). Conclusions and Relevance This diagnostic study suggests that sensitive quantitative VAF assays of BRAF V600E and TERT promoter variants can elucidate the interpatient variability in tumors and facilitate a definitive cancer diagnosis of thyroid nodules by differentiating the variation extent of genomic variants, even at low VAFs.
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Affiliation(s)
- Guodong Fu
- Alex and Simona Shnaider Research Laboratory in Molecular Oncology, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
| | - Ronald S Chazen
- Alex and Simona Shnaider Research Laboratory in Molecular Oncology, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
| | - Eric Monteiro
- Department of Otolaryngology-Head & Neck Surgery, Mount Sinai Hospital, Sinai Health and University of Toronto, Toronto, Ontario, Canada
| | - Allan Vescan
- Department of Otolaryngology-Head & Neck Surgery, Mount Sinai Hospital, Sinai Health and University of Toronto, Toronto, Ontario, Canada
| | - Jeremy L Freeman
- Department of Otolaryngology-Head & Neck Surgery, Mount Sinai Hospital, Sinai Health and University of Toronto, Toronto, Ontario, Canada
- Joseph and Mildred Sonshine Family Centre for Head and Neck Diseases, Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
| | - Ian J Witterick
- Alex and Simona Shnaider Research Laboratory in Molecular Oncology, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
- Department of Otolaryngology-Head & Neck Surgery, Mount Sinai Hospital, Sinai Health and University of Toronto, Toronto, Ontario, Canada
- Joseph and Mildred Sonshine Family Centre for Head and Neck Diseases, Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
| | - Christina MacMillan
- Alex and Simona Shnaider Research Laboratory in Molecular Oncology, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Sinai Health and University of Toronto, Toronto, Ontario, Canada
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4
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Hamour AF, Manojlovic‐Kolarski M, Eskander A, Biskup M, Taylor SM, Laliberte F, Vescan A, Witterick IJ, Freeman J, Monteiro E. Postoperative opioid use following head and neck endocrine surgery: A multi-center prospective study. Laryngoscope Investig Otolaryngol 2023; 8:786-791. [PMID: 37342109 PMCID: PMC10278108 DOI: 10.1002/lio2.1065] [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: 04/02/2023] [Accepted: 04/13/2023] [Indexed: 06/22/2023] Open
Abstract
Background Opioid abuse is widespread in North America and the over-prescription of opioids are a contributing factor. The goal of this prospective study was to quantify over-prescription rates, evaluate postoperative experiences of pain, and understand the impact of peri-operative factors such as adequate pain counseling and use of non-opioid analgesia. Methods Consecutive recruitment of patients undergoing head and neck endocrine surgery was undertaken from January 1st 2020 to December 31st 2021 at four Canadian hospitals in Ontario and Nova Scotia. Postoperative tracking of pain levels and analgesic requirements were employed. Chart review and preoperative and postoperative surveys provided information on counseling, use of local anesthesia, and disposal plans. Results A total of 125 adult patients were included in the final analysis. Total thyroidectomy was the most common procedure (40.8%). Median use of opioid tablets was 2 (IQR 0-4), with 79.5% of prescribed tablets unused. Patients who reported inadequate counseling (n = 35, 28.0%) were more likely to use opioids (57.2% vs. 37.8%, p < .05) and less likely to use non-opioid analgesia in the early postoperative course (42.9% vs. 63.3%, p < .05). Patients who received local anesthesia peri-operatively (46.4%, n = 58) reported less severe pain on average [2.86 (2.13) vs. 4.86 (2.19), p < .05] and used less analgesia on postoperative day one [0 MME (IQR 0-4) vs. 4 MME (IQR 0-8), p < .05]. Conclusion Over-prescription of opioid analgesia following head and neck endocrine surgery is common. Patient counseling, use of non-opioid analgesia, and peri-operative local anesthesia were important factors in narcotic use reduction. Level of evidence Level 3.
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Affiliation(s)
- Amr F. Hamour
- Department of Otolaryngology – Head & Neck SurgeryUniversity of TorontoTorontoOntarioCanada
| | | | - Antoine Eskander
- Department of Otolaryngology – Head & Neck SurgeryUniversity of TorontoTorontoOntarioCanada
- Department of Otolaryngology – Head & Neck SurgeryMichael Garron HospitalTorontoOntarioCanada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public HealthUniversity of TorontoTorontoCanada
| | - Mathew Biskup
- Division of Otolaryngology – Head & Neck Surgery, Department of SurgeryDalhousie UniversityHalifaxNova ScotiaCanada
| | - S. Mark Taylor
- Division of Otolaryngology – Head & Neck Surgery, Department of SurgeryDalhousie UniversityHalifaxNova ScotiaCanada
| | - Frederick Laliberte
- Department of Otolaryngology – Head & Neck SurgeryUniversity of TorontoTorontoOntarioCanada
| | - Allan Vescan
- Department of Otolaryngology – Head & Neck SurgeryUniversity of TorontoTorontoOntarioCanada
- Department of Otolaryngology – Head & Neck SurgeryMount Sinai HospitalTorontoOntarioCanada
| | - Ian J. Witterick
- Department of Otolaryngology – Head & Neck SurgeryUniversity of TorontoTorontoOntarioCanada
- Department of Otolaryngology – Head & Neck SurgeryMount Sinai HospitalTorontoOntarioCanada
| | - Jeremy Freeman
- Department of Otolaryngology – Head & Neck SurgeryUniversity of TorontoTorontoOntarioCanada
- Department of Otolaryngology – Head & Neck SurgeryMount Sinai HospitalTorontoOntarioCanada
| | - Eric Monteiro
- Department of Otolaryngology – Head & Neck SurgeryUniversity of TorontoTorontoOntarioCanada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public HealthUniversity of TorontoTorontoCanada
- Department of Otolaryngology – Head & Neck SurgeryMount Sinai HospitalTorontoOntarioCanada
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5
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Fu R, Sutradhar R, Li Q, Hanna TP, Chan KKW, Irish JC, Coburn N, Hallet J, Dare A, Singh S, Parmar A, Earle CC, Lapointe-Shaw L, Krzyzanowska MK, Finelli A, Louie AV, Look Hong NJ, Witterick IJ, Mahar A, Urbach DR, McIsaac DI, Enepekides D, Eskander A. Association between the COVID-19 pandemic and first cancer treatment modality: a population-based cohort study. CMAJ Open 2023; 11:E426-E433. [PMID: 37160325 PMCID: PMC10174267 DOI: 10.9778/cmajo.20220102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Physicians were directed to prioritize using nonsurgical cancer treatment at the beginning of the COVID-19 pandemic. We sought to quantify the impact of this policy on the modality of first cancer treatment (surgery, chemotherapy, radiotherapy or no treatment). METHODS In this population-based study using Ontario data from linked administrative databases, we identified adults diagnosed with cancer from January 2016 to November 2020 and their first cancer treatment received within 1 year postdiagnosis. Segmented Poisson regressions were applied to each modality to estimate the change in mean 1-year recipient volume per thousand patients (rate) at the start of the pandemic (the week of Mar. 15, 2020) and change in the weekly trend in rate during the pandemic (Mar. 15, 2020, to Nov. 7, 2020) relative to before the pandemic (Jan. 3, 2016, to Mar. 14, 2020). RESULTS We included 321 535 people diagnosed with cancer. During the first week of the COVID-19 pandemic, the mean rate of receiving upfront surgery over the next year declined by 9% (rate ratio 0.91, 95% confidence interval [CI] 0.88-0.95), and chemotherapy and radiotherapy rates rose by 30% (rate ratio 1.30, 95% CI 1.23-1.36) and 13% (rate ratio 1.13, 95% CI 1.07-1.19), respectively. Subsequently, the 1-year rate of upfront surgery increased at 0.4% for each week (rate ratio 1.004, 95% CI 1.002-1.006), and chemotherapy and radiotherapy rates decreased by 0.9% (rate ratio 0.991, 95% CI 0.989-0.994) and 0.4% (rate ratio 0.996, 95% CI 0.994-0.998), respectively, per week. Rates of each modality resumed to prepandemic levels at 24-31 weeks into the pandemic. INTERPRETATION An immediate and sustained increase in use of nonsurgical therapy as the first cancer treatment occurred during the first 8 months of the COVID-19 pandemic in Ontario. Further research is needed to understand the consequences.
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Affiliation(s)
- Rui Fu
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Rinku Sutradhar
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Qing Li
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Timothy P Hanna
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Kelvin K W Chan
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Jonathan C Irish
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Natalie Coburn
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Julie Hallet
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Anna Dare
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Simron Singh
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Ambica Parmar
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Craig C Earle
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Lauren Lapointe-Shaw
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Monika K Krzyzanowska
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Antonio Finelli
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Alexander V Louie
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Nicole J Look Hong
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Ian J Witterick
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Alyson Mahar
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - David R Urbach
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Daniel I McIsaac
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Danny Enepekides
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Antoine Eskander
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont.
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Fu R, Sutradhar R, Li Q, Hanna TP, Chan KKW, Irish JC, Coburn N, Hallet J, Dare A, Singh S, Parmar A, Earle CC, Lapointe-Shaw L, Krzyzanowska MK, Finelli A, Louie AV, Hong NJL, Witterick IJ, Mahar A, Urbach DR, McIsaac DI, Enepekides D, Tinmouth J, Eskander A. Timeliness and Modality of Treatment for New Cancer Diagnoses During the COVID-19 Pandemic in Canada. JAMA Netw Open 2023; 6:e2250394. [PMID: 36626169 PMCID: PMC9856765 DOI: 10.1001/jamanetworkopen.2022.50394] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
IMPORTANCE The impact of COVID-19 on the modality and timeliness of first-line cancer treatment is unclear yet critical to the planning of subsequent care. OBJECTIVE To explore the association of the COVID-19 pandemic with modalities of and wait times for first cancer treatment. DESIGN, SETTING, AND PARTICIPANTS This retrospective population-based cohort study using administrative data was conducted in Ontario, Canada, among adults newly diagnosed with cancer between January 3, 2016, and November 7, 2020. Participants were followed up from date of diagnosis for 1 year, until death, or until June 26, 2021, whichever occurred first, to ensure a minimum of 6-month follow-up time. EXPOSURES Receiving a cancer diagnosis in the pandemic vs prepandemic period, using March 15, 2020, the date when elective hospital procedures were halted. MAIN OUTCOMES AND MEASURES The main outcome was a time-to-event variable describing number of days from date of diagnosis to date of receiving first cancer treatment (surgery, chemotherapy, or radiation) or to being censored. For each treatment modality, a multivariable competing-risk regression model was used to assess the association between time to treatment and COVID-19 period. A secondary continuous outcome was defined for patients who were treated 6 months after diagnosis as the waiting time from date of diagnosis to date of treatment. RESULTS Among 313 499 patients, the mean (SD) age was 66.4 (14.1) years and 153 679 (49.0%) were male patients. Those who were diagnosed during the pandemic were less likely to receive surgery first (subdistribution hazard ratio [sHR], 0.97; 95% CI, 0.95-0.99) but were more likely to receive chemotherapy (sHR, 1.26; 95% CI, 1.23-1.30) or radiotherapy (sHR, 1.16; 95% CI, 1.13-1.20) first. Among patients who received treatment within 6 months from diagnosis (228 755 [73.0%]), their mean (SD) waiting time decreased from 35.1 (37.2) days to 29.5 (33.6) days for surgery, from 43.7 (34.1) days to 38.4 (30.6) days for chemotherapy, and from 55.8 (41.8) days to 49.0 (40.1) days for radiotherapy. CONCLUSIONS AND RELEVANCE In this cohort study, the pandemic was significantly associated with greater use of nonsurgical therapy as initial cancer treatment. Wait times were shorter in the pandemic period for those treated within 6 months of diagnosis. Future work needs to examine how these changes may have affected patient outcomes to inform future pandemic guideline development.
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Affiliation(s)
- Rui Fu
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Rinku Sutradhar
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Qing Li
- ICES, Toronto, Ontario, Canada
| | - Timothy P. Hanna
- Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen’s University, Kingston, Ontario, Canada
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Kelvin K. W. Chan
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Odette Cancer Centre–Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Ontario Health–Cancer Care Ontario, Toronto, Ontario, Canada
| | - Jonathan C. Irish
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology–Head & Neck Surgery/Surgical Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Natalie Coburn
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Ontario Health–Cancer Care Ontario, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Julie Hallet
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Odette Cancer Centre–Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Anna Dare
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Simron Singh
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ambica Parmar
- ICES, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Craig C. Earle
- ICES, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lauren Lapointe-Shaw
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Monika K. Krzyzanowska
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Antonio Finelli
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Alexander V. Louie
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Nicole J. Look Hong
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ian J. Witterick
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Ontario Health–Cancer Care Ontario, Toronto, Ontario, Canada
- Department of Otolaryngology–Head & Neck Surgery/Surgical Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Alyson Mahar
- School of Nursing, Queen’s University, Kingston, Ontario, Canada
| | - David R. Urbach
- ICES, Toronto, Ontario, Canada
- Department of Surgery, Women’s College Hospital, Toronto, Ontario, Canada
| | - Daniel I. McIsaac
- ICES, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Danny Enepekides
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jill Tinmouth
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Odette Cancer Centre–Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Ontario Health–Cancer Care Ontario, Toronto, Ontario, Canada
| | - Antoine Eskander
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
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7
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Fu R, Sutradhar R, Li Q, Hanna TP, Chan KKW, Irish JC, Coburn N, Hallet J, Dare A, Singh S, Parmar A, Earle CC, Lapointe-Shaw L, Krzyzanowska MK, Finelli A, Louie AV, Look Hong NJ, Witterick IJ, Mahar A, Gomez D, McIsaac DI, Enepekides D, Urbach DR, Eskander A. Incident Cancer Detection During Multiple Waves of COVID-19: The Tsunami After the Earthquake. J Natl Compr Canc Netw 2022; 20:1190-1192. [PMID: 36351330 DOI: 10.6004/jnccn.2022.7075] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/15/2022] [Indexed: 11/11/2022]
Abstract
No population-based study exists to demonstrate the full-spectrum impact of COVID-19 on hindering incident cancer detection in a large cancer system. Building upon our previous publication in JNCCN, we conducted an updated analysis using 12 months of new data accrued in the pandemic era (extending the study period from September 26, 2020, to October 2, 2021) to demonstrate how multiple COVID-19 waves affected the weekly cancer incidence volume in Ontario, Canada, and if we have fully cleared the backlog at the end of each wave.
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Affiliation(s)
- Rui Fu
- 1ICES, Toronto, Ontario
- 2Institute of Health Policy, Management, and Evaluation, and
- 3Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto
| | - Rinku Sutradhar
- 1ICES, Toronto, Ontario
- 2Institute of Health Policy, Management, and Evaluation, and
| | | | - Timothy P Hanna
- 4Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston
- 5Ontario Institute for Cancer Research (OICR), Toronto
| | - Kelvin K W Chan
- 6Odette Cancer Centre-Sunnybrook Health Sciences Centre, Toronto
- 7Ontario Health-Cancer Care Ontario, Toronto
| | - Jonathan C Irish
- 2Institute of Health Policy, Management, and Evaluation, and
- 8Department of Otolaryngology-Head & Neck Surgery/Surgical Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto
| | - Natalie Coburn
- 1ICES, Toronto, Ontario
- 2Institute of Health Policy, Management, and Evaluation, and
- 7Ontario Health-Cancer Care Ontario, Toronto
- 9Department of Surgery
| | - Julie Hallet
- 1ICES, Toronto, Ontario
- 2Institute of Health Policy, Management, and Evaluation, and
- 6Odette Cancer Centre-Sunnybrook Health Sciences Centre, Toronto
- 9Department of Surgery
| | - Anna Dare
- 1ICES, Toronto, Ontario
- 2Institute of Health Policy, Management, and Evaluation, and
- 9Department of Surgery
| | - Simron Singh
- 1ICES, Toronto, Ontario
- 2Institute of Health Policy, Management, and Evaluation, and
- 10Department of Medicine, and
| | - Ambica Parmar
- 1ICES, Toronto, Ontario
- 10Department of Medicine, and
| | - Craig C Earle
- 1ICES, Toronto, Ontario
- 10Department of Medicine, and
| | - Lauren Lapointe-Shaw
- 1ICES, Toronto, Ontario
- 2Institute of Health Policy, Management, and Evaluation, and
- 10Department of Medicine, and
| | - Monika K Krzyzanowska
- 1ICES, Toronto, Ontario
- 2Institute of Health Policy, Management, and Evaluation, and
- 10Department of Medicine, and
| | - Antonio Finelli
- 1ICES, Toronto, Ontario
- 2Institute of Health Policy, Management, and Evaluation, and
- 9Department of Surgery
| | | | - Nicole J Look Hong
- 1ICES, Toronto, Ontario
- 2Institute of Health Policy, Management, and Evaluation, and
- 9Department of Surgery
| | - Ian J Witterick
- 3Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto
- 7Ontario Health-Cancer Care Ontario, Toronto
- 8Department of Otolaryngology-Head & Neck Surgery/Surgical Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto
| | - Alyson Mahar
- 12School of Nursing, Queen's University, Kingston
| | - David Gomez
- 1ICES, Toronto, Ontario
- 2Institute of Health Policy, Management, and Evaluation, and
- 9Department of Surgery
- 13Division of General Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto
| | - Daniel I McIsaac
- 1ICES, Toronto, Ontario
- 14Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa; and
| | - Danny Enepekides
- 3Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto
| | - David R Urbach
- 1ICES, Toronto, Ontario
- 15Department of Surgery, Women's College Hospital, Toronto, Ontario, Canada
| | - Antoine Eskander
- 1ICES, Toronto, Ontario
- 2Institute of Health Policy, Management, and Evaluation, and
- 3Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto
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8
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Fu R, Sutradhar R, Dare A, Li Q, Hanna TP, Chan KKW, Irish JC, Coburn N, Hallet J, Singh S, Parmar A, Earle CC, Lapointe-Shaw L, Krzyzanowska MK, Finelli A, Louie AV, Witterick IJ, Mahar A, Urbach DR, McIsaac DI, Enepekides D, Look Hong NJ, Eskander A. Cancer Patients First Treated with Chemotherapy: Are They More Likely to Receive Surgery in the Pandemic? Curr Oncol 2022; 29:7732-7744. [PMID: 36290888 PMCID: PMC9600641 DOI: 10.3390/curroncol29100611] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/09/2022] [Accepted: 10/12/2022] [Indexed: 11/05/2022] Open
Abstract
Due to the ramping down of cancer surgery in early pandemic, many newly diagnosed patients received other treatments first. We aimed to quantify the pandemic-related shift in rate of surgery following chemotherapy. This is a retrospective population-based cohort study involving adults diagnosed with cancer between 3 January 2016 and 7 November 2020 in Ontario, Canada who received chemotherapy as first treatment within 6-months of diagnosis. Competing-risks regression models with interaction effects were used to quantify the association between COVID-19 period (receiving a cancer diagnosis before or on/after 15 March 2020) and receipt of surgical reSection 9-months after first chemotherapy. Among 51,653 patients, 8.5% (n = 19,558) of them ultimately underwent surgery 9-months after chemotherapy initiation. Receipt of surgery was higher during the pandemic than before (sHR 1.07, 95% CI 1.02-1.13). Material deprivation was independently associated with lower receipt of surgery (least vs. most deprived quintile: sHR 1.11, 95% CI 1.04-1.17), but did not change with the pandemic. The surgical rate increase was most pronounced for breast cancer (sHR 1.13, 95% CI 1.06-1.20). These pandemic-related shifts in cancer treatment requires further evaluations to understand the long-term consequences. Persistent material deprivation-related inequity in cancer surgical access needs to be addressed.
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Affiliation(s)
- Rui Fu
- ICES, Toronto, ON M4N 3M5, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
- Department of Otolaryngology—Head and Neck Surgery, University of Toronto, Toronto, ON M5G 1X5, Canada
| | - Rinku Sutradhar
- ICES, Toronto, ON M4N 3M5, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
| | - Anna Dare
- ICES, Toronto, ON M4N 3M5, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
- Department of Surgery, University of Toronto, Toronto, ON M5T 1P5, Canada
| | - Qing Li
- ICES, Toronto, ON M4N 3M5, Canada
| | - Timothy P. Hanna
- Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen’s University, Kingston, ON K7L 3N6, Canada
- Ontario Institute for Cancer Research (OICR), Toronto, ON M5G 0A3, Canada
| | - Kelvin K. W. Chan
- Odette Cancer Centre—Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Ontario Health—Cancer Care Ontario, Toronto, ON M5G 2L7, Canada
| | - Jonathan C. Irish
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
- Department of Otolaryngology—Head & Neck Surgery/Surgical Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON M5G 1X5, Canada
| | - Natalie Coburn
- ICES, Toronto, ON M4N 3M5, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
- Department of Surgery, University of Toronto, Toronto, ON M5T 1P5, Canada
- Ontario Health—Cancer Care Ontario, Toronto, ON M5G 2L7, Canada
| | - Julie Hallet
- ICES, Toronto, ON M4N 3M5, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
- Department of Surgery, University of Toronto, Toronto, ON M5T 1P5, Canada
- Odette Cancer Centre—Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
| | - Simron Singh
- ICES, Toronto, ON M4N 3M5, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Ambica Parmar
- ICES, Toronto, ON M4N 3M5, Canada
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Craig C. Earle
- ICES, Toronto, ON M4N 3M5, Canada
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Lauren Lapointe-Shaw
- ICES, Toronto, ON M4N 3M5, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Monika K. Krzyzanowska
- ICES, Toronto, ON M4N 3M5, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Antonio Finelli
- ICES, Toronto, ON M4N 3M5, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
- Department of Surgery, University of Toronto, Toronto, ON M5T 1P5, Canada
| | - Alexander V. Louie
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5T 1P5, Canada
| | - Ian J. Witterick
- Department of Otolaryngology—Head and Neck Surgery, University of Toronto, Toronto, ON M5G 1X5, Canada
- Odette Cancer Centre—Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Ontario Health—Cancer Care Ontario, Toronto, ON M5G 2L7, Canada
| | - Alyson Mahar
- School of Nursing, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - David R. Urbach
- ICES, Toronto, ON M4N 3M5, Canada
- Department of Surgery, Women’s College Hospital, Toronto, ON M5S 1B2, Canada
| | - Daniel I. McIsaac
- ICES, Toronto, ON M4N 3M5, Canada
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, ON K1Y 4E9, Canada
| | - Danny Enepekides
- Department of Otolaryngology—Head and Neck Surgery, University of Toronto, Toronto, ON M5G 1X5, Canada
| | - Nicole J. Look Hong
- ICES, Toronto, ON M4N 3M5, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
- Department of Surgery, University of Toronto, Toronto, ON M5T 1P5, Canada
| | - Antoine Eskander
- ICES, Toronto, ON M4N 3M5, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
- Department of Otolaryngology—Head and Neck Surgery, University of Toronto, Toronto, ON M5G 1X5, Canada
- Correspondence: ; Tel.: +1-416-480-6705
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9
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Hamour AF, Chen T, Cottrell J, Campisi P, Witterick IJ, Chan Y. Discrimination, harassment, and intimidation amongst otolaryngology: head and neck surgeons in Canada. J Otolaryngol Head Neck Surg 2022; 51:35. [PMID: 36180943 PMCID: PMC9524112 DOI: 10.1186/s40463-022-00590-w] [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: 02/06/2022] [Accepted: 07/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Understanding mistreatment within medicine is an important first step in creating and maintaining a safe and inclusive work environment. The objective of this study was to quantify the prevalence of perceived workplace mistreatment amongst otolaryngology-head and neck surgery (OHNS) faculty and trainees in Canada. METHODS This national cross-sectional survey was administered to practicing otolaryngologists and residents training in an otolaryngology program in Canada during the 2020-2021 academic year. The prevalence and sources of mistreatment (intimidation, harassment, and discrimination) were ascertained. The availability, awareness, and rate of utilization of institutional resources to address mistreatment were also studied. RESULTS The survey was administered to 519 individuals and had an overall response rate of 39.1% (189/519). The respondents included faculty (n = 107; 56.6%) and trainees (n = 82; 43.4%). Mistreatment (intimidation, harassment, or discrimination) was reported in 47.6% of respondents. Of note, harassment was reported at a higher rate in female respondents (57.0%) and White/Caucasian faculty and trainees experienced less discrimination than their non-White colleagues (22.7% vs. 54.5%). The two most common sources of mistreatment were OHNS faculty and patients. Only 14.9% of those experiencing mistreatment sought assistance from institutional resources to address mistreatment. The low utilization rate was primarily attributed to concerns about retribution. INTERPRETATION Mistreatment is prevalent amongst Canadian OHNS trainees and faculty. A concerning majority of respondents reporting mistreatment did not access resources due to fear of confidentiality and retribution. Understanding the source and prevalence of mistreatment is the first step to enabling goal-directed initiatives to address this issue and maintain a safe and inclusive working environment.
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Affiliation(s)
- Amr F Hamour
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, 6 Queen's Park Cres. W, Toronto, ON, M5S 3H2, Canada
| | - Tanya Chen
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, 6 Queen's Park Cres. W, Toronto, ON, M5S 3H2, Canada
| | - Justin Cottrell
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, 6 Queen's Park Cres. W, Toronto, ON, M5S 3H2, Canada
| | - Paolo Campisi
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, 6 Queen's Park Cres. W, Toronto, ON, M5S 3H2, Canada
| | - Ian J Witterick
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, 6 Queen's Park Cres. W, Toronto, ON, M5S 3H2, Canada
| | - Yvonne Chan
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, 6 Queen's Park Cres. W, Toronto, ON, M5S 3H2, Canada.
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10
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Fu G, Witterick IJ. Management of thyroid nodules with indeterminate fine-needle aspiration cytology: histogram analysis of greyscale sonograms and molecular assay of residual tissue from fine-needle aspiration biopsies. Transl Cancer Res 2022; 11:2483-2486. [PMID: 36093553 PMCID: PMC9459511 DOI: 10.21037/tcr-22-1919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 08/15/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Guodong Fu
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Sinai Health, Toronto, ON, Canada
| | - Ian J. Witterick
- Department of Otolaryngology-Head & Neck Surgery, Mount Sinai Hospital, Sinai Health, and University of Toronto, Toronto, ON, Canada
- Joseph and Mildred Sonshine Family Centre for Head and Neck Diseases, Mount Sinai Hospital, Sinai Health, Toronto, ON, Canada
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11
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Hamour AF, Laliberte F, Padhye V, Monteiro E, Agid R, Lee JM, Witterick IJ, Vescan AD. Development of a management protocol for internal carotid artery injury during endoscopic surgery: a modified Delphi method and single-center multidisciplinary working group. J Otolaryngol Head Neck Surg 2022; 51:30. [PMID: 35902904 PMCID: PMC9331087 DOI: 10.1186/s40463-022-00582-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 01/07/2022] [Accepted: 05/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intra-operative internal carotid artery (ICA) injury during transnasal endoscopic surgery is a potentially catastrophic event. Such an injury is life-threatening in the immediate setting, with a reported peri-operative mortality rate of 10%. Nasal packing, muscle patches, direct vessel closure, and endovascular techniques have been described as useful strategies for managing ICA bleeds. The objective of this study was to develop a formalized management protocol for intra-operative ICA injury through engagement with a multi-disciplinary panel. METHODS A modified Delphi method including literature review, iterative rounds of stakeholder feedback, and expert panel discussions was used to develop a management protocol for ICA injury during transnasal endoscopic surgery. The 10-person multi-disciplinary panel included otolaryngologists, neurosurgeons, interventional neuroradiologists, anesthesiologists, and operating room nursing staff. RESULTS After three rounds of stakeholder engagement with the expert panel, consensus was reached on important elements to include within the protocol. The protocol was divided in three categories: Alert, Control, and Transfer. 'Alert' focusses on early communication with anesthesia and nursing staff. 'Control' focusses on techniques to expose the injury and obtain hemostasis or adequate tamponade. Lastly, 'Transfer' describes the process of contacting neuro-interventional radiology and safely transferring the patient. A one-page handout of the protocol was developed for placement in operating theatres. CONCLUSION Due to the life-threatening nature of ICA injury, it is imperative that endoscopic sinus and skull base surgeons are prepared to manage this complication. Using a modified Delphi method with a multidisciplinary expert panel, a protocol for management of intra-operative ICA injury was developed.
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Affiliation(s)
- Amr F Hamour
- Department of Otolaryngology - Head and Neck Surgery, Temerty Faculty of Medicine, University of Toronto, Mount Sinai Hospital, 600 University Ave, Suite 401, Toronto, ON, M5G 1X5, Canada
| | - Frederick Laliberte
- Department of Otolaryngology - Head and Neck Surgery, Temerty Faculty of Medicine, University of Toronto, Mount Sinai Hospital, 600 University Ave, Suite 401, Toronto, ON, M5G 1X5, Canada
| | - Vikram Padhye
- Department of Otolaryngology - Head and Neck Surgery, Temerty Faculty of Medicine, University of Toronto, Mount Sinai Hospital, 600 University Ave, Suite 401, Toronto, ON, M5G 1X5, Canada
| | - Eric Monteiro
- Department of Otolaryngology - Head and Neck Surgery, Temerty Faculty of Medicine, University of Toronto, Mount Sinai Hospital, 600 University Ave, Suite 401, Toronto, ON, M5G 1X5, Canada.,Department of Otolaryngology - Head and Neck Surgery, Sinai Health System, Toronto, ON, Canada
| | - Ronit Agid
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - John M Lee
- Department of Otolaryngology - Head and Neck Surgery, Temerty Faculty of Medicine, University of Toronto, Mount Sinai Hospital, 600 University Ave, Suite 401, Toronto, ON, M5G 1X5, Canada.,Department of Otolaryngology - Head and Neck Surgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Ian J Witterick
- Department of Otolaryngology - Head and Neck Surgery, Temerty Faculty of Medicine, University of Toronto, Mount Sinai Hospital, 600 University Ave, Suite 401, Toronto, ON, M5G 1X5, Canada.,Department of Otolaryngology - Head and Neck Surgery, Sinai Health System, Toronto, ON, Canada
| | - Allan D Vescan
- Department of Otolaryngology - Head and Neck Surgery, Temerty Faculty of Medicine, University of Toronto, Mount Sinai Hospital, 600 University Ave, Suite 401, Toronto, ON, M5G 1X5, Canada. .,Department of Otolaryngology - Head and Neck Surgery, Sinai Health System, Toronto, ON, Canada.
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12
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Eskander A, Li Q, Yu J, Hallet J, Coburn NG, Dare A, Chan KKW, Singh S, Parmar A, Earle CC, Lapointe-Shaw L, Krzyzanowska MK, Hanna TP, Finelli A, Louie AV, Look Hong N, Irish JC, Witterick IJ, Mahar A, Noel CW, Urbach DR, McIsaac DI, Enepekides D, Sutradhar R. Incident Cancer Detection During the COVID-19 Pandemic. J Natl Compr Canc Netw 2022; 20:276-284. [PMID: 35104788 DOI: 10.6004/jnccn.2021.7114] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/18/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Resource restrictions were established in many jurisdictions to maintain health system capacity during the COVID-19 pandemic. Disrupted healthcare access likely impacted early cancer detection. The objective of this study was to assess the impact of the pandemic on weekly reported cancer incidence. PATIENTS AND METHODS This was a population-based study involving individuals diagnosed with cancer from September 25, 2016, to September 26, 2020, in Ontario, Canada. Weekly cancer incidence counts were examined using segmented negative binomial regression models. The weekly estimated backlog during the pandemic was calculated by subtracting the observed volume from the projected/expected volume in that week. RESULTS The cohort consisted of 358,487 adult patients with cancer. At the start of the pandemic, there was an immediate 34.3% decline in the estimated mean cancer incidence volume (relative rate, 0.66; 95% CI, 0.57-0.75), followed by a 1% increase in cancer incidence volume in each subsequent week (relative rate, 1.009; 95% CI, 1.001-1.017). Similar trends were found for both screening and nonscreening cancers. The largest immediate declines were seen for melanoma and cervical, endocrinologic, and prostate cancers. For hepatobiliary and lung cancers, there continued to be a weekly decline in incidence during the COVID-19 period. Between March 15 and September 26, 2020, 12,601 fewer individuals were diagnosed with cancer, with an estimated weekly backlog of 450. CONCLUSIONS We estimate that there is a large volume of undetected cancer cases related to the COVID-19 pandemic. Incidence rates have not yet returned to prepandemic levels.
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Affiliation(s)
- Antoine Eskander
- 1ICES, Toronto, Ontario.,2Institute of Health Policy, Management, and Evaluation.,3Department of Otolaryngology - Head and Neck Surgery
| | | | - Jiayue Yu
- 4Division of Biostatistics, Dalla Lana School of Public Health
| | - Julie Hallet
- 1ICES, Toronto, Ontario.,2Institute of Health Policy, Management, and Evaluation.,5Department of Surgery
| | - Natalie G Coburn
- 1ICES, Toronto, Ontario.,2Institute of Health Policy, Management, and Evaluation.,5Department of Surgery
| | - Anna Dare
- 1ICES, Toronto, Ontario.,2Institute of Health Policy, Management, and Evaluation.,5Department of Surgery
| | - Kelvin K W Chan
- 1ICES, Toronto, Ontario.,2Institute of Health Policy, Management, and Evaluation.,6Division of Medical Oncology, Department of Medicine, and
| | - Simron Singh
- 1ICES, Toronto, Ontario.,2Institute of Health Policy, Management, and Evaluation.,6Division of Medical Oncology, Department of Medicine, and
| | - Ambica Parmar
- 1ICES, Toronto, Ontario.,6Division of Medical Oncology, Department of Medicine, and
| | - Craig C Earle
- 1ICES, Toronto, Ontario.,6Division of Medical Oncology, Department of Medicine, and
| | - Lauren Lapointe-Shaw
- 1ICES, Toronto, Ontario.,2Institute of Health Policy, Management, and Evaluation.,7Department of Medicine, University of Toronto, Toronto, Ontario
| | - Monika K Krzyzanowska
- 1ICES, Toronto, Ontario.,2Institute of Health Policy, Management, and Evaluation.,7Department of Medicine, University of Toronto, Toronto, Ontario
| | - Timothy P Hanna
- 1ICES, Toronto, Ontario.,8Division of Radiation Oncology, Queen's University, Kingston, Ontario
| | - Antonio Finelli
- 1ICES, Toronto, Ontario.,2Institute of Health Policy, Management, and Evaluation.,5Department of Surgery
| | | | - Nicole Look Hong
- 1ICES, Toronto, Ontario.,2Institute of Health Policy, Management, and Evaluation.,5Department of Surgery
| | - Jonathan C Irish
- 3Department of Otolaryngology - Head and Neck Surgery.,10Department of Otolaryngology - Head and Neck Surgery, Princess Margaret Cancer Centre and Ontario Health - Cancer Care Ontario, Toronto, Ontario
| | - Ian J Witterick
- 3Department of Otolaryngology - Head and Neck Surgery.,10Department of Otolaryngology - Head and Neck Surgery, Princess Margaret Cancer Centre and Ontario Health - Cancer Care Ontario, Toronto, Ontario
| | - Alyson Mahar
- 11Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba
| | - Christopher W Noel
- 2Institute of Health Policy, Management, and Evaluation.,3Department of Otolaryngology - Head and Neck Surgery
| | - David R Urbach
- 1ICES, Toronto, Ontario.,12Department of Surgery, Women's College Hospital, Toronto, Ontario; and
| | - Daniel I McIsaac
- 1ICES, Toronto, Ontario.,13Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | | | - Rinku Sutradhar
- 1ICES, Toronto, Ontario.,2Institute of Health Policy, Management, and Evaluation.,4Division of Biostatistics, Dalla Lana School of Public Health
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13
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Grose E, Chen T, Siu J, Campisi P, Witterick IJ, Chan Y. National Trends in Gender Diversity Among Trainees and Practicing Physicians in Otolaryngology-Head and Neck Surgery in Canada. JAMA Otolaryngol Head Neck Surg 2021; 148:13-19. [PMID: 34792563 DOI: 10.1001/jamaoto.2021.1431] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Importance Monitoring the evolution of gender diversity within medicine is essential to understanding the medical workforce and anticipating its future. Objective To evaluate gender distribution and trends among trainees and practicing physicians in the field of otolaryngology-head and neck surgery (OHNS) across Canada. Design, Setting, and Participants This cross-sectional study collected demographic data on the Canadian population, medical students, resident physicians, fellows, practicing physicians, and full-time professors from the following publicly available databases: the Canadian Post-MD Education Registry, the Canadian Medical Education Statistics from the Association of Faculties of Medicine of Canada, the Canadian Medical Association Masterfile, the Canadian Resident Matching Service archives, and the Canadian Institute for Health Information from 2000 to 2019. Information about the gender distribution in leadership positions and fellowships was obtained through publicly available websites where gender was either listed or assigned by authors. Main Outcomes and Measures The primary outcomes were the proportion of women in OHNS and the evolution of gender diversity over time. Results In 2019, 65 of 155 of OHNS trainees were female (41.9%), whereas female representation among all surgical trainees combined was 1225 of 2496 (49.1%). Female OHNS trainees and practicing physicians are underrepresented despite a 13.3% increase in female trainees and a 14.3% increase in female staff physicians from 2000 to 2019. Proportionally fewer female graduates pursued a fellowship during a 10-year period compared with their male counterparts, with otology and neurotology having the lowest female representation (6 of 27 [22.2%]). A minimal increase occurred in the number of women holding academic leadership positions (eg, 4 of 13 residency training programs had a previous or current female director). Conclusions and Relevance Despite the overall increase in the representation of women in the field of OHNS in Canada, these findings suggest that persistent gender gaps remain with respect to academic leadership positions and fellowship training. Continuous monitoring of the surgical workforce is important to highlight and address gender disparities within OHNS.
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Affiliation(s)
- Elysia Grose
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Tanya Chen
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Siu
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Paolo Campisi
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head & Neck Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ian J Witterick
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head & Neck Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Yvonne Chan
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head & Neck Surgery, St Michael's Hospital, Toronto, Ontario, Canada
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14
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Ziai H, Yu E, Weinreb I, Perez-Ordonez B, Yao CMKL, Xu W, Yang D, Witterick IJ, Monteiro E, Gilbert RW, Irish JC, Gullane PJ, Goldstein DP, Ringash J, Bayley A, de Almeida JR. Regional Recurrences and Hyams Grade in Esthesioneuroblastoma. J Neurol Surg B Skull Base 2021; 82:608-614. [PMID: 34745827 DOI: 10.1055/s-0040-1715809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 06/02/2020] [Indexed: 10/23/2022] Open
Abstract
Objective The aim of this study is to determine if Hyams grade may help predict which patients with esthesioneuroblastoma (ENB) tumors are likely to develop regional recurrences, and to determine the impact of tumor extent on regional failure in ENB patients without evidence of nodal disease at presentation. Design The study was designed as a retrospective review for ENB patients. Settings The study was prepared at tertiary care academic center for ENB patients. Participants Patients with ENB were included in the study. Main Outcome Measures Oncologic outcomes (5-year regional and locoregional control (LRC) and overall survival) in patients with Hyams low grade versus high grade. Oncologic outcomes based on radiographic disease extent. Results A total of 43 patients were included. Total 25 patients (58%) had Hyams low-grade tumor, and 18 (42%) had high-grade tumor. Of the 34 patients without regional disease at presentation, 8 (24%) were treated with elective nodal radiation. There were no statistically significant differences in 5-year regional control in the Hyams low-grade versus high-grade groups (78 vs. 89%; p = 0.4). The 5-year LRC rates in patients with low grade versus high grade were 73 versus 89% ( p = 0.6). The 5-year overall survival rates in patients with low-grade versus high-grade tumors were 86 versus 63% ( p = 0.1). Radiographic extension of disease into the olfactory groove, olfactory nerve, dura, and periorbita were statistically associated with decreased 5-year overall survival (5-year OS 49 vs. 91% [ p = 0.04], 49 vs. 91% [ p = 0.04], 44 vs. 92% [ p = 0.02], and 44 vs. 80% [ p = 0.04], respectively). Conclusion ENBs are associated with a risk of regional failure. The current analysis suggests that Hyams low-grade and high-grade malignancies have comparable rates of early and delayed regional recurrences, although small sample size may limit our conclusions.
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Affiliation(s)
- Hedyeh Ziai
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Eugene Yu
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Ilan Weinreb
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Bayardo Perez-Ordonez
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Christopher M K L Yao
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Wei Xu
- Department of Biostatistics, the Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Dongyang Yang
- Department of Biostatistics, the Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Ian J Witterick
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Eric Monteiro
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ralph W Gilbert
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan C Irish
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Patrick J Gullane
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - David P Goldstein
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jolie Ringash
- Department of Radiation Oncology, the Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Andrew Bayley
- Department of Radiation Oncology, the Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - John R de Almeida
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
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15
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Fu G, Chazen RS, MacMillan C, Witterick IJ. Development of a Molecular Assay for Detection and Quantification of the BRAF Variation in Residual Tissue From Thyroid Nodule Fine-Needle Aspiration Biopsy Specimens. JAMA Netw Open 2021; 4:e2127243. [PMID: 34613404 PMCID: PMC8495535 DOI: 10.1001/jamanetworkopen.2021.27243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 07/09/2021] [Indexed: 12/14/2022] Open
Abstract
Importance Thyroid cancer, predominantly papillary thyroid carcinoma (PTC), is common, but an estimated 30% of ultrasonography-guided fine-needle aspiration (FNA) biopsies of thyroid nodules are indeterminate. BRAF variation, associated with poor clinicopathological characteristics, is a useful molecular marker for diagnostics. Objective To develop a sensitive molecular assay for BRAF V600E detection in remaining tissue of thyroid FNA biopsies to identify patients with cancer carrying a BRAF variation. Design, Setting, and Participants This diagnostic study used tumor tissue from surgical formalin-fixed, paraffin-embedded (FFPE) specimens and residual tissue from thyroid FNA biopsies for genomic DNA extraction. FFPE specimens served as the validation set, and residual tissue from FNA biopsies served as the test set. A molecular assay was developed for accurate detection of BRAF V600E variation using locked nucleic acid (LNA) probe-based droplet digital polymerase chain reaction (dPCR), and the assay was validated by BRAF V600E immunohistochemical staining (IHC). The study was conducted between February 2019 and May 2021. Results A total of 271 specimens, including 77 FFPE specimens (with a follow-up of 48 matched surgical specimens) and 146 residual FNA samples, were collected from 223 patients (mean [SD] age, 53.8 [15.3] years; 174 [78.0%] women; 49 [22.0%] men). The molecular assay by dPCR was first established to specifically and accurately detect and quantify wild-type BRAF and variant BRAF in DNA from human follicular thyroid carcinoma-derived FTC-133 and papillary thyroid carcinoma-derived BCPAP cells. The linearity of quantification of BRAF V600E was calculated (y = 0.7339x; R2 = 0.9996) with sensitivity at 0.02 copies/μL and reproducibility in detecting variant DNA at various dilutions(coefficient of variance in 0.3% DNA, 9.63%; coefficient of variance in 1.0% DNA, 7.41%). In validation testing, the dPCR assay and IHC staining exhibited 100% specificity in concordantly identifying BRAF V600E in PTCs (κ = 0.873; P < .001) and sensitivity of 32.0% (95% CI, 19.1% to 44.9%) in dPCR and 26.0% (95% CI, 13.1% to 38.9%) in IHC staining, with an improvement by 23.08% in dPCR compared with the IHC staining. The dPCR assay further detected BRAF V600E in 39 of 146 residual FNA specimens (26.7%). At short-term follow-up, 48 patients, including 14 of 39 patients with BRAF variation and 34 of 107 patients without BRAF variation on residual FNA specimens, underwent resection. The dPCR assay of BRAF status in the matched surgical specimens showed BRAF V600E variations in 12 patients and wild-type BRAF in 36 patients, with a high agreement to that in residual tissue of FNA specimens (κ = 0.789; P < .001). Among 14 patients with BRAF variations on residual FNA, 13 were diagnosed with PTC and 1 was diagnosed with anaplastic thyroid cancer at the thyroidectomy. Conclusions and Relevance This diagnostic study developed a sensitive molecular assay for detection and quantification of BRAF V600E variation in residual tissue from thyroid FNA biopsies to identify patients with cancer harboring BRAF V600E in a cost-effective manner, highlighting the clinical value of molecular assay of the remaining FNA tissue in the management of thyroid nodules.
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Affiliation(s)
- Guodong Fu
- Alex and Simona Shnaider Research Laboratory in Molecular Oncology, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Mount Sinai Hospital, Toronto, Canada
| | - Ronald S. Chazen
- Alex and Simona Shnaider Research Laboratory in Molecular Oncology, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Mount Sinai Hospital, Toronto, Canada
| | - Christina MacMillan
- Alex and Simona Shnaider Research Laboratory in Molecular Oncology, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Mount Sinai Hospital, Toronto, Canada
- Department of Pathology and Laboratory Medicine, Sinai Health System, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Ian J. Witterick
- Alex and Simona Shnaider Research Laboratory in Molecular Oncology, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Mount Sinai Hospital, Toronto, Canada
- Joseph and Mildred Sonshine Family Centre for Head and Neck Diseases, Sinai Health System, Mount Sinai Hospital, Toronto, Canada
- Department of Otolaryngology-Head and Neck Surgery, Sinai Health System, Mount Sinai Hospital, University of Toronto, Toronto, Canada
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16
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Hamour AF, Yang W, Lee JJW, Wu V, Ziai H, Singh P, Eskander A, Sahovaler A, Higgins K, Witterick IJ, Vescan A, Freeman J, de Almeida JR, Goldstein D, Gilbert R, Chepeha D, Irish J, Enepekides D, Monteiro E. Association of the Implementation of a Standardized Thyroid Ultrasonography Reporting Program With Documentation of Nodule Characteristics. JAMA Otolaryngol Head Neck Surg 2021; 147:343-349. [PMID: 33570552 DOI: 10.1001/jamaoto.2020.5233] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Importance Although most thyroid nodules are benign, the potential for malignant neoplasms is associated with unnecessary workup in the form of imaging, fine-needle aspiration, and diagnostic surgery. The American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) is commonly used to assess the malignant neoplasm risk potential of thyroid nodules imaged by ultrasonography. However, standardized reporting of ACR TI-RADS descriptors is inconsistent. Objective To increase the documentation rate of ACR TI-RADS thyroid nodule characteristics to 80% in 18 months. Design, Setting, and Participants This prospective interrupted time series quality improvement study was conducted from December 1, 2018, to March 31, 2020, at a tertiary outpatient head and neck clinic among 229 patients who had at least 1 documented thyroid nodule identified on bedside clinic ultrasonography. Data analysis was performed throughout the entire study period because this was a quality improvement study with iterative small cycle changes; final analysis of the data was performed in April 2020. Main Outcomes and Measures The primary outcome was the documentation rates of 6 ACR TI-RADS ultrasonographic descriptors. Secondary outcomes included nodule fine-needle aspiration biopsy rate and physician-reported clinic flow efficiency. Results A total of 229 patients had at least 1 documented thyroid nodule and were included in the analysis. Size was the most frequently documented nodule characteristic (72 of 74 [97.3%]) at baseline, followed by echogenic foci (31 of 74 [41.9%]), composition (23 of 74 [31.1%]), echogenicity (17 of 74 [23.0%]), margin (6 of 74 [8.1%]), and shape (1 of 74 [1.4%]). After 3 Plan, Do, Study, Act (PDSA) cycles, the final intervention consisted of a standardized ultrasonography reporting form and educational initiatives for surgical trainees. After the third PDSA cycle (n = 36), reporting of nodule size, echogenic foci, and composition increased to 100%. Similarly, reporting of echogenicity (34 of 36 [94.4%]), shape (28 of 36 [77.8%]), and margin (25 of 36 [69.4%]) all increased. This represented a cumulative 90.3% documentation rate (195 of 216), a 56.5% increase from baseline (95% CI, 50.0%-61.9%). The standardized reporting form was used in 83.3% of eligible thyroid ultrasonography cases (30 of 36) after PDSA cycle 3, demonstrating good fidelity of implementation. There were no unintended consequences associated with clinic workflow, as a balancing measure, reported by staff surgeons. Conclusions and Relevance This study suggests that implementation of an ACR TI-RADS-based reporting form in conjunction with educational initiatives improved documentation of ultrasonographic thyroid nodule characteristics, potentially allowing for improved bedside risk stratification and communication among clinicians.
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Affiliation(s)
- Amr F Hamour
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Weining Yang
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - John J W Lee
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Vincent Wu
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Hedyeh Ziai
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Praby Singh
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Department of Surgery, The Scarborough Hospital, Toronto, Ontario, Canada
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Axel Sahovaler
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Kevin Higgins
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ian J Witterick
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Sinai Health System, Toronto, Ontario, Canada
| | - Allan Vescan
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Sinai Health System, Toronto, Ontario, Canada
| | - Jeremy Freeman
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Sinai Health System, Toronto, Ontario, Canada
| | - John R de Almeida
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - David Goldstein
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Ralph Gilbert
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Douglas Chepeha
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Jonathan Irish
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Danny Enepekides
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Eric Monteiro
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Sinai Health System, Toronto, Ontario, Canada
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17
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Saydy N, Moubayed SP, Bussières M, Janjua A, Kilty S, Lavigne F, Monteiro E, Nayan S, Piché M, Smith K, Sommer D, Sowerby L, Tewfik MA, Witterick IJ, Wright E, Desrosiers M. What is the optimal outcome after endoscopic sinus surgery in the treatment of chronic rhinosinusitis? A consultation of Canadian experts. J Otolaryngol Head Neck Surg 2021; 50:36. [PMID: 34134762 PMCID: PMC8210358 DOI: 10.1186/s40463-021-00519-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 05/14/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Many experts feel that in the absence of well-defined goals for success, they have an easier time identifying failure. As success ought to not be defined only by absence of failure, we aimed to define optimal outcomes for endoscopic sinus surgery (ESS) in chronic rhinosinusitis (CRS) by obtaining expert surgeon perspectives. METHODS A total of 12 surgeons participated in this targeted consultation. Face to face semi-structured interviews were performed with expert surgeons in the field of CRS and ESS. General impressions and personal definitions of acceptable operative success and optimal operative outcomes were compiled and summarized. RESULTS According to an expert survey, patients' main objectives are an improvement in their chief complain, a general improvement in quality of life (QoL), and a better overall symptomatic control. The most important aspects of endoscopy for defining a successful intervention were an adequate mucus circulation, a healthy mucosa, minimal edema, and patency of all explored cavities or ostia. In the assessment of surgical outcomes, it was determined that both objective and patient reported data must be carefully examined, with more attention given to subjective outcomes. CONCLUSIONS According to data gathered from a Canadian expert consultation, a definition of success must be based on both subjective data and nasal endoscopy. We propose to define an acceptable outcome as either a subjective improvement of at least the minimal clinically improvement difference of a validated patient reported outcome questionnaire, along with a satisfactory endoscopic result (1) or a complete subjective resolution with a sub-optimal endoscopy (2).
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Affiliation(s)
- Nadim Saydy
- Division of Otolaryngology - Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal, Quebec, Canada
| | - Sami P Moubayed
- Division of Otolaryngology - Head & Neck Surgery, Maisonneuve-Rosemont Hospital, Université de Montréal, Montreal, Quebec, Canada
| | - Marie Bussières
- Division of Otolaryngology - Head & Neck Surgery, Centre Hospitalier de l'Université de Sherbrooke - Hôtel-Dieu Hospital, University of Sherbrooke, Quebec, Canada
| | - Arif Janjua
- Division of Otolaryngology - Head & Neck Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shaun Kilty
- Division of Otolaryngology - Head & Neck Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - François Lavigne
- Division of Otolaryngology - Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal, Quebec, Canada
| | - Eric Monteiro
- Division of Otolaryngology - Head & Neck Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Smriti Nayan
- Division of Otolaryngology - Head & Neck Surgery, Cambridge Memorial Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Marilou Piché
- Division of Otolaryngology - Head & Neck Surgery, Hôpital Saint-Sacrement, Laval University, Quebec, Quebec, Canada
| | - Kristine Smith
- Division of Otolaryngology - Head & Neck Surgery, Winnipeg Health Sciences Center, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Doron Sommer
- Division of Otolaryngology - Head & Neck Surgery, Cambridge Memorial Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Leigh Sowerby
- Division of Otolaryngology - Head & Neck Surgery, St-Joseph's Hospital, Western University, London, Ontario, Canada
| | - Marc A Tewfik
- Division of Otolaryngology - Head & Neck Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Ian J Witterick
- Division of Otolaryngology - Head & Neck Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Erin Wright
- Division of Otolaryngology - Head & Neck Surgery, Walter C MacKenzie Health Sciences Center, University of Alberta, Edmonton, Alberta, Canada
| | - Martin Desrosiers
- Division of Otolaryngology - Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal, Quebec, Canada.
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18
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Lee DJ, Forner D, End C, Yao CMKL, Samargandy S, Monteiro E, Witterick IJ, Freeman JL. Outpatient versus inpatient superficial parotidectomy: clinical and pathological characteristics. J Otolaryngol Head Neck Surg 2021; 50:10. [PMID: 33579392 PMCID: PMC7881444 DOI: 10.1186/s40463-020-00484-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 02/19/2020] [Accepted: 12/21/2020] [Indexed: 12/26/2022] Open
Abstract
Background Superficial parotidectomy has a potential to be performed as an outpatient procedure. The objective of the study is to evaluate the safety and selection profile of outpatient superficial parotidectomy compared to inpatient parotidectomy. Methods A retrospective review of individuals who underwent superficial parotidectomy between 2006 and 2016 at a tertiary care center was conducted. Primary outcomes included surgical complications, including transient/permanent facial nerve palsy, wound infection, hematoma, seroma, and fistula formation, as well as medical complications in the postoperative period. Secondary outcome measures included unplanned emergency room visits and readmissions within 30 days of operation due to postoperative complications. Results There were 238 patients included (124 in outpatient and 114 in inpatient group). There was no significant difference between the groups in terms of gender, co-morbidities, tumor pathology or tumor size. There was a trend towards longer distance to the hospital from home address (111 Km in inpatient vs. 27 in outpatient, mean difference 83 km [95% CI,- 1 to 162 km], p = 0.053). The overall complication rates were comparable between the groups (24.2% in outpatient group vs. 21.1% in inpatient, p = 0.56). There was no difference in the rate of return to the emergency department (3.5% vs 5.6%, p = 0.433) or readmission within 30 days (0.9% vs 0.8%, p = 0.952). Conclusion Superficial parotidectomy can be performed safely as an outpatient procedure without elevated risk of complications. Graphical abstract ![]()
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Affiliation(s)
- Daniel J Lee
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - David Forner
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada.,Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, Dalhousie University, Halifax, ON, Canada
| | - Christopher End
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Christopher M K L Yao
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Shireen Samargandy
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Eric Monteiro
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada.,Department of Otolaryngology - Head & Neck Surgery, Sinai Health System, 600 University Avenue, Suite 401, Toronto, ON, M5G 1X5, Canada
| | - Ian J Witterick
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada.,Department of Otolaryngology - Head & Neck Surgery, Sinai Health System, 600 University Avenue, Suite 401, Toronto, ON, M5G 1X5, Canada
| | - Jeremy L Freeman
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada. .,Department of Otolaryngology - Head & Neck Surgery, Sinai Health System, 600 University Avenue, Suite 401, Toronto, ON, M5G 1X5, Canada.
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19
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Chan Y, Banglawala SM, Chin CJ, Côté DWJ, Dalgorf D, de Almeida JR, Desrosiers M, Gall RM, Gevorgyan A, Hassan Hassan A, Janjua A, Lee JM, Leung RM, Mechor BD, Mertz D, Monteiro E, Nayan S, Rotenberg B, Scott J, Smith KA, Sommer DD, Sowerby L, Tewfik MA, Thamboo A, Vescan A, Witterick IJ. CSO (Canadian Society of Otolaryngology - Head & Neck Surgery) position paper on rhinologic and skull base surgery during the COVID-19 pandemic. J Otolaryngol Head Neck Surg 2020; 49:81. [PMID: 33272328 PMCID: PMC7714255 DOI: 10.1186/s40463-020-00476-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 10/25/2020] [Indexed: 01/19/2023] Open
Abstract
Healthcare services in many countries have been partially or completely disrupted by the Coronavirus (COVID-19) pandemic since its onset in the end of 2019. Amongst the most impacted are the elective medical and surgical services in order to conserve resources to care for COVID-19 patients. As the number of infected patients decrease across Canada, elective surgeries are being restarted in a staged manner. Since Otolaryngologists - Head & Neck Surgeons manage surgical diseases of the upper aerodigestive tract where the highest viral load reside, it is imperative that these surgeries resume in a safe manner. The aim of this document is to compile the current best evidence available and provide expert consensus on the safe restart of rhinologic and skull base surgeries while discussing the pre-operative, intra-operative, and post-operative care and tips. Risk assessment, patient selection, case triage, and pre-operative COVID-19 testing will be analyzed and discussed. These guidelines will also consider the optimal use of personal protective equipment for specific cases, general and specific operative room precautions, and practical tips of intra-operative maneuvers to optimize patient and provider safety. Given that the literature surrounding COVID-19 is rapidly evolving, these recommendations will serve to start our specialty back into elective rhinologic surgeries over the next months and they may change as we learn more about this disease.
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Affiliation(s)
- Yvonne Chan
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada.
| | - Sarfaraz M Banglawala
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Christopher J Chin
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Dalhousie University, Saint John, NB, Canada
| | - David W J Côté
- University of Montreal Hospital Center (CHUM) and Research Center (CRCHUM), Montreal, QC, Canada
| | - Dustin Dalgorf
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - John R de Almeida
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | | | - Richard M Gall
- Department of Otolaryngology - Head and Neck Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Artur Gevorgyan
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - A Hassan Hassan
- Department of Clinical Sciences, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Arif Janjua
- Division of Otolaryngology - Head & Neck Surgery, University of British Columbia, Vancouver, BC, Canada
| | - John M Lee
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Randy M Leung
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | | | - Dominik Mertz
- Division of Infectious Diseases, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Eric Monteiro
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Smriti Nayan
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Brian Rotenberg
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada
| | - John Scott
- Department of Otolaryngology - Head & Neck Surgery, Dalhousie University, Halifax, NS, Canada
| | - Kristine A Smith
- Department of Otolaryngology - Head and Neck Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Doron D Sommer
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Leigh Sowerby
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada
| | - Marc A Tewfik
- Department of Otolaryngology - Head & Neck Surgery, McGill University, Montreal, QC, Canada
| | - Andrew Thamboo
- Division of Otolaryngology - Head & Neck Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Allan Vescan
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Ian J Witterick
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
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20
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Cottrell J, Yip J, Campisi P, Chadha NK, Damji A, Hong P, Lachance S, Leitao D, Nguyen LH, Saunders N, Strychowsky J, Yunker W, Vaccani JP, Chan Y, de Almeida JR, Eskander A, Witterick IJ, Monteiro E. Quality indicators for the diagnosis and management of pediatric tonsillitis. Int J Pediatr Otorhinolaryngol 2020; 139:110441. [PMID: 33120099 DOI: 10.1016/j.ijporl.2020.110441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 10/07/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Pediatric tonsillitis is encountered frequently across specialties, and while high quality guidelines exist, there is persistent evidence of care which is not evidence based, including antibiotic overprescribing and surgical practice variability. Quality indicators (QIs) can be utilized for initiatives to improve the quality of care and subsequent patient outcomes. We sought to develop pediatric tonsillitis QIs that are applicable across specialties and that cover aspects of both diagnosis and the spectrum of management options. METHODS A guideline-based approach to QI development was employed. Candidate indicators (CIs) were extracted from international guidelines deemed high quality by two reviewers and evaluated by an eleven-member expert panel consisting of otolaryngology - head & neck surgeons, a pediatrician and a family physician. The final QIs were selected utilizing a modified RAND/UCLA appropriateness methodology. RESULTS Twenty-six CIs were identified after initial literature review. After the first round of evaluations, the panel agreed on thirteen candidate indicators as appropriate QIs. A subsequent expert panel meeting provided a platform to discuss areas of disagreement, discuss any recently published research, and to brainstorm additional CIs not identified from the guideline extraction. Following the second round of evaluations, the expert panel agreed upon sixteen QIs as appropriate measures of high-quality care. CONCLUSIONS This study proposes sixteen QIs developed through a multidisciplinary lens to guide practitioners in the diagnosis and management of pediatric tonsillitis. These QIs can be used to improve transparency, accountability, and provide objective data to assist future quality improvement initiatives.
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Affiliation(s)
- Justin Cottrell
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, St. George Campus, C. David Naylor Building, 6 Queen's Park Crescent West, Suite 120, Toronto, ON, M5S 3H2, Canada.
| | - Jonathan Yip
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, St. George Campus, C. David Naylor Building, 6 Queen's Park Crescent West, Suite 120, Toronto, ON, M5S 3H2, Canada
| | - Paolo Campisi
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, St. George Campus, C. David Naylor Building, 6 Queen's Park Crescent West, Suite 120, Toronto, ON, M5S 3H2, Canada
| | - Neil K Chadha
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada
| | - Ali Damji
- Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada
| | - Paul Hong
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, Dalhousie University, QEII Health Sciences Centre, 3rd floor Dickson Building, 5820 University Avenue, Halifax, NS, B3H 1Y9, Canada
| | - Sophie Lachance
- Département d'Oto-rhino-laryngologie et chirurgie cervico-faciale, CHUL, Pavillon Ferdinand-Vandry, 1050, avenue de la Médecine Université Laval, Québec, G1V 0A6, Canada
| | - Darren Leitao
- Department of Otolaryngology, Head and Neck Surgery, University of Manitoba, GB421 - 820 Sherbrook Street, University of Manitoba, Winnipeg, MB, R3T 2N2, Canada
| | - Lily Hp Nguyen
- Department of Otolaryngology - Head and Neck Surgery, McGill University, 3801 Rue University, Montréal, QC, H3A 1A1, Canada
| | - Natasha Saunders
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ON, M5G 1X8, Canada
| | - Julie Strychowsky
- Department of Otolaryngology - Head and Neck Surgery, Western University, London Health Sciences Centre - Victoria Hospital London, Ontario, N6A 5W9, Canada
| | - Warren Yunker
- Sections of Pediatric Surgery and Otolaryngology - Head & Neck Surgery, Department of Surgery, University of Calgary, 2500 University Dr. NW, Calgary, AB, T2N 1N4, Canada
| | - Jean-Philippe Vaccani
- Department of Otolaryngology-Head and Neck Surgery, The University of Ottawa and the Ottawa Hospital, S3, 501 Smyth Rd. Ottawa, ON, K1H 8L6, Canada
| | - Yvonne Chan
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, St. George Campus, C. David Naylor Building, 6 Queen's Park Crescent West, Suite 120, Toronto, ON, M5S 3H2, Canada
| | - John R de Almeida
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, St. George Campus, C. David Naylor Building, 6 Queen's Park Crescent West, Suite 120, Toronto, ON, M5S 3H2, Canada
| | - Antoine Eskander
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, St. George Campus, C. David Naylor Building, 6 Queen's Park Crescent West, Suite 120, Toronto, ON, M5S 3H2, Canada
| | - Ian J Witterick
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, St. George Campus, C. David Naylor Building, 6 Queen's Park Crescent West, Suite 120, Toronto, ON, M5S 3H2, Canada
| | - Eric Monteiro
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, St. George Campus, C. David Naylor Building, 6 Queen's Park Crescent West, Suite 120, Toronto, ON, M5S 3H2, Canada
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Chan Y, Angel D, Aron M, Hartl T, Moubayed SP, Smith KA, Sommer DD, Sowerby L, Spafford P, Mertz D, Witterick IJ. CSO (Canadian Society of Otolaryngology - Head & Neck Surgery) position paper on return to Otolaryngology - Head & Neck Surgery Clinic Practice during the COVID-19 pandemic in Canada. J Otolaryngol Head Neck Surg 2020; 49:76. [PMID: 33106189 PMCID: PMC7586368 DOI: 10.1186/s40463-020-00466-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/16/2020] [Indexed: 12/14/2022] Open
Abstract
The novel Coronavirus (COVID-19) has created a worldwide deadly pandemic that has become a major public health challenge. All semi-urgent and elective medical care has come to a halt to conserve capacity to care for patients during this pandemic. As the numbers of COVID-19 cases decrease across Canada, our healthcare system also began to reopen various facilities and medical offices. The aim for this document is to compile the current evidence and provide expert consensus on the safe return to clinic practice in Otolaryngology - Head & Neck Surgery. These recommendations will also summarize general precaution principles and practical tips for office across Canada to optimize patient and provider safety. Risk assessment and patient selection are crucial to minimizing exposure to COVID-19. Controversial topics such as COVID-19 mode of transmission, duration of exposure, personal protective equipment, and aerosol-generating procedures will be analyzed and discussed. Practical solutions of pre-visit office preparation, front office and examination room set-up, and check out procedures are explored. Specific considerations for audiology, pediatric population, and high risk AGMPs are also addressed. Given that the literature surrounding COVID-19 is rapidly evolving, these guidelines will serve to start our specialty back into practice over the next weeks to months and they may change as we learn more about this disease.
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Affiliation(s)
- Y Chan
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada.
| | - D Angel
- Division of Otolaryngology - Head & Neck Surgery, Memorial University of Newfoundland, St. John's, NL, Canada
| | - M Aron
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - T Hartl
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - S P Moubayed
- Division of Otolaryngology - Head & Neck Surgery, University of Montreal, Montreal, QC, Canada
| | - K A Smith
- Department of Otolaryngology - Head & Neck Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - D D Sommer
- Otolaryngology - Head & Neck Surgery Division, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - L Sowerby
- Department of Otolaryngology - Head & Neck Surgery, Western University, London, ON, Canada
| | - P Spafford
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Saskatchewan, Saskatoon, SK, Canada
| | - D Mertz
- Division of Infectious Diseases, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - I J Witterick
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
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22
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de Almeida JR, Noel CW, Forner D, Zhang H, Nichols AC, Cohen MA, Wong RJ, McMullen C, Graboyes EM, Divi V, Shuman AG, Rosko AJ, Lewis CM, Hanna EY, Myers J, Paleri V, Miles B, Genden E, Eskander A, Enepekides DJ, Higgins KM, Brown D, Chepeha DB, Witterick IJ, Gullane PJ, Irish JC, Monteiro E, Goldstein DP, Gilbert R. Development and validation of a Surgical Prioritization and Ranking Tool and Navigation Aid for Head and Neck Cancer (SPARTAN-HN) in a scarce resource setting: Response to the COVID-19 pandemic. Cancer 2020; 126:4895-4904. [PMID: 32780426 PMCID: PMC7436362 DOI: 10.1002/cncr.33114] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 06/08/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 12/22/2022]
Abstract
Background In the wake of the coronavirus disease 2019 (COVID‐19) pandemic, access to surgical care for patients with head and neck cancer (HNC) is limited and unpredictable. Determining which patients should be prioritized is inherently subjective and difficult to assess. The authors have proposed an algorithm to fairly and consistently triage patients and mitigate the risk of adverse outcomes. Methods Two separate expert panels, a consensus panel (11 participants) and a validation panel (15 participants), were constructed among international HNC surgeons. Using a modified Delphi process and RAND Corporation/University of California at Los Angeles methodology with 4 consensus rounds and 2 meetings, groupings of high‐priority, intermediate‐priority, and low‐priority indications for surgery were established and subdivided. A point‐based scoring algorithm was developed, the Surgical Prioritization and Ranking Tool and Navigation Aid for Head and Neck Cancer (SPARTAN‐HN). Agreement was measured during consensus and for algorithm scoring using the Krippendorff alpha. Rankings from the algorithm were compared with expert rankings of 12 case vignettes using the Spearman rank correlation coefficient. Results A total of 62 indications for surgical priority were rated. Weights for each indication ranged from −4 to +4 (scale range; −17 to 20). The response rate for the validation exercise was 100%. The SPARTAN‐HN demonstrated excellent agreement and correlation with expert rankings (Krippendorff alpha, .91 [95% CI, 0.88‐0.93]; and rho, 0.81 [95% CI, 0.45‐0.95]). Conclusions The SPARTAN‐HN surgical prioritization algorithm consistently stratifies patients requiring HNC surgical care in the COVID‐19 era. Formal evaluation and implementation are required. Lay Summary Many countries have enacted strict rules regarding the use of hospital resources during the coronavirus disease 2019 (COVID‐19) pandemic. Facing delays in surgery, patients may experience worse functional outcomes, stage migration, and eventual inoperability. Treatment prioritization tools have shown benefit in helping to triage patients equitably with minimal provider cognitive burden. The current study sought to develop what to the authors' knowledge is the first cancer–specific surgical prioritization tool for use in the COVID‐19 era, the Surgical Prioritization and Ranking Tool and Navigation Aid for Head and Neck Cancer (SPARTAN‐HN). This algorithm consistently stratifies patients requiring head and neck cancer surgery in the COVID‐19 era and provides evidence for the initial uptake of the SPARTAN‐HN.
To the authors' knowledge, the Surgical Prioritization and Ranking Tool and Navigation Aid for Head and Neck Cancer (SPARTAN‐HN) is the first cancer surgery–specific prioritization tool for use during the coronavirus disease 2019 (COVID‐19) pandemic. The SPARTAN‐HN algorithm is reliable and valid for the stratification of patients with head and neck cancer who require urgent cancer care in resource‐restricted practice environments.
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Affiliation(s)
- John R de Almeida
- Division of Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Christopher W Noel
- Division of Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - David Forner
- Division of Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Division of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Han Zhang
- Division of Otolaryngology-Head and Neck Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Anthony C Nichols
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Marc A Cohen
- Department of Otolaryngology-Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Richard J Wong
- Department of Otolaryngology-Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Caitlin McMullen
- Head and Neck-Endocrine Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Evan M Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Vasu Divi
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California
| | - Andrew G Shuman
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Andrew J Rosko
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Carol M Lewis
- Department of Otolaryngology-Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ehab Y Hanna
- Department of Otolaryngology-Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeffrey Myers
- Department of Otolaryngology-Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Vinidh Paleri
- Head and Neck Unit, The Royal Marsden Hospital, London, United Kingdom
| | - Brett Miles
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Eric Genden
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Danny J Enepekides
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Kevin M Higgins
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Dale Brown
- Division of Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Douglas B Chepeha
- Division of Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ian J Witterick
- Department of Otolaryngology-Head and Neck Surgery, Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - Patrick J Gullane
- Division of Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan C Irish
- Division of Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Eric Monteiro
- Department of Otolaryngology-Head and Neck Surgery, Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - David P Goldstein
- Division of Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ralph Gilbert
- Division of Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Abstract
PURPOSE The purpose of this review is to assess the recent evidence regarding the management of squamous cell carcinoma of the skull-base and to discuss the implications of these findings on clinical practice. METHOD Free text Medline and MeSH term search of publications relating to Squamous Cell Carcinoma & Skull-base and Skull base, Neoplasm respectively. Multidisciplinary clinical guidelines were also reviewed. RESULTS The primary search yielded a total of 271 papers which following initial review was reduced to 28. Secondary search yielded 56 papers. There were no randomised controlled trials relating to squamous cell carcinoma of the skull-base and as such this review is based on cohort studies, case series and expert opinion. CONCLUSION Squamous cell carcinoma (SCC) is the most common cancer occurring in the Head and Neck. Squamous cell carcinoma is also the most common cancer arising within the nose and sinuses of which skull-base squamous cell carcinoma is a rare subgroup. Evidence relating to the management and survival of skull-base SCC is based on expert opinion and. retrospective analyses Clinical examination and biopsy, imaging and a broad multidisciplinary team are key to the management of skull-base SCC. The information gathered should be used to guide informed discussion by suitably trained experts with patients regarding surgical approach, post-operative recovery and adjuvant or neoadjuvant treatments. The standard of care is currently to perform skull base resection with or without additional craniotomy, pedicled or free flap reconstruction in multiple layers and post-operative radiation (usually photons or protons). Open approaches have traditionally been the mainstay, however in certain cases endoscopic approaches can yield equivalent results and offer many advantages. Despite advances in care survival remains poor with a nearly one in five risk of nodal recurrence within two years.
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Affiliation(s)
- Colin G Leonard
- Department of Otolaryngology, Head and Neck Surgery, University of Toronto, Toronto, Canada
| | - Vikram Padhye
- Department of Otolaryngology, Head and Neck Surgery, University of Toronto, Toronto, Canada
| | - Ian J Witterick
- Department of Otolaryngology, Head and Neck Surgery, University of Toronto, Toronto, Canada.
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Wu V, Noel CW, Forner D, Zhang Z, Higgins KM, Enepekides DJ, Lee JM, Witterick IJ, Kim JJ, Waldron JN, Irish JC, Hua Q, Eskander A. Considerations for head and neck oncology practices during the coronavirus disease 2019 (COVID-19) pandemic: Wuhan and Toronto experience. Head Neck 2020; 42:1202-1208. [PMID: 32338807 PMCID: PMC7267482 DOI: 10.1002/hed.26205] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 04/14/2020] [Indexed: 12/16/2022] Open
Abstract
The practices of head and neck surgical oncologists must evolve to meet the unprecedented needs placed on our health care system by the Coronavirus disease 2019 (COVID-19) pandemic. Guidelines are emerging to help guide the provision of head and neck cancer care, though in practice, it can be challenging to operationalize such recommendations. Head and neck surgeons at Wuhan University faced significant challenges in providing care for their patients. Similar challenges were faced by the University of Toronto during the severe acute respiratory syndrome (SARS) pandemic in 2003. Herein, we outline our combined experience and key practical considerations for maintaining an oncology service in the midst of a pandemic.
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Affiliation(s)
- Vincent Wu
- Department of Otolaryngology—Head and Neck SurgeryUniversity of TorontoTorontoOntarioCanada
| | - Christopher W. Noel
- Department of Otolaryngology—Head and Neck SurgeryUniversity of TorontoTorontoOntarioCanada
- Institute of Health Policy, Management and Evaluation, University of TorontoTorontoOntarioCanada
| | - David Forner
- Institute of Health Policy, Management and Evaluation, University of TorontoTorontoOntarioCanada
- Division of Otolaryngology—Head and Neck SurgeryDalhousie UniversityHalifaxNova ScotiaCanada
| | - Zhi‐Jian Zhang
- Department of Otolaryngology—Head and Neck SurgeryRenmin Hospital of Wuhan UniversityWuhanChina
| | - Kevin M. Higgins
- Department of Otolaryngology—Head and Neck SurgeryUniversity of TorontoTorontoOntarioCanada
| | - Danny J. Enepekides
- Department of Otolaryngology—Head and Neck SurgeryUniversity of TorontoTorontoOntarioCanada
| | - John M. Lee
- Department of Otolaryngology—Head and Neck SurgeryUniversity of TorontoTorontoOntarioCanada
| | - Ian J. Witterick
- Department of Otolaryngology—Head and Neck SurgeryUniversity of TorontoTorontoOntarioCanada
| | - John J. Kim
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network and Department of Radiation OncologyUniversity of TorontoTorontoOntarioCanada
| | - John N. Waldron
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network and Department of Radiation OncologyUniversity of TorontoTorontoOntarioCanada
| | - Jonathan C. Irish
- Department of Otolaryngology—Head and Neck SurgeryUniversity of TorontoTorontoOntarioCanada
| | - Qing‐Quan Hua
- Department of Otolaryngology—Head and Neck SurgeryRenmin Hospital of Wuhan UniversityWuhanChina
| | - Antoine Eskander
- Department of Otolaryngology—Head and Neck SurgeryUniversity of TorontoTorontoOntarioCanada
- Institute of Health Policy, Management and Evaluation, University of TorontoTorontoOntarioCanada
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25
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Fu T, Wu V, Campisi P, Witterick IJ, Chan Y. Academic benchmarks for leaders in Otolaryngology - Head & Neck Surgery: a Canadian perspective. J Otolaryngol Head Neck Surg 2020; 49:27. [PMID: 32375901 PMCID: PMC7201551 DOI: 10.1186/s40463-020-00419-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 12/06/2019] [Accepted: 04/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The present study summarizes the demographics, subspecialty training, and academic productivity of contemporary leaders in Canadian Otolaryngology - Head & Neck Surgery (OHNS) training programs across Canada. METHODS Demographic data regarding chairpersons (CPs) and program directors (PDs) were obtained from publicly-available faculty listings and online sources, and included employment institution, residency training, fellowship training status, gender, and years of post-graduate experience. Research productivity was measured using the h-index and number of publications, obtained from Scopus. Characteristics of CPs and PDs were compared using statistical analysis. RESULTS Cross-sectional data was obtained from a total of 27 CPs and PDs from 13 accredited OHNS training programs across Canada active on July 1, 2019. All academic leaders completed at least 1 year of fellowship training. Head and neck oncology represented 77% of CPs and 59% of academic leaders overall, while pediatric otolaryngology represented 43% of PDs. Females represented 11% of academic leaders. There was a significant association between location of residency training and employment, with 56% (15/27) of physicians working where they had trained (p = 0.001, Fisher's exact test; φ = 2.63, p = 0.001). On average, individuals with a graduate (Master's) degree had a significantly higher H-index (17.7 vs 7.4, p = 0.001) and greater number of publications (106 vs. 52, p = 0.02). Compared to PDs, CPs had a significantly higher average h-index score (14.5 vs. 8.14, p = 0.04) and accrued more years of post-graduate experience (29.7 vs. 21.3 years, p = 0.008). There were no differences in the proportions of CPs and PDs with graduate degrees. There appeared to be a decline in research productivity beginning 3 years after academic appointment. CONCLUSIONS This cross-sectional overview of academic leaders in Canadian OHNS programs demonstrates the following key findings: 1) all leaders completed fellowship training; 2) head and neck surgical oncology was the most common fellowship training subspecialty; 3) leaders were likely to be employed at the institution where they trained; 4) a Master's degree may be associated with increased research productivity; 5) there is a potential risk of decreased productivity after appointment to a leadership position; and 6) women are underrepresented in academic leadership roles.
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Affiliation(s)
- Terence Fu
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Canada
| | - Vincent Wu
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Canada
| | - Paolo Campisi
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Canada
| | - Ian J Witterick
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Canada
| | - Yvonne Chan
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Canada.
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26
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Sommer DD, Engels PT, Weitzel EK, Khalili S, Corsten M, Tewfik MA, Fung K, Cote D, Gupta M, Sne N, Brown TFE, Paul J, Kost KM, Witterick IJ. Recommendations from the CSO-HNS taskforce on performance of tracheotomy during the COVID-19 pandemic. J Otolaryngol Head Neck Surg 2020; 49:23. [PMID: 32340627 PMCID: PMC7184547 DOI: 10.1186/s40463-020-00414-9] [Citation(s) in RCA: 106] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 04/13/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION The performance of tracheotomy is a common procedural request by critical care departments to the surgical services of general surgery, thoracic surgery and otolaryngology - head & neck surgery. A Canadian Society of Otolaryngology - Head & Neck Surgery (CSO-HNS) task force was convened with multi-specialty involvement from otolaryngology-head & neck surgery, general surgery, critical care and anesthesiology to develop a set of recommendations for the performance of tracheotomies during the COVID-19 pandemic. MAIN BODY The tracheotomy procedure is highly aerosol generating and directly exposes the entire surgical team to the viral aerosol plume and secretions, thereby increasing the risk of transmission to healthcare providers. As such, we believe extended endotracheal intubation should be the standard of care for the entire duration of ventilation in the vast majority of patients. Pre-operative COVID-19 testing is highly recommended for any non-emergent procedure. CONCLUSION The set of recommendations in this document highlight the importance of avoiding tracheotomy procedures in patients who are COVID-19 positive if at all possible. Recommendations for appropriate PPE and environment are made for COVID-19 positive, negative and unknown patients requiring consideration of tracheotomy. The safety of healthcare professionals who care for ill patients and who keep critical infrastructure operating is paramount.
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Affiliation(s)
- D D Sommer
- Division of Otolaryngology - Head & Neck Surgery - Department of Surgery, McMaster University Medical Centre, McMaster University, 3V1 Clinic, 1200 Main St West, Hamilton, ON, L8N 3Z5, Canada.
| | - P T Engels
- Department of Surgery and Critical Care, McMaster University, Hamilton, ON, Canada
| | - E K Weitzel
- United States Army Institute of Surgical Research, Fort Sam Houston, TX, USA
| | - S Khalili
- Aurora Neuroscience Innovation Institute, Milwaukee, WI, USA
| | - M Corsten
- Division of Otolaryngology - Head & Neck Surgery, Dalhousie University, Halifax, NS, Canada
| | - M A Tewfik
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - K Fung
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada
| | - D Cote
- Division of Otolaryngology - Head and Neck Surgery, University of Alberta, Edmonton, AB, Canada
| | - M Gupta
- Division of Otolaryngology - Head & Neck Surgery - Department of Surgery, McMaster University Medical Centre, McMaster University, 3V1 Clinic, 1200 Main St West, Hamilton, ON, L8N 3Z5, Canada
| | - N Sne
- Department of Surgery and Critical Care, McMaster University, Hamilton, ON, Canada
| | - T F E Brown
- Division of Otolaryngology - Head & Neck Surgery, Dalhousie University, Halifax, NS, Canada
| | - J Paul
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - K M Kost
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - I J Witterick
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
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27
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Forner D, Lee DJ, Walsh C, Witterick IJ, Taylor SM, Freeman J. Outpatient versus Inpatient Parotidectomy: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2020; 162:818-825. [PMID: 32286187 DOI: 10.1177/0194599820911725] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Parotidectomies are commonly performed procedures by head and neck surgeons. Although parotidectomies are historically inpatient procedures, recent observational evidence has highlighted the potential for parotidectomies to be performed on an outpatient basis. This systematic review and meta-analysis sought to compare complications and unplanned health care utilization between patients undergoing outpatient versus inpatient parotidectomy. DATA SOURCES A systematic review was performed using MEDLINE, EMBASE, and the Cochrane Library. REVIEW METHODS Studies comparing the outcomes of outpatient parotidectomy with those of inpatient parotidectomy were included. Risk of bias was assessed using the Newcastle-Ottawa Scale. Postoperative complications (hematoma, facial nerve dysfunction, seroma, fistulisation, Frey syndrome, and wound infection) and rates of 30-day readmission, reintervention, and emergency department presentation were compared. RESULTS We screened 1018 nonduplicate articles to include 5 studies, all of which were retrospective cohort studies. There were fewer complications found in the outpatient group (relative risk = 0.61, 95% confidence interval: 0.40-0.93). Outpatient procedures were more commonly performed on patients who lived close to the hospital, had fewer comorbidities, and had less extensive planned surgery. CONCLUSION Outpatient parotidectomy appears safe in select patients with outcomes comparable with inpatient surgery. However, evidence overall is of low quality, and further work is needed to delineate a satisfactory set of criteria for appropriate patient identification.
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Affiliation(s)
- David Forner
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Ontario, Canada
| | - Daniel J Lee
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Chris Walsh
- Sidney Liswood Health Sciences Library, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Ian J Witterick
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - S Mark Taylor
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Ontario, Canada
| | - Jeremy Freeman
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
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Cottrell J, Yip J, Chan Y, Chin CJ, Damji A, de Almeida JR, Desrosiers M, Eskander A, Janjua A, Kilty S, Lee JM, Macdonald KI, Meen EK, Rudmik L, Sommer DD, Sowerby L, Tewfik MA, Thamboo A, Vescan AD, Witterick IJ, Wright E, Monteiro E. Quality Indicators for the Diagnosis and Management of Acute Bacterial Rhinosinusitis. Am J Rhinol Allergy 2020; 34:519-531. [DOI: 10.1177/1945892420912158] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Acute bacterial rhinosinusitis (ABRS) is a highly prevalent disease that is treated by a variety of specialties, including but not limited to, family physicians, emergency physicians, otolaryngology—head and neck surgeons, infectious disease specialists, and allergy and immunologists. Unfortunately, despite high-quality guidelines, variable and substandard care continues to be demonstrated in the treatment of ABRS. Objective This study aimed to develop ABRS-specific quality indicators (QIs) to evaluate the diagnosis and management that reduces symptoms, improves quality of life, and prevents complications. Methods A guideline-based approach, proposed by Kötter et al., was used to develop QIs for ABRS. Candidate indicators (CIs) were extracted from 4 guiding documents and evaluated using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. Each CI and its supporting evidence was summarized and reviewed by an expert panel based on validity, reliability, and feasibility of measurement. Final QIs were selected from CIs utilizing the modified RAND/University of California at Los Angeles appropriateness methodology. Results Twenty-nine CIs were identified after literature review and evaluated by our panel. Of these, 5 CIs reached consensus as being appropriate QIs, with 1 requiring additional discussion. After a second round of evaluations, the panel selected 7 QIs as appropriate measures of high-quality care. Conclusion This study proposes 7 QIs for the diagnosis and management of patients with ABRS. These QIs can serve multiple purposes, including documenting the quality of care; comparing institutions and providers; prioritizing quality improvement initiatives; supporting accountability, regulation, and accreditation; and determining pay for performance initiatives.
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Affiliation(s)
- Justin Cottrell
- Division of Rhinology, Department of Otolaryngology—Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan Yip
- Division of Rhinology, Department of Otolaryngology—Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Yvonne Chan
- Division of Rhinology, Department of Otolaryngology—Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Christopher J Chin
- Division of Otolaryngology—Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ali Damji
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - John R. de Almeida
- Division of Rhinology, Department of Otolaryngology—Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Martin Desrosiers
- Division of Otolaryngology—Head and Neck Surgery, Centre Hospitalier de l’University de Montreal, Montreal, Quebec, Canada
| | - Antoine Eskander
- Division of Rhinology, Department of Otolaryngology—Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Arif Janjua
- Division of Otolaryngology—Head and Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shaun Kilty
- Department of Otolaryngology—Head and Neck Surgery, The University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada
| | - John M. Lee
- Division of Rhinology, Department of Otolaryngology—Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Kristian I. Macdonald
- Department of Otolaryngology—Head and Neck Surgery, The University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Eric K. Meen
- Department of Otolaryngology—Head and Neck Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Luke Rudmik
- Division of Otolaryngology—Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Doron D. Sommer
- Division of Otolaryngology—Head and Neck Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Leigh Sowerby
- Department of Otolaryngology—Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Marc A. Tewfik
- Department of Otolaryngology—Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Andrew Thamboo
- Division of Otolaryngology—Head and Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Allan D. Vescan
- Division of Rhinology, Department of Otolaryngology—Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ian J. Witterick
- Division of Rhinology, Department of Otolaryngology—Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Erin Wright
- Division of Otolaryngology—Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Eric Monteiro
- Division of Rhinology, Department of Otolaryngology—Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
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Siu JM, McCarty JC, Gadkaree S, Caterson EJ, Randolph G, Witterick IJ, Eskander A, Bergmark RW. Association of Vessel-Sealant Devices vs Conventional Hemostasis With Postoperative Neck Hematoma After Thyroid Operations. JAMA Surg 2019; 154:e193146. [PMID: 31532475 DOI: 10.1001/jamasurg.2019.3146] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Importance Vessel-sealant devices (VSDs) have been popularized for use in thyroid operations; however, the association of their use with postoperative neck hematoma, a rare but potentially fatal complication, has not been well studied. Objective To examine the association of VSDs vs conventional hemostasis (CH) in thyroid operations with the development of neck hematoma. Design, Setting, and Participants This retrospective cohort study evaluated 10 903 patients in the Thyroid Procedure-Targeted Database of the National Surgical Quality Improvement Program from January 1, 2016, to December 31, 2017. One-to-one nearest-neighbor propensity score matching was conducted to adjust for differences in baseline covariates, including demographics, comorbidities, indications for thyroid procedure (goiter, Graves disease, malignant and benign thyroid nodule), and several other thyroid-specific characteristics, between the VSD and CH groups. Main Outcomes and Measures The primary outcome was postoperative hematoma requiring intervention with open evacuation, return to the operating room, tracheostomy, additional observation, or extended length of stay. Secondary outcomes include recurrent laryngeal nerve injury, operative duration, and hospital length of stay. Results One-to-one propensity score matching yielded 6522 patients (mean [SD] age, 52 [15] years; 8544 [78.4%] female) with 3261 in each exposure group such that distribution of observed baseline covariates was not different between groups of the same propensity score. Within the matched cohort, CH was associated with higher odds of neck hematoma compared with VSD (odds ratio, 2.33; 95% CI, 1.55-3.49; P < .001), with 34 (1.0%) hematomas in the VSD group and 78 (2.4%) in the CH group. On the basis of this analysis, the number needed to treat with a VSD to prevent 1 postoperative hematoma was 74. Secondary outcomes included longer length of hospital stay (incidence rate ratio, 1.29; 95% CI, 1.23-1.36; P < .001]) in the CH group compared with the VSD group but no difference in the odds of recurrent laryngeal nerve injury (odds ratio, 0.90; 95% CI, 0.73-1.11; P = .32) or operative duration (incidence rate ratio, 0.99; 95% CI, 0.96-1.01; P = .24). Conclusions and Relevance Use of VSDs during thyroid operations was associated with reduced odds of neck hematoma compared with CH techniques without increasing odds of nerve injury. The results suggest that postoperative neck hematoma rates after thyroid surgery may differ based on the hemostasis technique and that these differences should be considered when developing strategies for quality improvement of postoperative outcomes.
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Affiliation(s)
- Jennifer M Siu
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Justin C McCarty
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts.,Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Shekhar Gadkaree
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston.,Department of Otolaryngology-Head & Neck Surgery, Harvard Medical School, Boston, Massachusetts
| | - Edward J Caterson
- Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Gregory Randolph
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston.,Department of Otolaryngology-Head & Neck Surgery, Harvard Medical School, Boston, Massachusetts
| | - Ian J Witterick
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Antoine Eskander
- Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head & Neck Surgery, Surgical Oncology, University of Toronto, Sunnybrook Health Sciences Centre and Michael Garron Hospital, Toronto, Ontario, Canada
| | - Regan W Bergmark
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Otolaryngology-Head & Neck Surgery, Harvard Medical School, Boston, Massachusetts.,Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, Massachusetts
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Hong CJ, Giannopoulos AA, Hong BY, Witterick IJ, Irish JC, Lee J, Vescan A, Mitsouras D, Dang W, Campisi P, de Almeida JR, Monteiro E. Clinical applications of three‐dimensional printing in otolaryngology–head and neck surgery: A systematic review. Laryngoscope 2019; 129:2045-2052. [DOI: 10.1002/lary.27831] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2019] [Indexed: 12/27/2022]
Affiliation(s)
- Chris J. Hong
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Toronto Toronto Ontario Canada
| | - Andreas A. Giannopoulos
- Cardiac Imaging Computed Tomography/Positron Emission Tomography/Magnetic Resonance Imaging, Department of Nuclear MedicineUniversity Hospital Zurich Zurich Switzerland
| | - Brian Y. Hong
- Division of Plastic and Reconstructive Surgery, Department of SurgeryUniversity of Toronto Toronto Ontario Canada
| | - Ian J. Witterick
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Toronto Toronto Ontario Canada
| | - Jonathan C. Irish
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Toronto Toronto Ontario Canada
| | - John Lee
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Toronto Toronto Ontario Canada
| | - Allan Vescan
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Toronto Toronto Ontario Canada
| | - Dimitrios Mitsouras
- Faculty of MedicineUniversity of Ottawa Ottawa Ontario Canada
- Applied Imaging Science Lab, Department of RadiologyBrigham and Women's Hospital, Harvard Medical School Boston Massachusetts U.S.A
| | - Wilfred Dang
- Department of Diagnostic RadiologyUniversity of Ottawa Ottawa Ontario Canada
| | - Paolo Campisi
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Toronto Toronto Ontario Canada
| | - John R. de Almeida
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Toronto Toronto Ontario Canada
| | - Eric Monteiro
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Toronto Toronto Ontario Canada
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Affiliation(s)
- Bryan McIver
- 1 Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Jeremy Freeman
- 2 Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Jatin P Shah
- 3 Department of Head and Neck Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Ashok R Shaha
- 4 Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | | | - Ezra Cohen
- 6 University of California San Diego, San Diego, California
| | - Ian J Witterick
- 2 Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Gregory W Randolph
- 7 Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
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Fu T, Chin CJ, Xu W, Che J, Huang SH, Monteiro E, Alghonaim Y, Ringash J, Witterick IJ. Impact of neoadjuvant radiation on margins for non-squamous cell carcinoma sinonasal malignancies. Laryngoscope 2018; 128:2796-2803. [DOI: 10.1002/lary.27316] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 02/22/2018] [Accepted: 05/07/2018] [Indexed: 01/24/2023]
Affiliation(s)
- Terence Fu
- Department of Otolaryngology-Head and Neck Surgery; University of Toronto; Toronto Ontario
| | - Christopher J. Chin
- Division of Otolaryngology- Head and Neck Surgery, Department of Surgery; Dalhousie Medicine New Brunswick; St. John New Brunswick
| | - Wei Xu
- Dalla Lana School of Public Health; University of Toronto; Ontario
- Department of Biostatistics; Princess Margaret Hospital; Toronto Ontario
| | - Jiahua Che
- Dalla Lana School of Public Health; University of Toronto; Ontario
- Department of Biostatistics; Princess Margaret Hospital; Toronto Ontario
| | - Shao Hui Huang
- Department of Radiation Oncology; Princess Margaret Cancer Centre-University Health Network, University of Toronto; Toronto Ontario Canada
| | - Eric Monteiro
- Department of Otolaryngology-Head and Neck Surgery; University of Toronto; Toronto Ontario
| | - Yazeed Alghonaim
- Department of Otolaryngology-Head and Neck Surgery; University of Toronto; Toronto Ontario
| | - Jolie Ringash
- Department of Otolaryngology-Head and Neck Surgery; University of Toronto; Toronto Ontario
- Department of Radiation Oncology; Princess Margaret Cancer Centre-University Health Network, University of Toronto; Toronto Ontario Canada
| | - Ian J. Witterick
- Department of Otolaryngology-Head and Neck Surgery; University of Toronto; Toronto Ontario
- Department of Radiation Oncology; Princess Margaret Cancer Centre-University Health Network, University of Toronto; Toronto Ontario Canada
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Ziai H, Yu E, Fu T, Muhanna N, Monteiro E, Vescan A, Zadeh G, Witterick IJ, Goldstein DP, Gentili F, de Almeida JR. Impact of Dural Resection on Sinonasal Malignancies with Skull Base Encroachment or Erosion. J Neurol Surg B Skull Base 2018; 79:419-426. [PMID: 30210968 PMCID: PMC6133664 DOI: 10.1055/s-0037-1612617] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 06/07/2017] [Accepted: 11/13/2017] [Indexed: 02/03/2023] Open
Abstract
Objectives (1) To determine the occult rate of dural invasion in patients with tumors extending to and/or eroding the bony anterior skull base but without evidence of dural invasion on preoperative imaging. (2) To determine the impact of dural resection and of skull base erosion on survival outcomes in this group of patients (without evidence of dural invasion upon preoperative imaging). Study Design Retrospective study. Setting Tertiary care academic center. Participants Patients with sinonasal malignancies with anterior skull base encroachment/erosion without dural invasion on preoperative imaging treated surgically. Main Outcome Measures (1) Histopathologic disease in the dura in patients who had dural resection and (2) Oncologic outcomes (5-year local recurrence, dural recurrence, disease-specific survival, and overall survival) in patients with and without dural resection, and patients with and without skull base erosion. Results Thirty-seven patients were included. The occult rate of dural invasion was 54%. Patients with dural resection had improved margin control versus those without dural resection (90% vs 56%, p = 0.02). Dural resection improved 5-year overall survival only in patients with esthesioneuroblastoma compared with bony skull base resection alone (100% vs 75%, p = 0.03). Patients with skull base erosion had reduced local control versus those without erosion (63% vs 93%, p = 0.047). Conclusion This study suggests a substantial rate of occult dural invasion despite no overt imaging findings. Dural resection may be associated with improved margin control, but no oncologic benefit except for esthesioneuroblastomas, although treatment heterogeneity and small sample size may limit conclusions.
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Affiliation(s)
- Hedyeh Ziai
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Eugene Yu
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Terence Fu
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nidal Muhanna
- Department of Otolaryngology Head and Neck Surgery, University of Toronto, Toronto, Canada
| | - Eric Monteiro
- Department of Otolaryngology Head and Neck Surgery, University of Toronto, Toronto, Canada
| | - Allan Vescan
- Department of Otolaryngology Head and Neck Surgery, University of Toronto, Toronto, Canada
| | - Gelareh Zadeh
- Division of Neurosurgery, University of Toronto, Toronto, Canada
| | - Ian J. Witterick
- Department of Otolaryngology Head and Neck Surgery, University of Toronto, Toronto, Canada
| | - David P. Goldstein
- Department of Otolaryngology Head and Neck Surgery, University of Toronto, Toronto, Canada
| | - Fred Gentili
- Division of Neurosurgery, University of Toronto, Toronto, Canada
| | - John R. de Almeida
- Department of Otolaryngology Head and Neck Surgery, University of Toronto, Toronto, Canada
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Witterick IJ. Mentorship, Education, and Teamwork in the Making of a Skull Base Surgeon: A Summary of the 28th Annual NASBS meeting: February 13-17, 2018; Loews Coronado Bay, Coronado, California, United States. J Neurol Surg B Skull Base 2018; 79:413-414. [PMID: 30210966 DOI: 10.1055/s-0038-1668109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- Ian J Witterick
- Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, Canada
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Eskander A, Campisi P, Witterick IJ, Pothier DD. Consultation diagnoses and procedures billed among recent graduates practicing general otolaryngology - head & neck surgery in Ontario, Canada. J Otolaryngol Head Neck Surg 2018; 47:47. [PMID: 30029682 PMCID: PMC6053828 DOI: 10.1186/s40463-018-0293-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 03/22/2018] [Accepted: 07/09/2018] [Indexed: 11/27/2022] Open
Abstract
Background An analysis of the scope of practice of recent Otolaryngology – Head and Neck Surgery (OHNS) graduates working as general otolaryngologists has not been previously performed. As Canadian OHNS residency programs implement competency-based training strategies, this data may be used to align residency curricula with the clinical and surgical practice of recent graduates. Methods Ontario billing data were used to identify the most common diagnostic and procedure codes used by general otolaryngologists issued a billing number between 2006 and 2012. The codes were categorized by OHNS subspecialty. Practitioners with a narrow range of procedure codes or a high rate of complex procedure codes, were deemed subspecialists and therefore excluded. Results There were 108 recent graduates in a general practice identified. The most common diagnostic codes assigned to consultation billings were categorized as ‘otology’ (42%), ‘general otolaryngology’ (35%), ‘rhinology’ (17%) and ‘head and neck’ (4%). The most common procedure codes were categorized as ‘general otolaryngology’ (45%), ‘otology’ (23%), ‘head and neck’ (13%) and ‘rhinology’ (9%). The top 5 procedures were nasolaryngoscopy, ear microdebridement, myringotomy with insertion of ventilation tube, tonsillectomy, and turbinate reduction. Although otology encompassed a large proportion of procedures billed, tympanoplasty and mastoidectomy were surprisingly uncommon. Conclusion This is the first study to analyze the nature of the clinical and surgical cases managed by recent OHNS graduates. The findings demonstrated a prominent representation of ‘otology’, ‘general’ and ‘rhinology’ based consultation diagnoses and procedures. The data derived from the study needs to be considered as residency curricula are modified to satisfy competency-based requirements.
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Affiliation(s)
- Antoine Eskander
- Department of Otolaryngology - Head & Neck Surgery, Surgical Oncology, University of Toronto, Sunnybrook Health Sciences Centre and Michael Garron Hospital, Toronto, ON, Canada. .,Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada. .,Department of Otolaryngology - Head & Neck Surgery, Sunnybrook Health Sciences Centre and the Odette Cancer Centre, Michael Garron Hospital, Endocrine Surgery, 2075 Bayview Ave., M1-102, Toronto, ON, M4N 3M5, Canada.
| | - Paolo Campisi
- Department of Otolaryngology - Head & Neck Surgery, Hospital for Sick Children, Toronto, ON, Canada
| | - Ian J Witterick
- Department of Otolaryngology - Head & Neck Surgery, Mount Sinai Hospital, Sinai Health System, Toronto, ON, Canada
| | - David D Pothier
- Department of Otolaryngology - Head & Neck Surgery, Toronto General Hospital, University Health Network, Toronto, ON, Canada
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Cottrell J, Yip J, Chan Y, Chin CJ, Damji A, de Almeida JR, Desrosiers M, Janjua A, Kilty S, Lee JM, Macdonald KI, Meen EK, Rudmik L, Sommer DD, Sowerby L, Tewfik MA, Vescan AD, Witterick IJ, Wright E, Monteiro E. Quality indicators for the diagnosis and management of chronic rhinosinusitis. Int Forum Allergy Rhinol 2018; 8:1369-1379. [PMID: 29999592 DOI: 10.1002/alr.22161] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 03/02/2018] [Revised: 05/07/2018] [Accepted: 05/14/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) has been identified as a high-priority disease category for quality improvement. To this end, this study aimed to develop CRS-specific quality indicators (QIs) to evaluate diagnosis and management that relieves patient discomfort, improves quality of life, and prevents complications. METHODS A guideline-based approach, proposed in 2012 by Kötter et al. was used to develop QIs for CRS. Candidate indicators (CIs) were extracted from 3 practice guidelines and 1 international consensus statement on the diagnosis and management of CRS. Guidelines were evaluated using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. Each CI and its supporting evidence was summarized and reviewed by an expert panel based on validity, reliability, and feasibility of measurement. Final QIs were selected from CIs utilizing the modified RAND Corporation-University of California, Los Angeles (RAND/UCLA) appropriateness methodology. RESULTS Thirty-nine CIs were identified after literature review and evaluated by our panel. Of these, 9 CIs reached consensus as being appropriate QIs, with 4 requiring additional discussion. After a second round of evaluations, the panel selected 9 QIs as appropriate measures of high-quality care. CONCLUSION This study proposes 9 QIs for the diagnosis and management of patients with CRS. These QIs can serve multiple purposes, including documenting the quality of care; comparing institutions and providers; prioritizing quality improvement initiatives; supporting accountability, regulation, and accreditation; and determining pay-for-performance initiatives.
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Affiliation(s)
- Justin Cottrell
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Jonathan Yip
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Yvonne Chan
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Christopher J Chin
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - Ali Damji
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - John R de Almeida
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Martin Desrosiers
- Division of Otolaryngology-Head and Neck Surgery, Centre Hospitalier de l'University de Montreal, Montreal, QC, Canada
| | - Arif Janjua
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Shaun Kilty
- Department of Otolaryngology-Head and Neck Surgery, The University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada
| | - John M Lee
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Kristian I Macdonald
- Department of Otolaryngology-Head and Neck Surgery, The University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada
| | - Eric K Meen
- Department of Otolaryngology-Head and Neck Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Luke Rudmik
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Doron D Sommer
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Leigh Sowerby
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
| | - Marc A Tewfik
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Allan D Vescan
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Ian J Witterick
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Erin Wright
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Eric Monteiro
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
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Abstract
BACKGROUND Previous studies describe the financial burden of chronic rhinosinusitis (CRS) from the perspective of third-party payers, but, to our knowledge, none analyze the costs borne by patients (i.e., out-of-pocket expenses [OOPE]). Furthermore, this burden has not been previously investigated in the context of a publicly funded health care system. OBJECTIVE The purpose of this study was to characterize the financial impact of CRS on patients, specifically by evaluating its associated OOPEs and the perceived financial burden. The secondary aim was to determine the factors predictive of OOPEs and perceived burden. METHODS Patients with CRS at a tertiary care sinus center completed a self-administered questionnaire that assessed their socioeconomic characteristics, disease-specific quality of life (22-item Sino-Nasal Outcome Test [SNOT-22]), workdays missed due to CRS, perceived financial burden, and direct medical and nonmedical OOPEs over a 12-month period. Total OOPEs were calculated from the sum of direct medical and nonmedical OOPEs. Regression analyses determined factors predictive of OOPEs and the perceived burden. RESULTS A total of 84 patients completed the questionnaires. After accounting for health insurance coverage and the median direct medical, direct nonmedical, and total OOPEs per patient over a 12-month period were Canadian dollars (CAD) $336.00 (2011) [U.S. $339.85], CAD $129.87 [U.S. $131.86], and CAD $607.10 [U.S. $614.06], respectively. CRS resulted in an average of 20.6 workdays missed over a 12-month period. Factors predictive of a higher financial burden included younger age, a greater number of previous sinus surgeries, <80% health insurance coverage, residing out of town, and higher SNOT-22 scores. CONCLUSION Total OOPEs incurred from the treatment of CRS may amount to CAD $607.10 [U.S. $614.06] per patient per year, within the context of a single-payer health care system. Managing clinicians should be aware of patient groups with a greater perceived financial burden and consider counseling them on strategies to offset expenses, including obtaining travel grants, using telemedicine for follow-up assessments, providing drug samples, and streamlining diagnostic testing with medical visits.
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Affiliation(s)
- Jonathan Yip
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
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Hsieh AMY, Polyakova O, Fu G, Chazen RS, MacMillan C, Witterick IJ, Ralhan R, Walfish PG. Programmed death-ligand 1 expression by digital image analysis advances thyroid cancer diagnosis among encapsulated follicular lesions. Oncotarget 2018; 9:19767-19782. [PMID: 29731981 PMCID: PMC5929424 DOI: 10.18632/oncotarget.24833] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 10/06/2017] [Accepted: 02/24/2018] [Indexed: 01/09/2023] Open
Abstract
Recognition of noninvasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTP) that distinguishes them from invasive malignant encapsulated follicular variant of papillary thyroid carcinoma (EFVPTC) can prevent overtreatment of NIFTP patients. We and others have previously reported that programmed death-ligand 1 (PD-L1) is a useful biomarker in thyroid tumors; however, all reports to date have relied on manual scoring that is time consuming as well as subject to individual bias. Consequently, we developed a digital image analysis (DIA) protocol for cytoplasmic and membranous stain quantitation (ThyApp) and evaluated three tumor sampling methods [Systemic Uniform Random Sampling, hotspot nucleus, and hotspot nucleus/3,3'-Diaminobenzidine (DAB)]. A patient cohort of 153 cases consisting of 48 NIFTP, 44 EFVPTC, 26 benign nodules and 35 encapsulated follicular lesions/neoplasms with lymphocytic thyroiditis (LT) was studied. ThyApp quantitation of PD-L1 expression revealed a significant difference between invasive EFVPTC and NIFTP; but none between NIFTP and benign nodules. ThyApp integrated with hotspot nucleus tumor sampling method demonstrated to be most clinically relevant, consumed least processing time, and eliminated interobserver variance. In conclusion, the fully automatic DIA algorithm developed using a histomorphological approach objectively quantitated PD-L1 expression in encapsulated thyroid neoplasms and outperformed manual scoring in reproducibility and higher efficiency.
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Affiliation(s)
- Anne M-Y Hsieh
- Alex and Simona Shnaider Research Laboratory in Molecular Oncology, Sinai Health System, Toronto, ON, Canada
| | - Olena Polyakova
- Alex and Simona Shnaider Research Laboratory in Molecular Oncology, Sinai Health System, Toronto, ON, Canada
| | - Guodong Fu
- Alex and Simona Shnaider Research Laboratory in Molecular Oncology, Sinai Health System, Toronto, ON, Canada
| | - Ronald S Chazen
- Alex and Simona Shnaider Research Laboratory in Molecular Oncology, Sinai Health System, Toronto, ON, Canada
| | - Christina MacMillan
- Department of Pathology and Laboratory Medicine, Sinai Health System, Toronto, Ontario, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Ian J Witterick
- Alex and Simona Shnaider Research Laboratory in Molecular Oncology, Sinai Health System, Toronto, ON, Canada.,Joseph and Mildred Sonshine Family Centre for Head and Neck Diseases, Sinai Health System, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Sinai Health System, Toronto, Ontario, Canada
| | - Ranju Ralhan
- Alex and Simona Shnaider Research Laboratory in Molecular Oncology, Sinai Health System, Toronto, ON, Canada.,Department of Pathology and Laboratory Medicine, Sinai Health System, Toronto, Ontario, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Sinai Health System, Toronto, Ontario, Canada
| | - Paul G Walfish
- Alex and Simona Shnaider Research Laboratory in Molecular Oncology, Sinai Health System, Toronto, ON, Canada.,Joseph and Mildred Sonshine Family Centre for Head and Neck Diseases, Sinai Health System, Toronto, Ontario, Canada.,Department of Pathology and Laboratory Medicine, Sinai Health System, Toronto, Ontario, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Sinai Health System, Toronto, Ontario, Canada.,Department of Medicine, Endocrine Division, Sinai Health System and University of Toronto Medical School, Toronto, Ontario, Canada
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Abstract
Historically, research into surgical treatment of Graves disease has assessed subtotal rather than total thyroidectomy. Most clinicians now recommend total thyroidectomy, but little information is available regarding quality-of-life (QOL) outcomes for this procedure. Our aim was to assess QOL after total thyroidectomy. This is a retrospective, pilot study of patients with Graves disease who underwent total thyroidectomy from 1991 to 2007 at a high-volume tertiary referral center in Toronto, Canada. Questionnaires addressing disease-specific symptoms and global QOL concerns were sent to 54 patients. Analyses included parametric and nonparametric tests to assess the differences between perception of symptoms and global QOL before and after surgery. Forty patients responded (response rate: 74%) at a median of 4.8 years postoperatively. On a 10-point scale, overall wellness improved from 4.1 preoperatively to 8.7 postoperatively (p < 0.001). Patients recalled missing less work or school after surgery (7.8 vs. 1.1 days/year; p = 0.001). Overall satisfaction with the procedure was high. On average, symptoms improved within 32 days of surgery, and all symptoms showed substantial improvement. This is the first North American study to assess QOL outcomes of patients with Graves disease after total thyroidectomy. Patients experienced marked and rapid improvement in QOL postoperatively. These findings suggest that total thyroidectomy is a safe and effective treatment.
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Affiliation(s)
- Lukas H Kus
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
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40
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Sommer DD, Arbab-Tafti S, Farrokhyar F, Tewfik M, Vescan A, Witterick IJ, Rotenberg B, Chandra R, Weitzel EK, Wright E, Ramakrishna J. A challenge-response endoscopic sinus surgery specific checklist as an add-on to standard surgical checklist: an evaluation of potential safety and quality improvement issues. Int Forum Allergy Rhinol 2018; 8:831-836. [PMID: 29485750 DOI: 10.1002/alr.22106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 11/17/2017] [Revised: 01/29/2018] [Accepted: 02/01/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND The goal of this study was to develop and evaluate the impact of an aviation-style challenge and response sinus surgery-specific checklist on potential safety and equipment issues during sinus surgery at a tertiary academic health center. The secondary goal was to assess the potential impact of use of the checklist on surgical times during, before, and after surgery. This initiative is designed to be utilized in conjunction with the "standard" World Health Organization (WHO) surgical checklist. Although endoscopic sinus surgery is generally considered a safe procedure, avoidable complications and potential safety concerns continue to occur. The WHO surgical checklist does not directly address certain surgery-specific issues, which may be of particular relevance for endoscopic sinus surgery. METHODS This prospective observational pilot study monitored compliance with and compared the occurrence of safety and equipment issues before and after implementation of the checklist. Forty-seven consecutive endoscopic surgeries were audited; the first 8 without the checklist and the following 39 with the checklist. The checklist was compiled by evaluating the patient journey, utilizing the available literature, expert consensus, and finally reevaluation with audit type cases. The final checklist was developed with all relevant stakeholders involved in a Delphi method. RESULTS Implementing this specific surgical checklist in 39 cases at our institution, allowed us to identify and rectify 35 separate instances of potentially unsafe, improper or inefficient preoperative setup. These incidents included issues with labeling of topical vasoconstrictor or injectable anesthetics (3, 7.7%) and availability, function and/or position of video monitors (2, 5.1%), endoscope (6, 15.4%), microdebrider (6, 15.4%), bipolar cautery (6, 15.4%), and suctions (12, 30.8%). CONCLUSION The design and integration of this checklist for endoscopic sinus surgery, has helped improve efficiency and patient safety in the operating room setting.
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Affiliation(s)
- Doron D Sommer
- Otolaryngology-Head and Neck Surgery Division, Department of Surgery-Otolaryngology, McMaster University Medical Centre, Hamilton, ON, Canada
| | - Sadaf Arbab-Tafti
- Otolaryngology-Head and Neck Surgery Division, Department of Surgery-Otolaryngology, McMaster University Medical Centre, Hamilton, ON, Canada
| | - Forough Farrokhyar
- Department of Surgery, McMaster University Medical Centre, Hamilton, ON, Canada.,Department of and Clinical Epidemiology and Biostatistics, McMaster University Medical Centre, Hamilton, ON, Canada
| | - Marc Tewfik
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montréal, QC, Canada
| | - Allan Vescan
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Ian J Witterick
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Brian Rotenberg
- Department of Otolaryngology-Head and Neck Surgery, London, ON, Canada
| | - Rakesh Chandra
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, Nashville, TN
| | - Erik K Weitzel
- Department of Otolaryngology, San Antonio Military Medical Center, Joint Base San Antonio, TX
| | - Erin Wright
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Jayant Ramakrishna
- Otolaryngology-Head and Neck Surgery Division, Department of Surgery-Otolaryngology, McMaster University Medical Centre, Hamilton, ON, Canada
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41
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Lee DJ, Chin CJ, Hong CJ, Perera S, Witterick IJ. Outpatient versus inpatient thyroidectomy: A systematic review and meta-analysis. Head Neck 2017; 40:192-202. [PMID: 29120517 DOI: 10.1002/hed.24934] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [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: 06/04/2017] [Revised: 07/08/2017] [Accepted: 07/20/2017] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Outpatient thyroidectomy has gained popularity due to improved resource utilization. METHODS We conducted a systematic review and meta-analysis using MEDLINE, EMBASE, CINAHL, Web of Science, and the Cochrane library. We included all studies examining the outcomes of outpatient thyroidectomy as compared with those of inpatient thyroidectomy. Risk of bias was assessed using the Newcastle-Ottawa scale. Postoperative complications (hematoma, hypocalcemia, and recurrent laryngeal nerve injury) and readmission/reintervention rates were compared. RESULTS After screening 1665 records, 10 nonrandomized observational studies were included. There were fewer complication rates in the outpatient group than the inpatient group (relative risk [RR] 0.56; 95% confidence interval [CI] 0.37-0.83). There was no difference in readmission/reintervention rates (RR 0.60; 95% CI 0.33-1.09). CONCLUSION The results suggest outpatient thyroidectomy may be as safe as inpatient thyroidectomy in appropriately selected patients. The results are limited by high risk of bias. Well-designed prospective studies are necessary to further assess the safety of outpatient thyroidectomy.
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Affiliation(s)
- Daniel J Lee
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Christopher J Chin
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Canada.,Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, Dalhousie Medicine New Brunswick, St. John, New Brunswick, Canada
| | - Chris J Hong
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Canada
| | - Stefan Perera
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Ian J Witterick
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada
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Hong CJ, Monteiro E, Badhiwala J, Lee J, de Almeida JR, Vescan A, Witterick IJ. Open versus endoscopic septoplasty techniques: A systematic review and meta-analysis. Am J Rhinol Allergy 2017; 30:436-442. [PMID: 28124656 DOI: 10.2500/ajra.2016.30.4366] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Septal deviation is a condition of high prevalence, which ranges from 22% in newborns to 90% in adults. Surgical intervention is frequently considered in the management of patients with symptoms. Although many surgeons prefer either the endoscopic or the open approach to septoplasty, there is an ongoing debate regarding comparative outcomes between the two approaches. OBJECTIVE The purpose of this study was to systematically review the literature and provide pooled summary estimates to evaluate the efficacy and safety of open versus endoscopic septoplasty techniques. METHODS This study was registered with PROSPERO (CRD42014010730). MEDLINE, EMBASE, Google Scholar, CINAHL, Web of Science, and The Cochrane Central Registry for Randomized Trials were searched for relevant studies by using the following keywords in varying combinations: "nasal septum," "nasal obstruction," "nasal cartilages," "nose," "nose diseases," "surgery," "nasal/septal deviation," and "septoplasty." All the studies that compared open versus endoscopic septoplasty techniques for the management of symptomatic septal deviation were considered. Two reviewers independently extracted data by using a preestablished extraction form and performed quality assessment by using the Jadad and Newcastle Ottawa Scales. Weighted pooled estimates were calculated and reported, along with relative risks and 95% confidence intervals. RESULTS Fourteen studies met our inclusion criteria. When comparing open versus endoscopic septoplasty techniques, there was significant improvement in postoperative symptoms (i.e., nasal obstruction, headaches) (p < 0.05) in the endoscopic septoplasty group. There also were significantly fewer complications associated with the endoscopic septoplasty technique (p < 0.05). Based on the quality assessment, included studies were deemed at a moderate-to-high risk of bias. CONCLUSION Our analysis indicated that endoscopic septoplasty may have some advantages over open septoplasty. However, our findings should be taken with caution given the poor quality of included studies.
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Affiliation(s)
- Chris J Hong
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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43
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Somasundaram RT, Kaur J, Leong I, MacMillan C, Witterick IJ, Walfish PG, Ralhan R. Subcellular differential expression of Ep-ICD in oral dysplasia and cancer is associated with disease progression and prognosis. BMC Cancer 2016; 16:486. [PMID: 27421772 PMCID: PMC4947324 DOI: 10.1186/s12885-016-2507-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 07/29/2015] [Accepted: 06/20/2016] [Indexed: 01/25/2023] Open
Abstract
Background Identification of patients with oral dysplasia at high risk of cancer development and oral squamous cell carcinoma (OSCC) at increased risk of disease recurrence will enable rigorous personalized treatment. Regulated intramembranous proteolysis of Epithelial cell adhesion molecule (EpCAM) resulting in release of its intracellular domain Ep-ICD into cytoplasm and nucleus triggers oncogenic signaling. We analyzed the expression of Ep-ICD in oral dysplasia and cancer and determined its clinical significance in disease progression and prognosis. Methods In a retrospective study, immunohistochemical analysis of nuclear and cytoplasmic Ep-ICD and EpEx (extracellular domain of EpCAM), was carried out in 115 OSCC, 97 oral dysplasia and 105 normal oral tissues, correlated with clinicopathological parameters and disease outcome over 60 months for oral dysplasia and OSCC patients. Disease-free survival (DFS) was determined by Kaplan-Meier method and multivariate Cox regression analysis. Results In comparison with normal oral tissues, significant increase in nuclear Ep-ICD and membrane EpEx was observed in dysplasia, and OSCC (p = 0.013 and < 0.001 respectively). Oral dysplasia patients with increased overall Ep-ICD developed cancer in short time period (mean = 47 months; p = 0.044). OSCC patients with increased nuclear Ep-ICD and membrane EpEx had significantly reduced mean DFS of 33.7 months (p = 0.018). Conclusions Our study provided clinical evidence for Ep-ICD as a predictor of cancer development in patients with oral dysplasia and recurrence in OSCC patients, suggesting its potential utility in enhanced management of those patients detected to have increased risk of progression to cancer and recurrence in OSCC patients.
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Affiliation(s)
- Raj Thani Somasundaram
- Alex and Simona Shnaider Laboratory, Laboratory Medicine in Molecular Onocolgy, Mount Sinia Hospital, Room 6-318, 600 University Avenue, Toronto, ON, M5G 1X5, Canada
| | - Jatinder Kaur
- Alex and Simona Shnaider Laboratory, Laboratory Medicine in Molecular Onocolgy, Mount Sinia Hospital, Room 6-318, 600 University Avenue, Toronto, ON, M5G 1X5, Canada
| | - Iona Leong
- Department of Otolaryngology, Head and Neck Surgery, Mount Sinai Hospital, Joseph and Wolf Lebovic Health Complex, 600 University Avenue, 6-500, Toronto, ON, M5G 1X5, Canada.,Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, M5G 1X5, Canada
| | - Christina MacMillan
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, M5G 1X5, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, M5S 1A8, Canada
| | - Ian J Witterick
- Joseph and Mildred Sonshine Family Centre for Head and Neck Diseases, Mount Sinai Hospital, Toronto, ON, M5G 1X5, Canada.,Department of Otolaryngology - Head and Neck Surgery, Alex and Simona Shnaider Laboratory in Molecular Oncology, Mount Sinai Hospital, Joseph & Wolf Lebovic Health Complex, 600 University Avenue, 6-500, Toronto, ON, M5G 1X5, Canada.,Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, ON, M5G 2N2, Canada
| | - Paul G Walfish
- Alex and Simona Shnaider Laboratory, Laboratory Medicine in Molecular Onocolgy, Mount Sinia Hospital, Room 6-318, 600 University Avenue, Toronto, ON, M5G 1X5, Canada. .,Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, M5G 1X5, Canada. .,Joseph and Mildred Sonshine Family Centre for Head and Neck Diseases, Mount Sinai Hospital, Toronto, ON, M5G 1X5, Canada. .,Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, ON, M5G 2N2, Canada. .,Department of Medicine, Endocrine Division, Mount Sinai Hospital and University of Toronto, Joseph & Wolf Lebovic Health Complex, Room 413-7, 600 University Avenue, Toronto, ON, M5G 1X5, Canada.
| | - Ranju Ralhan
- Alex and Simona Shnaider Laboratory, Laboratory Medicine in Molecular Onocolgy, Mount Sinia Hospital, Room 6-318, 600 University Avenue, Toronto, ON, M5G 1X5, Canada. .,Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, M5G 1X5, Canada. .,Joseph and Mildred Sonshine Family Centre for Head and Neck Diseases, Mount Sinai Hospital, Toronto, ON, M5G 1X5, Canada. .,Department of Otolaryngology - Head and Neck Surgery, Alex and Simona Shnaider Laboratory in Molecular Oncology, Mount Sinai Hospital, Joseph & Wolf Lebovic Health Complex, 600 University Avenue, 6-500, Toronto, ON, M5G 1X5, Canada. .,Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, ON, M5G 2N2, Canada.
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44
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Dixon BJ, Chan H, Daly MJ, Qiu J, Vescan A, Witterick IJ, Irish JC. Three-dimensional virtual navigation versus conventional image guidance: A randomized controlled trial. Laryngoscope 2016; 126:1510-5. [PMID: 27075606 DOI: 10.1002/lary.25882] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 10/28/2015] [Revised: 12/12/2015] [Accepted: 12/29/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Providing image guidance in a 3-dimensional (3D) format, visually more in keeping with the operative field, could potentially reduce workload and lead to faster and more accurate navigation. We wished to assess a 3D virtual-view surgical navigation prototype in comparison to a traditional 2D system. METHODS Thirty-seven otolaryngology surgeons and trainees completed a randomized crossover navigation exercise on a cadaver model. Each subject identified three sinonasal landmarks with 3D virtual (3DV) image guidance and three landmarks with conventional cross-sectional computed tomography (CT) image guidance. Subjects were randomized with regard to which side and display type was tested initially. Accuracy, task completion time, and task workload were recorded. RESULTS Display type did not influence accuracy (P > 0.2) or efficiency (P > 0.3) for any of the six landmarks investigated. Pooled landmark data revealed a trend of improved accuracy in the 3DV group by 0.44 millimeters (95% confidence interval [0.00-0.88]). High-volume surgeons were significantly faster (P < 0.01) and had reduced workload scores in all domains (P < 0.01), but they were no more accurate (P > 0.28). CONCLUSION Real-time 3D image guidance did not influence accuracy, efficiency, or task workload when compared to conventional triplanar image guidance. The subtle pooled accuracy advantage for the 3DV view is unlikely to be of clinical significance. Experience level was strongly correlated to task completion time and workload but did not influence accuracy. LEVEL OF EVIDENCE N/A. Laryngoscope, 126:1510-1515, 2016.
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Affiliation(s)
- Benjamin J Dixon
- Department of Surgery, University of Melbourne, St Vincent's Hospital and Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Harley Chan
- Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada
| | - Michael J Daly
- Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada.,Institute of Medical Science, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
| | - Jimmy Qiu
- Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada
| | - Allan Vescan
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Ian J Witterick
- Departments of Surgical Oncology, University Health Network, Toronto, Ontario, Canada.,Otolaryngology-Head and Neck Surgery, Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan C Irish
- Departments of Surgical Oncology, University Health Network, Toronto, Ontario, Canada.,Otolaryngology-Head and Neck Surgery, Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada
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45
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Chin CJ, Rotenberg BW, Witterick IJ. Epistaxis in hereditary hemorrhagic telangiectasia: an evidence based review of surgical management. J Otolaryngol Head Neck Surg 2016; 45:3. [PMID: 26754744 PMCID: PMC4709944 DOI: 10.1186/s40463-016-0116-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 01/05/2016] [Indexed: 12/21/2022] Open
Abstract
Patients with Hereditary Hemorrhagic Telangiectasia (HHT) frequently present with epistaxis. Up to 98 % of these patients will have epistaxis at some point in their life. There are multiple ways to deal with this problem, including conservative, medical and surgical options. We present a case and an update on the treatment options for HHT, with a focus on the newer and experimental techniques.
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Affiliation(s)
- Christopher J Chin
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Room 413, Mount Sinai Hospital, 600 University Avenue, Toronto, ON, M5G 1X5, Canada.
| | - Brian W Rotenberg
- Department of Otolaryngology-Head and Neck Surgery, Western University, Toronto, Canada.
| | - Ian J Witterick
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Room 413, Mount Sinai Hospital, 600 University Avenue, Toronto, ON, M5G 1X5, Canada.
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46
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Sommer DD, Rotenberg BW, Sowerby LJ, Lee JM, Janjua A, Witterick IJ, Monteiro E, Gupta MK, Au M, Nayan S. A novel treatment adjunct for aspirin exacerbated respiratory disease: the low-salicylate diet: a multicenter randomized control crossover trial. Int Forum Allergy Rhinol 2016; 6:385-91. [DOI: 10.1002/alr.21678] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 09/25/2015] [Accepted: 10/09/2015] [Indexed: 12/17/2022]
Affiliation(s)
- Doron D. Sommer
- Division of Otolaryngology-Head and Neck Surgery; Department of Surgery McMaster University; Hamilton Canada
| | - Brian W. Rotenberg
- Department of Otolaryngology-Head and Neck Surgery; Western University; London Canada
| | - Leigh J. Sowerby
- Department of Otolaryngology-Head and Neck Surgery; Western University; London Canada
| | - John M. Lee
- Department of Otolaryngology-Head and Neck Surgery; University of Toronto; Toronto Canada
| | - Arif Janjua
- Division of Otolaryngology-Head and Neck Surgery; University of British Columbia; Vancouver Canada
| | - Ian J. Witterick
- Department of Otolaryngology-Head and Neck Surgery; University of Toronto; Toronto Canada
| | - Eric Monteiro
- Department of Otolaryngology-Head and Neck Surgery; University of Toronto; Toronto Canada
| | - Michael K. Gupta
- Division of Otolaryngology-Head and Neck Surgery; Department of Surgery McMaster University; Hamilton Canada
| | - Michael Au
- Department of Otolaryngology-Head and Neck Surgery; University of Toronto; Toronto Canada
| | - Smriti Nayan
- Division of Otolaryngology-Head and Neck Surgery; Department of Surgery McMaster University; Hamilton Canada
- Department of Otolaryngology-Head and Neck Surgery; Cambridge Memorial Hospital; Cambridge Canada
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47
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Sklar MC, Eskander A, Dore K, Witterick IJ. Comparing the traditional and Multiple Mini Interviews in the selection of post-graduate medical trainees. Can Med Educ J 2015; 6:e6-e13. [PMID: 27004078 PMCID: PMC4795078] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND The traditional, panel style interview and the multiple mini interview (MMI) are two options to use in the selection of medical trainees with each interview format having inherent advantages and disadvantages. Our aim was to compare the traditional and MMI on the same cohort of postgraduate applicants to the Department of Otolaryngology - Head & Neck Surgery at the University of Toronto. METHOD Twenty-seven applicants from the 2010 Canadian Residency Matching Service selected for interview at the University of Toronto, Department of Otolaryngology - Head & Neck Surgery were included in the study. Each applicant participated in both a traditional interview and MMI. RESULTS Traditional interviews marked out of a total maximum score of 570. On the traditional interview, scores ranged from 397-543.5 (69.6 - 95.3%), the mean was 460.2. The MMI maximum score was out of 180. MMI scores ranged from 93 - 146 (51.7 - 81.1%) with a mean of 114.8. Traditional interview total scores were plotted against MMI total scores. Scores correlated reasonably well, Pearson Correlation = 0.315 and is statistically significant at p = 0.001. Inter-interview reliability for the two interview methods was 0.038, with poor overall agreement 0.07%. CONCLUSIONS MMI and traditional interview scores are correlated but do not reliably lead to the same rank order. We have demonstrated that these two interview formats measure different characteristics. One format may also be less reliable leading to greater variation in final rank. Further validation research is certainly required.
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Affiliation(s)
| | - Antoine Eskander
- Department of Otolaryngology – Head & Neck Surgery, University of Toronto
| | - Kelly Dore
- Deparment of Biostatistics, McMaster University
| | - Ian J Witterick
- Department of Otolaryngology – Head & Neck Surgery, University of Toronto
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48
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Ralhan R, Veyhl J, Chaker S, Assi J, Alyass A, Jeganathan A, Somasundaram RT, MacMillan C, Freeman J, Vescan AD, Witterick IJ, Walfish PG. Immunohistochemical Subcellular Localization of Protein Biomarkers Distinguishes Benign from Malignant Thyroid Nodules: Potential for Fine-Needle Aspiration Biopsy Clinical Application. Thyroid 2015; 25:1224-34. [PMID: 26131603 DOI: 10.1089/thy.2015.0114] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND It is of critical clinical importance to select accurately for surgery thyroid nodules at risk for malignancy and avoid surgery on those that are benign. Using alterations in subcellular localization for seven putative biomarker proteins (identified by proteomics), this study aimed to define a specific combination of proteins in surgical tissues that could distinguish benign from malignant nodules to assist in future surgical selection by fine-needle aspiration biopsy (FNAB). METHODS Immunohistochemical subcellular localization (IHC) analyses of seven proteins were retrospectively performed on surgical tissues (115 benign nodules and 114 papillary-based thyroid carcinomas [TC]), and a risk model biomarker panel was developed and validated. The biomarker panel efficacy was verified in 50 FNAB formalin-fixed and paraffin-embedded cell blocks, and 26 cytosmears were prepared from fresh surgically resected thyroid nodules. RESULTS Selection modeling using these proteins resulted in nuclear phosphoglycerate kinase 1 (PGK1) loss and nuclear Galectin-3 overexpression as the best combination for distinguishing TC from benign nodules (area under the curve [AUC] 0.96 and 0.95 in test and validation sets, respectively). A computed malignancy score also accurately identified TC in benign and indeterminate nodules (test and validation sets: AUC 0.94, 0.90; specificity 98%, 99%). Its efficacy was confirmed in surgical FNAB cell blocks and cytosmears. CONCLUSION Using surgical tissues, it was observed that a combination of PGK1 and Galectin-3 had high efficiency for distinguishing benign from malignant thyroid nodules and could improve surgical selection for TC among indeterminate nodules. Further validation in prospective preoperative FNAB will be required to confirm such a clinical application.
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Affiliation(s)
- Ranju Ralhan
- 1 Alex and Simona Shnaider Research Laboratory in Molecular Oncology, Mount Sinai Hospital , Toronto, Canada
- 2 Department of Pathology and Laboratory Medicine, Mount Sinai Hospital , Toronto, Canada
- 3 Laboratory Medicine and Pathobiology, University of Toronto , Toronto, Canada
- 4 Joseph and Mildred Sonshine Family Centre for Head and Neck Diseases, Department of Otolaryngology-Head and Neck Surgery Program, Mount Sinai Hospital , Toronto, Canada
- 5 Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital , Toronto, Canada
- 6 Department of Otolaryngology-Head and Neck Surgery, University of Toronto , Toronto, Canada
| | - Joe Veyhl
- 1 Alex and Simona Shnaider Research Laboratory in Molecular Oncology, Mount Sinai Hospital , Toronto, Canada
| | - Seham Chaker
- 1 Alex and Simona Shnaider Research Laboratory in Molecular Oncology, Mount Sinai Hospital , Toronto, Canada
| | - Jasmeet Assi
- 1 Alex and Simona Shnaider Research Laboratory in Molecular Oncology, Mount Sinai Hospital , Toronto, Canada
| | - Akram Alyass
- 1 Alex and Simona Shnaider Research Laboratory in Molecular Oncology, Mount Sinai Hospital , Toronto, Canada
| | - Ajitha Jeganathan
- 1 Alex and Simona Shnaider Research Laboratory in Molecular Oncology, Mount Sinai Hospital , Toronto, Canada
| | - Raj Thani Somasundaram
- 1 Alex and Simona Shnaider Research Laboratory in Molecular Oncology, Mount Sinai Hospital , Toronto, Canada
| | - Christina MacMillan
- 2 Department of Pathology and Laboratory Medicine, Mount Sinai Hospital , Toronto, Canada
- 3 Laboratory Medicine and Pathobiology, University of Toronto , Toronto, Canada
| | - Jeremy Freeman
- 4 Joseph and Mildred Sonshine Family Centre for Head and Neck Diseases, Department of Otolaryngology-Head and Neck Surgery Program, Mount Sinai Hospital , Toronto, Canada
- 5 Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital , Toronto, Canada
- 6 Department of Otolaryngology-Head and Neck Surgery, University of Toronto , Toronto, Canada
| | - Allan D Vescan
- 4 Joseph and Mildred Sonshine Family Centre for Head and Neck Diseases, Department of Otolaryngology-Head and Neck Surgery Program, Mount Sinai Hospital , Toronto, Canada
- 5 Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital , Toronto, Canada
- 6 Department of Otolaryngology-Head and Neck Surgery, University of Toronto , Toronto, Canada
| | - Ian J Witterick
- 4 Joseph and Mildred Sonshine Family Centre for Head and Neck Diseases, Department of Otolaryngology-Head and Neck Surgery Program, Mount Sinai Hospital , Toronto, Canada
- 5 Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital , Toronto, Canada
- 6 Department of Otolaryngology-Head and Neck Surgery, University of Toronto , Toronto, Canada
| | - Paul G Walfish
- 1 Alex and Simona Shnaider Research Laboratory in Molecular Oncology, Mount Sinai Hospital , Toronto, Canada
- 2 Department of Pathology and Laboratory Medicine, Mount Sinai Hospital , Toronto, Canada
- 3 Laboratory Medicine and Pathobiology, University of Toronto , Toronto, Canada
- 4 Joseph and Mildred Sonshine Family Centre for Head and Neck Diseases, Department of Otolaryngology-Head and Neck Surgery Program, Mount Sinai Hospital , Toronto, Canada
- 7 Department of Medicine, Endocrine Division, Mount Sinai Hospital , Toronto, Canada
- 8 Department of Medicine, University of Toronto Medical School , Toronto, Canada
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Macdonald KI, Wright ED, Sowerby LJ, Rotenberg BW, Chin CJ, Rudmik L, Sommer DD, Nayan S, DesRosiers M, Tewfik MA, Valdes CJ, Massoud E, Thomas D, Kilty SJ, Vescan A, Mechor B, Lavigne F, Fandino M, Javer AR, Witterick IJ. Squeeze bottle versus saline spray after endoscopic sinus surgery for chronic rhinosinusitis: a pilot multicentre trial. Am J Rhinol Allergy 2015; 29:e13-7. [PMID: 25590308 DOI: 10.2500/ajra.2015.29.4125] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND There is a need for controlled trials to guide the perioperative management of patients undergoing endoscopic sinus surgery (ESS). The authors performed a pilot multicenter trial to compare two types of saline delivery devices in this population. METHODS Patients were randomized to high volume saline irrigation with a squeeze bottle and low volume saline spray after ESS in patients with chronic rhinosinusitis (CRS). Surgeons were blinded to treatment, and one-month postoperative scores for sinonasal outcomes [Sinonasal Outcome Test-22 (SNOT-22)] scale, nasal and sinus symptom score (NSS), and perioperative sinus endoscopy (POSE) scale were compared with preoperative scores. RESULTS Nine centers provided data for 86 patients. All three outcomes measures improved significantly for both groups. Saline spray: SNOT-22 48.8 versus. 23.7, treatment effect 25.1 (95% confidence interval [CI], 17.9-32.2), POSE 21.1 versus. 8.4, treatment effect 12.7 (95% CI, 9.2-16.1), and NSS 8.2 versus 5.0, treatment effect 3.1 (95% CI, 1.4-4.9) pre- and postoperatively, respectively (all p < 0.0001). Squeeze bottle: SNOT-22 49.5 versus 23.6, treatment effect 25.9 (95% CI, 20.3-31.6), POSE 18.6 versus 9.2, treatment effect 9.3, (95% CI 6.7-12.0), and NSS 9.0 versus 5.7, treatment effect 3.3 (95% CI, 2.3-4.3) pre- and postoperatively, respectively (all p < 0.0001). Analysis of variance did not identify a difference between the two treatment groups. Subgroup analysis based on preoperative disease severity did not change the nonassociation of saline bottle with outcome measures. Post hoc sample size calculation determined that 176 patients is required to detect an 8.9-point difference in SNOT-22 scores. CONCLUSION In this pilot multicenter trial examining patients with chronic rhinosinusitis undergoing ESS, both squeeze bottle and saline spray showed significant improvement in SNOT-22, POSE, and NSS scores at one-month postoperatively. Because the study was nonpowered, we cannot rule out a potential difference between the two treatment groups.
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Affiliation(s)
- K I Macdonald
- Department of Otolaryngology, Head and Neck Surgery, University of Ottawa, Canada ON
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50
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Orlov S, Salari F, Kashat L, Freeman JL, Vescan A, Witterick IJ, Walfish PG. Post-operative stimulated thyroglobulin and neck ultrasound as personalized criteria for risk stratification and radioactive iodine selection in low- and intermediate-risk papillary thyroid cancer. Endocrine 2015; 50:130-7. [PMID: 25792004 DOI: 10.1007/s12020-015-0575-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 03/09/2015] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to demonstrate the utility of a personalized risk stratification and radioactive iodine (RAI) selection protocol (PRSP) using post-operative stimulated thyroglobulin (Stim-Tg) and neck ultrasound in low- and intermediate-risk papillary thyroid carcinoma (PTC) patients. Patients with PTC tumors ≥1 cm were prospectively followed after total thyroidectomy and selective therapeutic central compartment neck dissection. Low/intermediate risk was defined as PTC confined to the thyroid or central (level VI) lymph nodes. Stim-Tg and neck ultrasound were performed approximately 3 months after surgery and used to guide RAI selection. Patients with Stim-Tg < 1 µg/L did not receive RAI, while those with Stim-Tg >5 µg/L routinely did. Those with Stim-Tg 1-5 µg/L received RAI on the basis of several clinical risk factors. Patients were followed for >6 years with serial neck ultrasound and basal/stimulated thyroglobulin. Among the 129 patients, 84 (65 %) had undetectable Stim-Tg after initial surgery, 40 (31 %) had Stim-Tg of 1-5 µg/L, and 5 (4 %) had Stim-Tg >5 µg/L. RAI was administered to 8 (20 %) patients with Stim-Tg 1-5 µg/L and 5 (100 %) with Stim-Tg >5 µg/L. Using this approach, RAI therapy was avoided in 17/20 (85 %) patients with tumors >4 cm, in 72/81 (89 %) patients older than 45 years, and in 6/9 (67 %) patients with central lymph node involvement. To date, 116 (90 %) patients in this cohort have not received RAI therapy with no evidence of residual/recurrent disease, whereas among the 13 patients who received RAI, 1 (8 %) had pathologic residual/recurrence disease. Using the proposed PRSP, RAI can be avoided in the majority of low/intermediate-risk PTC patients. Moreover, traditional risk factors considered to favor RAI treatment were not always concordant with the PRSP and may lead to overtreatment.
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Affiliation(s)
- Steven Orlov
- Endocrine Division, Department of Medicine, Joseph and Mildred Sonshine Family Centre for Head & Neck Diseases, Mount Sinai Hospital, 413-7, 600 University Avenue, Toronto, ON, M5G 1X5, Canada,
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