The impact of multidisciplinary cancer conferences (MCC) on the treatment of metastatic rectal cancer (MRC) at the Ottawa Hospital Cancer Centre (TOHCC).

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e14686-e14686
Author(s):  
Tanya Di Valentin ◽  
Timothy R. Asmis ◽  
Rebecca Ann C. Auer
Keyword(s):  
Treatment Plan ◽  
Retrospective Chart Review ◽  
Multidisciplinary Care ◽  
Standard Of Care ◽  
Ottawa Hospital ◽  
Patient Demographics ◽  
Relative Risks ◽  
Included Patient ◽  
Treatment Plans ◽  
The Impact

e14686 Background: There is significant controversy surrounding the management of surgically resectable MRC. The use and timing of neoadjuvant chemotherapy, pelvic radiation, and relative risks and benefits of a combined surgical resection are areas of debate among surgeons, medical, and radiation oncologists. The TOHCC multidisciplinary Cancer Conferences (MCC) provide an opportunity to discuss these cases and propose treatment plans for these patients. Methods: We conducted a retrospective chart review of all the cases of MRC which were discussed at MCC at the TOHCC from November 2007 until October 2009. Information collected included patient demographics, site of metastases, the treatment they received prior to their case being discussed at MCC (past surgeries, chemotherapy, radiotherapy), the treatment plan discussed at MCC, treatment actually administered post MCC discussion, and patient outcome at 6 months. Results: Forty-two patients with MRC were reviewed. The most common sites of metastases were liver (45.2%) and lung (31%). Once diagnosed with metastatic disease, prior to the MCC, patients had received the following treatments alone or in combination: chemotherapy (33.3%), radiotherapy (21.4%), surgery (19.0%), no treatment (n=57.1%). After their case was presented, 38 patients (90.5%) received the treatment recommended at the MCC , while 4 (9.5%) did not. Treatment post MCC included: chemotherapy (neoadjuvant: 38.1%; adjuvant: 23.8%; palliative: 28.6%), radiotherapy (neoadjuvant: 14.3%; adjuvant: 7.1%; palliative: 7.1%) and surgery (31.0%). Conclusions: There is no standardized approach to the management of MRC. Given its complexity, many cases are reviewed at MCC, which allow coordination for multidisciplinary care of these patients. The results of this study suggest that in a majority of cases, the recommendations brought forth at MCC are indeed acted upon. Given that these meetings have a significant impact on the treatment plan and outcome of patients with MRC, they should represent the standard of care when treating this disease.

Utility of a multidisciplinary tumor board in the management of pancreatic diseases.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 319-319
Author(s):  
David G. Brauer ◽  
Matthew S. Strand ◽  
Dominic E. Sanford ◽  
Maria Majella Doyle ◽  
Faris Murad ◽  
...  
Keyword(s):  
Treatment Plan ◽  
Diagnostic Testing ◽  
Retrospective Chart Review ◽  
Multidisciplinary Care ◽  
Tumor Board ◽  
Cancer Center ◽  
Common Diagnosis ◽  
Tumor Boards ◽  
Cancer Network ◽  
The Impact

319 Background: Multidisciplinary Tumor Boards (MTBs) are a requirement for comprehensive cancer centers and are routinely used to coordinate multidisciplinary care in oncology. Despite their widespread use, the impact of MTBs is not well characterized. We studied the outcomes of all patients presented at our pancreas MTB, with the goal of evaluating our current practices and resource utilization. Methods: Data were prospectively collected for all patients presented at a weekly pancreas-specific MTB over the 12-month period at a single-institution NCI-designated cancer center. The conference is attended by surgical, medical, and radiation oncologists, interventional gastroenterologists, pathologists, and radiologists (diagnostic and interventional). Retrospective chart review was performed at the end of the 12-month period under an IRB-approved protocol. Results: A total of 470 patient presentations were made over a 12-month period. Average age at time of presentation was 61.5 years (range 17 – 89) with 51% males. 61.7% of cases were presented by surgical oncologists and 26% by medical oncologists. 174 cases were the result of new diagnoses or referrals. 78 patients were presented more than once (average of 2.3 times). Pancreatic adenocarcinoma was the most common diagnosis (37%), followed by uncharacterized pancreatic mass (16%), and pancreatic cyst (7%). The treatment plan proposed by the presenting clinician was known or could be evaluated prior to conference in 402 cases. Presentation of a case at MTB changed the plan of management 25% (n = 100) of the time, including MTB recommendation against a planned resection in 46 cases. When the initial plan changed as a result of MTB discussion, the most common new plan was to obtain further diagnostic testing such as biopsy and/or endoscopy (n = 24). Conclusions: MTBs are required and resource-intensive but offer the opportunity to discuss a wide array of pathologies and influence management decisions in a sizable proportion of cases. Additional investigations evaluating adherence rates to MTB decisions and to published guidelines (i.e. National Comprehensive Cancer Network) will further enhance the assessment and utility of MTBs.

Impact of a geriatric oncology (GO) clinic on cancer treatment plans and supportive care for older adults with genitourinary (GU) cancer.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 238-238
Author(s):  
Shabbir M.H. Alibhai ◽  
Allison Loucks ◽  
Rana Jin ◽  
Martine Puts ◽  
Sarah Watt ◽  
...  
Keyword(s):  
Older Adults ◽  
Supportive Care ◽  
Treatment Plan ◽  
Tertiary Care ◽  
Geriatric Oncology ◽  
Operative Management ◽  
Best Supportive Care ◽  
Care Hospital ◽  
Treatment Plans ◽  
The Impact

238 Background: Older adults with cancer are complex due to multiple comorbidities, polypharmacy, and functional/cognitive impairments, leading to over-treatment and undertreatment. Studies examining the impact of geriatric assessment (GA) in older adults with various cancers found a median of 39% of treatment plans were revised after the GA ( Ann Oncol 2014; 25:307). Although these findings support the need for a GO clinic, whether such a clinic leads to changes in treatment in patients with GU malignancies is not clear. We examined the impact on the treatment plan of a GO assessment in GU patients, along with other enhancements to patient care for consecutive patients referred to the GO clinic in a tertiary care hospital. Methods: All referred older adults (age 65+) with a GU malignancy seen in the GO clinic at the Princess Margaret Cancer Centre, Toronto, Canada between July 2015 and June 2017 were included. Patients were seen by a geriatric oncologist and GO nurse and treatment recommendations were provided to the referring oncologist. Pre- and post-GO clinic treatment plans and enhancements to supportive care were recorded prospectively. Analyses were descriptive. Results: 98 patients (mean age 80) were seen in the GO clinic, of whom 35 were seen pre-treatment (25 prostate, 5 kidney, 5 bladder). 31 of 35 were referred for input on the treatment plan. The initial treatment plan included surgery (n = 6), radiation (n = 14), systemic therapy (n = 8), and hormonal therapy (n = 11). The final treatment plan was intensified in 1 patient, reduced in 6 patients, changed to best supportive care in 8 patients, and unchanged in 15 patients. Overall, GO resulted in a treatment modification in 52% of patients. Enhancements to care included comorbidity management (87%), educational support (94%), disease-related symptoms (39%), and peri-operative management (19%). Conclusions: The GO clinic results in modifications to the proposed treatment plan in over half of referred patients (predominantly a reduction in treatment intensity), and enhancements to care in the vast majority of patients. GO clinics have the potential to avoid overtreatment and improve care for older adults with GU malignancies.

Evaluation of electronic health record implementation on pharmacist interventions related to oral chemotherapy management

2016 ◽  
Vol 23 (8) ◽  
pp. 563-574 ◽  
Author(s):  
Anastasia Finn ◽  
Carolyn Bondarenka ◽  
Kathy Edwards ◽  
Rebekah Hartwell ◽  
Cathy Letton ◽  
...  
Keyword(s):  
Treatment Plan ◽  
Retrospective Chart Review ◽  
Outpatient Setting ◽  
Oral Chemotherapy ◽  
Pharmacist Interventions ◽  
Before And After ◽  
Treatment Plans ◽  
Implementation Time ◽  
Chemotherapy Agents ◽  
Beacon Period

Background With the ever growing arsenal of oral chemotherapy agents now available, cancer treatment is being increasingly managed in the outpatient setting. However, oral chemotherapy use is often associated with several potential obstacles and complications. In order to provide optimal patient safety and oral chemotherapy monitoring, our institution implemented an oral chemotherapy program managed by clinical pharmacists electronically through Epic Beacon. Objective To describe implementation of a novel pharmacist-managed oral chemotherapy program and evaluate pharmacist interventions before and after implementation of an oral chemotherapy program. Methods This was a single-center retrospective chart review of documented pharmacy interventions for oral chemotherapy prescriptions during three months prior to as well as three months following Epic Beacon implementation. Time periods for data inclusion were October–December 2013 (pre-Beacon) and October–December 2014 (post-Beacon). Patients included in the study had one or more oral chemotherapy orders during the pre-Beacon period, the post-Beacon period, or both pre- and post-Beacon. Our analysis did not include oral chemotherapy orders that were placed outside of a treatment plan in the post-Beacon period. Results A total of 240 patients with 450 total oral chemotherapy orders were assessed over the duration of the study. Beacon implementation allowed a greater number of oral chemotherapy orders to be reviewed, with 134 oral chemotherapy orders reviewed in the study period prior to Beacon implementation and 316 orders reviewed in the post-Beacon period. Additionally, there were 660% more pharmacist interventions (89 interventions pre-Beacon versus 681 interventions post-Beacon), with an increased focus on coordination of care, chemotherapy calendar coordination, and assistance with treatment plans. Furthermore, implementation of Epic Beacon allowed identification of over 500% more chemotherapy order errors (41 total errors identified pre-Beacon versus 250 total errors identified post-Beacon). Pharmacists were also able to identify more significant, serious, or potentially lethal errors following implementation. The time associated with oral chemotherapy review and intervention also increased accordingly with number of orders reviewed. Conclusion Implementation of an electronic workflow for oral chemotherapy dramatically increased pharmacist review of orders, resulting in improved documentation of interventions and errors, decreased need for clarification of orders, as well as increased volume of prescriptions at our on-site pharmacy. This study demonstrates a comprehensive approach to maximize safety when oral chemotherapy is utilized as a component of the treatment regimen.

scholarly journals CBCT influences endodontic therapeutic decision-making in immature traumatized teeth with suspected pulp necrosis: a before-after study

2021 ◽  
pp. 20200594
Author(s):  
Fernando José Mota de Almeida ◽  
Dalya Hassan ◽  
Ghada Nasir Abdulrahman ◽  
Malin Brundin ◽  
Nelly Romani Vestman
Keyword(s):  
Decision Making ◽  
Treatment Plan ◽  
Dental Trauma ◽  
Expectant Management ◽  
Rank Test ◽  
Therapeutic Decision ◽  
Radiographic Findings ◽  
Treatment Plans ◽  
Therapeutic Decision Making ◽  
The Impact

Objective: To evaluate the impact of cone-beam computed tomography (CBCT) in endodontic therapeutic decision-making of immature traumatized teeth with suspected pulp necrosis. Methods: Over two years, consecutive patients with a dental trauma in their front teeth (apex >0.5 mm) and with suspected pulp necrosis based on clinical and radiographic findings were referred to a specialist clinic in Sweden. Fifteen patients aged 6–13 (18 teeth) were included and clinically examined by an endodontist. Intraoral radiographs and CBCT examinations were obtained. Five practitioners, three endodontists and two residents in endodontics, used these examinations to determine the most appropriate treatment for the 18 cases (all central incisors) on two occasions scheduled 19 weeks apart. On the first occasion, the practitioners had access to clinical information and the intraoral radiographs (‘before’ CBCT); on the second occasion, the practitioners had also access to a radiologist report and the CBCT images (‘after’ CBCT). Their treatment plans – no treatment, watchful waiting, endodontic orthograde treatment, or extraction – were made anonymously and independently. Results were analysed using descriptive statistics and Wilcoxon signed-rank test. Results: ‘After’ CBCT, practitioners changed treatment plans in 30% of the 90 assessments, 74% of which were more aggressive (p = 0.028). In 49% of the assessments, practitioners who chose the watchful and waiting treatment plan ‘before’ CBCT changed to a more aggressive therapy such as endodontic orthograde treatment and extraction ‘after’ CBCT (p = 0.005). Conclusion: This study provides evidence that CBCT influences endodontic therapeutic decision-making regarding immature traumatised teeth with suspected pulp necrosis, chiefly when expectant management (i.e., watchful and waiting) was selected before access to CBCT.

scholarly journals An analysis on medical expenses of multidisciplinary cancer care under health insurance

2021 ◽  
Vol 64 (10) ◽  
pp. 711-716
Author(s):  
Myungjin Jung ◽  
Byungyul Jun
Keyword(s):  
Health Insurance ◽  
Cancer Patients ◽  
Cancer Care ◽  
Treatment Plan ◽  
Multidisciplinary Care ◽  
Therapeutic Modality ◽  
Patient Treatment ◽  
Medical Expenses ◽  
Hospitalization Costs ◽  
Treatment Plans

Background: Cancer has been the leading cause of death in Korea for more than 40 years. As the aging population in the country increases, this trend is expected to continue. Cancer care is also being subdivided into specialties according to the development of medical technology. This division of care has made it difficult for a single physician to set up a complete cancer treatment plan. As a result, the call for multidisciplinary care has risen. Multidisciplinary cancer care allows physicians to share opinions and choose optimal patient treatment plans across multiple specialties. In August 2014, the Ministry of Health and Welfare designated a set number of approved multidisciplinary treatments and has included them under its health insurance coverage. As a result, multidisciplinary care is rapidly increasing.Current Concepts: An analysis on cancer care was conducted from 2014 to 2018, which examined the average medical expenses, hospitalization costs, and surgery costs per person according to therapeutic modality. Findings showed that multidisciplinary care decreased the overall cost of medical care in cancer patients compared to segmented care provided by single specialty physicians.Discussion and Conclusion: This study predicted that multidisciplinary care would be effective in reducing medical expenses. Cancer patients do not need to be treated by individual subspecialty physicians when personalized care treatment plans through a multidisciplinary approach is possible. The results of this study show that the Korean government should expand health insurance premium support and coverage for multidisciplinary cancer care.

Factors Associated With Patient Nonattendance in Rhinology Clinics

2019 ◽  
Vol 33 (3) ◽  
pp. 317-322
Author(s):  
Benjamin N. Hunter ◽  
Brandon Cardon ◽  
Gretchen M. Oakley ◽  
Arun Sharma ◽  
Dana L. Crosby
Keyword(s):  
Chart Review ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Retrospective Chart Review ◽  
The United States ◽  
Patient Demographics ◽  
Medical Centers ◽  
Insurance Type ◽  
Academic Medical ◽  
Included Patient

Background Nonattendance to clinical appointments is a global problem appreciated by clinicians with an ambulatory presence. There are few reports of nonattendance in otolaryngology clinics, and no reports on nonattendance for a single otolaryngology subspecialty. Objective To describe the no-show population in rhinology clinics. Methods A retrospective chart review was performed involving rhinology clinics from 2 academic medical centers in the United States. All patients who either attended their clinic appointment(s) or did not attend without previously cancelling from June 2016 to May 2017 were included. Data collected included patient demographics, appointment status, season and time of visit, insurance status, type of visit (new vs established), and provider seen. Results There were 2791 clinical appointments evaluated over a 12-month period at 2 rhinology clinics involving 4 fellowship-trained rhinologists. Ninety-two percent of patients kept their appointments, while 8% did not. Sex, season of visit, time of visit (am vs pm), type of visit, provider sex, provider location, or provider’s experience (<10 years vs ≥10 years) were not associated with patient’s attendance status. Univariate analysis showed that patient’s age ≤50 ( P = .001) and primary insurance type ( P < .001) were associated with nonattendance. Medicaid as the primary insurance type was associated with clinic nonattendance. Multivariable analysis showed that age ≤ 50 years, odds ratio (OR) 1.62 (95% confidence interval [CI] 1.14–2.30), P = .007, and primary insurance type (Medicaid: OR 3.75 [95% CI 2.58–5.45], P < .001) remained significant predictors of nonattendance. Conclusion Patients younger than 50 years and patients with Medicaid as the primary insurance types are associated with risk of missing rhinology clinic appointments. As a subspecialty, delivery of timely care and clinical efficiency could be improved by interventions directed toward improving attendance among this population.

Impact and Cost Effectiveness of Videonystagmography

2020 ◽  
pp. 000348942096887
Author(s):  
Garrett Ni ◽  
Christine Kim ◽  
Lakshmi Nair ◽  
Alexander G. Bien ◽  
Daohai Yu ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Treatment Plan ◽  
Cost Effective ◽  
Diagnosis And Treatment ◽  
Medicare Reimbursement ◽  
Treatment Plans ◽  
Vestibular Symptoms ◽  
The Cost ◽  
Evidence Based Guidelines ◽  
The Impact

Objective: Videonystagmography (VNG) is a commonly ordered test to evaluate patients with vestibular complaints. To date, there are no evidence-based guidelines for evaluating patients presenting with vestibular symptoms. This study evaluates the cost effectiveness of VNG and the impact of VNG findings on patient management. Methods: Patient charts were reviewed from 3 institutions to collect the pre- and post-VNG ICD-9/10 diagnosis and treatment plan. VNG findings were recorded to calculate the incidence of abnormal findings and the incidence of change in diagnosis and/or treatment plan. The cost effectiveness of VNG was estimated based on these calculations. Results: A total of 120 patient charts were reviewed. 69/120 (57.5%; 95% CI: 48.2%-66.5%) patients had abnormal findings on their VNG. A change in diagnosis was noted in 24/120 (20.0%; 95% CI: 13.3%-28.3%) patients. A change in treatment plan was noted in 62/120 (51.7%; 95% CI: 42.4%-60.9%) patients, and 11/120 (9.2%; 95% CI: 4.7%-15.8%) had a change in diagnosis that led to change in treatment plan. Using the average Medicare reimbursement for VNG, the cost effectiveness analysis showed a cost of $869.57 per VNG with abnormal findings and a cost of $5454.55 per VNG that lead to a change in diagnosis and treatment plan. Conclusions: VNG findings may not result in changes in clinical diagnosis. However, VNG is impactful at influencing treatment plan changes. VNG results are beneficial for counseling patients, guiding treatment plans, and managing patient expectations. When there is a clear indication, VNG testing can be cost effective in managing patients presenting with vestibular symptoms.

Utility of Fiberoptic Bronchoscopy at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia

2019 ◽  
Author(s):  
Fahmi Oumer Ahmed ◽  
Madhavi J. Parekh ◽  
Amsalu Bekele Binegdie ◽  
Tola Bayisa Tolessa ◽  
Otto Brandli ◽  
...  
Keyword(s):  
Diagnostic Yield ◽  
Smoking Status ◽  
Addis Ababa ◽  
Fiberoptic Bronchoscopy ◽  
Retrospective Chart Review ◽  
Patient Demographics ◽  
Specialized Hospital ◽  
Tikur Anbessa Specialized Hospital ◽  
Included Patient ◽  
Former Smokers

Abstract Objective Fiberoptic bronchoscopy (FOB) is a widely used tool in the diagnosis and treatment of pulmonary diseases. However, little is known regarding the indications and diagnostic yield of FOB in Ethiopia. The objective of this study was to determine the indications and diagnostic yield of FOB at Tikur Anbessa Specialized Hospital (TASH), the largest public health hospital in Ethiopia. Results In this retrospective chart review, all patients undergoing FOB between January and December 2013 in the bronchoscopy suite were studied. Data included: patient demographics, smoking, HIV status, procedure indications, and microbiologic, cytological and pathologic results. During the study period, 141 patients underwent FOB. The mean age was 42 years; 90(63%) were men. Among those whose smoking status was known, 15% were current or former smokers. The most common indications for FOB were: lung mass (presumed malignancy) 54% (76), tuberculosis 13% (18), and pleural effusion with possible underlying lung cancer 9%(13). 65 patients had endobronchial and/or transbronchial biopsies; 48% (31/65) were diagnostic and of these 68% (21/31) had malignancies. 57 patients had BAL performed; 33% (19/57) were diagnostic and of these 37% (7/19) had tuberculosis. We found that bronchoscopy was a safe and effective tool for diagnosing lung disease in Ethiopia.

Aiming Beyond: A Pharmacist Impact on 90-Day Readmissions and Clinical Outcomes Within a Family Medicine Service

2019 ◽  
Vol 33 (6) ◽  
pp. 738-744
Author(s):  
Lindsey E. Wiegmann ◽  
Matthew S. Belisle ◽  
Kristin S. Alvarez ◽  
Neelima J. Kale
Keyword(s):  
Family Medicine ◽  
Intervention Group ◽  
Retrospective Chart Review ◽  
Standard Of Care ◽  
Care Group ◽  
Readmission Rates ◽  
Medicine Service ◽  
The Impact ◽  
Disease Specific

Previous studies have shown pharmacists positively impact 30-day readmission rates. However, there is limited data regarding the effect of clinical pharmacist (CP) follow-up on 90-day readmission or evaluation of disease-specific goals after hospitalization. Investigators analyzed the impact of postdischarge extended CP follow-up within a family medicine service (FMS). The primary end point was all-cause 90-day readmission rates. Secondary end points included all-cause 30- and 60-day readmission rates and the achievement of disease-specific goals postdischarge. Retrospective chart review was performed for patients admitted from August 2016 to November 2017 who were seen by a physician within the FMS 14 days postdischarge. Fourteen percent of patients within the CP intervention group were readmitted within 90 days in comparison to 22% in the standard of care group ( P = .244). Readmission rates at 30 and 60 days were as follows: intervention group 2%, 10%, and standard of care group 16%, 22% ( P = .015, P = .089, respectively). In addition, multiple patients with uncontrolled diabetes who completed CP visits upon hospital discharge met glycemic goals at the end of the study time period. Despite inclusion of the CP in postdischarge care, 90-day readmission rate remained unchanged.

scholarly journals Impact of the COVID-19 Pandemic Surge on Radiation Treatment: Report From a Multicenter New York Area Institution

2021 ◽  
pp. OP.20.00619
Author(s):  
Sewit Teckie ◽  
Janna Zeola Andrews ◽  
William Chun-Ying Chen ◽  
Anuj Goenka ◽  
Daniel Koffler ◽  
...  
Keyword(s):  
New York ◽  
Linear Accelerator ◽  
Radiation Treatment ◽  
Care Pathway ◽  
Treatment Plan ◽  
Standard Of Care ◽  
Priority Level ◽  
Patients With Cancer ◽  
Treatment Intent ◽  
The Impact

PURPOSE: During the COVID-19 surge months of March and April 2020, our New York multicenter health system experienced an influx of cases with COVID-19. We sought to study the impact of the surge period on patients with cancer prescribed radiation treatment (RT). METHODS: We reviewed our secure departmental quality assurance database for all patients who underwent RT planning simulations from March 6, 2020, through April 30, 2020. A priority level between 1 and 3 was prospectively assigned to each case based on faculty consensus to determine which patients required immediate RT. In May 2020, each faculty physician again retrospectively reviewed their patients from the database and provided additional commentary on how the COVID-19 pandemic had affected each patient's care. All statistics are descriptive. RESULTS: A total of 412 RT courses in 406 unique patients were simulated for linear accelerator–based external beam RT. The median age was 66 years. Treatment intent was curative in 70.6% and palliative in 29.4%. Of the 412 cases, 66.7% were priority 1, 25% priority 2, and 7.8% priority 3. Two hundred thirty-nine cases (58%) underwent standard-of-care diagnosis, workup, and treatment plan. Seventeen patients (4.1%) electively canceled their RT, and 17 others (4.1%) electively delayed RT start. Thirty-four (8.3%) were prescribed hypofractionation to shorten their RT course, and 22 (5.3%) had a change in modality. Incomplete or delayed workup was identified in 19 cases (4.6%). CONCLUSION: The COVID-19 pandemic surge resulted in 42% of our patients having a non–standard-of-care pathway. This outcome demonstrates a significant impact of the COVID-19 crisis on routine cancer care.

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