Optimizing the care of lung cancer patients: a multidisciplinary approach

Lung cancer poses an immense problem for our society, both in terms of health and the economic costs of caring for affected patients. This introductory overview highlights the issues that are addressed in this Clinics devoted to non-small cell lung cancer.     

Impact of pharmaceutical care interventions on multidisciplinary care of older patients with cancer: A systematic review

IntroductionOptimizing medication use is a major issue in older patients with cancer and pharmacists are increasingly involved in their multidisciplinary care. The implementation of pharmaceutical care interventions must be supported by impact evaluations to enable their development and funding. This systematic review aims to synthesize evidence on the impact of pharmaceutical care interventions in older patients with cancer.Materials and MethodsA comprehensive search was performed in the PubMed/Medline, Embase, and Web of Science databases, for articles reporting evaluations of pharmaceutical care interventions for patients with cancer aged 65 years or older.ResultsEleven studies met the selection criteria. Most pharmacists were part of multidisciplinary geriatric oncology teams. Whether in outpatient or inpatient settings, interventions had common components, including patient interview, medication reconciliation, and comprehensive medication review to assess drug-related problems (DRPs). DRPs were identified in 95% of patients with 1.7 to 3 DRPs on average. Pharmacist recommendations resulted in a 20–40% reduction in the total number of DRPs and a 20–25% decrease in the prevalence of DRP. Prevalence of potentially inappropriate or omitted medications and their subsequent deprescribing or addition varied greatly between studies, notably depending on detection tools used. Clinical impact was insufficiently evaluated. Only one study reported a reduction of anticancer treatment toxicities following a joint pharmaceutical and geriatric assessment. A single economic evaluation calculated a potential net benefit of $3,864.23 per patient resulting from the intervention.DiscussionThese encouraging results must be confirmed by more robust evaluations to support the involvement of pharmacists in multidisciplinary care of older patients with cancer.     

Policy statement on multidisciplinary cancer care

BackgroundCancer care is undergoing an important paradigm shift from a disease-focused management to a patient-centred approach, in which increasingly more attention is paid to psychosocial aspects, quality of life, patients’ rights and empowerment and survivorship. In this context, multidisciplinary teams emerge as a practical necessity for optimal coordination among health professionals and clear communication with patients. The European Partnership for Action Against Cancer (EPAAC), an initiative launched by the European Commission in 2009, addressed the multidisciplinary care from a policy perspective in order to define the core elements that all tumour-based multidisciplinary teams (MDTs) should include. To that effect, a working group conference was held in January 2013 within the EPAAC Work Package 7 (on Healthcare) framework.MethodsThe consensus group consisted of high-level representatives from the following European scientific societies, patient associations and stakeholders: European CanCer Organisation (ECCO), European SocieTy for Radiology & Oncology (ESTRO), European Society for Medical Oncology (ESMO), European Society of Surgical Oncology (ESSO), International Society of Geriatric Oncology (SIOG), European Association for Palliative Care (EAPC), European Oncology Nursing Society (EONS), International Psycho-Oncology Society (IPOS),European Cancer Patient Coalition (ECPC), EuropaColon, Europa Donna - The European Breast Cancer Coalition, Association of European Cancer Leagues (ECL), Organisation of European Cancer Institutes (OECI), EUSOMA - European Society of Breast Cancer Specialists, European Hospital and Healthcare Federation (HOPE) and EPAAC Work Packages 5 (Health promotion and prevention), 7, 8 (Research), 9 (Information systems) and 10 (Cancer plans). A background document with a list of 26 core issues drawn from a systematic review of the literature was used to guide the discussion. Five areas related to MDTs were covered: care objectives, organisation, clinical assessment, patients’ rights and empowerment and policy support. Preliminary drafts of the document were widely circulated for consultation and amendments by the working group before final approval.ResultsThe working group unanimously formulated a Policy Statement on Multidisciplinary Cancer Care to define the core elements that should be implemented by all tumour-based MDTs. This document identifies MDTs as the core component in cancer care organisation and sets down the key elements to guide changes across all European health systems.ConclusionMDTs are an essential instrument of effective cancer care policy, and their continued development crucial to providing patients the care they need and deserve. While implementation must remain in local hands, European health systems can still benefit from having a basis for an effective multidisciplinary model of cooperation. This policy statement is intended to serve as a reference for policymakers and healthcare providers who wish to improve the services currently provided to the cancer patients whose lives and well-being depend on their action.     

The multidisciplinary management of patients with cancer.

We read with interest the recent article by Blazeby et al. [1],which described the implementation of decisions made by a multidisciplinaryteam (MDT). The study evaluated 273 decisions about patientmanagement made at a central MDT meeting in Bristol, which assessedcases of patients with upper gastrointestinal cancer, includingcases     

COVID-19 and the multidisciplinary care of patients with lung cancer: an evidence-based review and commentary

Delivering lung cancer care during the COVID-19 pandemic has posed significant and ongoing challenges. There is a lack of published COVID-19 and lung cancer evidence-based reviews, including for the whole patient pathway. We searched for COVID-19 and lung cancer publications and brought together a multidisciplinary group of stakeholders to review and comment on the evidence and challenges. A rapid review of the literature was undertaken up to 28 October 2020, producing 144 papers, with 113 full texts screened. We focused on new primary data collection (qualitative or quantitative evidence) and excluded case reports, editorials and commentaries. Following exclusions, 15 published papers were included in the review and are summarised. They included one qualitative paper and 14 quantitative studies (surveys or cohort studies), with a total of 2295 lung cancer patients data included (mean study size 153 patients; range 7–803). Review of current evidence and commentary included awareness and help-seeking; lung cancer screening; primary care assessment and referral; diagnosis and treatment in secondary care, including oncology and surgery; patient experience and palliative care. Cross-cutting themes and challenges were identified using qualitative methods for patients, healthcare professionals and service delivery, with a clear need for continued studies to guide evidence-based decision-making.Subject terms: Lung cancer, Lung cancer     

多学科协作模式的延续性管理对乳腺癌患者术后恢复及不良情绪的影响

目的探讨多学科协作模式的延续性管理对乳腺癌患者术后恢复及不良情绪的影响。方法依据术后干预方式的不同将80例乳腺癌根治术后患者分为常规组(n=35)和多学科协作管理组(n=45),常规组实施常规术后干预,多学科协作管理组在此基础上实施多学科协作模式的延续性管理。比较两组患者的疼痛程度、不良情绪、营养指标、肢体功能恢复情况及自护能力。结果干预后,多学科协作管理组患者的视觉模拟评分量表(VAS)、焦虑自评量表(SAS)和抑郁自评量表(SDS)评分均明显低于常规组,血清白蛋白(ALB)、血清前白蛋白(PAB)水平均明显高于常规组(P﹤0.01)。干预后,多学科协作管理组患者肩关节内收、肩关节外展、肩关节伸屈和肩关节后伸的活动度均明显大于常规组(P﹤0.01)。干预后,多学科协作管理组患者的自护技能、自护责任感、自我概念和健康知识水平评分均明显高于常规组(P﹤0.01)。结论多学科协作模式的延续管理能够缓解乳腺癌术后患者的疼痛及焦虑、抑郁情绪,改善营养状态,促进肢体功能恢复,提高其自护能力。     

Breast cancer: multidisciplinary care and clinical outcomes

A multidisciplinary approach to the management of breast cancer is the standard of care in developed health systems. We performed a systematic review to assess the extent and quality of evidence on whether multidisciplinary care (MDC), or related aspects of care contribute to clinical outcomes in breast cancer, and in particular whether these influence survival. Only two primary studies have looked at MDC and neither of these studies considered long-term outcomes. The studies of MDC (case series) provide weak evidence that MDC may alter treatment patterns. Several population-based cohort studies showed that related aspects of team work, specialist (surgeon) and hospital workload and specialisation, are associated with improved survival. This group of studies used better quality design with more clearly defined outcome measures, and most of the studies have allowed for possible confounding variables. Evidence of a survival benefit was most consistent for specialist (surgeon) effect. However, the reasons behind the improved survival reported in these studies are unclear, and it is unlikely that this is entirely attributable to treatment patterns. We conclude that although intrinsically multidisciplinary care should be associated with better survival, there remains a paucity of evidence to support this. Studies of the long-term clinical effects of MDC in breast cancer should be a priority for future evaluation.     

Establishing a cancer center data bank and biorepository for multidisciplinary research.

The establishment of a biorepository with linkage to clinical and epidemiologic data will provide an invaluable resource for cancer research, including studies of cancer etiology, progression, and prognosis, as well as development of biomarkers for early detection. Developing an infrastructure for a biorepository linked to clinical, pathologic, and epidemiologic data requires significant efforts in strategic planning for efficient means to ascertain, identify, and consent participants, as well as guidelines for blood collection, processing, and storage while maintaining participant privacy rights. In this report, we present an approach to developing a Data Bank and Biorepository at our own institution, with discussion of elements to be considered when establishing such a bank.     

不良心理状态对姑息治疗肺癌患者生活质量的影响

目的探讨分析不良心理状态对姑息治疗肺癌患者生活质量的影响。方法选取2009年2月至2013年5月间进行姑息治疗的肺癌患者148例作为观察组,选取同期健康志愿者100名作为对照组。采用焦虑评分量表(SAS)、抑郁评分量表(SDS)、心理健康评分量表(SCL-90)及生活质量评分量表(QLQ-C30)统计分析姑息治疗肺癌患者心理状态与其生活质量的关系。结果观察组患者SAS、SDS、SCL-90得分显著高于健康对照组,差异有统计学意义(P<0.05)。观察组患者的生活质量评分为(60.12±11.96)分,生活质量较差。多因素Logistic分析显示,肺癌患者的焦虑、抑郁及不良心理状态是影响患者生活质量的危险因素(P<0.05)。结论姑息治疗的肺癌患者心理状态较差,且其不良的心理状态显著影响了生活质量。     

The geriatrician's perspective on practical aspects of the multidisciplinary care of older adults with cancer

Multidisciplinary teams (MDTs) have been incorporated into the practical care of elderly patients with cancer. Several geriatric oncology centres have attempted to determine the best way to implement MDTs by using geriatric assessment (GA). Developing a geriatric oncology service is a feasible work, which requires significant resources. The challenges of MDTs must be known so that better care planning for elderly patients with cancer can be devised. The aim of this paper is to discuss the practical aspects of the multidisciplinary care of older adults with cancer by considering a geriatric point of view and the recent literature. Reviewing data from recent studies helps enumerate the major challenges in establishing collaboration in geriatric oncology: evaluating the resources of your centre, knowing the role of each member of the team, establishing good communication both within the team and with the patients, and determining referral criteria and using screening tests to select which patients can benefit the most from the multidisciplinary evaluation and a more thorough GA.     

An evaluation of patient satisfaction with care provided by a multidisciplinary cancer team

This article describes an evaluation of patient satisfaction with the care provided by a multidisciplinary cancer team based in a cancer unit which is a designated specialist cancer-treatment centre. An opportunistic sample of patients attending cancer out-patient clinics were approached, and 93 (84%) completed the questionnaire. Most patients were highly satisfied with the care and information provided by doctors, cancer nurses and other attached professionals. However, dissatisfaction was expressed with the amount of information given about treatment trials and research, and with waiting times in clinics and pharmacy. In addition, the team was shown to be relatively poor at identifying depressed patients and offering them appropriate services. Changes implemented following this audit of care are described.     

The radiologist's role in the multidisciplinary team for patients with colon cancer peritoneal metastases

BackgroundPrevention and treatment of peritoneal metastases from colon cancer is currently under a critical reevaluation. An expanded role of the radiologist in imaging the peritoneum and extrahepatic structures is crucial to progress in this endeavor.MethodsThe critical role of radiology in the evaluation of a primary colon cancer and in diagnosis and assessment of recurrent colon cancer is evaluated.ResultsFor primary colon cancer the radiologist should forewarn the multidisciplinary team of patients whose malignancy is at high risk for peritoneal metastases and for local recurrence. In recurrent colon cancer a quantitative assessment of the concerning radiologic features are of help to select patients for reoperation.ConclusionAn improved primary surgical treatment strategy and more knowledgeable patient selection for reoperation can result from this information.     

多学科会诊模式在结肠癌手术患者中的应用效果

目的分析多学科会诊(MDT)模式对结肠癌患者术后胃肠功能恢复及并发症的效果评价。方法将2017年1月至12月收治的50例结肠癌患者作为对照组,给予常规干预措施;将2018年1月至12月收治的50例结肠癌患者为观察组,采取MDT模式干预。比较两组患者的胃肠功能恢复情况及一般围手术期指标;干预前和干预后2周,采用世界卫生组织生存质量评估量表(WHOQOL-BREF)评估两组患者的生活质量;术后3天,采用视觉模拟评分法(VAS)评估两组患者腹胀发生情况;比较两组患者术后并发症发生情况。结果观察组患者肛门排气时间、首次排便时间、肠鸣音恢复时间、禁食时间、伤口愈合时间、住院时间、术后下床时间均短于对照组患者,差异均有统计学意义(P﹤0.05)。干预后2周,两组患者环境领域、社会领域、心理领域、生理领域及总体健康评分均高于本组干预前,且观察组患者环境领域、社会领域、心理领域、生理领域及总体健康评分均明显高于对照组患者,差异均有统计学意义(P﹤0.05)。术后3天,观察组患者的腹胀程度低于对照组患者,差异有统计学意义(P﹤0.05)。观察组患者术后并发症总发生率为6.0%,低于对照组患者的20.0%,差异有统计学意义(P﹤0.05)。结论MDT模式干预可促进患者术后胃肠功能恢复情况,缩短伤口愈合时间及住院时间,降低术后并发症发生率,并改善了患者的生活质量。     

Critical care of patients with cancer

Answer questions and earn CME/CNE The increasing prevalence of patients living with cancer in conjunction with the rapid progress in cancer therapy will lead to a growing number of patients with cancer who will require intensive care treatment. Fortunately, the development of more effective oncologic therapies, advances in critical care, and improvements in patient selection have led to an increased survival of critically ill patients with cancer. As a consequence, critical care has become an important cornerstone in the continuum of modern cancer care. Although, in many aspects, critical care for patients with cancer does not differ from intensive care for other seriously ill patients, there are several challenging issues that are unique to this patient population and require special knowledge and skills. The optimal management of critically ill patients with cancer necessitates expertise in oncology, critical care, and palliative medicine. Cancer specialists therefore have to be familiar with key principles of intensive care for critically ill patients with cancer. This review provides an overview of the state‐of‐the‐art in the individualized management of critically ill patients with cancer. CA Cancer J Clin 2016;66:496–517. © 2016 American Cancer Society .     

抗凝治疗在恶性肿瘤前血栓状态中的应用

目的:分析抗凝治疗在恶性肿瘤前血栓状态中的临床应用价值.方法:2012年1月-2014年12月间,采用前瞻性随机对照的研究方法,检测肿瘤病例的D-二聚体(D-dimer,D-D)水平,确定是否合并前血栓状态.根据是否合并前血栓状态将肿瘤病例分为三组:D-D正常组、D-D异常给予抗凝治疗组、D-D异常未给予抗凝治疗组,抗凝药物选用肝素/华法林/拜阿司匹林等,统计各组血栓发生率.结果:2 663例中,D-D异常1 177例,异常率44.2％.发生血栓12例,血栓发生率0.45％.D-D正常组1 486例中发生血栓3例(0.20％),D-D异常组1 177例中,发生静脉血栓9例(0.76％).其中,D-D异常给予抗凝治疗组1 005例中发生5例(0.50％),未给予抗凝治疗组172例中发生4例(2.33％),三组比较差异有显著性(P＜0.01).主要副反应为急性胃黏膜病变,未见消化道大出血等严重并发症发生.结论:合并前血栓状态的肿瘤病人给予抗凝治疗可以有效预防静脉血栓的发生率,提高病人的生活质量.