Multidisciplinary Oncology Team Research Articles

Using guideline-based clinical decision support in oncological multidisciplinary team meetings: A prospective, multicenter concordance study.

BackgroundMultidisciplinary team meetings formulate guideline-based individual treatment plans based on patient and disease characteristics and motivate reasons for deviation. Clinical decision trees could support multidisciplinary teams to adhere more accurately to guidelines. Every clinical decision tree is tailored to a specific decision moment in a care pathway and is composed of patient and disease characteristics leading to a guideline recommendation.ObjectiveThis study investigated (1) the concordance between multidisciplinary team and clinical decision tree recommendations and (2) the completeness of patient and disease characteristics available during multidisciplinary team meetings to apply clinical decision trees such that it results in a guideline recommendation.MethodsThis prospective, multicenter, observational concordance study evaluated 17 selected clinical decision trees, based on the prevailing Dutch guidelines for breast, colorectal and prostate cancers. In cases with sufficient data, concordance between multidisciplinary team and clinical decision tree recommendations was classified as concordant, conditional concordant (multidisciplinary team specified a prerequisite for the recommendation) and non-concordant.ResultsFifty-nine multidisciplinary team meetings were attended in 8 different hospitals, and 355 cases were included. For 296 cases (83.4%), all patient data were available for providing an unconditional clinical decision tree recommendation. In 59 cases (16.6%), insufficient data were available resulting in provisional clinical decision tree recommendations. From the 296 successfully generated clinical decision tree recommendations, the multidisciplinary team recommendations were concordant in 249 (84.1%) cases, conditional concordant in 24 (8.1%) cases and non-concordant in 23 (7.8%) cases of which in 7 (2.4%) cases the reason for deviation from the clinical decision tree generated guideline recommendation was not motivated.ConclusionThe observed concordance of recommendations between multidisciplinary teams and clinical decision trees and data completeness during multidisciplinary team meetings in this study indicate a potential role for implementation of clinical decision trees to support multidisciplinary team decision-making.

Pulmonary Oncology—Scope of the Pulmonologist

AbstractThe International Agency for Research on Cancer GLOBOCAN project has predicted that India's cancer burden will nearly double in the next 20 years, from slightly more than a million new cases in 2012 to more than 1·7 million by 2035. In India, chronic respiratory diseases have emerged as a leading health care burden with chronic obstructive pulmonary disease (COPD) being the second leading cause of deaths and disability-adjusted life years. Patients with COPD are 6.35 times more likely to develop lung cancer. The deadly dual epidemic of “chronic respiratory diseases and cancer” warrants not only prevention but also creating an increased awareness among oncologists as well as pulmonologists to enable early diagnosis and treatment. It would be incorrect to assume that the scope of a pulmonologist in oncology is just diagnosing and treating lung cancer or prescribing chemotherapy for lung cancer. There is a larger world full of opportunities beyond that, and we look at the pulmonologist as a member of a multidisciplinary oncology team working together with the surgical, radiation, and medical oncologist and ancillary specialties to address all the issues highlighted earlier that are faced in oncology practice. The current exposure to pulmonary oncology and related complications during postgraduate training for respiratory medicine in India is limited. It is necessary not only to educate the pulmonologist on their role in an oncology setup but also to increase the awareness across all oncology specialties regarding the pulmonologist's contribution in management of the cancer patient. In this review, written based on our experience gained in our pulmonology service in our tertiary oncology center, we have tried to portray the wide role of the pulmonologist in oncology. We have realized that what is lacking is the basic awareness regarding the above potential, both among pulmonologists and oncologists. Our mission is to take this message across specialists in India, highlighting how we can work synergistically in the fight against cancer.

Mode of Referral of Ovarian Cancer Patients: Does it Alter Treatment and Survival?

Some studies have shown that ovarian cancer patients admitted after referral to the emergency department had a worse prognosis than those referred through non-emergency pathways. We believe that our study is the first in the UK to explore this difference and aimed to compare the 1-year, 3-year, and 5-year overall survival rates of ovarian cancer patients referred non-urgently from the general practitioner (GP) vs. patients referred urgently to the emergency department (ED). This was a retrospective cohort study conducted at the University Hospitals of Leicester (UHL) from 1st January 2015 to 31st December 2019 involving 298 ovarian cancer patients: 197 referred non-urgently from the GP and 101 patients referred to the ED. There was no significant difference in the 1-year, 3-year, and 5-year overall survival in ovarian cancer patients referred from the GP compared to patients referred to the ED, 84.8%, 62.2%, and 48.4% versus 80.2%, 64.8%, and 43.5%, respectively (p=0.732). The mode of referral for ovarian cancer patients may not affect their prognosis. Prompt referral to the gynaecological oncology multidisciplinary team, a good acute oncology service, early imaging and image-guided diagnostic pathways, timely appointment, and timely initiation of treatment in our centre may have minimized the difference in outcome in the two groups.

Survival of clinical stage III NSCLC according to therapeutic strategy: Relevance of the tumor board decision in the era of immunotherapy

IntroductionStage III NSCLC comprises a heterogeneous population. Different treatment strategies are available, including surgery, radiotherapy, and chemotherapy. The PACIFIC trial results represented a significant change and improvement in the therapeutic strategy for these patients. We aimed to compare the different treatment strategies employed in Stage III NSCLC patients within our institution. MethodsAll Stage III NSCLC patients discussed during the weekly thoracic oncology multidisciplinary team meetings at the University hospital Grenoble Alpes (France) between January 2010 and January 2017 were included. Patients’ overall survival (OS) according to treatment strategies along with their respective changes were compared. ResultsOverall, 476 patients were identified. Among patients initially scheduled to receive neoadjuvant chemotherapy followed by surgery (n = 60), only 37 (62%) actually underwent surgery. Median OS of the cohort was 21.3 months [IQR 25%–75%: 9.6–48.3]. Patients who received neoadjuvant chemotherapy followed by surgery displayed better survival than those treated by CT-RT: 53.2 months [IQR 25%–75%: 16.1–87.3] versus 23.9 [IQR 25%–75%, 13.3–48.1]. Survival was slightly superior for patients treated by upfront CT-RT than for those planned for neoadjuvant chemotherapy followed by surgery who eventually converted to CT-RT (concurrent or sequential): 23.9 months [IQR 25%–75%: 13.3–48.1] versus 20.4 [IQR 25%–75%:10.8–36], respectively. ConclusionWhile patients who underwent neoadjuvant chemotherapy followed by surgery displayed a better survival than those treated using CT-RT, switch from surgery to CT-RT actually shortened survival. These results stress the relevance of the tumor board in deciding which is the best therapeutic strategy for Stage III disease patients.

Locally advanced groin neurofibrosarcoma misdiagnosed twice as inguinal hernia: a case report

Neurofibrosarcoma is a rare malignant, aggressive peripheral nerve sheet tumour. It presents diagnostic challenges as it is difficult to be distinguished from other tumours. It may present in all body regions. The authors report a case of a 26-year-old male who presented with recurrent inguinal mass following repair of an inguinal hernia. He was diagnosed with a malignant neurofibrosarcoma and multidisciplinary team (MDT) reviews done by the hospital oncology MDT declared the patient was not eligible for chemotherapy. The patient had tumour excision, and he died 3 months later. Inguinal masses may mimic an inguinal hernia. Traditional characteristics of an inguinal hernia should be sought for in all inguinal masses and a high index of suspicion be maintained.

Evaluation of a prospective radiation oncology departmental team review process using standardized simulation directives

IntroductionThe primary objective of this study is to evaluate the utility and value of an institutional, multi-disciplinary radiation oncology team review process prior to radiotherapy (RT) simulation. MethodsOver a period of 3 months and through an iterative team-based process, a standardized simulation requisition directive (SSRD) was developed, piloted, modified, and subsequently implemented for all patients treated with external beam RT at a single tertiary care institution from January to December 2020. The SSRDs were reviewed at a daily multi-disciplinary radiation oncology team review conference; modifications consequential to the review were prospectively recorded in a quality database. Results1500 consecutive SSRDs were prospectively reviewed for this study. 397 modifications on 290 (19.3%) SSRDs were recorded and parsed into 5 main categories and 18 subcategories. The most common modifications resulted from changes in immobilization device (n = 88, 22.2%), RT care path (n = 56, 14.1%), and arm positioning (n = 43, 10.8%). On univariate analysis, modifications were associated with RT intent, scan parameters, tumor site, and consultation type. An increased rate modifications was observed for patients had telemedicine consults (n = 101, 22.7%) compared to in-person consultations (n = 189, 17.9%) (p = 0.032). Using logistic regression analysis, there was also a statistically significant relationship between postoperative RT delivery and modification rates (OR: 2.913, 95% CI: 1.014–8.372) (p = 0.0126). Overall, only 14 patients (0.9%) needed re-simulation during the entire study period. ConclusionsProspective multi-disciplinary radiation oncology team review prior to simulation identifies actionable change in approximately 19% of procedures, and results in an extremely low rate (<1%) of re-simulation. As departmental processes transition to virtual platforms, thorough attention is needed to identify patients at higher risk of simulation modifications.

Hearing Loss After Radiation and Chemotherapy for Central Nervous System and Head and Neck Tumors in Children

Hearing loss (HL) is a serious secondary effect of treatment for head and neck (H&N) and central nervous system (CNS) tumors in children. Radiation and platinum chemotherapy independently increase the risk of HL; however, combined modality treatment is routinely used and the effect of chemoradiation on HL risk is not well-studied. Using chemotherapy and cochlear radiation (RT) doses, we created a model that predicts for HL, including a nomogram that can be used in the clinical setting to calculate the risk of clinically-significant HL.In this single institution retrospective study, 171 patients with H&N or CNS tumors were treated with radiation, with or without chemotherapy and had longitudinal (≥2) audiological evaluation. SIOP-Boston (SIOP) and Chang grades were assigned to 2,420 hearing assessments of 342 ears; analyses using SIOP grades are presented here. For the nomogram, SIOP grade ≥3 was considered clinically-significant HL (requiring hearing aids). An Andersen-Gill model for recurrent events was used to obtain inverse intensity weights to account for factors explaining the number of assessments. Multivariable weighted ordinal logistic regression was fitted to evaluate the effect of clinicopathologic features on HL. Clustered robust standard errors were calculated to account for intra-patient correlation.Patients underwent a median of 6 (range 2-23) assessments over a median of 3.1 years from diagnosis to last audiogram (range 0.1-15.2 years). Cisplatin was given to 63% of patients and 34% received carboplatin. The mean cochlear doses on the right and left were 36.8 Gy (standard deviation [SD] 16.5) and 37.0 Gy (SD 16.2), respectively. Multivariable regression revealed that mean cochlear dose (odds ratio [OR] 1.04 per Gy, 95% confidence interval [CI] 1.02-1.05, P < 0.001), time since RT (OR 1.2 per year, 95% CI 1.2-1.3, P < 0.001), cisplatin use (OR 5.33, 95% CI 2.9-9.9, P < 0.001), and carboplatin use (OR 2.3, 95% CI 1.27-4.17, P = 0.006) were associated with increasing SIOP grade of HL; age at RT, hydrocephalus, surgery, amifostine, and laterality were not correlated with HL. There was no synergistic effect of RT and cisplatin (interaction term, P = 0.4) or RT and carboplatin (interaction term, P = 0.9). Cumulative incidence of high-frequency HL (> 4 kHz) was > 50% at 5 years post-RT in those who received mean dose > 20 Gy to the cochlea, while incidence of HL across all frequencies continued to increase beyond 5 years post-RT.RT and chemotherapy have an additive, not synergistic, effect on HL risk. Mean cochlear radiation dose, time since radiation, and platinum chemotherapy use were associated with HL. This modelling can guide survivorship care by multidisciplinary pediatric oncology teams with respect to audiology follow-up in an effort to that ensure suitable educational accommodations and assistive devices are in place.

A MISSED PULMONARY ARTERY SARCOMA REQUIRING RADICAL EXCISION AND PNEUMONECTOMY: SURGICAL TECHNIQUE

<h3>BACKGROUND</h3> A 64-year-old previously well male patient was referred with a 3-month history of progressive shortness of breath (New York Heart Association class III) and non-exertional chest pain radiating to the back. TA transthoracic echocardiogram (TTE) demonstrated mild flow acceleration across the pulmonary valve, without insufficiency and estimated pulmonary pressures of 55 - 60 mmHg. Repeat CT scan identified an approximately 6 cm mass completely filling the right pulmonary artery (RPA) to the hilum and extending down the main pulmonary artery (MPA), potentially involving the pulmonary valve. The left pulmonary artery (LPA) appeared mostly spared. Multidisciplinary oncological team evaluation suggested concerns for pulmonary artery sarcoma prompting consideration for urgent radical excision with homograft reconstruction and right pneumonectomy. <h3>METHODS AND RESULTS</h3> Upon discovery of bilateral PAS in our patient, we decided intraoperatively to continue with a complete radical resection and pneumonectomy, keeping with the goal of complete curative excision. This required extensive planning for surgery including ensuring homograft availability for reconstruction of the pulmonary root and its branches. Cardioplegic arrest was utilized to allow aortic transection to provide optimal exposure posterior to the aorta to determine tumor extension. Given only partial extension into the LPA, we prioritized good margins distally towards the left lung, and used an additional pulmonary allograft for reconstruction. Complete obstruction of the RPA and tumor extension into the right lung necessitated a right pneumonectomy. Pathology confirmed intimal sarcoma with negative margins, and confirmed tumor spread into the right lung parenchyma. At 6 months follow-up, this patient is doing well with no signs of tumour recurrence. Repeat CT demonstrates a patent and functional reconstructed MPA and LPA. <h3>CONCLUSION</h3> Though this technique requires meticulous planning and surgical expertise, it offers a reasonable alternative to conventional management with greater survival benefit. The hope is this approach can build on past literature and lead to longer survival post-operation in patients diagnosed with this rare but deadly disease.

Proposal for development of a guideline in maintaining quality cancer care during and post-covid-19 in an upper middle-income country with universal health coverage

BackgroundDuring periods of high community transmission of COVID-19, the public hospitals in Malaysia, an upper middle-income country, have been forced to scale down elective surgeries, prioritize cancer treatments based on treatment benefits, and postpone non-emergency imaging procedures. These inevitably led to disruptions in cancer care delivery within the public health care system. This study aims to explore the facilitators and barriers faced by healthcare providers and cancer survivors in cancer care, and to co-design a guideline to maintain the delivery of cancer care amid the disaster situations. MethodIn-depth interviews (IDIs) will be conducted with Malaysian healthcare providers and cancer survivors and findings will be analysed thematically. The insights will be used in a subsequent phase to co-design a guideline to maintain the delivery of quality cancer care in Malaysia via a three-round modified Delphi survey with a broad range of cancer stakeholders. Expected resultsFindings derived from IDIs and existing literature will be included for rating across three rounds by the expert panel. Feedback provided will be refined until consensus on the best practises for cancer care continuity during crises is achieved. ConclusionThe output of the present study is not only expected to ensure the continuity of delivery of high-quality cancer care in Malaysia during the ongoing pandemic but also to be adapted during unforeseen crises in the near future. Policy summary statementCollaborative work between policy makers, public health physicians, members of the multidisciplinary oncology team as well as cancer survivors is vital in developing an evidenced- based contingency plan for maintaining access to cancer care.

Experience of Uncommon EGFR Mutation in Lung Scheme Quality Program: Discussing Risks and Opportunities for the Improvement of Laboratory Response.

Background The quality programs can be considered to be a valuable tool for global and individual growth. Each result, obtained by a single laboratory, contributes to define the standardization of the response. In the case of the uncommon epidermal growth factor receptor (EGFR) mutations, the molecular result is sometimes difficult to interpret in terms of biological significance and therapy choosing. The standardization effort in the diagnostic lung setting also consists of active quality program participation. Materials and Methods The quality control analysis, which is defined as a clinical case, was performed by the extraction of DNA from FFPE sections and by RT-PCR on the EGFR (exons 19, 20, 21), BRAF, and KRAS genes. The laboratory performed a validation sequencing of EGFR exon 20 with the help of the Sanger method. Results The laboratory reported positivity for EGFR exon 20 insertions and negative results for BRAF and KRAS. The quality test finished with the redaction of a report containing the recommendation to consider the efficacy of therapy with tyrosine kinase inhibitors (TKI). This specific interpretation has determined poor performance judgment by the quality provider, which explained why most of these mutations are TKI-resistant. Conclusions This experience provides an opportunity to reflect on the critical aspects of this diagnostic setting. The detection of some uncommon EGFR mutations should entail the mutation characterization, especially for the rare exon 20 insertions, of which are not classifiable as “resistant.” Moreover, this experience allows reflecting on the quality program design, mandatory actions for the laboratory, and routine activity in the oncologic multidisciplinary team.

The Next Step Toward Patient-Centeredness in Multidisciplinary Cancer Team Meetings: An Interview Study with Professionals.

BackgroundPatient-centeredness is essential in complex oncological multidisciplinary team decision-making. Improvement seems to be needed, while there is a lack of knowledge about health care providers’ needs for improvement.ObjectiveTo explore multidisciplinary team members’ perspectives on the need to improve patient-centeredness in complex decision-making, and subsequently the strategies to enhance it.MethodsThis was a qualitative descriptive interview study. The participants were twenty-four professionals who attended multidisciplinary cancer team meetings weekly. The setting was five multidisciplinary teams (gastrointestinal, gynecological, urological, head and neck, and hematological cancer) in a Dutch academic hospital. Data were collected by semi-structured interviews and were analyzed with a combination of inductive and deductive content analysis.ResultsThe participants voiced the need for additional information (patient-centered information, patients’s needs and preferences, individualized medical information) during the multidisciplinary team meeting, to be more patient-centered in the decision-making conversation with the patient following the meeting, and for more information following the meeting to support patient-centeredness. The strategies, which mostly originated from the needs, were categorized as organization, decision-making, and communication. The most prominent strategies were those aimed at collecting and using patient-centered information, and to facilitate the decision-making conversation with the patient following the multidisciplinary team meeting.ConclusionOur findings highlighted the need to improve patient-centeredness in oncological multidisciplinary teams and provided a comprehensive overview of strategies for improvement, supported by multidisciplinary team members. These strategies emphasize involvement of patients throughout the continuous process of decision-making for patients with cancer. These strategies may be implemented in other oncological multidisciplinary teams, taking in mind the local needs. Future research may help to prioritize the strategies and to determine and evaluate the effect on endpoints, like patient or professional satisfaction, shared decision-making, and on the decision that was made.

Disparities in Breast Cancer Associated With African American Identity

Persistent disparities in the burden of breast cancer between African Americans and White Americans have been documented over many decades. Features characterizing breast cancer in the African American community include a 40% higher mortality rate, younger age distribution, greater advanced-stage distribution, increased risk of biologically aggressive disease such as the triple-negative phenotype, and increased incidence of male breast cancer. Public health experts, genetics researchers, clinical trialists, multidisciplinary oncology teams, and advocates must collaborate to comprehensively address the multifactorial etiology of and remedies for breast cancer disparities. Efforts to achieve breast health equity through improved access to affordable, high-quality care are especially imperative in the context of the COVID-19 pandemic and its disproportionately high economic toll on African Americans.

Translation of oncology multidisciplinary team meeting (MDM) recommendations into clinical practice

BackgroundMultidisciplinary team meeting (MDM) processes differ according to clinical setting and tumour site. This can impact on decision making. This study aimed to evaluate the translation of MDM recommendations into clinical practice across solid tumour MDMs at an academic centre.MethodsA retrospective audit of oncology records was performed for nine oncology MDMs held at Liverpool Hospital, NSW, Australia from 1/2/17–31/7/17. Information was collected on patient factors (age, gender, country of birth, language, postcode, performance status, comorbidities), tumour factors (diagnosis, stage) and MDM factors (number of MDMs, MDM recommendation). Management was audited up to a year post MDM to record management and identify reasons if discordant with MDM recommendations. Univariate and multivariable regression analyses were performed to assess for factors associated with concordant management.ResultsEight hundred thirty-five patients were discussed, median age was 65 years and 51.4% were males. 70.8% of patients were presented at first diagnosis, 77% discussed once and treatment recommended in 73.2%. Of 771 patients assessable for concordance, management was fully concordant in 79.4%, partially concordant in 12.8% and discordant in 7.8%. Concordance varied from 84.5% for lung MDM to 97.6% for breast MDMs. On multivariable analysis, breast and upper GI MDMs and discussion at multiple MDMs were significantly associated with concordant management. The most common reason for discordant management was patient/guardian decision (28.3%).ConclusionThere was variability in translation of MDM recommendations into clinical practice by tumour site. Routine measurement of implementation of MDM recommendations should be considered as a quality indicator of MDM practice.

Pancreatic cancer detection and characterization: state of the art and radiomics.

Pancreatic ductal adenocarcinoma (PDAC) represents a challenge for a multidisciplinary oncology team. Diagnosis of PDAC remains challenging due to overlapping imaging features with benign lesions, notwithstanding great advances with computed tomography (CT) and magnetic resonance imaging (MRI). The term "Radiomics" has recently been introduced to define a mathematical process to extract countless quantitative features from medical images (including each diagnostic technique) with high throughput computing for diagnosis and prediction. This article is an updated overview of the imaging techniques to be employed during detection and characterization of pancreatic cancer diagnostic workup. Particularly, the limitations and advantages of the different imaging techniques are discussed, with a particular focus on functional imaging. This overview is the result of a self-study without protocol and registration number. Articles published in the English language from January 2000 to January 2021 were included. We analyzed 15 papers on radiomics. The possibility of functional imaging, such as CT, MRI, and radiomics has revolutionized pancreatic imaging, improving the detection and characterization of the lesions and allowing a prognosis related to radiological features, favoring the process of personalized medicine.

Virtual reality and artificial intelligence for 3-dimensional planning of lung segmentectomies.

BackgroundThere has been an increasing trend toward pulmonary segmentectomies to treat early-stage lung cancer, small intrapulmonary metastases, and localized benign pathology. A complete preoperative understanding of pulmonary anatomy is essential for accurate surgical planning and case selection. Identifying intersegmental divisions is extremely difficult when performed on computed tomography. For the preoperative planning of segmentectomies, virtual reality (VR) and artificial intelligence could allow 3-dimensional visualization of the complex anatomy of pulmonary segmental divisions, vascular arborization, and bronchial anatomy. This technology can be applied by surgeons preoperatively to gain better insight into a patient's anatomy for planning segmentectomy.MethodsIn this prospective observational pilot study, we aim to assess and demonstrate the technical feasibility and clinical applicability of the first dedicated artificial intelligence-based and immersive 3-dimensional-VR platform (PulmoVR; jointly developed and manufactured by Department of Cardiothoracic Surgery [Erasmus Medical Center, Rotterdam, The Netherlands], MedicalVR [Amsterdam, The Netherlands], EVOCS Medical Image Communication [Fysicon BV, Oss, The Netherlands], and Thirona [Nijmegen, The Netherlands]) for preoperative planning of video-assisted thoracoscopic segmentectomies.ResultsA total of 10 eligible patients for segmentectomy were included in this study after referral through the institutional thoracic oncology multidisciplinary team. PulmoVR was successfully applied as a supplementary imaging tool to perform video-assisted thoracoscopic segmentectomies. In 40% of the cases, the surgical strategy was adjusted due to the 3-dimensional-VR–based evaluation of anatomy. This underlines the potential benefit of additional VR-guided planning of segmentectomy for both surgeon and patient.ConclusionsOur study demonstrates the successful development and clinical application of the first dedicated artificial intelligence and VR platform for the planning of pulmonary segmentectomy. This is the first study that shows an immersive virtual reality-based application for preoperative planning of segmentectomy to the best of our knowledge.

P05.13 Central vs Peripheral Thoracic Malignancies Treated with SBRT: Early Outcomes of a Prospective Quality of Life Study

Thoracic malignancies in close proximity to central mediastinal structures are known to have a higher rate of treatment-related toxicity following stereotactic body radiation therapy (SBRT). Intrinsic damage secondary to tumor invasion may contribute to this increased toxicity and could be identified by pretreatment quality of life metrics. The appropriate dose fractionation schedule as well as daily treatment schedule that may mitigate the aforementioned central toxicity remains nebulous. We reviewed patients on a prospective trial assessing quality of life before and after SBRT and stratified based on central versus peripheral anatomical location. In this single institutional study, patients were enrolled on a prospective quality of life trial approved by the local Institutional Review Board. All patients were evaluated by a multidisciplinary thoracic oncology team and were diagnosed with thoracic malignancy amenable to stereotactic body radiation therapy delivered in 5 or fewer treatment fractions on an every other day schedule. Central tumors were defined as those within 2 cm of central mediastinal structures including the proximal bronchial tree. Patients underwent pre-and post-treatment quality of life questionnaires including the prospectively validated EORTC Quality of Life Core questionnaire (QLQ-C30 version 3) and Supplemental Lung Cancer module questionnaire (QLQ-LC13). Baseline differences between groups were analyzed using the Mann-Whitney U and Chi-squared tests. Score comparisons for EORTC questionnaires pre- and post- SBRT were conducted using the Wilcoxon signed-rank test. All statistics were performed in SPSS, version 24. A total of 31 patients from February 2018 to February 2020 were enrolled with a median age of 70 (59-90) years. The majority of patients had an ECOG of 1 (n = 15) and the most common histology was adenocarcinoma (n = 17). A total of 13 patients were found to have central lung tumors. There were no significant pretreatment differences in age, performance status, gender or the predefined EORTC questionnaire-specific subcategorized functional, quality of life, or symptom domains between patients diagnosed with central versus peripheral tumors. Following SBRT, there were notable, statistically significant improvements in the Emotional functioning (EF) domain (pre- and post- treatment median: 61.5 and 91.7, respectively, z=-2.01, p=.044) and the Cognitive functioning (CF) domain (pre- and post- treatment median: 75.0 and 91.7, respectively z=-2.06, p=.039) in patients treated for central lung tumors. Similar improvements were not observed in patients treated for peripheral lung tumors. There were no significant changes in any other functional, symptom, or quality of life domain following treatment for either group. Pretreatment EORTC quality of life metrics did not demonstrate significant differences in patients diagnosed with central versus peripheral thoracic malignancies in our prospective cohort. However, patients with central lung tumors experienced significant improvements in their EF and CF domains following SBRT. These findings suggest patients with central lung tumors may experience greater psychological distress from their disease independent of self-reported physical symptom burden.

Reorganizing the Multidisciplinary Team Meetings in a Tertiary Centre for Gastro-Intestinal Oncology Adds Value to the Internal and Regional Care Pathways. A Mixed Method Evaluation.

Introduction:The reorganisation of the structure of a Gastro-Intestinal Oncology Multidisciplinary Team Meeting (GIO-MDTM) in a tertiary centre with three care pathways is evaluated on added value.Methods:In a mixed method investigation, process indicators such as throughput times were analysed and stakeholders were interviewed regarding benefits and drawbacks of the reorganisation and current MDTM functioning.Results:For the hepatobiliary care pathway, the time to treatment plan increased, but the time to start treatment reduced significantly. The percentage of patients treated within the Dutch standard of 63 days increased for the three care pathways. From the interviews, three themes emerged: added value of MDTMs, focus on planning integrated care and awareness of possible improvements.Discussion:The importance of evaluating interventions in oncology care pathways is shown, including detecting unexpected drawbacks. The evaluation provides insight into complex dynamics of the care pathways and contributes with recommendations on functioning of an MDTM.Conclusions:Throughput times are only partly determined by oncology care pathway management, but have influence on the functioning of MDTMs. Process indicator information can help to reflect on integration of care in the region, resulting in an increase of patients treated within the Dutch standard.

Chinses expert consensus on the multidisciplinary team diagnosis and treatment of lung cancer

Lung cancer is by far the most common cancer and the leading cause of cancer death in China. Through multidimensional discussion and analysis of disease, the multidisciplinary team (MDT) diagnosis and treatment brings lots of benefits for cancer patients, including increasing patient satisfaction, reducing hospitalization expense, shortening treatment waiting time, providing more reasonable diagnosis and treatment pathways and strategies, relieving medical disputes, increasing enrollment opportunities for patients in high-quality clinical trials, patients'prognosis and life quality and so on. Presently, lung cancer MDT in China needs to be improved, including guideline following, democratic decision, landing performance and feedback, meeting records, patient follow-up and so on. So this consensus combines lung cancer MDT experience of China with leading-edge global oncology MDT experience to construct patient-centered lung cancer MDT diagnosis and treatment model, including MDT responsibility and obligations, organizational framework, working modality, standard procedures, assessment methods, and encouragement mechanisms and so on. Chinese Thoracic Oncology Group; Chinese Society of Lung Cancer; Lung Cancer Group of Oncology Branch, Chinese Medical Association; Multidisciplinary Team Diagnosis and Treatment Committee, Chinses Medical Doctor Association jointly publish this consensus. The purpose of this consensus is to provide procedures and criteria for lung cancer MDT of China.

Implications of COVID-19 pandemic on lung cancer management: A multidisciplinary perspective.

Treatment of patients with lung cancer during the current COVID-19 pandemic is challenging. Lung cancer is a heterogenous disease with a wide variety of therapeutic options. Oncologists have to determine the risks and benefits of modifying the treatment plans of patients especially in situation where the disease biology and treatment are complex. Health care visits carry a risk of transmission of SARS-CoV-2 and the similarities of COVID-19 symptoms and lung cancer manifestations represent a dominant problem. Efforts to modify treatment of lung cancer during the current pandemic have been adapted by many healthcare institutes to reduce exposure of lung cancer patients to SARS-CoV-2. We summarized the implications of COVID-19 pandemic on the management of lung cancer from the perspective of different specialties of thoracic oncology multidisciplinary team.

Involvement of radiologists in oncologic multidisciplinary team meetings: an international survey by the European Society of Oncologic Imaging

ObjectivesMultidisciplinary tumour boards (MTBs) play an increasingly important role in managing cancer patients from diagnosis to treatment. However, many problems arise around the organisation of MTBs, both in terms of organisation-administration and time management. In this context, the European Society of Oncologic Imaging (ESOI) conducted a survey among its members, aimed at assessing the quality and amount of involvement of radiologists in MTBs, their role in it and related issues.MethodsAll members were invited to fill in a questionnaire consisting of 15 questions with both open and multiple-choice answers. Simple descriptive analyses and graphs were performed.ResultsA total of 292 ESOI members in full standing for the year 2018 joined the survey. Most respondents (89%) declared to attend MT-Bs, but only 114 respondents (43.9%) review over 70% of exams prior to MTB meetings, mainly due to lack of time due to a busy schedule for imaging and reporting (46.6%). Perceived benefits (i.e. surgical and histological feedback (86.9%), improved knowledge of cancer treatment (82.7%) and better interaction between radiologists and referring clinicians for discussing rare cases (56.9%)) and issues (i.e. attending MTB meetings during regular working hours (71.9%) and lack of accreditation with continuing medical education (CME) (85%)) are reported.ConclusionsDespite the value and benefits of radiologists’ participation in MTBs, issues like improper preparation due to a busy schedule and no counterpart in CME accreditation require efforts to improve the role of radiologists for a better patient care.Key Points• Most radiologists attend multidisciplinary tumour boards, but less than half of them review images in advance, mostly due to time constraints.• Feedback about radiological diagnoses, improved knowledge of cancer treatment and interaction with referring clinicians are perceived as major benefits.• Concerns were expressed about scheduling multidisciplinary tumour boards during regular working hours and lack of accreditation with continuing medical education.