scholarly journals Global Practice and Efficiency of Multidisciplinary Tumor Boards: Results of an American Society of Clinical Oncology International Survey

2015 ◽  
Vol 1 (2) ◽  
pp. 57-64 ◽  
Author(s):  
Nagi S. El Saghir ◽  
Raghid N. Charara ◽  
Firas Y. Kreidieh ◽  
Vanessa Eaton ◽  
Kate Litvin ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Colorectal Cancer ◽  
Clinical Oncology ◽  
The United States ◽  
Management Change ◽  
Patients With Cancer ◽  
Tumor Boards ◽  
Treatment Plans ◽  
American Society ◽  
E Mail

Purpose Multidisciplinary tumor boards (MDTBs) are universally recommended, but recent literature has challenged their efficiency. Methods The American Society of Clinical Oncology (ASCO) conducted a survey of a randomly selected cohort of international ASCO members. The survey was built on SurveyMonkey and was sent via e-mail to a sample of 5,357 members. Results In all, 501 ASCO members practicing outside the United States responded, and 86% of them participated in MDTBs at their own institutions. Those who attended represented a variety of disciplines in 70% to 86% of all MDTBs. The majority of MDTBs held weekly specialty and/or general meetings. Eighty-nine percent of 409 respondents attended for advice on treatment decisions. Survey respondents reported changes of 1% to 25% in treatment plans for 44% to 49% of patients with breast cancer and in 47% to 50% of patients with colorectal cancer. They reported 25% to 50% changes in surgery type and/or treatment plans for 14% to 21% of patients with breast cancer and 12% to 18% of patients with colorectal cancer. Of the 430 respondents 96% said overall benefit to patients was worth the time and effort spent at MDTBs, and 96% said that MDTBs have teaching value. Mini tumor boards held with whatever types of specialists were available were considered valid. In all, 94.8% (425 of 448) said that MDTBs should be required in institutions in which patients with cancer are treated. Conclusion MDTBs are commonplace worldwide. A majority of respondents attend them to obtain recommendations, and they report changes in patient management. Change occurred more frequently with nonmedical oncologists and with physicians who had less than 15 years in practice. MDTBs helped practitioners make management decisions. Mini tumor boards may improve time efficiency and are favored when the full team is not available. Suggestions for improving MDTBs included making them more efficient, better selection and preparation of cases, choosing an effective team leader, and improving how time is used, but more research is needed on ways to improve the efficiency of MDTBs.

1997 update of recommendations for the use of tumor markers in breast and colorectal cancer. Adopted on November 7, 1997 by the American Society of Clinical Oncology.

1998 ◽  
Vol 16 (2) ◽  
pp. 793-795 ◽  
Keyword(s):  
Breast Cancer ◽  
Colorectal Cancer ◽  
Clinical Practice ◽  
Clinical Oncology ◽  
Tumor Markers ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Disease Free Survival ◽  
Research Committee ◽  
American Society

OBJECTIVE The primary objective was to update the 1996 clinical practice guidelines for the use of tumor marker tests in the prevention, screening, treatment, and surveillance of breast and colorectal cancers. These guidelines are intended for use in the care of patients outside of clinical trials. OPTIONS Six tumor markers for colorectal cancer and eight for breast cancer were considered. They could be recommended or not for routine use or for special circumstances. In addition to carcinoembryonic antigen (CEA) and cancer antigen (CA) 15-3, CA 27.29 also was considered in regard to circulatory tumor markers for breast cancer. OUTCOMES In general, the significant health outcomes identified for use in making clinical practice guidelines (overall survival, disease-free survival, quality of life, lesser toxicity, and cost effectiveness) were used. EVIDENCE A computerized literature search from 1994 to July 1997 was performed. VALUES The same values for Use, Utility, and Levels of Evidence were used by the Committee. BENEFITS, HARMS, AND COSTS The same benefit, harms, and costs were used. RECOMMENDATION No changes in any guidelines were recommended (see text). VALIDATION External review by the American Society of Clinical Oncology (ASCO) Health Services Research Committee and by ASCO Board of Directors. SPONSOR American Society of Clinical Oncology.

2000 Update of Recommendations for the Use of Tumor Markers in Breast and Colorectal Cancer: Clinical Practice Guidelines of the American Society of Clinical Oncology*

2001 ◽  
Vol 19 (6) ◽  
pp. 1865-1878 ◽  
Author(s):  
Robert C. Bast ◽  
Peter Ravdin ◽  
Daniel F. Hayes ◽  
Susan Bates ◽  
Herbert Fritsche ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Colorectal Cancer ◽  
Clinical Practice ◽  
Clinical Oncology ◽  
Tumor Markers ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Disease Free Survival ◽  
Research Committee ◽  
American Society

OBJECTIVE: To update the 1997 clinical practice guidelines for the use of tumor marker tests in the prevention, screening, treatment, and surveillance of breast and colorectal cancers. These guidelines are intended for use in the care of patients outside of clinical trials. OPTIONS: Six tumor markers for colorectal cancer and eight for breast cancer were considered. They could be recommended or not for routine use or for special circumstances. In addition to carcinoembryonic antigen (CEA) and CA 15-3, CA 27.29 was also considered among the serum tumor markers for breast cancer. OUTCOMES: In general, the significant health outcomes identified for use in making clinical practice guidelines (overall survival, disease-free survival, quality of life, lesser toxicity, and cost-effectiveness) were used. EVIDENCE: A computerized literature search from 1994 to March 1999 was performed. VALUES: The same values for use, utility, and levels of evidence were used by the committee. BENEFITS, HARMS, AND COSTS: The same benefit, harms, and costs were used. RECOMMENDATION: Changes were recommended (see Appendix). VALIDATION: The updated recommendations were validated by external review by the American Society of Clinical Oncology’s (ASCO’s) Health Services Research Committee and by ASCO’s Board of Directors. SPONSOR: American Society of Clinical Oncology.

Improving the Evidence Base for Treating Older Adults With Cancer: American Society of Clinical Oncology Statement

2015 ◽  
Vol 33 (32) ◽  
pp. 3826-3833 ◽  
Author(s):  
Arti Hurria ◽  
Laura A. Levit ◽  
William Dale ◽  
Supriya G. Mohile ◽  
Hyman B. Muss ◽  
...  
Keyword(s):  
Older Adults ◽  
Clinical Trials ◽  
Clinical Oncology ◽  
Age Distribution ◽  
Evidence Base ◽  
Institute Of Medicine ◽  
Patients With Cancer ◽  
Treatment Plans ◽  
American Society ◽  
Journal Policies

The American Society of Clinical Oncology (ASCO) convened a subcommittee to develop recommendations on improving the evidence base for treating older adults with cancer in response to a critical need identified by the Institute of Medicine. Older adults experience the majority of cancer diagnoses and deaths and make up the majority of cancer survivors. Older adults are also the fastest growing segment of the US population. However, the evidence base for treating this population is sparse, because older adults are underrepresented in clinical trials, and trials designed specifically for older adults are rare. The result is that clinicians have less evidence on how to treat older adults, who represent the majority of patients with cancer. Clinicians and patients are forced to extrapolate from trials conducted in younger, healthier populations when developing treatment plans. This has created a dearth of knowledge regarding the risk of toxicity in the average older patient and about key end points of importance to older adults. ASCO makes five recommendations to improve evidence generation in this population: (1) Use clinical trials to improve the evidence base for treating older adults with cancer, (2) leverage research designs and infrastructure for generating evidence on older adults with cancer, (3) increase US Food and Drug Administration authority to incentivize and require research involving older adults with cancer, (4) increase clinicians' recruitment of older adults with cancer to clinical trials, and (5) use journal policies to improve researchers' reporting on the age distribution and health risk profiles of research participants.

Breast Cancer Care: Developments in 1998

1998 ◽  
Vol 5 (4) ◽  
pp. 338-345
Author(s):  
John Horton
Keyword(s):  
Breast Cancer ◽  
Cancer Care ◽  
Metastatic Breast ◽  
The United States ◽  
Axillary Node ◽  
Standards Of Care ◽  
Sources Of Information ◽  
Breast Cancer Care ◽  
Mortality And Morbidity ◽  
American Society

Background Breast cancer is a significant cause of mortality and morbidity worldwide, although death rates in the United States and some other countries are beginning to fall. Methods Several sources of information in 1998, including publications and presentations at the 1998 meeting of the American Society of Clinical Oncology, are pertinent to contemporary breast cancer care. Results It is now possible to prescribe hormonal therapy that will reduce the incidence of breast cancer. Methods are available to reduce the morbidity from axillary node dissection, and improvements in adjuvant therapy and management of metastatic breast cancer are now at hand. Conclusions The information presented provides a broad-based platform for new standards of care for breast cancer that will serve as a sound base for further progress in this important disease.

Clinical Oncology Practice 2015: Preparing for the Future

2015 ◽  
pp. e622-e627 ◽  
Author(s):  
Michael P. Kosty ◽  
Anupama Kurup Acheson ◽  
Eric D. Tetzlaff
Keyword(s):  
Clinical Oncology ◽  
Nurse Practitioners ◽  
Cancer Care ◽  
Medical Knowledge ◽  
Physician Assistants ◽  
The United States ◽  
Practice Model ◽  
American Society ◽  
Oncology Practice

The clinical practice of oncology has become increasingly complex. An explosion of medical knowledge, increased demands on provider time, and involved patients have changed the way many oncologists practice. What was an acceptable practice model in the past may now be relatively inefficient. This review covers three areas that address these changes. The American Society of Clinical Oncology (ASCO) National Oncology Census defines who the U.S. oncology community is, and their perceptions of how practice patterns may be changing. The National Cancer Institute (NCI)-ASCO Teams in Cancer Care Project explores how best to employ team science to improve the efficiency and quality of cancer care in the United States. Finally, how physician assistants (PAs) and nurse practitioners (NPs) might be best integrated into team-based care in oncology and the barriers to integration are reviewed.

American Society of Clinical Oncology 1998 Update of Recommended Breast Cancer Surveillance Guidelines

1999 ◽  
Vol 17 (3) ◽  
pp. 1080-1080 ◽  
Author(s):  
Thomas J. Smith ◽  
Nancy E. Davidson ◽  
David V. Schapira ◽  
Eva Grunfeld ◽  
Hyman B. Muss ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Clinical Oncology ◽  
Expert Panel ◽  
Cancer Recurrence ◽  
Disease Free Survival ◽  
Cancer Surveillance ◽  
Surveillance Strategy ◽  
Research Committee ◽  
Services Research ◽  
American Society

OBJECTIVE: To determine an effective, evidence-based, postoperative surveillance strategy for the detection and treatment of recurrent breast cancer. Tests are recommended only if they have an impact on the outcomes specified by American Society of Clinical Oncology (ASCO) for clinical practice guidelines. POTENTIAL INTERVENTION: All tests described in the literature for postoperative monitoring were considered. In addition, the data were critically evaluated to determine the optimal frequency of monitoring. OUTCOME: Outcomes of interest include overall and disease-free survival, quality of life, toxicity reduction, and secondarily cost-effectiveness. EVIDENCE: A search was performed to determine all relevant articles published over the past 20 years on the efficacy of surveillance testing for breast cancer recurrence. These publications comprised both retrospective and prospective studies. VALUES: Levels of evidence and guideline grades were rated by a standard process. More weight was given to studies that tested a hypothesis directly relating testing to one of the primary outcomes in a randomized design. BENEFITS, HARMS, AND COSTS: The possible consequences of false-positive and -negative tests were considered in evaluating a preference for one of two tests providing similar information. Cost alone was not a determining factor. RECOMMENDATIONS: The attached guidelines and text summarize the updated recommendations of the ASCO breast cancer expert panel. Data are sufficient to recommend monthly breast self-examination, annual mammography of the preserved and contralateral breast, and a careful history and physical examination every 3 to 6 months for 3 years, then every 6 to 12 months for 2 years, then annually. Data are not sufficient to recommend routine bone scans, chest radiographs, hematologic blood counts, tumor markers (carcinoembryonic antigen, cancer antigen [CA] 15-5, and CA 27.29), liver ultrasonograms, or computed tomography scans. VALIDATION: The recommendations of the breast cancer expert panel were evaluated and supported by the ASCO Health Services Research Committee reviewers and the ASCO Board of Directors. SPONSOR: American Society of Clinical Oncology.

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