Oncology multidisciplinary clinic development.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 62-62 ◽  
Author(s):  
Sheila Jacobs ◽  
Kathy Mashanic
Keyword(s):  
Treatment Plan ◽  
Surgical Oncology ◽  
Breast Cancer Patients ◽  
Model Of Care ◽  
Referral Networks ◽  
Additional Equipment ◽  
Multidisciplinary Clinic ◽  
Operational Issues ◽  
Key Staff ◽  
Patient Referrals

62 Background: In 2014 it was decided that a multidisciplinary approach would be beneficial for our breast cancer patients. A pre-conference for a multidisciplinary discussion on the treatment plan for the patients and their ability to see medical oncology, surgical oncology, and radiation oncology in one visit was the goal. Methods: A multidisciplinary planning committee was established to discuss operational issues. Location of the pre-conference and exam rooms were assigned along with the development of the MDC schedule templates for the physicians. The staffing resources were identified along with any additional equipment or supplies. Key staff were engaged to determine a new scheduling workflow including how patient referrals would be handled between departments, phone numbers the patient/family or physician would call for an appointment, and scripted messages to educate all on this model of care. Physicians developed triage questions to direct the caller to appropriate clinic and schedule an MDC appointment. A single phone number was created to ensure adequate access. Physician leadership and the managers of the affected areas worked with marketing on developing a variety of communication strategies to introduce the multidisciplinary initiative to providers, staff, referral networks, and patients. Results: Since the pilot in 2014, additional breast, thyroid/endocrine, thoracic, genitourinary, and gastrointestinal/colorectal MDC clinics have been launched as the outcomes have been very positive. Total MDC’s visits have increased by 200% from 132 in 2017 to 399 projected in 2019. Market share in the MDC programs has increased an average of 3.6 points. There has been a 44% increase in diagnosis at an earlier stage and both patient and provider satisfaction have trended upwards. Conclusions: The MDC’s have been a positive addition to our cancer program. The comprehensive approach to care has resulted in quality experience for all touched by cancer.

scholarly journals Magnetic Seed (Magseed) Localisation in Breast Cancer Surgery: A Multicentre Clinical Trial

Breast Care ◽  
2020 ◽  
pp. 1-6
Author(s):  
Jan Žatecký ◽  
Otakar Kubala ◽  
Oldřich Coufal ◽  
Markéta Kepičová ◽  
Adéla Faridová ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Surgical Oncology ◽  
Breast Tumour ◽  
Axillary Node ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Breast Cancer Patients ◽  
Magnetic Marker ◽  
Magnetic Seeds

<b><i>Introduction:</i></b> The aim of this study was to evaluate the accuracy and reliability of the Magseed magnetic marker in breast cancer surgery. <b><i>Methods:</i></b> Thirty-nine patients with 41 implanted Magseeds undergoing surgical treatment in 3 surgical oncology departments were included in the retrospective trial to study pilot use of the Magseed magnetic marker in the Czech Republic for localisation of breast tumours or pathological axillary nodes in breast cancer patients. <b><i>Results:</i></b> Thirty-four breast cancer and 7 pathological lymph node localisations were performed by Magseed implantation. No placement failures, or perioperative detection failures of Magseeds were observed (0/41, 0.0%), but one case of Magseed migration was present (1/41, 2.4%). All magnetic seeds were successfully retrieved (41/41, 100.0%). Negative margins were achieved in 29 of 34 (85.3%) breast tumour localisations by Magseed. <b><i>Conclusion:</i></b> Magseed is a reliable marker for breast tumour and pathological axillary node localisation in breast cancer patients. Magseed is comparable to conventional localisation methods in terms of oncosurgical radicality and safety.

scholarly journals Application and Effect of the Gymnastic Exercise Mode during Chemotherapy for Breast Cancer Patients

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Feifei Xie
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Incidence Rate ◽  
Evaluation System ◽  
Malignant Tumors ◽  
Treatment Plan ◽  
Breast Cancer Surgery ◽  
Breast Cancer Patients ◽  
Rehabilitation Training ◽  
Cancer Related Fatigue

Breast cancer is one of the most common malignant tumors in women, which seriously threatens the health of women. With the improvement of living standards, the incidence rate of breast cancer is also rising. In the past ten years, the incidence rate of breast cancer in China’s major cities has increased by 37%, far higher than that in Europe and America. At present, chemotherapy and radiotherapy are the main treatment methods for breast cancer, but many patients will have cancer-related fatigue after surgery. Some studies believe that appropriate sports can improve cancer-related fatigue, but there is no specific research in this area. In view of this problem, this paper puts forward a rehabilitation training method based on gymnastics for breast cancer surgery. This paper is divided into three parts. The first part is the basic theory and core concept of breast cancer and cancer-related fatigue. Through the in-depth study of the theory, this paper believes that breast cancer patients paying attention to rehabilitation training can effectively improve cancer-related fatigue and affect the final therapeutic effect. The second part is the rehabilitation training program based on the way of gymnastics. The corresponding experimental model is established by using real cases as samples. In order to ensure the quality of the experiment, this paper gives the treatment plan in detail and establishes a unified evaluation system. In the third part of this paper, the relevant experiments and results analysis are given, and through data analysis, this paper believes that gymnastics can effectively help breast cancer patients with postoperative rehabilitation and continuous recovery of the upper limb function and improve cancer-related fatigue and other issues.

Anthracycline-based preoperative chemotherapy plus lapatinib and trastuzumab or both in HER2-positive breast cancer: Preliminary cardiac safety report of the CHER LOB trial

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 573-573
Author(s):  
V. Guarneri ◽  
A. Frassoldati ◽  
A. Bottini ◽  
K. Cagossi ◽  
L. Cavanna ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Preoperative Chemotherapy ◽  
Treatment Plan ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Breast Cancer Patients ◽  
Cardiac Safety ◽  
Ventricular Ejection Fraction ◽  
Her 2 ◽  
Positive Breast Cancer

573 Background: The combination of anthracyclines and anti-HER-2 agents is highly active in HER-2 positive breast cancer, but its use is limited by an enhanced risk of cardiac toxicity. We are running a randomized phase II trial of combined preoperative chemotherapy (CT) with anthracycline plus trastuzumab, lapatinib, or both in HER-2 positive stage II-IIIA breast cancer patients. Aims of the study are the percentage of pathological complete response (pCR = breast + axillary nodes) and cardiac safety. We report the updated cardiac safety and activity data following the IDMC recommendation to continue study accrual. Methods: CT consists of sequential paclitaxel (P) 80 mg/m2 weekly for 12 weeks followed by 4 courses of FE75C administered every 3 weeks. Arm A is CT + trastuzumab 2 mg/kg weekly; arm B is CT + lapatinib 1500 mg po daily; arm C is CT + trastuzumab 2 mg/kg weekly + lapatinib 1,000 mg po daily. Both trastuzumab and lapatinib are started concomitantly with the first P administration, and are administered throughout the duration of CT. Left ventricular ejection fraction (LVEF) is evaluated at baseline, before the start of FE75C, and at the completion of treatment. The planned sample size is 120 patients, and has been calculated according to the two steps Simon's design. Results: 53 out of the 120 planned patients have been randomized: 16 in arm A, 17 in arm B, and 20 in arm C. Median age is 48 years (range 27–66). The mean LVEF was 63% (range 54–77%) at baseline, 61% (50–78%) at the completion of weekly P + trastuzumab, lapatinib, or trastuzumab + lapatinib, and 60.3% (54–74%) at the completion of the whole treatment plan. Thirty patients underwent surgery: 19 patients (63%) received breast conserving surgery; 13 patients (43%) achieved a pCR. Conclusions Following the updated interim analysis, the combination of T, L or both with an anthracycline-containing regimen is feasible, with very interesting level of activity. The next planned analysis will be performed when 60 patients will be evaluable and will be presented at the Meeting. [Table: see text]

FDG PET-CT in breast cancer: A single institution experience from India.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e11027-e11027
Author(s):  
Nalini K Rao ◽  
Basavalinga S Ajaikumar ◽  
Kumar G Kallur ◽  
P S Sridhar ◽  
Bhattacharjee Somorat ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Fdg Pet ◽  
Treatment Plan ◽  
Whole Body ◽  
Breast Cancer Patients ◽  
Term Survival ◽  
New Findings ◽  
Pet Ct ◽  
Fdg Pet Ct

e11027 Background: Whole body FDG PET CT is a useful tool in diagnosis, staging and prognosis; and its timely use is critical for early intervention and achieving long term survival in patients with early and advanced breast cancer. Methods: In this observational retrospective study, we report FDG PET CT findings of all breast cancer patients enrolled in our hospital based cancer registry between the years 2008 to 2011. Results: One thousand and fifty three women underwent a total of 1638 scans. Two hundred and forty five scans (14.96%) were done for staging /restaging/diagnosis, 1208 (73.75%) were for response evaluation to chemotherapy and 185 (11.29%) were for surveillance. The median age at diagnosis was 53 years. We identified a possible synchronous breast primary in 28 (2.66%) women and a probable new or existing second non-breast primary in 21(1.99%) women. Internal nodal metastasis was identified in 76 (7.21%) women at diagnosis. There were 26 (2.47%) patients with multicentric tumors. There was an increased uptake in the thyroid gland in 49(2.99%) and in the adrenal in 41 (2.50%) women. There were other random ‘Incidental findings of concern’ in 7 (0.37%) of women, diagnosed either on the CT or PET-CT component. Findings on PET-CT, including- upstaging of the breast primary and unexpected new findings, unrelated to the breast primary, changed the treatment plan in approximately 7% -10% of the patients. We did find that PET-CT did not impact early tumors; however, it did contribute in, 1) the assessment of internal mammary nodes, 2) prognostication based on tumor burden and, 3) aggressive management of oligometastases. Conclusions: Whole body FDG PET CT is a useful tool for staging and prognostication in breast cancer patients. However, the timing of such scans for surveillance needs to be defined for early detection of progression to have an impact on survival.

Value of thoracic multidisciplinary clinic (TMDC) in determining appropriate treatment of stage III non-small cell lung cancer (NSCLC).

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 82-82 ◽  
Author(s):  
Eliot L Friedman ◽  
Michael F Szwerc ◽  
Robert Kruklitis ◽  
Michael J Weiss
Keyword(s):  
Clinical Pathway ◽  
Initial Treatment ◽  
Clinical Pathways ◽  
Treatment Plan ◽  
Clinical Status ◽  
Stage Iii ◽  
Definitive Treatment ◽  
Mediastinal Staging ◽  
Multidisciplinary Clinic ◽  
Stage Iii Nsclc

82 Background: Treatment of stage III NSCLC involves surgery, radiation therapy and chemotherapy. Treatment depends on the size and location of the primary tumor and lymph nodes as well as clinical status of the patient. Evaluation of these patients should take place in a multidisciplinary clinic, where treating physicians and pulmonary medicine provide a unified treatment plan. Methods: All patients with Stage III NSCLC seen at the Lehigh Valley Health Network (LVHN) between March of 2010 and March of 2012 were analyzed retrospectively. We compared initial treatment of out-patients seen in our TMDC with those out-patients seen outside the TMDC. Results: Thirty-five patients were seen in TMDC (34 treated at LVHN) and 44 patients were seen outside TMDC (34 treated at LVHN). Eleven patients were treated elsewhere or were not treatable. Of patients with stage III NSCLC, 37.5% were seen in TMDC year 1 (March 2010 – March 2011) compared to 61% of patients year 2 (March 2011 – March 2012) (p = 0.05). Patients were seen by physicians from at least two specialties 100% of the time when seen in TMDC, but only 64.7% of the time when seen outside TMDC (p < 0.001). Mediastinal staging (EBUS or mediastinoscopy) was performed more frequently in patients seen in TMDC; 58.9% compared to 23.5% outside TMDC (p = 0.009). The LVHN clinical pathway for stage III NSCLC recommends initial therapy with concomitant chemoradiation, either in the neo-adjuvant setting or as definitive treatment. Eighty-eight percent of patients seen in TMDC followed our clinical pathway while 46% of patients seen outside TMDC conformed to the clinical pathway (p < 0.001). The time from first contact with a treating physician to initiation of treatment was reduced by almost 30% (29.03 days outside TMDC; 20.62 days at TMDC). Conclusions: All patients with stage III NSCLC should be seen in a multidisciplinary setting. At LVHN we saw an increase in these patients being referred to our TMDC over time. These patients were more likely to have mediastinal staging and enjoyed quicker initiation of their therapy. They were more likely to have at least two physicians involved in their initial treatment plan and were more likely to conform to our clinical pathways.

Using technology to improve patient-provider communication and delivery of quality care.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 76-76
Author(s):  
Gabrielle Betty Rocque ◽  
Amanda Hathaway ◽  
Karina I. Halilova ◽  
Michele Gaguski ◽  
Kathryn A Thomas ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Shared Decision Making ◽  
Treatment Plan ◽  
Planning System ◽  
Site Quality ◽  
Cancer Center ◽  
Shared Decision ◽  
Breast Cancer Patients ◽  
Provider Education

76 Background: Shared decision making (SDM) is a cornerstone of patient-centered care with 85-90% of breast cancer (BC) patients preferring an active or shared role in decision-making for breast surgery. SDM has been shown to, improve patients’ understanding of treatment options, result in more conservative care choices, and lead to lower healthcare costs. However, implementation is complex as numerous misconceptions exist. Methods: We are conducting a multi-site, quality improvement (QI) project to improve SDM behaviors and adherence to quality measures through a combination of provider education and use of a novel technology platform, the Carevive Care Planning System. This platform elicits patient preferences, concerns, history, and symptoms, and presents these data with algorithm-driven recommendations as part of a treatment plan. We report results from baseline provider surveys assessing perception and knowledge of SDM. Results: Baseline surveys from 28 participants were analyzed; 43% from a university based cancer center and 57% from community based cancer centers. Survey respondents were MDs (43%), NPs (7%) and RNs (46%), all specializing in Hematology and/or Oncology. When asked, “What percentage of breast cancer patients prefers an active or shared role in decision making?”, only 29% believed 85-90% of BC patients desired an active or shared role as suggested by surgical literature; 43% believed between 55-70% of patients wanted to be engaged in decision-making. Commonly reported barriers to SDM are shown in the table below. Conclusions: Physicians may underestimate patient’s desire to participate in shared decision-making. The barriers to implementing SDM in oncology practice will likely require multi-faceted interventions to overcome. We aim to address these gaps through an intervention aimed at enhancing knowledge and patient-provider engagement through treatment summaries. [Table: see text]

The impact of a well breast cancer patient transition model of care on oncologists’ practice.

2018 ◽  
Vol 36 (7_suppl) ◽  
pp. 39-39
Author(s):  
Seungree Nam ◽  
Julie Gilbert ◽  
Jonathan Sussman ◽  
Leta Forbes ◽  
Victoria Zwicker ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Family Physicians ◽  
Post Treatment ◽  
Transition Model ◽  
Breast Cancer Patients ◽  
Model Of Care ◽  
Early Communication ◽  
Practice Methods ◽  
The Impact

39 Background: The transitioning of well breast cancer patients, post-treatment, to family physicians is accepted as a safe and effective model of care. Numerous studies have focused on patients’ experience and health outcomes, but research has not examined the experience of oncologists who are practicing in this model of care. The purpose of this research is to explore the impact of a transition model of care on oncologists’ practice. Methods: Purposive sampling was employed to recruit and interview oncologists who have been transitioning patients to family physicians for two or more years. A total of 15 medical and radiation oncologists practicing in Ontario, Canada were interviewed. Data were analyzed using thematic analysis. Results: Most oncologists interviewed were confident that the transitioning of patients to family physicians is safe for many patients post-treatment. Despite some concerns about the feasibility of the model, namely acceptance of the model among patients and family physicians, oncologists perceived that the model enhances efficiency and sustainability of the cancer system. As the volume of patients in follow-up decreased, oncologists saw a variety of impacts including: a reduction in overbooking in their clinics; more new patients able to be seen in consultation each week; more flexibility in their schedules to accept urgent appointments; and an increased ability to spend more time with patients who are dealing with complex issues. For some oncologists, well patient appointments are a rewarding part of their work. Meanwhile, many experience challenges with increased intensity of workload. Oncologists recognize that some patients and family physicians may be reluctant but they believe that early communication with patients about eventual transition, and improved communication with family physicians can enhance the acceptability of this model of care. Conclusions: Oncologists interviewed in this study reported that the time they used to spend with well follow-up patients can now be spent on other activities that contribute to the enhancement of quality of care for cancer survivors and efficiency in the broader cancer system.

scholarly journals The Optimal Treatment Plan to Avoid Axillary Lymph Node Dissection in Early-Stage Breast Cancer Patients Differs by Surgical Strategy and Tumor Subtype

2017 ◽  
Vol 24 (12) ◽  
pp. 3527-3533 ◽  
Author(s):  
Melissa Pilewskie ◽  
Emily C. Zabor ◽  
Anita Mamtani ◽  
Andrea V. Barrio ◽  
Michelle Stempel ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Cancer Patients ◽  
Axillary Lymph Node ◽  
Early Stage ◽  
Treatment Plan ◽  
Axillary Lymph ◽  
Tumor Subtype ◽  
Breast Cancer Patients ◽  
Node Dissection

scholarly journals Breast cancer during pregnancy: retrospective institutional case series

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Erika Matos ◽  
Tanja Ovcaricek
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
De Novo ◽  
Treatment Plan ◽  
Case Series ◽  
Blue Dye ◽  
Breast Cancer Patients ◽  
Her2 Positive ◽  
Tertiary Institution ◽  
International Guidelines

Abstract Background Pregnancy associated breast cancer is a rare disease. It presents a unique entity of breast cancer with aggressive phenotype. The main aim was to evaluate how the international guidelines were followed in daily practice. Patients and methods Data concerning patients’ and tumours’ characteristics, management, delivery and maternal outcome were recorded from institutional electronic database. In this paper a case series of pregnant breast cancer patients treated at single tertiary institution between 2007 and 2019 are presented and the key recommendations on managing such patients are summarized. Results Fourteen patients met the search criteria. The majority of tumours were high grade, triple negative or HER2 positive, two patients were de novo metastatic. Treatment plan was made for each patient by multidisciplinary team. Eight patients were treated with systemic chemotherapy with no excess toxicity or severe maternal/fetal adverse effects. In all but two patients, delivery was on term and without major complications. Only one event, which was not in whole accordance with international guidelines, was identified. It was the use of blue dye in one patient. Conclusions Women with pregnancy associated breast cancer should be managed like non-pregnant breast cancer patients and should expect a similar outcome, without causing harm to the unborn child. To achieve a good outcome in pregnancy associated breast cancer, a multidisciplinary approach is mandatory.

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