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Christopher K. Bichakjian

It is difficult to imagine a field of medicine in which the importance of multidisciplinary care is greater than in oncology. Whether a patient is treated for breast cancer or sarcoma, prostate cancer or melanoma, the ensuing journey through the

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Shereef M. Elnahal, Peter J. Pronovost and Joseph M. Herman

resources) to meet the needs of patients and their caregivers. We provide a framework to achieve more robust delivery of multidisciplinary care to patients with cancer. Too often, cancer care is organized around physicians. Patients and families are often

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Jaffer A. Ajani, James S. Barthel, David J. Bentrem, Thomas A. D'Amico, Prajnan Das, Crystal S. Denlinger, Charles S. Fuchs, Hans Gerdes, Robert E. Glasgow, James A. Hayman, Wayne L. Hofstetter, David H. Ilson, Rajesh N. Keswani, Lawrence R. Kleinberg, W. Michael Korn, A. Craig Lockhart, Mary F. Mulcahy, Mark B. Orringer, Raymond U. Osarogiagbon, James A. Posey, Aaron R. Sasson, Walter J. Scott, Stephen Shibata, Vivian E. M. Strong, Thomas K. Varghese Jr., Graham Warren, Mary Kay Washington, Christopher Willett and Cameron D. Wright

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Ayal A. Aizer, Jonathan J. Paly, Anthony L. Zietman, Paul L. Nguyen, Clair J. Beard, Sandhya K. Rao, Irving D. Kaplan, Andrzej Niemierko, Michelle S. Hirsch, Chin-Lee Wu, Aria F. Olumi, M. Dror Michaelson, Anthony V. D’Amico and Jason A. Efstathiou

-low-risk patients with an expected survival of less than 20 years, active surveillance avoids overtreatment of a disease that is of minimal threat to survival. 1 , 2 , 8 , 9 The purpose of this study was to test the hypothesis that multidisciplinary care is

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Anke Wind, Francisco Rocha Gonçalves, Edit Marosi, Lucia da Pieve, Monica Groza, Marco Asioli, Marco Albini and Wim van Harten

disciplines, 3 and therefore high-quality multidisciplinary care can be compromised by inadequate coordination. 4 The implementation of care pathways has been shown to reduce variability in clinical practice and to improve outcomes. 5 “Clinical

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Jill R. Tichy, Elgene Lim and Carey K. Anders

for individualized multidisciplinary care requiring complex decision-making. In addition to the traditional team of medical, radiation, and surgical oncologists, optimal care of AYA patients with breast cancer might also include medical geneticists

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Nora M. Hansen, Sally Anne Scherer and Seema Khan

The management of patients with breast cancer has become very complex, and a multidisciplinary approach is paramount to optimal treatment. A multidisciplinary approach requires timely coordination among the varied disciplines involved in patient care, and timely intervention has been shown to lead to better outcomes. To evaluate some of the key processes in providing timely multidisciplinary care, NCCN awarded grants to institutions to evaluate opportunities for improvement in breast cancer care. This article reports on the opportunities for improvement project at Feinberg School of Medicine at Northwestern University.

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Michael D. Green and James A. Hayman

The management of Merkel cell carcinoma (MCC) requires multidisciplinary care for optimal patient outcomes. Radiotherapy (RT) is most commonly used as adjuvant therapy to improve locoregional control in patients with MCC who undergo surgery. Additionally, it can sometimes be used as definitive monotherapy for patients who decline or are not candidates for surgery and as palliative treatment in those with metastatic MCC. This article discusses the indications, treatment considerations, and recommended dose prescriptions for RT in the management of early- and advanced-stage disease. Considerable hope exists that immunotherapy advances will synergize with RT to further enhance clinical outcomes.

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Jennifer M. Hinkel

The issues of patient safety and preventing medical errors routinely make headlines, with reports of thousands of preventable deaths and costs in the billions of dollars per year. Far less noticeable, but potentially more important, is the work taking place on a daily basis to develop new systems and processes of safety and use of technology in the effort to reduce preventable adverse events. The NCCN Third Annual Patient Safety Summit examined 3 processes central to maintaining patient safety in the oncology setting: medication reconciliation, communication during patient hand-offs, and reporting of events, including “near-miss” events that do not reach a patient or result in harm. The NCCN Patient Safety Summit included a multidisciplinary audience of safety experts, clinicians, and hospital administrators from NCCN member institutions, with speakers from member institutions sharing clinical and practical experiences in implementing safety improvements. Common themes included transitions from paper to electronic systems, education and training for individuals and teams as new methods are put into place, and the need for all members of the multidisciplinary care team to recognize their impact on patient safety.

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Jarushka Naidoo, Jiajia Zhang, Evan J. Lipson, Patrick M. Forde, Karthik Suresh, Kendall F. Moseley, Seema Mehta, Shawn G. Kwatra, Alyssa M. Parian, Amy K. Kim, John C. Probasco, Rosanne Rouf, Jennifer E. Thorne, Satish Shanbhag, Joanne Riemer, Ami A. Shah, Drew M. Pardoll, Clifton O. Bingham III, Julie R. Brahmer and Laura C. Cappelli

Background: Immune checkpoint inhibitors (ICIs) may cause immune-related adverse events (irAEs). Methods to obtain real-time multidisciplinary input for irAEs that require subspecialist care are unknown. This study aimed to determine whether a virtual multidisciplinary immune-related toxicity (IR-tox) team of oncology and medicine subspecialists would be feasible to implement, be used by oncology providers, and identify patients for whom multidisciplinary input is sought. Patients and Methods: Patients treated with ICIs and referred to the IR-tox team in August 2017 through March 2018 were identified. Feasibility was defined as receipt of electronic referrals and provision of recommendations within 24 hours of referral. Use was defined as the proportion of referring providers who used the team’s recommendations, which was determined through a postpilot survey. Demographics and tumor, treatment, and referral data were collected. Patient features and irAE associations were analyzed. Results: The IR-tox team was found to be feasible and used: 117 referrals from 102 patients were received in 8 months, all providers received recommendations within 24 hours, 100% of surveyed providers used the recommendations, and 74% changed patient management based on IR-tox team recommendations. Referrals were for suspected irAEs (n=106; 91%) and suitability to treat with ICIs (n=11; 10%). In referred patients, median age was 64 years, 54% were men, 13% had prior autoimmunity, and 46% received ICI combinations versus monotherapy (54%). The most commonly referred toxicities were pneumonitis (23%), arthritis (16%), and dermatitis (15%); 15% of patients had multisystem toxicities. Multiple referrals were more common in those treated with combination ICIs (odds ratio [OR], 6.0; P=.035) or with multisystem toxicities (OR, 8.1; P=.005). The IR-tox team provided a new multidisciplinary forum to assist providers in diagnosing and managing complex irAEs. This model identifies educational and service needs, and patients with irAEs for whom multidisciplinary care is most sought. Conclusions: A virtual multidisciplinary toxicity team for irAEs was a feasible and used service, and facilitated toxicity identification and management.