Multidisciplinary Approach to the Treatment of Bone Metastases: Osteo-Oncology Center, a New Organizational Model

Ibrahim, Toni; Flamini, Emanuela; Fabbri, L.; Serra, Patrizia; Mercatali, Laura; Ricci, Rossana; Sacanna, Emanuele; Falasconi, Maria Cristina; Casadei, Roberto; Galassi, Riccardo; Giannini, Massimo Carlo; Bazzocchi, Oscar; Calzolari, Filippo; Nunziatini, Roberta; Gaudio, Michele; Maltoni, Marco; Amadori, Dino

doi:10.1177/030089160909500304

Cited by 49 publications

(47 citation statements)

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“…All studies concluded that a multidisciplinary setting resulted in improved patient outcomes in terms of diagnosis and/or treatment planning [14][15][16][18][19][20][21][22][25][26][27][28][29][31][32][33][35][36][37]40,42], improvements in survival [15,17,21,23,[28][29][30]36,39,41], patient satisfaction [24,31,38] and clinician satisfaction as a consequence of teamwork communication and cooperation [15,34]. Evidence of improved survival was found for colorectal [15,17,28,36], head and neck [29,41], breast [39], oesophageal [21] and lung [30] cancer.…”

Section: Impact On Patient Outcomesmentioning

confidence: 99%

“…The studies documented two motivating principles: firstly, MDTs ensure more appropriate treatment through a preoperative review of imaging and pathology results [19,20,22,25,26,40,42]; and secondly, a multidisciplinary approach guarantees the most up-todate treatment for all cancer patients seen at the facility or discussed online [16,18,21,23,32,33,35,[38][39][40][41]53]. Other clinical-based goals included improving patients' quality of life [24,32,42,[53][54][55] and setting up a structured followup care plan [53,[59][60][61]. Concerning team performance, the main goals cited were improving coordination and continuity of care by reducing time from diagnosis to treatment (or access to MDTs) [30,35,38,58] Table 1 Studies which demonstrated improved outcomes with multidisciplinary patient management.…”

Section: Mdt Goals and Scope Of Practicementioning

confidence: 99%

“…Secondary objectives also included providing a teaching environment for healthcare professionals and junior doctors [18,20,24,30,32,34,54]; acting as a quality improvement group [22,34,50,54]; and increasing enrolment in the tumour registry [16].…”

Section: Type Of Study Endpoints Assessed Outcomementioning

confidence: 99%

“…Core and allied members included radiologists, pathologists, surgeons, radiation and medical oncologists, oncology nurses, palliative care physicians, head and neck specialists, nuclear medicine specialists, respiratory disease physicians, gastrointestinal disease physicians and anaesthesiologists, some of whom were frequently sub-specialised by tumour site [20,29,30,[32][33][34]42,43,45,52,53]. The support members included psychologists, nutritionists, dieticians, plastic surgeons, speech therapists, patients' GPs, physiotherapists, practitioners of complementary medicine, orthopaedic specialists, medical physicists, odontologists, faith counsellors, biologists, data managers, genetic counsellors, hospital pharmacists, social workers and occupational therapists [24,27,40,45,49,54,55].…”

Section: Mdt Organisationmentioning

confidence: 99%

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Is it worth reorganising cancer services on the basis of multidisciplinary teams (MDTs)? A systematic review of the objectives and organisation of MDTs and their impact on patient outcomes

et al. 2015

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a b s t r a c tMultidisciplinary teams (MDTs) are considered the gold standard of cancer care in many healthcare systems, but a clear definition of their format, scope of practice and operational criteria is still lacking. The aims of this review were to assess the impact of MDTs on patient outcomes in cancer care and identify their objectives, organisation and ability to engage patients in their care. We conducted a systematic review of the literature in the Medline database. Fifty-one peer-reviewed papers were selected from November 2005 to June 2012. MDTs resulted in better clinical and process outcomes for cancer patients, with evidence of improved survival among colorectal, head and neck, breast, oesophageal and lung cancer patients in the study period. Also, it was observed that MDTs have been associated with changes in clinical diagnostic and treatment decision-making with respect to urological, pancreatic, gastro-oesophageal, breast, melanoma, bladder, colorectal, prostate, head and neck and gynaecological cancer. Evidence is consistent in showing positive consequences for patients' management in multiple dimensions, which should encourage the development of structured multidisciplinary care, minimum standards and exchange of best practices.

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Section: Impact On Patient Outcomesmentioning

confidence: 99%

Section: Mdt Goals and Scope Of Practicementioning

confidence: 99%

Section: Type Of Study Endpoints Assessed Outcomementioning

confidence: 99%

Section: Mdt Organisationmentioning

confidence: 99%

See 2 more Smart Citations

Is it worth reorganising cancer services on the basis of multidisciplinary teams (MDTs)? A systematic review of the objectives and organisation of MDTs and their impact on patient outcomes

et al. 2015

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“…Bone metastases are responsible for high morbidity and reduced quality of life due to the frequent onset of clinical complications defined as skeletal-related events (SREs), which lead to a reduction in functional independence and quality of life, decrease survival rates and substantially increase healthcare costs (5,6).…”

Section: Introductionmentioning

confidence: 99%

RANKL: A promising circulating marker for bone metastasis response

et al. 2016

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Abstract. Bone metastases are a frequent event in patients with solid tumors. Although great advances have been made in the treatment of these patients, the identification of novel, accurate indicators of bone response would greatly facilitate the clinical management of the disease. The receptor activator of nuclear factor-κB (RANK)/RANK ligand (RANKL)/osteoprotegerin (OPG) signaling pathway is significantly involved in bone metastasis formation. The main aim of the present study was to evaluate the role of circulating RANK, RANKL and OPG levels in predicting bone response. Marker accuracy was also compared with that of the conventional tumor marker N-terminal telopeptide of type I collagen (NTX). A prospective study was performed on 49 patients with bone metastases from breast, lung and prostate cancer, who were undergoing treatment with zoledronic acid. Patients were monitored for 1 year with blood tests, clinical evaluation and instrumental exams according to the response evaluation criteria of the University of Texas M. D. Anderson Cancer Center (Houston, TX, USA) and the Positron Emission Tomography Response Criteria in Solid Tumors. Circulating RANK/RANKL/OPG transcripts and NTX levels were evaluated by reverse transcription -quantitative polymerase chain reaction and immune enzymatic assay, respectively. The baseline RANKL levels differed significantly between responders and non-responders, whereas no differences in NTX levels were observed between the two groups. Receiver operating characteristic curve evaluation for all markers revealed that RANKL was the most accurate marker, with an area under the curve of 0.74 (95% confidence interval, 0.54-0.93). In addition, RANKL, which is the target of the novel monoclonal antibody denosumab, was the most accurate predictor of bone response in the present series of patients with bone metastases. Thus, the use of RANKL as a marker could potentially improve clinical practice, as current bone response evaluation is still somewhat problematic. IntroductionBone metastases are common in numerous solid cancers, including breast, prostate and lung cancer (1,2). In the USA, ~2/3 of patients who succumb to cancer each year have bone metastases, and ~20-25% of patients with neoplastic disease develop clinically evident bone metastases during the natural course of the disease (3,4).Bone metastases are responsible for high morbidity and reduced quality of life due to the frequent onset of clinical complications defined as skeletal-related events (SREs), which lead to a reduction in functional independence and quality of life, decrease survival rates and substantially increase healthcare costs (5,6).Bisphosphonates have improved the quality of life of patients with bone metastases from breast cancer by inducing both a reduction in SREs and in the risk of mortality (7). In particular, zoledronic acid (ZA), a potent third-generation nitrogen-containing bisphosphonate, has achieved widespread clinical use in the treatment of bone metastases from solid tumors (8-10). Denosumab, a ...

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Patterns of Multidisciplinary Care of Head and Neck Squamous Cell Carcinoma in Medicare Patients

Hansen

Egleston

Leachman

et al. 2020

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Multidisciplinary care (MDC) yields proven benefits for patients with cancer, although it may be underused in the complex management of head and neck squamous cell carcinoma (HNSCC).OBJECTIVE To characterize the patterns of MDC in the treatment of HNSCC among elderly patients in the US. DESIGN, SETTING, AND PARTICIPANTSThis nationwide, population-based, retrospective cohort study used Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data from January 1, 1991, to December 31, 2011, to identify patients 66 years or older diagnosed with head and neck cancer and determine the dates of diagnosis, oncology consultations, treatment initiation, and speech therapy evaluation in addition to MDC completion. Multidisciplinary care was defined in a stage-dependent manner: localized disease necessitated consultations with radiation and surgical oncologists, and advanced-stage disease also included a medical oncology consultation, all before definitive treatment. Data were analyzed between December 2016 and September 2020. MAIN OUTCOMES AND MEASURESRates of MDC across all subsites of head and neck cancer as measured by the presence of an evaluation for each oncologist on the MDC team and its effect on treatment initiation. RESULTSThis cohort study assessed 28 293 patients with HNSCC (mean [SD] age, 75.1 [6.6] years; 67% male; 87% White) from the SEER-Medicare linked database. The HNSCC subsites included larynx (40%), oral cavity (30%), oropharynx (21%), hypopharynx (7%), and nasopharynx (2%). Overall, the practice of MDC significantly increased over time, from 24% in 1991 to 52% in 2011 (P < .001). For patients with localized (stage 0-II) tumors, 60% received care in the multidisciplinary setting, whereas 28% of those with advanced-stage disease did. A total of 18 181 patients (64%) were treated with initial definitive nonsurgical therapy across all stages. Regardless of stage and subsite, few patients (2%) underwent evaluation by a speech-language pathologist before definitive therapy. Multidisciplinary care prolonged the time to initiation of definitive treatment by 11 days for localized disease and 10 days for advanced disease.CONCLUSIONS AND RELEVANCE This cohort study found that most elderly patients with localized HNSCC received MDC, whereas few patients with advanced-stage disease received such care, although a significant proportion received adjuvant therapy. Multidisciplinary care may prolong time to initiation of definitive treatment with an uncertain impact. Consultation with a speech-language pathologist before definitive therapy was rare.

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Multidisciplinary Approach to the Treatment of Bone Metastases: Osteo-Oncology Center, a New Organizational Model

Abstract: Our preliminary results confirm the usefulness of a multidisciplinary center for the management of patients with bone metastases, especially in terms of decreasing psychophysical suffering.

Cited by 49 publications

References 12 publications

Is it worth reorganising cancer services on the basis of multidisciplinary teams (MDTs)? A systematic review of the objectives and organisation of MDTs and their impact on patient outcomes

Is it worth reorganising cancer services on the basis of multidisciplinary teams (MDTs)? A systematic review of the objectives and organisation of MDTs and their impact on patient outcomes

RANKL: A promising circulating marker for bone metastasis response

Patterns of Multidisciplinary Care of Head and Neck Squamous Cell Carcinoma in Medicare Patients

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