Multidisciplinary Team Meetings Research Articles

1029 EVEN LIMITED GERIATRICIAN INVOLVEMENT REDUCES LENGTH OF STAY FOR ALL-AGE ACUTE GENERAL SURGERY PATIENTS

Abstract Background More than half of patients undergoing emergency general surgery are older than 651. The Emergency Laparotomy and Frailty (ELF) study identified that frail patients (CFS ≥5) were vulnerable to adverse outcomes and longer hospital stays and should be reviewed by a geriatrician2. The 2021 National Emergency Laparotomy Audit (NELA) found that only 27% were reviewed by a geriatrician1. Local problem A local hospital had no routine geriatrician input to perioperative care of older people admitted under the care of general surgeons. Method/Intervention In one month prior to intervention, we noted CFS recorded once and a geriatrician involved in only 3 patients over the age of 65 (n = 35). We introduced a service comprising twice-weekly geriatrician-led multi-disciplinary team (MDT) meetings of all-age patients followed by selected patient ward rounds. This equated to 2.5 Programmed Activity’s (PA) per week. After another month we measured the number of patients having CFS recorded, those who had geriatrician involvement and length of stay. We also surveyed members of the MDT. Results All 31 patients aged over 65 received geriatrician input with 93.5% having a CFS recorded. Length of stay of all-age patients (n = 75) was reduced from 12.8 to 8.8 days, with the most significant reduction of 6.5 days in over 65’s (16.7 to 10.2); >200 bed days saved for older people. The MDT comments included: ‘improved MDT communication’, ‘early identification of discharge barriers’ and ‘pro-active approach’. Conclusion NELA highlights that consistent geriatrician input remains generally poor. Even a limited geriatrician-led service can be highly effective at guaranteeing review of appropriate patients in line with recommendations from NELA. Alongside targeted patient review geriatricians can support and lead decision making of all-age patients. This cost-effective strategy can reduce length of stay for young and old alike and gained excellent feedback from the MDT.

995 MULTIPLE ORGANISATIONAL FACTORS IMPROVE MULTI-DISCIPLINARY CARE DELIVERY TO PATIENTS WITH HIP FRACTURES: A QUALITATIVE STUDY

Abstract Introduction Hip fractures are devastating injuries which incur high healthcare costs. Despite national standards and guidelines, there is substantial variation in hospital delivery of hip fracture care and in patient outcomes. This study aimed to understand organisational processes that facilitate successful delivery of hip fracture services. Method Forty qualitative interviews were conducted with healthcare professionals involved in delivering hip fracture care at four English hospitals. Interview data were supplemented with documentary analysis of 23 anonymised British Orthopaedic Association hospital-initiated peer-review reports of services. Data were analysed thematically, with themes transposed onto key components of the care pathway. Results We identified multiple aspects of service organisation that facilitated good care delivery. At admission, standardisation of training in nerve block administration impacted care delivery. During hospital stays, service delivery was improved by integrated, shared-care between orthopaedics and orthogeriatrics, and by strategies to improve trauma list efficiency. Adequately staffed orthogeriatric services and the ‘right’ skills and seniority mix were important to holistic care provision. Placing patients on designated hip fracture wards concentrated staff expertise. Collaborative working was achieved through multi-disciplinary team (MDT) meetings between key staff, protocols and care pathways that defined roles and responsibilities, MDT documentation, ‘joined-up’ IT systems within hospitals and with primary care, and shared working spaces such as shared offices and onwards. Trauma and hip fracture coordinators organised care processes and provided a valuable central point of contact within teams. Nominated leads, representing diverse specialties, worked together in MDT planning meetings to develop joint protocols, establish audit priorities, and agree shared goals. Routine, comprehensive monitoring and evaluation of service delivery, with findings shared throughout the MDT, was beneficial. Conclusion Our study has characterised potentially modifiable elements of successful hip fracture service delivery. Findings are intended to help services overcome organisational barriers towards delivery of high-quality hip fracture services.

MDT stage migration in MRI of significant rectal polyps and early rectal cancers.

To audit the diagnostic accuracy of MRI for staging early and polyp rectal cancers with the purpose of identifying scope for service improvement. This is an IRB approved retrospective study of patients who underwent staging MRI for rectal growths followed by upfront TME type surgery or local excision without neoadjuvant therapy between 2018 and 2021. MR-T-stage was compared with surgical histopathology. The degree of stage migration in the multidisciplinary team meetings (MDT) was assessed and training needs were identified. 53 patients (32 males) with a mean (SD) age of 56.7 (13.6) years with 54 rectal lesions and underwent trans-anal excision (n = 18) or upfront surgery (n = 35) were included. Pathology showed < / = pT1 stage in n = 18 and > / = pT2 stage in n = 36. Radio-pathological concordance rate was 38.9% and 74.1%, respectively, for primary reports and MDT reads, respectively, and during MDT, the rates improved by 44.5% and 30.5% for < / = pT1 and > / = pT2 stages ,respectively. The overall T-stage migration rate at MDT was 44.6% (25/54) and the migration rate was higher (61.1%) for < / = pT1 stage lesions. The best sensitivity, specificity, PPV, NPV and accuracy of MRI for T-staging was 83.3%, 91.6%, 83.3%, 91.6% and 88.8%, respectively. Radio-pathological correlation for MRI T-stage is excellent for MDT reads by experienced radiologists. MDT reads lead to significant down-staging of T-stage in polyp and early rectal cancer thereby improving radio-path correlation.

Observations of community-based multidisciplinary team meetings in health and social care for older people with long term conditions in England.

BackgroundCommunity-based multi-disciplinary teams (MDTs) are the most common means to encourage health and social care service integration in England yet are rarely studied or directly observed. This paper reports on two rounds of non-participant observations of community-based multi-disciplinary team (MDT) meetings in two localities, as part of an evaluation of the Integrated Care and Support Pioneers Programme. We sought to understand how MDT meetings coordinate care and identify their ‘added value’ over bilateral discussions.MethodsTwo rounds of structured non-participant observations of 11 MDTs (28 meetings) in an inner city and mixed urban–rural area in England (June 2019-February 2020), using a group analysis approach.ResultsDespite diverse settings, attendance and caseloads, MDTs adopted similar processes of case management: presentation; information seeking/sharing; narrative construction; solution seeking; decision-making and task allocation. Patient-centredness was evident but scope to strengthen ‘patient-voice’ exists. MDTs were hampered by information governance rules and lack of interoperability between patient databases. Meetings were characterised by mutual respect and collegiality with little challenge. Decision-making appeared non-hierarchical, often involving dyads or triads of professionals. ‘Added value’ lay in: rapid patient information sharing; better understanding of contributing agencies’ services; planning strategies for patients that providers had struggled to find the right way to engage satisfactorily; and managing risk and providing mutual support in stressful cases.ConclusionsMore attention needs to be given to removing barriers to information sharing, creating scope for constructive challenge between staff and deciding when to remove cases from the caseload. Supplementary InformationThe online version contains supplementary material available at 10.1186/s12913-022-07971-x.

Multidisciplinary Team Meeting Proposal and Final Therapeutic Choice in Early Breast Cancer: Is There an Agreement?

BackgroundA multidisciplinary team meeting (MDM) approach in breast cancer (BC) management is a standard of care. One of the roles of MDMs is to identify the best diagnostic and therapeutic strategies for patients (pts) with new diagnosis of early BC. The purpose of this study was to define whether there was an agreement between the planned program (i.e., MDMs-based decision) and that actually applied. In addition, the study explored factors associated with discordance.MethodsWe conducted a retrospective study of a consecutive series of 291 patients with new diagnosis of early BC, discussed at MDMs at the University Hospital of Udine (Italy), from January 2017 to June 2018. The association between clinico-biological factors and discordance between what was decided during the MDMs and what was consequently applied by the oncologist was explored through uni- and multivariate logistic regression analyses.ResultsThe median age was 62 years (range 27–88 years). Among invasive early BC patients, the most frequent phenotype was luminal A (38%), followed by luminal B (33%), HER2-positive (12%), and triple-negative (5%). In situ carcinoma (DCIS) represented 12% of cases. The median time from MDM discussion to first oncologic examination was 2 weeks. The rate of discordance between MDM-based decision and final choice, during a face-to-face consultation with the oncologist, was 15.8% (46/291). The most frequent reason for changing the MDM-based program was clinical decision (87%). Follow-up was preferred to the chemotherapy (CT) proposed within the MDMs in 15% of cases, and to the endocrine therapy (ET) in 39% of cases (among these, 44.5% had a diagnosis of DCIS). Therapeutic change from sequential CT-ET to ET alone was chosen in 16/46 pts (35%): among these patients, seven had a luminal B disease and six had an HER2-positive disease. On univariate analysis, factors associated with discordance were values of Ki-67 14%–30% (OR 3.91; 95% CI 1.19–12.9), age >70 years (OR 2.44, 95% CI 1.28–4.63), housewife/retired status (OR 2.35, 95% CI 1.14–4.85), polypharmacy (OR 1.95; 95% CI 1.02–3.72), postmenopausal status (OR 4.15; 95% CI 1.58–10.9), and high Charlson Comorbidity Index (OR 1.31; 95% CI 1.09–1.57). The association with marital status, educational level, alcohol and smoke habits, presence of a caregiver, parity, grading, histotype and phenotype, and stage was not statistically significant. On multivariate analysis, only Ki-67 value maintained its statistical significance.ConclusionThe results of our study could be useful for enhancing the role of MDMs in the clinical decision-making process in early BC.

Real-world single-centre experience of rheumatoid arthritis patients requiring four or more higher cost drugs: response and duration of treatment.

Records from our multi-disciplinary team meeting (MDT) that is used to decide on the use of HCDs were used to identify all RA patients who had been exposed to four or more HCDs. Notes were scrutinised for sequence of treatments, duration and response to treatments and reasons for stopping at each choice point. From a total of 2648 RA patients in our service, 49 (< 2%) had been exposed to four or more HCDs. Response rates based on descriptive assessments for fourth to sixth choices were between 50 and 55% as well as some partial responders. There were responders and failures to all drugs at every choice point. Patients who had responded to one drug were more likely to respond to the next. Patients often responded to drugs for approximately 2years. Only four patients had stopped looking for the next HCD. Patients often respond to late choice HCDs. There are responders and failures at each time point and they are difficult to predict. There is no justification for restricting the number of HCDs that can be tried for RA. Key Points • Less than 2% of our RA patients required 4 or more higher cost drugs. • Fourth to sixth choice drugs still worked in 50 to 55% of patients. • There is no justification for CCGs restricting the number of drugs that can be tried.

Development, Testing, and Implementation of the Belgian Patient Reported Experience Measure for Pancreatic Cancer Care (PREPARE) Project: Protocol for a Multi-Method Research Project.

BackgroundPatients with pancreatic cancer do not feel involved in the development of their treatment and care plans. In Belgium, these plans are decided on during multidisciplinary team meetings. However, limited time is spent on the discussion of the preferences of the patient during these meetings. This research project aims to develop a patient-reported experience measure (PREM) for pancreatic cancer and assess if its use can support collaborative treatment decision-making.ObjectiveThis paper aims to outline the protocol for a multi-method research project to improve person-centered pancreatic cancer care in Belgium. Three subobjectives are pursued: (1) to develop a PREM to assess the experiences of care-related aspects in pancreatic cancer care, (2) to validate the PREM, and (3) to develop and evaluate an educational intervention to support the use of the PREM’s results.MethodsFor the development of the PREM, an exploratory mixed methods study design will be used. The study will start with a survey followed by a telephone interview involving patients with pancreatic cancer and digestive oncology health care professionals. Study two is the testing of the content and construct validity of the PREM. Study three involves the implementation study according to the Medical Research Council framework of a complex intervention introducing the PREM in practice. The effectiveness of the intervention will be investigated using a pragmatic randomized controlled trial study design.ResultsThe protocol presents the entire structure of the research project. Ethics approval to conduct the exploratory mixed methods study (objective 1) has been obtained, and recruitment has started since January 2022.ConclusionsThe poor prognosis of patients with pancreatic cancer should not be considered a hurdle to not study this patient population group. Involving patients in the research and decision-making processes early on is key. This project aims to realize a scientifically sound research process providing research outputs that can easily and timely be implemented in the care trajectory of patients with pancreatic cancer. This research project will also lead to recommendations on how to involve patients with pancreatic cancer and how the methodology of this research project can be translated to other patient groups.International Registered Report Identifier (IRRID)PRR1-10.2196/29004

LINC-15. Sustaining multidisciplinary care of children with central nervous system tumors during the COVID-19 pandemic

INTRODUCTION: A multidisciplinary team (MDT) approach is essential for quality cancer care. Since 2019, we have conducted regular MDT meetings to discuss pediatric patients with central nervous system (CNS) tumors at the Philippine General Hospital. Because of COVID-19, an abrupt transition from in-person to virtual meetings became necessary. METHODS: We reviewed the proceedings of MDT meetings for pediatric CNS tumors from March 2020–December 2021. We identified the strategies and adaptations of our pediatric neuro-oncology group, and outlined recommendations for other institutions in low- and middle-income countries. RESULTS: Our pediatric neuro-oncology group conducted 18 virtual MDT meetings during the study period. Meetings were scheduled every last Tuesday of the month, with pediatric oncologists, neurologists, neurosurgeons, radiation oncologists, radiologists, and neuropathologists regularly attending. We invited other specialists as needed. In total, we had 135 case discussions for 79 unique patients, or about 8 patients per meeting. These included both inpatients (74%) and outpatients (26%). Ten patients received prior treatment elsewhere. At the time of the meeting, 86% were postoperative, 8% were preoperative, and 6% did not require surgery. Most (60%) had malignant CNS tumors and 15% had disseminated/leptomeningeal disease. Histopathologic diagnosis was obtained for 62 patients (79%). Concerns addressed were: formulating a treatment plan (88%), surveillance strategy (10%), and diagnostic workup (5%). DISCUSSION: Several factors contributed to the ease of online transition: (1) motivated care providers including a patient navigator, (2) fixed schedule, (3) institutional Zoom account for securing data privacy, and (4) availability of picture archiving and communication system (PACS) for neuroimaging. Challenges included: (1) delays due to internet connectivity, (2) Zoom fatigue and online distractions, and (3) risk for miscommunication or misunderstanding. Commitment of the entire neuro-oncology team is essential to ensure the delivery of best possible care for pediatric patients with CNS tumors.

The Use of Next-generation Sequencing in the Diagnosis of Rare Inherited Anaemias: A Joint BSH/EHA Good Practice Paper.

The Use of Next-generation Sequencing in the Diagnosis of Rare Inherited Anaemias: A Joint BSH/EHA Good Practice Paper.

Indicators of frailty in newly diagnosed lung cancer patients: A retrospective review.

e24017 Background: Lung cancer is frequently diagnosed over the age of 70 years, in a population with increased risk factors for frailty. Frailty impacts cancer treatment selection, tolerance, and quality of life. We performed a retrospective study to determine whether there is a difference in the indicators of frailty in patients of different ages, and if this impacted treatment choice. Methods: Electronic records of patients who were discussed at the University Hospitals of Leicester Lung multidisciplinary team meeting (MDT) between January to December 2019 with a suspected diagnosis of lung cancer were reviewed. Populations below the age of 65 years and over the age of 65 years were compared. Results: 846 patient records were reviewed, and 80% were aged over 65 years. Baseline WHO performance status (PS) where recorded showed 35% were PS 0-1, and 28% were 3-4. Comparatively, in the under 65 population 46% were PS 0-1, and 10% were 3-4. The over 65s had a lower rate of independence with activities of daily living (ADLs) compared to the under 65s (54% vs 71%), assistance with basic ADLs was higher (10% vs 5%) and patients with unassisted mobility was also lower (48% vs 66%). The over 65s had an increased rate of multiple comorbidities compared to the younger group (no comorbidity 25% vs 30%, 3 or more comorbidities 27% vs 14% respectively.) Where curative intent was intended, in the under 65s, surgical review deemed 24% unsuitable and of these, 72% had a discussion regarding radiotherapy with 61% receiving treatment. Comparatively in the older population, 40% of patients were deemed unsuitable for surgery and 69% went for discussion regarding radiotherapy with 44% receiving treatment. Where systemic anti-cancer therapy (SACT) discussion was advised, more patients in the under 65 group saw a medical oncologist compared to the older group (73% vs 61%) and had a higher rate of subsequent SACT (80% vs 61%). There were similar rates of non-completion of SACT in the over 65s compared to the younger group (55% vs 54%) and number of dose reductions (18% vs 15%). 35% of the over 65s and 46% of the under 65s received immunotherapy. In the older population, 30% received monotherapy, compared to 17% in the younger population. 37% of the older patients having SACT were admitted with a median stay of 2 days (range 1-30) compared to 31% in the younger group, with a median stay of 1.5 days (range 1-2). Conclusions: Our review demonstrates that in the older population, PS is higher, with a lower independence rate for ADLs, a higher level of assisted mobility and increased comorbidity. These frailty indicators impacted treatment options; less older patients were suitable for treatment compared to the younger population. The older population displayed more indicators of frailty potentially impacting treatment options, and this highlights the need for active frailty assessment and rapid intervention in the lung cancer population to allow a full range of treatment options.

MDT Clinics on a General Adult Acute Psychiatric Ward: Staff's Views and Person-Centred Care

AimsPerson-Centred Care (PCC) focuses on knowing the person behind the patient, engaging them as an active partner in their treatment, encouraging self-management and shared decisions. Inpatient multidisciplinary (MDT) clinics offer an opportunity for PCC by working collaboratively with service users (SU) in developing care plans. The aims of this project were to explore staff views and levels of satisfaction regarding the running of MDT clinics, to assess the quality and efficacy of changes made to MDT clinics, and to identify areas of practice which need improvement.MethodsIn April 2021, MDT meetings of an acute inpatient clinical team were repurposed to 30-minute clinics with SU and relevant key professionals present, focusing on SU needs. Two staff surveys were completed in June and October 2021. Following the first survey, changes were made to the days clinics were run, attendance schedule, and staff allocation of responsibilities for efficient clinic running. In the second survey, a 14-question questionnaire was sent to all 48 staff members. The questions explored staff experience of MDT clinics. The measures were both qualitative and quantitative.ResultsThe overall response rate was 31.25%, of which 40% by medical and 40% by nursing staff. Staff reported there was a positive impact in the collaborative development of care plans, including improved SU involvement, increased involvement of families, improved contribution from different professionals, and formulations providing greater insight. They reported improved task orientation, directed responsibility for task completion within the team, and enhanced role and responsibility of the named nurse. They thought there was less time for 1:1 work, but that the “overall benefits are worth it”. Improved relationship with SU was reported by 85%, increased engagement with SU care by 93%, and identifying clear goals for care plans by 93%. Nevertheless, problems with planning and logistics were reported by 77%. Main challenges included time management especially with external visitors or combination of remote and face-to-face attendees, relatively poor attendance of CMHT and family members, difficulties with informing and preparing SU ahead of their clinic times, number of attendees, and dissemination of MDT care plans.ConclusionRepurposing MDT meetings to MDT clinics focusing on SU needs has a positive impact in inpatient clinical practice. MDT clinic planning and improving the involvement of community teams and family members can contribute to an optimal purposeful inpatient admission. Conducting inpatient MDT clinics can be a crucial part of working collaboratively with SU and PCC.

Factors associated with non-presentation in a multidisciplinary team meeting for colon cancer: A matched retrospective cohort study in a French area

BackgroundSurvival of patients with colon cancer has increased in recent years due to advances in treatment and the implementation of multidisciplinary team meetings (MDTm). However, the organization of MDTm can be improved. The objectives of this work were to characterize patients with colon cancer who were not presented in MDTm and to analyse the reasons for their non-presentation. MethodsThe study was based on a retrospective cohort including patients with colon cancer diagnosed between 2014 and 2016. Risk factors for non-presentation in MDTm were investigated after 1:1 matching on age, gender and tumour location, using multivariate analysis. Resultsamongst 1616 patients diagnosed with colon cancer, 20.5% were not presented in MDTm. The most common reasons for non-presentation were ‘advanced age or poor general condition’ (22.6%) and ‘superficial tumour’ (20.5%), while 20.8% of non-presentation remained unexplained. Non-presentation in MDTm was associated with ECOG PS of 2 (OR 0.51, 95%CI 0.32–0.81, p = 0.005), best supportive care (OR 0.05, 95%CI 0.00–0.38, p = 0.016) and early death (OR 0.09, 95%CI 0.04–0.19, p<0.001). By contrast, patients with symptomatic tumours were more likely to be presented in MDTm than patients participating in mass screening (OR 2.16, 95%CI 1.09–4.32, p = 0.028). Presentation was significantly associated with diagnosis by a digestive surgeon (OR 2.16, 95%CI 1.22–3.92, p = 0.01) and a high UICC stage. ConclusionsThis study identified factors associated with non-presentation in a multidisciplinary team meeting for colon cancer such as an advanced age or a superficial tumour, paving the way for targeted improvements.

The sports cardiology team: personalising athlete care through a comprehensive, multidisciplinary approach

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): Dutch National Olympic Committee &amp; National Sports Federation (NOC*NSF)Amsterdam Movement Sciences (AMS) Background/Introduction Multidisciplinary teams (MDTs) are an integral part of cardiology. In sports cardiology, multidisciplinary expertise is required to differentiate between extraordinary pathophysiological adaption and pathology. In addition, expert consensus-based sports advice should be prescribed with care considering the potential severe impact on (professional) sports careers. A formally organised sports cardiology MDT could potentially improve quality of care; we therefore established a formally organised sports cardiology MDT at the Amsterdam UMC in April 2019, aiming to facilitate the diagnostic process, enhance the process of formulating optimal sports advice, and to maximise safety in sports. However, no studies have reported on the effects of such teams. Purpose To systematically investigate and document infrastructure, practices, recommendations, and clinical consequences of a sports cardiology MDT. Methods We retrospectively analysed all reviewed athletes of our (online) bimonthly sports cardiology MDT meetings (April 2019 to January 2021). The MDT consisted of a permanent panel of experts in sports cardiology, sports- and exercise medicine, cardio/clinical genetics, paediatric cardiology, cardiovascular imaging, and electrophysiology (Figure 1). Cases were referred (inter)nationally by sports physicians or cardiologists. The primary objective of this study was to investigate the 2 years of experiences of practices, recommendations, and clinical consequences of a formal sports cardiology MDT. Results In total 115 athletes underwent MDT review, mean age 32 (SD 16.0) years, 11% women, 65% recreational athletes, and 54% performed 'mixed' type of sports. MDT review led to diagnosis revision of ‘suspected cardiac pathology’ to ‘no cardiac pathology’ in 44/115 (38%) (Figure 2) and increased the number of definitive diagnoses; 77/115 before to 109/115 after MDT review (P&amp;lt;0.05). We observed less ‘total sports restrictions’ (6 to 0 p&amp;lt;0.05) and more tailored sports advice concerning ‘no peak load/specific maximum load’ (10 to 26 p&amp;lt;0.05) (Figure 2). At 14 (± 6) months follow-up, 112 (97%) athletes reported no cardiovascular events, 111 (97%) no (new) cardiac symptoms, 113 (98%) adherence to MDT sports advice, and no diagnoses were revised. Conclusion Our experiences with a comprehensive sports cardiology MDT demonstrate that this approach leads to a higher percentage of definitive diagnoses and fewer diagnosis of cardiac pathology, more tailored treatment- and sports advice, high rates of sports advice adherence, and less total sports restrictions. Our findings highlight the added value of dedicated sports cardiology MDTs in care for elite, professional, and recreational athletes and patients who wish to engage in sports and exercise.

Multidisciplinary team meetings: the epilepsy experience.

Multidisciplinary team (MDT) meetings are essential for ensuring optimal and consistent management for patients with complex problems and a variety of treatment options. Epilepsy surgery MDTs are a good example of complex decision making and planning to the best possible outcomes. The meetings need to run to an agreed format, with participants from neurology, neurophysiology, neuroimaging, neuropsychology, neuropsychiatry and neurosurgery all contributing succinct opinions to enable an informed discussion. A key feature of a successful MDT is to have a clear record of complementary data and perspectives, and to document management options. It is crucial to have a debrief after the event if an outcome is less good than anticipated, with the case being gone through in as much detail as a preoperative case, and ensuring that the whole team shares the successes and the disappointments and learns from the experience.

The COVID-19 Pandemic Is Associated with Reduced Survival after Pancreatic Ductal Adenocarcinoma Diagnosis: A Single-Centre Retrospective Analysis.

The COVID-19 pandemic has hugely disrupted healthcare provision, including oncology services. To evaluate the effects of the pandemic on referral routes leading to diagnosis, treatments, and prognosis in patients with pancreatic ductal adenocarcinoma, we performed a retrospective cohort study at a single tertiary centre in the UK. The patients were identified from the weekly hepatopancreatobiliary multidisciplinary team meetings between February 2018 and March 2021. The demographic, referral, and treatment data for each patient and date of death, where applicable, were extracted from the electronic patient record. The patients (n = 203) were divided into “pre-pandemic” and “pandemic” cohorts based on a referral date cut-off of 23rd March 2020. The median survival was 7.4 months [4.9–9.3] in the “pre-pandemic” cohort (n = 125), halving to 3.3 months [2.2–6.0], (p = 0.015) in the “pandemic” cohort (n = 78). There was no significant difference in patient characteristics between the two cohorts. There was a trend toward increased emergency presentations at diagnosis and reduced use of surgical resection in the “pandemic” cohort. This small-scale study suggested that the COVID-19 pandemic is associated with a halving of median survival in pancreatic ductal adenocarcinoma. Urgent further studies are required to confirm these findings and examine corresponding effects in other cancer types.

Screening, Surveillance, and Management of Hepatocellular Carcinoma During the COVID-19 Pandemic: a Narrative Review.

PurposeThe COVID-19 pandemic has been a burden to the global community as a whole but the healthcare community had bore the brunt of it. The pandemic resulted in policy changes that interfered with effective healthcare delivery. The healthcare community attempted to cope with the pandemic by triaging and prioritizing emergency conditions especially COVID related, ahead of elective conditions like cancer care. There was also fear that patients with cancer were at an increased risk of sever COVID-19 with increased mortality. Hepatocellular carcinoma (HCC) was also affected by these policies.MethodsWe reviewed the modified measures adopted in screening, surveillance, and management of HCC during the pandemic using PubMed, Medline, Index Medicus, EMBASE, SCOPUS, and Google Scholar databases.ResultThe main modification in surveillance and screening for HCC during the pandemic includes limiting the surveillance to those with very high risk of HCC. The interval between surveillan was also delayed by few months in some cases. The adoption of teleconferencing for multidisciplinary team meetings and patient consultation is one of the highlights of this pandemic all in an effort to reduce contact and spread of the virus. The treatment of early-stage HCC was also modified as needed. The role of ablative therapy in the management of early HCC was very prominent during the pandemic as the surgical therapy was significantly affected by the lacks of ventilators and intensive care unit space resulting from the pandemic. Transplantation, especially living donor liver transplantation, was suspended in few centers because of the risk of infection to the living donors.ConclusionAs we gradually recover from the pandemic, we should prepare for the fallout from the pandemic as we may encounter increased presentation of those patients deferred from screening during the pandemic.

MP47-17 IMPACT OF PATIENT AND LIFESTYLE FACTORS IN PATIENTS WITH STAGE III &amp; IV RENAL CANCER: A DANISH NATIONWIDE STUDY

You have accessJournal of UrologyCME1 May 2022MP47-17 IMPACT OF PATIENT AND LIFESTYLE FACTORS IN PATIENTS WITH STAGE III & IV RENAL CANCER: A DANISH NATIONWIDE STUDY Freja Ebbestad, Louise Geertsen, Naomi Nadler, Sofie Axelsen, Trine Horsbøll, Susanne Dalton, Jane Christensen, Frede Donskov, Lars Lund, and Nessn Azawi Freja EbbestadFreja Ebbestad More articles by this author , Louise GeertsenLouise Geertsen More articles by this author , Naomi NadlerNaomi Nadler More articles by this author , Sofie AxelsenSofie Axelsen More articles by this author , Trine HorsbøllTrine Horsbøll More articles by this author , Susanne DaltonSusanne Dalton More articles by this author , Jane ChristensenJane Christensen More articles by this author , Frede DonskovFrede Donskov More articles by this author , Lars LundLars Lund More articles by this author , and Nessn AzawiNessn Azawi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002618.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In this nationwide study, we investigated the effect of patient-related and lifestyle factors, and the use of multidisciplinary team meetings (MDT) in patient decision making, with overall and cancer-specific death, risk of recurrence and risk of death after recurrence as endpoints. METHODS: The study population included 949 patients with stage III and IV renal cancer, registered in the Danish Renal Cancer Database between 2014 and 2016 and followed until January 2021. Data sources were national registries supplemented with manual extraction of information from patient medical records. The hazard ratio (HR) with corresponding 95 % confidence intervals (CI) over overall death, cancer-specific death and recurrence were estimated using Cox proportional hazards regression with multivariate adjustment. RESULTS: Of 949 patients included, 502 (53 %) had localized disease only and 447 (47%) had stage IV at diagnosis; 625 (73%) had nephrectomy, 464 (49%) had treatment decisions made in MDT, and 526 (55%) had hypertension at diagnosis. Hypertension, poor performance status and primary metastasis increased the HR of both overall and cancer-specific death, while smoking was associated with a borderline increased HR of overall death (Table 1). 167 of 500 patients (33%) had recurrence after nephrectomy; only positive surgical margin (HR: 2.32, CI: 1.41;3.80) was statistically significant for risk of recurrence. HR of overall death after recurrence was 0.63 (CI: 0.47;0.84) per year from primary diagnosis to the diagnosis of recurrence. When treatment of recurrence was solely oncological (HR: 4.02, CI: 1.52;10.59), or no treatment was given (HR: 3.57, CI: 1.11;11.44), patients had a higher risk of overall death compared to patients treated with surgery. CONCLUSIONS: Patient-related factors such as hypertension and performance status were associated with survival and warrant attention in patient risk stratification. A longer time to recurrence reduced the risk of death after recurrence. Patients whose recurrence was treated without surgery had worse survival, confirming the role of surgery in treating advanced renal cancer. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e817 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Freja Ebbestad More articles by this author Louise Geertsen More articles by this author Naomi Nadler More articles by this author Sofie Axelsen More articles by this author Trine Horsbøll More articles by this author Susanne Dalton More articles by this author Jane Christensen More articles by this author Frede Donskov More articles by this author Lars Lund More articles by this author Nessn Azawi More articles by this author Expand All Advertisement PDF DownloadLoading ...

Management of breast incidentalomas: A closed loop audit experience at royal surrey foundation trust

Introduction: Breast Incidentalomas occur as an unexpected abnormality demonstrated on imaging performed for unrelated symptoms. Pre-COVID19 pandemic management involved urgent referrals for initial breast team evaluation. Clinical encounters occurred prior to the Multi-Disciplinary Team meeting (MDT). COVID-19 restrictions necessitated streamlining and optimising service provision with clinically appropriate encounters. Our aim was to re-audit (SU-CA-21-22-068) findings and management of breast incidentalomas during the pandemic.

Implementation rate and effects of multidisciplinary team meetings on decision making about radiotherapy: an observational study at a single Japanese institution

BackgroundCancer treatment requires a multidisciplinary approach. Therefore, multidisciplinary team meetings (MDTMs) have been widely used to determine the direction of treatment. However, no standard provisions exist for conducting MDTMs, and recommendations discussed in MDTMs are sometimes not implemented. ​This study analyzed the indications for radiotherapy discussed and recommended at MDTMs, identified the rate of radiotherapy recommendations for patients that were not implemented, and clarified the reasons at a single academic center in Japan.MethodsThis was a cross-sectional study that analyzed the minutes and electronic medical records of cases discussed at MDTMs held between April 2012-March 2017 at Yamagata University Hospital. We categorized how radiotherapy was initially presented at MDTMs, determined the rate of radiotherapy recommendations made through MDTMs, analyzed whether treatment recommendations were subsequently implemented, and examined the causes of non-implementation. We performed a statistical analysis to assess some clinical factors (sex, age, number of multidisciplinary team meetings, and classification of planned treatment) associated with the non-implementation of radiotherapy recommendations from MDTMs.ResultsA total of 1813 cases were discussed at MDTMs, of which 71% (1293 cases) were presented with treatment plans, including radiotherapy. Further, 66% (1205 cases) were recommended for radiotherapy through the MDTMs. Recommendations from MDTMs were not implemented in 7% (142 cases). The most typical reason for non-implementation was the clinician’s opinion (30%), followed by patient preferences (27%) and disease progression (20%). Change in cancer stage and improvement in symptoms were 12% and 4%, respectively. These ratios were similar each year. We could not find the factors associated with the non-implementation of radiotherapy recommendations from MDTMs.ConclusionsMDTMs had a significant effect on the recommendation of radiotherapy for each patient with a tumor. The primary reason for the non-implementation of decisions made at MDTMs was the opinion of clinicians and the patient’s preference. These results were similar to previous studies. We need to establish a monitoring system where patients themselves can decide the treatments based on their choices while using the recommendations from MDTMs.

Mohs micrographic surgery revisited: A multidisciplinary, collaborative approach for the treatment of aggressive and recurrent basal cell carcinoma on the head and neck

Mohs micrographic surgery is the preferred surgical option for high-risk basal cell carcinomas. In our institution, the method is exclusively used for the treatment of aggressive and recurrent facial tumours selected via multidisciplinary team meetings and consistently managed using a multidisciplinary approach. The aim of this retrospective patient-record study was to examine the outcomes for basal cell carcinomas managed with Mohs micrographic surgery and to present our experience from multidisciplinary team meetings and interdisciplinary collaborations. All patients treated between September 2009 and March 2019 at Karolinska University hospital were included. In a total of 143 facial basal cell carcinomas in 138 patients, 86 primary and 57 recurrent, the recurrence rate was 4.9% after a median follow-up of 24 months. In regions, where highly specialised Mohs surgeons performing all the steps of the procedure are limited, interdisciplinary collaboration can be an effective strategy for appropriate patient selection and for performing all steps of Mohs surgery with dermatosurgeons eradicating the tumour, pathologists evaluating the histopathology, followed by reconstructive surgery by plastic surgeons. The approach we present here provides a robust and functioning Mohs surgical service during the build-up of the organisation, while providing the opportunity to train new surgeons. Once the clinic has been set up, the multidisciplinary approach should always be considered and applied when dealing with complex cases.