The Multidisciplinary Meeting

2019 ◽  
pp. 89-102
Author(s):  
Terry Sarantou ◽  
Cary Kaufman ◽  
Alexandru Eniu ◽  
Sabine Siesling ◽  
Marc Espié ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Clinical Trials ◽  
Multidisciplinary Team ◽  
Standard Of Care ◽  
Complex Case ◽  
Important Research ◽  
Pathological Findings ◽  
Cancer Disease ◽  
Treatment Algorithms ◽  
Team Based Care

Abstract: Team-based care for a patient diagnosed with breast cancer is critical. The breast cancer disease-based team is composed of physicians from different specialties as well as nurses and other support staff. Breast cancer conference and tumour boards allow experts to review a complex case and work together to develop and refine therapeutic strategy. In each case presented, patient history with clinical, radiological, and pathological findings should be reviewed. Applicable treatment algorithms or care paths should be discussed as part of the overall process and to elevate the standard of care. Patients can be given access to clinical trials and important research. The multidisciplinary team (MDT) should meet at a given time (whether physically in one place or by video or teleconferencing) to discuss patients with breast cancer. The presence of an MDT, which meets at least biweekly, is often a requirement or indicator for audits and accreditation. Breast conferences should be accessible to MDT members, participation should be tracked on scorecards, and MDT programmes should be accountable.

scholarly journals Immunotherapeutic Approaches in Triple-Negative Breast Cancer: State of the Art and Future Perspectives

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Karima Oualla ◽  
Loay Kassem ◽  
Lamiae Nouiakh ◽  
Lamiae Amaadour ◽  
Zineb Benbrahim ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Clinical Trials ◽  
Triple Negative Breast Cancer ◽  
Triple Negative ◽  
Growth Factor Receptor ◽  
Tumor Infiltrating Lymphocytes ◽  
Standard Of Care ◽  
Breast Cancers ◽  
Poor Outcomes ◽  
Infiltrating Lymphocytes

Triple-negative breast cancer (TNBC) is characterized by the absence of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2). It accounts for 15%–20% of all breast cancers and is associated with an aggressive evolution and poor outcomes with the majority of recurrences and deaths occurring in the first 5 years. Chemotherapy remains the mainstay of treatment in the absence of effective targets, but the good understanding of immune tumor microenvironment, the identification of immune-related targets, and the role of tumor-infiltrating lymphocytes (TILs) in TNBC has allowed to develop promising immunotherapeutic strategies for this unique subset of breast cancer. Recently, immunotherapy is being extensively explored in TNBC and clinical trials have shown promising results. In this article, we tried to explain the rationale and mechanisms of targeting the immune system in TNBC, to report the results from recent clinical trials that put immunotherapy as a new standard of care in TNBC in addition to ongoing trials and future directions in the next decade.

scholarly journals Use of HER2-Directed Therapy in Metastatic Breast Cancer and How Community Physicians Collaborate to Improve Care

2020 ◽  
Vol 9 (6) ◽  
pp. 1984 ◽  
Author(s):  
Joanne E. Mortimer ◽  
Laura Kruper ◽  
Mary Cianfrocca ◽  
Sayeh Lavasani ◽  
Sariah Liu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Clinical Trials ◽  
Metastatic Breast Cancer ◽  
Metastatic Breast ◽  
Standard Of Care ◽  
Research Network ◽  
Her2 Positive ◽  
Community Partners ◽  
Significant Prolongation ◽  
Positive Breast Cancer

The development of new HER2-directed therapies has resulted in a significant prolongation of survival for women with metastatic HER2-positive breast cancer. Discoveries in the laboratory inform clinical trials which are the basis for improving the standard of care and are also the backbone for quality improvement. Clinical trials can be completed more rapidly by expanding trial enrollment to community sites. In this article we review some of the challenges in treating metastatic breast cancer with HER2-directed therapies and our strategies for incorporating our community partners into the research network.

The relationship between treatment intensity and characteristics of patients with early-stage breast cancer.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 125-125
Author(s):  
Jeffrey Franks ◽  
Nicole Caston ◽  
Courtney Williams ◽  
Andres Azuero ◽  
Monica S. Aswani ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Clinical Trials ◽  
High Intensity ◽  
Early Stage ◽  
Standard Of Care ◽  
Early Stage Breast Cancer ◽  
Treatment Intensity ◽  
Low Intensity ◽  
Her2 Breast Cancer ◽  
To Receive

125 Background: Clinical trials are used to generate standard-of-care, yet often do not reflect patient populations treated in real-world settings. Elderly patients or patients of color who are often underrepresented in trials, which may impact what types of treatments are prescribed. This study examines how patient characteristics are associated with treatment intensity in early stage breast cancer. Methods: This retrospective cross-sectional study included women with a stage I-III breast cancer from American Society of Clinical Oncology’s CancerLinQ database treated by chemotherapy from 2005-2019. Seven standard-of-care regimens were characterized by intensity. For patients with ER+/- HER2- breast cancer, low-intensity regimens were Taxol and Cyclophosphamide or Adriamycin and Cyclophosphamide; while Taxol, Adriamycin, and Cyclophosphamide was considered high intensity. For patients with HER2+ breast cancer, the low intensity regimen was Taxol and Herceptin; while Adriamycin and Cyclophosphamide followed by Taxol and Herceptin; Taxol, Carboplatin, and Herceptin; or Taxol, Carboplatin, Herceptin, and Pertuzumab were considered high intensity. A model estimating the likelihood of intensity was calculated using log-binomial regression, in order to produce relative risks. The models were adjusted for patient demographics and cancer stage. Results: Of 24,383 patients, 51% had ER+HER2-, 20% ER-HER2-, and 29% HER2+ breast cancer. Most patients were White (60%), age 40-69 (80%), had stage II breast cancer (39%), and received higher intensity treatment (65%). Adjusted for the other covariates, patient who were Black were more likely to receive high-intensity treatment than patients who were White (61% vs 58%; RR 1.05, 95%CI 1.02-1.06. Additionally, older adults were more likely to receive low-intensity treatment, with 42% of patients over 70 receiving low intensity treatment, and 29% of patients between the ages 40 and 69 received low intensity treatment (RR 1.5, 95% CI 1.44 -1.54). Conclusions: Differences in treatment intensity were observed for patients with differing demographic characteristics. Further research is needed to determine lack of representation in clinical trials impacts on prescribing patterns, regimen intensity, and survival.

scholarly journals P-P50 Analysis of the efficiency of the hepatobiliary multidisciplinary team meeting to identify quality improvement strategies

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Nabeegh Nadeem ◽  
Jenifer Barrie ◽  
Richard Bell ◽  
Nehal Shah
Keyword(s):  
Quality Improvement ◽  
Multidisciplinary Team ◽  
Standard Of Care ◽  
Complex Case ◽  
Multidisciplinary Team Meeting ◽  
Cystic Neoplasms ◽  
Team Meeting ◽  
Number Of Patients ◽  
Improvement Strategies ◽  
Quality Improvement Interventions

Abstract Background The multidisciplinary team meeting is the mainstay of management of patients with hepatopancreatobiliary (HPB) cancer and is considered the gold standard of care. Disadvantages of these meetings include large numbers of patients to be discussed covering multiple super-specialities over a short time span. This can lead to decision fatigue amongst clinicians. Logistical factors such as information technology and presence of clinicians with relevant expertise may also hamper the progress of the meeting. The aim of this study was to analyse the efficiency of our HPB MDT with a view to identifying multi-factorial quality improvement interventions. Methods 13 weeks of prospectively generated multidisciplinary team meeting outcomes were analysed from our departments weekly 150-minute long MDT meeting between 01/06/21 and 24/08/21. Patient demographics and pathology were noted. The number of overall discussions in each meeting were recorded.  Number of patients in each sub-category (1. Regional pancreatic cancer service, 2. Hepatocellular carcinoma or liver adenoma, 3. pancreatic cystic neoplasms, 4. Gallbladder cancer and cholangiocarcinoma, 5. Pancreatic neuroendocrine tumours and 6. Other) were recorded. The number of patients without a recorded outcome was collated and reasons for no outcome being generated were categorised. Results 174/ 869 patients (20 %) did not receive an outcome from the meeting and were carried forward to the next week. Of the patients carried forward to the next week; 33/177 (18.6%) had no available histopathology following biopsies. Of these 33 patients, 23 did not have post-operative histopathology yet available for discussion.  82/177 (46 %) patients did not have the relevant investigations performed or available to move the discussion forward. These investigations were wide ranging and included radiological and endoscopic interventions. Of these, 19 patients (2 % over-all) had not had images sent across from a peripheral centre. 3 patients required both histology and radiology for further discussion. 59/869 (6%) of patients were not discussed due to time constraints. This equated to an average of 4 patients per meeting.  Conclusions This study demonstrates the breadth and depth of a general HPB MDT. Strategies are required to simplify the MDT process to allow for time for discussion of the most complex patients, in particular those requiring surgery. Multifactorial reasons for a lack of MDT outcome at any single meeting have been found in this study. This signifies that a more robust triage process involving multiple specialities needs to be considered. Logistical factors also need to be in place allowing for transfer of relevant images from peripheral units. Histopathology reporting takes time and appropriate expectations for the availability of these results needs to be in place. The next step in this study is to identify and implement effective quality improvement strategies to improve outcome rates and allow more time for complex case discussions.

Need for systematic de-escalation of care in HER2+ breast cancer patients.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e12657-e12657
Author(s):  
Tushar Pandey ◽  
Tyler M Earnest ◽  
John A Cole ◽  
Eduardo Braun
Keyword(s):  
Breast Cancer ◽  
Clinical Trials ◽  
Cancer Patients ◽  
In Silico ◽  
Treatment Plan ◽  
Standard Of Care ◽  
Her2 Status ◽  
Breast Cancer Patients ◽  
Her2 Positive ◽  
Her2 Breast Cancer

e12657 Background: Over the last decade, there has been incredible progress in HER2-positive breast cancer patients with the adoption of targeted therapies like Trastuzumab and Pertuzumab to complement existing chemotherapies. Increasingly neoadjuvant therapy is the preferred method of therapy as it is better able to predict prognosis via pCR as well as guide adjuvant therapeutic strategy in cases with residual tumor. There are now a variety of combination therapies recommended for HER2-positive patients. As new therapies are developed, the standard-of-care shifts towards the regimen with highest pCR rate. The latest regimen being TCHP which produced pCR rates over 60% in clinical trials. While the improvement in pCR rates at a population level is encouraging, there is a growing sentiment among physicians that we may be over treating patients impacting both costs and resulting toxicity. Methods: We performed an analysis of Breast Cancer trials with pCR as the primary end point and stratification available based on HER2+ status. The cost (median insurance reimbursement) was also referenced from a recent ASCO observational study as a proxy for direct costs of drugs. Toxicities were referenced and each regimen scored (TS) from NCCN Evidence Blocks and adverse events from clinical trials. Potential savings were evaluated if a clinician had the ability to individualize regimen choice by patient. We utilized the SimBioSys TumorScope platform to perform in silico simulations to predict response to alternate therapies as it had previously used to analyze potential deescalate between AC-T vs TC in a HER2- cohort. Results: The following regimens were evaluated HP (pCR:17%,TS:1), TH (pCR: 29%,TS: 2) THP (pCR: 46%, TS: 3), TCH (pCR: 43%, TS: 4), TCHP (pCR: 64%, TS: 5), AC-TH (pCR: 43%, TS: 6), AC-THP(pCR: 55%, TS: 7). Based on an in-silico analysis and selection (where pCR was likely with multiple regimens), the lowest cost & toxicity regimen was selected. The estimated average saving per case of over $100,000 for the overall treatment plan . The calculated toxicity score was also reduced by this method to under 4 from the TCHP(5) standard of care. Conclusions: While the results above are estimates and perfection in such individualization may not be possible, an in-silico approach provides a promising solution.

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