Outcome Of Multidisciplinary Treatment Research Articles

1753P Outcomes of multidisciplinary treatment of localized myxofibrosarcoma: Retrospective analysis from a reference center

1753P Outcomes of multidisciplinary treatment of localized myxofibrosarcoma: Retrospective analysis from a reference center

Does a Multidisciplinary Pain Management Treatment Improve Sleep Quality in Patients with Chronic Widespread Pain and Sleep Problems? Results from the AMS-Pain Cohort

Background: Poor sleep quality is a significant concern for patients with chronic widespread pain (CWP), impacting their emotional, cognitive, and physical well-being. While there is little specific attention given to the treatment of sleep in such programs, it is possible that its ingredients, such as cognitive behavioral therapy, improving body awareness, relaxation, having a balanced daily routine, and physical activity, have a positive effect on sleep. The objectives of this study are to examine: 1. whether sleep improves after a multidisciplinary pain management treatment. 2. and to explore predictors of treatment outcome, in patients with chronic widespread pain (CWP) and sleep problems. Methods: Data were used from pre- and post-treatment measurements of 121 patients with CWP and sleep problems, treated with a multidisciplinary pain management treatment (not specifically focusing on sleep). Mean difference in subjective sleep quality and standard outcome of multidisciplinary treatment, as measured with Pittsburg Sleep Quality Index (PSQI) and IMMPACT outcome measures, were analyzed and Cohens d were calculated. Regression models were used to assess whether pretreatment variables predicted poor improvement of subjective sleep quality post treatment. Results: The effect size of improvement in sleep quality was small (Cohen’s d=0.3) and 94% of the patients still experienced poor sleep quality after treatment (PSQI ≥ 6). Moderate effects sizes were found for pain (d=0.6), fatigue (d=0.56) and disability (d=0.53). Pretreatment poorer sleep quality, higher levels of pain related disability, psychological distress and less concern predicted poorer sleep quality post-treatment. Conclusion: The improvement of sleep quality after following a multidisciplinary pain management treatment not specifically focusing on sleep was limited. To improve sleep, specific strategies targeting sleep (e.g., sleep education, sleep hygiene and /or cognitive behavioral therapy for sleep) may need to be included into multidisciplinary treatment. Addressing pain related disability and psychological distress, may also help to improve sleep quality.

Outcome of multidisciplinary treatment in laryngeal cancer: A retrospective study with 10-year follow-up

Outcome of multidisciplinary treatment in laryngeal cancer: A retrospective study with 10-year follow-up

The Outcome of Multidisciplinary Treatment of Spinal Tumors: Institutional Experience of a Tertiary Care Hospital

Objective: Spinal metastatic tumors are mostly extradural. Intradural extramedullary tumors include neurofibromas and meningiomas while intramedullary tumors are mostly astrocytoma and ependymoma. The purpose of this study was to share the experience of managing these patients as a multidisciplinary team (neurosurgeons, general surgeons, thoracic surgeons, ENT surgeons, plastic surgeons, and oncology) in selected cases where the tumors grow into the surrounding structures.
 Material and Methods: This study was conducted at the Neurosurgery Department at Jinnah hospital Lahore from January 2021 to September 2022. 50 patients admitted to the Neurosurgery Department from OPD/emergency with the diagnosis of a spinal tumor confirmed on MRI were included in the study. Those patients who were unfit for surgery were not included in the study. Data was analyzed for gender, region, and location of the tumor, histopathological diagnosis, and multidisciplinary team involvement.
 Results: Out of 50 patients, 28 (56%) patients were male and 22 (44%) patients were female while ages ranged from 14 to 63 years. Extradural location was the most frequently encountered location, i.e., 50%. Metastatic tumors were the commonest. A multidisciplinary treatment board was conducted in 31 (62%) patients whereas adjuvant treatment was done in 15 (30%) patients.
 Conclusion: Multidisciplinary treatment of spinal tumors should be encouraged at tertiary care hospitals and routine multidisciplinary treatment boards conducted before and after surgical excision.

308 PROGNOSTIC FACTORS OF PATIENTS WITH LYMPH NODE RECURRENCE AFTER ESOHAGECTOMY

Abstract Background: Lymph node recurrence (LNrec) is a frequent form of recurrence in esophageal squamous cell carcinoma (ESCC), but is often characterized as a systemic disease. However, loco-regional treatment may provide cure for lymph node-only recurrence without distant metastases. There is no consensus on the outcome of multidisciplinary treatment, including surgical resection. The aim of this study is to identify the prognostic factors and to establish treatment strategy for LNrec. Methods Methods: Among 1160 patients who underwent esophagectomy for ESCC between 2004 and 2017 in our hospital, 117 patients (12.4%) who had LN-only recurrence without distant recurrence were analyzed retrospectively. The standard operation consisted of subtotal esophagectomy with 2- or 3-field lymph node dissection via right thoracotomy or video assisted thoracic surgery (VATS) and gastric tube reconstruction. Recurrence site, treatment for LN rec, and survival after recurrence were examined. Survival curves were plotted using the Kaplan–Meier method, and differences between survival curves were compared using the log-rank Test. Results The 3-year survival rate after recurrence of all lymph node-only cases was 19.5%. The 3-year survival rate after recurrence was significantly better in patients with single recurrence: 25.1%/multiple recurrence 12.4% (p = 0.0222). The 3-year survival rate after recurrence was initial p-stage: II or lower/III or higher = 39.0/14.1% (p = 0.0107). Patients with a high p-stage at initial surgery had a significantly poor prognosis. Patients who underwent local treatment (C RT or surgery) after recurrence had significantly better prognosis than those who did not (25.8/10.6%; p = 0.0006). Conclusion Single LN rec, low initial p-stage, local treatment (CRT or surgery) were identified as prognostic factors in patients with LN-only recurrence.

The Outcomes of Multi-Disciplinary Treatment of Esophageal Cancer in Vajira Hospital

Background: Esophageal cancer is one of the most fatal and difficult-to-treat cancer. Multi-modality management is the key to success of improving outcomes, however, which modality is the most proper is difficult to determine. Objective: To evaluate the overall survival (OS) of patients with early or locally-advanced (E/LA) esophageal carcinoma treated in Vajira Hospital. The outcomes of the multi-modality management among patients with E/LA diseases were evaluated. Materials and Methods: The retrospective analyses of esophageal carcinoma patients who attended at Vajira Hospital between January 1, 2012 and December 31, 2016 were performed. Results: There were 86 patients with complete medical records. The median age was 60.5 years (IQR 52 to 66). Sixty-five patients (75.6%) presented with E/LA diseases. Most of the patients had primary site at thoracic part of esophagus (58 patients, 67.4%) and had squamous cell carcinoma histology (84 patients, 97.7%). Tri-modality treatment including neoadjuvant chemoradiation and esophagectomy for clinically fitted patients without evidence of mediastinal involvement and non-regional lymph node metastasis resulted in the best survival outcome [28.56 months (IQR 10.64 to 46.47)]. The OS of patients with E/LA disease was only 9.15 months (IQR 4.49 to 23.02). Male patients, non-cervical site, and non-surgical treatment were associated with the worse OS. Conclusion: The outcomes of patients with esophageal carcinoma treated in a real-world practice is still not impressive. Tri-modality management would be the best paradigm; however, it is suitable for well-selected patients. Keywords: Esophageal cancer, Multi-modality treatment, Real-world practice

Outcome of multidisciplinary treatment of peripheral primitive neuroectodermal tumor

Peripheral primitive neuroectodermal tumors (PNETs) constitute very rare and aggressive malignancies. To date, there are no standard guidelines for management of peripheral PNETs due to the paucity of cases arising in various body sites. Therapeutic approach is derived from Ewing sarcoma family, which currently remains multimodal. Our study retrospectively analyzed 86 PNET patients from February 1, 1998 to February 1, 2018 at Peking Union Medical College Hospital with an additional 75 patients from review of literature. The clinicopathologic and treatment plans associated with survival was investigated. Surgery, chemotherapy, female sex, small tumor size, no lymph node metastasis, R0 surgical resection, (vincristine + doxorubicin + cyclophosphamide)/(isophosphamide + etoposide) regimen, and more than 10 cycles of chemotherapy were associated with improved overall survival in univariate analysis. Surgery, more than 10 cycles of chemotherapy, and small tumor size were independent prognostic factors for higher overall survival. Our data indicates that multimodal therapy is the mainstay therapeutic approach for peripheral PNET.

1649P Outcomes of multidisciplinary treatment of fibromatosis – Retrospective analysis from a reference center

1649P Outcomes of multidisciplinary treatment of fibromatosis – Retrospective analysis from a reference center

Outcome of multidisciplinary treatment in laryngeal cancer. Retrospective study with 10-years follow-up.

In laryngeal cancer, multidisciplinary treatment improves the patient's quality of life and the possibility of preserving the larynx. Most cases occur in a locally advanced stage. The aim is to present the results according to the stage. A retrospective study which analyzed the clinical stage, type of primary treatment, outcomes, and survival were analyzed. 451 patients were included. The median age was 66 years. The majority of the tumors presented in advanced stage (72%) and the most affected subsite was the glottis (84.5%). In the early stage the most frequent treatment was radiotherapy as the only treatment modality. In stages III and IVA, 65% were resectable. In stage IVB the management was non-surgical, with control in 26% of the cases. Survival at 10 years was related to the clinical stage: 81.7% for stage I and 0% for stages IVB and IVC. Patients with laryngeal cancer should be treated according to the clinical stage, through a multidisciplinary approach. Long-term follow-up showed a worse prognosis for advanced clinical stages.

Long-term treatment results and prognostic factors of synchronous and metachronous squamous cell carcinoma of head and neck and esophagus.

BackgroundThe purpose was to investigate the prognosis of patients with synchronous and metachronous squamous cell carcinoma of head and neck (HNSCC) and esophagus (ESCC), and to evaluate the prognostic factors of these patients.MethodsA retrospective review was performed on 70 patients with synchronous and metachronous HNSCC and ESCC treated in our institution from January 2005 to December 2016. Kaplan-Meier method and Cox proportional hazard model were used to evaluate overall survival (OS) and determine the prognostic factors associated with survival outcomes.ResultsThe 1-, 2- and 3-year OS rates were 77.1%, 57.1% and 37.1% with the median survival time for 33.5 months. The univariate analysis results revealed that the patients with early-stage of ESCC, metachronous cancer, and receiving surgery for both cancer had better OS (P=0.003; P=0.035; P=0.002). The multivariate analysis showed that the clinical stage of ESCC and receiving surgery for both cancer or not were the independent prognostic factors for OS.ConclusionsThe multidisciplinary treatment outcome is acceptable, especially for patients with early clinical stage ESCC and with chance to receiving surgery for both cancer.

Therapeutic Impact of Percutaneous Pedicle Screw Fixation on Palliative Surgery for Metastatic Spine Tumors.

Background:Percutaneous pedicle screw (PPS) fixation has been introduced into palliative surgery for metastatic spine tumors; however, the therapeutic effects of PPS on the outcomes of multidisciplinary treatment for such tumors are unclear. Therefore, the therapeutic impact of PPS was investigated among patients with metastatic spine tumors and with revised Tokuhashi scores of ≤8.Materials and Methods:A total of 47 patients who underwent conventional palliative surgery (posterior decompression and stabilization, 33; posterior stabilization alone, 14) before the introduction of PPS and 38 patients who underwent PPS (posterior decompression and stabilization, 19; posterior stabilization alone, 19) were included. Surgical stress (operative time, blood loss, complications, etc.) and treatment outcomes (postoperative survival time, visual analog scale scores, Frankel classification, and the Barthel index at the final followup) were compared between the conventional and PPS groups.Results:The age of the indicated patients significantly increased after the introduction of PPS (P < 0.05). Regarding posterior decompression and stabilization, there were no significant intergroup differences in surgical stress or treatment outcomes. As for posterior stabilization alone, there were significant preoperative differences in various parameters between the conventional and PPS groups (P < 0.01) and also significant postoperative intergroup differences between surgical stress and treatment outcomes (P < 0.01).Conclusions:For patients with early-stage metastatic spine tumors, the use of PPS-based posterior stabilization combined with multidisciplinary adjuvant therapy has changed the age range of the patients indicated for surgery and caused significant improvements in surgical stress, postoperative survival time, and Barthel index.

Outcomes of multidisciplinary treatment planning in US cancer care settings.

Multidisciplinary treatment planning (MTP) is a process of engaging multiple disciplines to develop or refine the disease management plan. It is widely implemented in US cancer treatment settings and is considered to have favorable effects on both care quality and other outcomes. However, evidence reviews to date regarding MTP effectiveness have based their conclusions on studies conducted predominantly outside the United States. The authors conducted a systematic review of US-based studies to synthesize and critically appraise evidence of the effects of MTP on cancer care quality, health services outcomes, and survival. Database searches identified studies of MTP outcomes conducted in US cancer care settings from 2000 to 2017. Forty-five studies met criteria for inclusion. MTP was associated with favorable effects on several indicators of cancer care quality, including delivery of guideline-concordant treatment and improvements in diagnostic accuracy, staging completeness, surgical technique, and timeliness. Effects on survival and clinical trials enrollment were mixed. Delivery formats for MTP were generally not well described, and study designs were nonrandomized, limiting the ability to identify mediators of intervention effects. Continued study is warranted to clarify effective components of MTP interventions, and to understand the mechanism(s) through which MTP produces favorable effects on outcomes.

Outcomes of multidisciplinary treatment in penile cancer: Experience from Thailand.

555 Background: Penile cancer is relatively more common in Thailand compared to western countries. We report multidisciplinary treatment outcomes of penile squamous cell carcinoma at a regional center in northeast of Thailand. Methods: Using an institutional database, a total of 68 patients with squamous cell carcinoma of penis treated during 2009-2015 were identified. Patient demographics, pathological data, and treatment modality were reviewed. Survival data was calculated using the Kaplan-Meier method. Results: Median age was 53 years (25-89 years) and the median follow-time was 2.7 years. At presentation, 39 patients (57.4%) were node positive, and 9 (13.2%) had metastatic disease. Management was penile preserving surgery in 13 patients, partial penectomy in 36 patients, total penectomy in 15 patients, and palliative with radiation and/or chemotherapy in 4 patients. The 3-year overall survival for patients with N0-1 and N2-3 was 86% and 35% respectively. For those with high risk (N2/N3) non-metastatic disease, multimodality treatment improved overall survival significantly compared with surgery alone (13.7 mo vs 8.6 mo; HR 0.32, p-value = 0.04) Conclusions: Patients present with locally advanced disease had a poor prognosis. Multidisciplinary management improved overall survival N2/N3 patients.

Body Awareness as an Important Target in Multidisciplinary Chronic Pain Treatment: Mediation and Subgroup Analyses.

The results of a recently performed randomized clinical trial showed that the effect of a multidisciplinary treatment of chronic pain patients on body awareness (BA), catastrophizing, and depression was improved by adding psychomotor therapy (PMT), an intervention targeting BA. No significant effects were found on quality of life and disability. The present follow-up study aimed to explore the relationship between improvements in BA and multidisciplinary chronic pain rehabilitation treatment outcome across treatment conditions and the possible mediating effect of BA between treatment conditions. Furthermore, the hypothesis that patients with low BA benefit more from PMT was investigated. In total, 94 patients with chronic pain participated in a randomized clinical trial comparing multidisciplinary treatment as usual (TAU) with TAU plus PMT. Outcome variables were health-related quality of life, disability, and depression. Self-efficacy and catastrophizing were the process variables of treatment and the potential mediating factors in the relationship between BA and the outcome variables. The data were analyzed by linear mixed-model analysis. Improvements in BA were related to improvements in all outcome variables across treatment conditions. The relationships were partly mediated by self-efficacy, catastrophizing, or both. In the regression model with depression as the outcome variable, the regression coefficient of treatment (ie, PMT vs. TAU) decreased by 34% and became nonsignificant when BA was added as a potential mediator. Patients with low BA seemed to benefit more from PMT than patients with high BA, especially on depression, BA, and catastrophizing. BA might be an important target of treatment to improve the multidisciplinary treatment outcome in chronic pain patients. Furthermore, PMT is an intervention that seems to provide its benefits through improving BA and may be especially beneficial for patients with low BA.

Predictive factors for the outcome of multidisciplinary treatments in chronic low back pain at the first multidisciplinary pain center of Japan.

[Purpose] Multidisciplinary treatments are recommended for treatment of chronic low back pain. The aim of this study was to show the associations among multidisciplinary treatment outcomes, pretreatment psychological factors, self-reported pain levels, and history of pain in chronic low back pain patients. [Subjects and Methods] A total of 221 chronic low back pain patients were chosen for the study. The pretreatment scores for the 10-cm Visual Analogue Scale, Hospital Anxiety and Depression Scale, Pain Catastrophizing Scale, Short-Form McGill Pain Questionnaire, Pain Disability Assessment Scale, pain drawings, and history of pain were collected. The patients were divided into two treatment outcome groups a year later: a good outcome group and a poor outcome group. [Results] One-hundred eighteen patients were allocated to the good outcome group. The scores for the Visual Analogue Scale, Pain Disability Assessment Scale, and affective subscale of the Short-Form McGill Pain Questionnaire and number of nonorganic pain drawings in the good outcome group were significantly lower than those in the poor outcome group. Duration of pain in the good outcome group was significantly shorter than in the poor outcome group. [Conclusion] These findings help better predict the efficacy of multidisciplinary treatments in chronic low back pain patients.

Predictors of multidisciplinary treatment outcome in patients with chronic musculoskeletal pain

Purpose: The present study aimed to identify predictors of rehabilitation outcome for patients with chronic musculoskeletal pain (CMP) and psychological problems. Methods: A retrospective cohort study including 230 adult patients with CMP admitted for multidisciplinary pain rehabilitation. Potential predictors were patient characteristics, duration of complaints, baseline functioning, pain, personality, coping style, fear of movement, psychological distress and type of treatment. Outcome measures were physical functioning, mental health, pain and patient-reported effect. Multiple (logistic) regression models were used to identify predictors. Results: Patients who were more disabled and patients with more pain benefitted more from the rehabilitation treatment than less disabled patients or those with less pain. Age, work status, vitality, depression and coping style also predicted outcomes significantly. The models explained between 27 and 80% of the outcomes. There was an interaction between type of treatment, work status and the baseline pain score as regards the outcome in terms of pain. Conclusions: No strong predictors of treatment outcome were found other than the baseline scores of the respective outcome variables. More disabled patients and patients with more pain benefitted more from the rehabilitation program. Other predictors improved the prediction models slightly.Implications for RehabilitationIt remains challenging to correctly predict the outcome of treatment from patients’ baseline sociodemographic and psychological characteristics; predictors other than baseline scores of the outcome variables are only slightly associated with treatment outcome.Patients with chronic musculoskeletal pain and poor physical functioning or mental health benefit most from pain rehabilitation.Older patients benefit less from a pain rehabilitation program than younger patients in terms of physical functioning.Pain reduction during a pain rehabilitation program is greatest in patients with high pain intensity who are not at work at the start of the rehabilitation program.Coping style influences the outcome of rehabilitation of patients with chronic musculoskeletal pain.

Multidisciplinary Treatment Outcome of Desmoid-Type Fibromatosis (Dtf). a Registry-Based Study from Spanish Group for Research on Sarcoma (Geis)

ABSTRACT Aim: We analyzed retrospectively data about treatment outcome with existing treatments in DTF. Methods: Descriptive analysis of data related to diagnosis and treatment from all DTF was collected in patients (p) between Sept. 1999 and Nov. 2013 in 26 hospitals of GEIS . Ethics committee approval was obtained. Results: 185 patients. Age: median 37 years (6-85) .63.2% female .Median time lapse from first symptom to diagnosis: 4 months(m). Location : trunk wall 81p (43.8%), extremities 50p (27%), retroperitoneum 10p (5.4%), Gastro-intestinal 16p (8.6%), Head/neck 6p( 3.2%), others 6p(3.2%), 2p (1.1%) missing . 20p (11%) presented a second neoplasia (throughout the whole process). Median tumor size: 8 cm(range 1-96). 3 p (1.6%) presented distant peritoneal disease. First treatment : No treatment 6p (2.7%), Surgery (S) alone 144 p ( 77.8%, 3p >1), S+radiotherapy (RT) 7p (3.7%), S+ chemotherapy (CT) 2 p (1.08%), S+hormonetherapy (HT) 3p (1.62%), S +HT+ Non steroidal antiinflammatory drug (NSAID)+Tirosin-kinasa inhibitor(TKI) 1p (0.54%), CT 5p (2.7%), RT 3p ( 1.6%),NSAID 5p (2.6%), HT 2p (1.08%), TKI 1p(0.54%), HT+NSAID 6p (2.7%). 128p (69.2%) became free of disease, in 49p (26.5%) residual disease remained . 61p (33%) progressed. Median Progression free survival (PFS) :109 m (95%CI 44.6-175.1).Multivariate analysis for PFS: extended/radical surgery(p=0.000) and tumor size Response to CT /other treatments CT treatment Other treatments (TKI, HT, NSAID) p % p % PR 12 30.7 4 7.4 SD 15 38.4 31 55.3 PD 3 7.6 10 17.8 NE 4 10.2 6 10.7 NA 5 12.8 5 8.9 Total 39 100 56 100 PR: partial response; SD: stable disease; PD: progressive disease; NE: non evaluable; NA: non available data. Conclusions: Surgical quality and tumor size seems to play a relevant role in predicting PFS in DFT. Other sistemic treatments showed meaningful activity in progressive disease. Disclosure: All authors have declared no conflicts of interest.

Cognitive mechanisms of change in multidisciplinary treatment of patients with chronic widespread pain: A prospective cohort study

To evaluate the contribution of improvement in negative emotional cognitions, active cognitive coping, and control and chronicity beliefs to the outcome of multidisciplinary treatment in patients with chronic widespread pain. Prospective cohort study. A total of 120 subjects diagnosed with chronic widespread pain, who completed a multidisciplinary pain programme. Data from baseline, 6 months and 18 months follow-up measurements were analysed. Longitudinal relationships were analysed between changes in cognitions and outcome, using generalized estimated equations. Outcome domains included: pain, interference of pain in daily life, depression, and global perceived effect. Cognitive domains included: negative emotional cognitions, active cognitive coping and control and chronicity beliefs. Improvements in negative emotional cognitions were associated with improvements in all outcome domains, in particular with improvement in interference of pain with daily life and depression (between baseline and 6 months, and 6 and 18 months). Improvements in active cognitive coping were associated with improvements in interference of pain in daily life (between baseline and 6 months). Improvements in control and chronicity beliefs were associated with improvements in pain and depression (between 6 and 18 months). Improvement in negative emotional cognitions seems to be a key mechanism of change in multidisciplinary treatment of chronic widespread pain. Improvement in active cognitive coping and improvement in control and chronic timeline beliefs may also constitute mechanisms of change, although the evidence is less strong.

AB1436-HPR Predictors of outcome of multidisciplinary treatment in chronic widespread pain: An observational study

BackgroundThe effectiveness of multidisciplinary treatment in chronic widespread pain (CWP) is limited. The considerable heterogeneity among patients is a likely explanation. Knowledge on predictors of the outcome of multidisciplinary treatment...

Predictors of outcome of multidisciplinary treatment in chronic widespread pain: an observational study

BackgroundThe effectiveness of multidisciplinary treatment in chronic widespread pain (CWP) is limited. The considerable heterogeneity among patients is a likely explanation. Knowledge on predictors of the outcome of multidisciplinary treatment can help to optimize treatment effectiveness. The purpose of this study was to identify predictors of multidisciplinary treatment outcome in patients with CWP.MethodsData were used from baseline and 6 months follow-up measurements of a prospective cohort study of 120 CWP. Regression models were used to assess whether baseline variables predicted treatment outcome. Outcome domains included: pain, pain interference, depression, and global perceived effect (GPE). Potential predictors included: psychological distress, illness and self-efficacy beliefs, fear-avoidance beliefs and behaviour, symptoms, disability, and socio-demographic factors.ResultsGreater improvement in pain was predicted by more pain at baseline and male gender. Greater improvement in interference of pain in daily life was predicted by more interference of pain in daily life at baseline, lower levels of anxiety, a stronger belief in personal control, less belief in consequences, male gender, and a higher level of education. Greater improvement in depression was predicted by higher baseline values of depression, stronger beliefs in personal control, and a higher level of education. Better outcome on GPE was predicted by less pain, less fatigue, and a higher level of education.ConclusionLess anxiety, stronger beliefs in personal control, less belief in consequences, less pain, less fatigue, higher level of education, and male gender are predictors of better outcome of multidisciplinary treatment in CWP. Tailoring treatment to these specific patient characteristics or selecting eligible patients for multidisciplinary treatment may further improve treatment outcome.