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Problem-solving
Published in Lawrence S. Chan, William C. Tang, Engineering-Medicine, 2019
In certain medical situations, the physicians of several specialties gather together to perform problem-solving activities as a team effort. One good example is Tumor Board, a team of oncology experts come together to determine the best option for diagnosis and treatment of a given cancer. The traditional tumor board usually consisted of a medical oncologist, a pathologist, a radiologist, and an oncological surgeon. According to National Cancer Institute, a tumor board is “A treatment planning approach in which a number of doctors who are experts in different specialties (disciplines) review and discuss the medical condition and treatment options of a patient. In cancer treatment, a tumor board review may include that of a medical oncologist (who provides cancer treatment with drugs), a surgical oncologist (who provides cancer treatment with surgery), and a radiation oncologist (who provides cancer treatment with radiation). A tumor board is also called a panel of ‘multidisciplinary opinion” (NCI 2018). More recently, a new kind of precision medicine-oriented Molecular Tumor Board is utilized for cancer treatment and its members could include a medical oncologist, an oncological surgeon, and a geneticist, who will provide the cancer genomic data to the board for treatment option discussion (van der Velden et al. 2017). Under these medical situations, groups of physicians perform problem-solving together.
Cancer rehabilitation: current trends and practices within an Austrian University Hospital Center*
Published in Disability and Rehabilitation, 2020
Richard Crevenna, Franz Kainberger, Christoph Wiltschke, Christine Marosi, Michael Wolzt, Fadime Cenik, Mohammad Keilani
Since its implementation in November 2010, the worldwide first and until yet unique “Tumour Board for Cancer Rehabilitation” (since 2010) of the Comprehensive Cancer Centre (CCC) of the Medical University of Vienna (General Hospital of Vienna, Austria) has been an untypical, but regular tumor board, such as the other existing tumor boards of this Centre [5,6]. It is guided by a physiatrist with an expertise in cancer rehabilitation and pain medicine. Referring specialists from different medical specialties and also different therapists – all involved in the rehabilitation process of cancer patients – are invited to attend this tumor board, where challenging cases of cancer patients are discussed with the goal to plan their rehabilitation – but not to treat their cancer itself [5,6,9]. During the board, an individual rehabilitation concept depending on individual functional deficits and on medical conditions of cancer patients is defined, and there is a statement, the so called “tumour board review” (a multidisciplinary opinion) at the end of this process [5,6,9]. This tumor board for cancer rehabilitation has found good acceptance and becomes an important interdisciplinary and multi-professional help to plan rehabilitation and supportive strategies in challenging cancer patients [5,6,9].
Management of two major postoperative bleeding complications after mandible reconstruction with fibula free flap in a patient under chronic warfarin treatment
Published in Case Reports in Plastic Surgery and Hand Surgery, 2019
Abelardo Medina, Ignacio Velasco Martinez
A 60-year-old male that was diagnosed with pT4aN0 clear cell odontogenic carcinoma of the left mandible. He was planned for tracheostomy, segmental mandible resection, left selective neck dissection, and reconstruction with left osteoseptocutaneous fibula free flap (FFF). His past-medical history was relevant for mechanical bi-leaflet mitral valve replacement (MVR) 4 years prior for which he was on warfarin (6 mg PO daily). The patient went through an extensive pre-operative assessment that included multidisciplinary tumor board review and surgical recommendation, assessment by different specialties (anesthesia, cardiology, oral maxillofacial, plastic surgery, dentist, etc.) and multidisciplinary session of virtual surgical planning (VSP). In addition, EKG and bloodwork (type and screen, electrolytes, INR, PTT, BUN, creatinine, eGFR, glucose, CBC and differential) were requested. The INR was checked prior to the surgery to ensure its value was ≤1.5 (patient’s value was 1.06). The patient was evaluated by his cardiologist preoperatively and instructed to stop warfarin 4 days prior to surgery and switch to therapeutic enoxaparin injections (30 mg SC BID). The cardiologist also suggested to re-start enoxaparin (80 mg BID) and warfarin (5 mg daily) when postoperative bleeding has been controlled. The enoxaparin could be stopped when INR ≥2 (with goal of INR 2–3).
Prediction of early mortality following stereotactic body radiotherapy for peripheral early-stage lung cancer
Published in Acta Oncologica, 2019
Sarah Baker, Aman Sharma, Robert Peric, Wilma D. Heemsbergen, Joost Jan Nuyttens
Limitations of the study include its retrospective nature, and the small number of events observed. Retrospective scoring of CIRS and CCI may not have captured all comorbidities. However, detailed clinical notes were available for all patients, and the majority of clinically relevant comorbidities were likely documented. Additionally, there were a small number of events observed. It is encouraging that only 6% of patients experienced death within 6 months of SBRT. However, low event number may have reduced statistical power for detecting potential prognostic factors. Of note, patients in the present study had been deemed suitable SBRT candidates after tumor board review. Investigating the survival times and prognostic factors for patients who are not referred for SBRT due to short anticipated life expectancy would yield valuable insights. An additional limitation of the analysis is that the prognostic factors identified cannot in isolation identify patient groups with very poor short-term survival; even patients with tumor diameter greater than 3 cm and CIRS scores of 8 or higher had a 6-month OS of 70%. This relatively high 6-month survival is an important observation, highlighting that patients with high CIRS score and large tumor diameter should not be excluded from SBRT on the basis of these characteristics alone. Whether additional adverse prognostic features may be identified which in combination reliably predict for very poor short term survival such that forgoing SBRT is warranted remains to be elucidated. Finally, we were unable to report the cause of death, as this information was not available for the majority of patients. Hence, short-term cancer-specific survival could not be assessed, nor treatment-related mortality. However, it is reassuring that we previously observed no grade 4–5 toxicity in peripheral early stage lung cancer patients treated with this regimen [5]. Further study into the cause of early mortality might yield valuable insight, such as whether comorbidities captured on CIRS and their severity are related to the specific cause of death. Nevertheless, the survival estimates here, as well as the identification of CIRS as an important determinant of short-term survival, provide useful information for patients and clinicians when discussing the cost-benefit analysis for definitive treatment.