Quality and Clinical Outcomes Improvement in the Management of Oncology Patients

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Survivorship and Quality of Life".

Deadline for manuscript submissions: 1 October 2024 | Viewed by 3833

Special Issue Editor

Special Issue Information

Dear Colleagues,

The art and science of the analysis and quality improvement of clinical outcomes in the management of oncology patients, along with patient safety, continue to evolve at an increasingly rapid pace. In fact, over the years, novel concepts have arisen (risk stratification, shared decision making, interdisciplinary meetings, prehabilitation, etc.), new initiatives have taken shape (e.g., state/nation-wide or international clinical databases), and new innovative treatments have emerged. In order to care for our patients, raise the standards of healthcare services, and be successful in today’s and tomorrow’s rapidly changing healthcare environment, understanding and advancing these fields represents an essential duty of all oncologists, surgeons, physicians, and professionals related to oncology patients.

In this context, we call oncologists, surgeons, physicians, and professionals from all disciplines involved in the perioperative pathway of oncology patients (oncologists, surgeons, anesthesiologists, radiologists, intensivists, cardiologists, pulmonologists, nurses, physiotherapists, nutritionists, etc.) to contribute to this Special Issue. Our vision is to provide the best currently available evidence on this crucial topic, thus providing all the necessary information to clinicians regarding core concepts in the management of oncology patients.

Dr. Dimitrios E. Magouliotis
Guest Editor

Manuscript Submission Information

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • oncology
  • surgical oncology
  • quality improvement
  • clinical outcomes
  • patient safety

Published Papers (4 papers)

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Research

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30 pages, 968 KiB  
Article
Different Patterns of Care and Survival Outcomes in Transplant-Centre Managed Patients with Early-Stage HCC: Real-World Data from an Australian Multi-Centre Cohort Study
by Jonathan Abdelmalak, Simone I. Strasser, Natalie L. Ngu, Claude Dennis, Marie Sinclair, Avik Majumdar, Kate Collins, Katherine Bateman, Anouk Dev, Joshua H. Abasszade, Zina Valaydon, Daniel Saitta, Kathryn Gazelakis, Susan Byers, Jacinta Holmes, Alexander J. Thompson, Dhivya Pandiaraja, Steven Bollipo, Suresh Sharma, Merlyn Joseph, Rohit Sawhney, Amanda Nicoll, Nicholas Batt, Myo J. Tang, Stephen Riordan, Nicholas Hannah, James Haridy, Siddharth Sood, Eileen Lam, Elysia Greenhill, John Lubel, William Kemp, Ammar Majeed, John Zalcberg and Stuart K. Robertsadd Show full author list remove Hide full author list
Cancers 2024, 16(11), 1966; https://doi.org/10.3390/cancers16111966 - 22 May 2024
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Abstract
The management of early-stage hepatocellular carcinoma (HCC) is complex, with multiple treatment strategies available. There is a paucity of literature regarding variations in the patterns of care and outcomes between transplant and non-transplant centres. We conducted this real-world multi-centre cohort study in two [...] Read more.
The management of early-stage hepatocellular carcinoma (HCC) is complex, with multiple treatment strategies available. There is a paucity of literature regarding variations in the patterns of care and outcomes between transplant and non-transplant centres. We conducted this real-world multi-centre cohort study in two liver cancer referral centres with an integrated liver transplant program and an additional eight non-transplant HCC referral centres across Australia to identify variation in patterns of care and key survival outcomes. Patients with stage Barcelona Clinic Liver Cancer (BCLC) 0/A HCC, first diagnosed between 1 January 2016 and 31 December 2020, who were managed at a participating site, were included in the study. Patients were excluded if they had a history of prior HCC or if they received upfront liver transplantation. A total of 887 patients were included in the study, with 433 patients managed at a liver cancer centre with a transplant program (LTC) and 454 patients managed at a non-transplant centre (NTC). Management at an LTC did not significantly predict allocation to resection (adjusted OR 0.75, 95% CI 0.50 to 1.11, p = 0.148). However, in those not receiving resection, LTC and NTC patients were systematically managed differently, with LTC patients five times less likely to receive upfront ablation than NTC patients (adjusted OR 0.19, 95% CI 0.13 to 0.28, p < 0.001), even after adjusting for tumour burden, as well as for age, gender, liver disease aetiology, liver disease severity, and medical comorbidities. LTCs exhibited significantly higher proportions of patients undergoing TACE for every tumour burden category, including those with a single tumour measuring 2 cm or less (p < 0.001). Using multivariable Cox proportional hazards analysis, management at a transplant centre was associated with reduced all-cause mortality (adjusted HR 0.71, 95% CI 0.51 to 0.98, p = 0.036), and competing-risk regression analysis, considering liver transplant as a competing event, demonstrated a similar reduction in risk (adjusted HR 0.70, 95% CI 0.50 to 0.99, p = 0.041), suggesting that the reduced risk of death is not fully explained by higher rates of transplantation. Our study highlights systematic differences in HCC care between large volume liver transplant centres and other sites, which has not previously been well-described. Further work is needed to better define the reasons for differences in treatment allocation and to aim to minimise unwarranted treatment variation to maximise patient outcomes across Australia. Full article
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16 pages, 1676 KiB  
Article
What Is a Sarcoma ‘Specialist Center’? Multidisciplinary Research Finds an Answer
by Roger Wilson, Denise Reinke, Gerard van Oortmerssen, Ornella Gonzato, Gabriele Ott, Chandrajit P. Raut, B. Ashleigh Guadagnolo, Rick L. M. Haas, Jonathan Trent, Robin Jones, Lauren Pretorius, Brandi Felser, Mandy Basson, Kathrin Schuster and Bernd Kasper
Cancers 2024, 16(10), 1857; https://doi.org/10.3390/cancers16101857 - 13 May 2024
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Abstract
The management of sarcomas in specialist centers delivers significant benefits. In much of the world, specialists are not available, and the development of expertise is identified as a major need. However, the terms ‘specialist’ or ‘expert’ center are rarely defined. Our objective is [...] Read more.
The management of sarcomas in specialist centers delivers significant benefits. In much of the world, specialists are not available, and the development of expertise is identified as a major need. However, the terms ‘specialist’ or ‘expert’ center are rarely defined. Our objective is to offer a definition for patient advocates and a tool for healthcare providers to underpin improving the care of people with sarcoma. SPAGN developed a discussion paper for a workshop at the SPAGN 2023 Conference, attended by 75 delegates. A presentation to the Connective Tissue Oncology Society (CTOS) and further discussion led to this paper. Core Principles were identified that underlie specialist sarcoma care. The primary Principle is the multi-disciplinary team discussing every patient, at first diagnosis and during treatment. Principles for optimal sarcoma management include accurate diagnosis followed by safe, high-quality treatment, with curative intent. These Principles are supplemented by Features describing areas of healthcare, professional involvement, and service provision and identifying further research and development needs. These allow for variations because of national or local policies and budgets. We propose the term ‘Sarcoma Intelligent Specialist Network’ to recognize expertise wherever it is found in the world. This provides a base for further discussion and local refinement. Full article
10 pages, 917 KiB  
Article
Improving Breast Cancer Outcomes for Indigenous Women in Australia
by Vita Christie, Lynette Riley, Deb Green, Janaki Amin, John Skinner, Chris Pyke and Kylie Gwynne
Cancers 2024, 16(9), 1736; https://doi.org/10.3390/cancers16091736 - 29 Apr 2024
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Abstract
In Australia, the incidence rate of breast cancer is lower in Indigenous* women than non-Indigenous women; however, the mortality rate is higher, with Indigenous women 1.2 times more likely to die from the disease. This paper provides practical and achievable solutions to improve [...] Read more.
In Australia, the incidence rate of breast cancer is lower in Indigenous* women than non-Indigenous women; however, the mortality rate is higher, with Indigenous women 1.2 times more likely to die from the disease. This paper provides practical and achievable solutions to improve health outcomes for Indigenous women with breast cancer in Australia. This research employed the Context–Mechanism–Outcome (CMO) framework to reveal potential mechanisms and contextual factors that influence breast cancer outcomes for Indigenous women, stratified into multiple levels, namely, micro (interpersonal), meso (systemic) and macro (policy) levels. The CMO framework allowed us to interpret evidence regarding Indigenous women and breast cancer and provides nine practical ways to improve health outcomes and survival rates. Full article
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18 pages, 4583 KiB  
Systematic Review
Perforator versus Non-Perforator Flap-Based Vulvoperineal Reconstruction—A Systematic Review and Meta-Analysis
by Séverin Wendelspiess, Loraine Kouba, Julia Stoffel, Nicole Speck, Christian Appenzeller-Herzog, Brigitta Gahl, Céline Montavon, Viola Heinzelmann-Schwarz, Ana Lariu, Dirk J. Schaefer, Tarek Ismail and Elisabeth A. Kappos
Cancers 2024, 16(12), 2213; https://doi.org/10.3390/cancers16122213 - 13 Jun 2024
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Abstract
Background: Patients with advanced vulvoperineal cancer require a multidisciplinary treatment approach to ensure oncological safety, timely recovery, and the highest possible quality of life (QoL). Reconstructions in this region often lead to complications, affecting approximately 30% of patients. Flap design has evolved towards [...] Read more.
Background: Patients with advanced vulvoperineal cancer require a multidisciplinary treatment approach to ensure oncological safety, timely recovery, and the highest possible quality of life (QoL). Reconstructions in this region often lead to complications, affecting approximately 30% of patients. Flap design has evolved towards perforator-based approaches to reduce functional deficits and (donor site) complications, since they allow for the preservation of relevant anatomical structures. Next to their greater surgical challenge in elevation, their superiority over non-perforator-based approaches is still debated. Methods: To compare outcomes between perforator and non-perforator flaps in female vulvoperineal reconstruction, we conducted a systematic review of English-language studies published after 1980, including randomized controlled trials, cohort studies, and case series. Data on demographics and surgical outcomes were extracted and classified using the Clavien–Dindo classification. We used a random-effects meta-analysis to derive a pooled estimate of complication frequency (%) in patients who received at least one perforator flap and in patients who received non-perforator flaps. Results: Among 2576 screened studies, 49 met our inclusion criteria, encompassing 1840 patients. The overall short-term surgical complication rate was comparable in patients receiving a perforator (n = 276) or a non-perforator flap (n = 1564) reconstruction (p* > 0.05). There was a tendency towards fewer complications when using perforator flaps. The assessment of patients’ QoL was scarce. Conclusions: Vulvoperineal reconstruction using perforator flaps shows promising results compared with non-perforator flaps. There is a need for the assessment of its long-term outcomes and for a systematic evaluation of patient QoL to further demonstrate its benefit for affected patients. Full article
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