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| Date post: | 05-Dec-2014 |
| Category: |
Health & Medicine |
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Multidisciplinary cancer teams
action
n
y
action
clinical state
decision
Algorythms
uncertainty
atypical cases
pt preferences
complexity
R p<0.05
R p<0.05
Decision analysis
action
action
outcome
outcome
utility
action
action
outcome
outcome U1utility =U2
utility =U3
U1utility =U1P1
P2
EU = (P1*U1)+(P2*U2)
EU = (1*U3)
“Strategic” clinical decision
radiation & chemo
surgery
radiation & chemo
surgery
Tumor boards
Organization
Surg
Med
RT
TUM TUM TUM
Organization
Surg
Med
RT
TUM TUM TUM
Decision rule
Psycho-oncologists
…is a patient-physician shared decision!
The good clinical decision…
The reference physician
Extra medical time!
Frequent solid cancers
inc./100,000/y
GI 110Urological 84Breast 64Lung 56Gynecological 28
Rare solid cancers
inc./100,000/y
Head & neck 16Melanoma 14 Sarcoma 6CNS 6Endocrine 4Neuroendocrine 3Thoracic rare 2
Rare solid cancers
inc./100,000/y
Head & neck 10Rare GI 6 Sarcoma 6CNS 6Endocrine 4Neuroendocrine 3Rare male genital 3Rare female genital 2Rare urological 2Rare thoracic 2Skin rare 1
From the reference center...
…to the Reference network
Rare cancers…
childhood
Rare cancers…
hematologicalchildhood
Rare cancers…
childhoodhematological
adult solid tumors
Rare Tumours in EuropeCHALLENGES AND SOLUTIONS6 November 2008 - Brussels
Rare Tumours in EuropeCHALLENGES AND SOLUTIONS
www.rarecancers.eu
PR
VA
LC
VI TV
BG
LU
GR
PG
CN
AL
MI
Desio
LO
PV
Alzano LombardoC
O
Casalpusterlengo M
N
Orbassano
CandioloTO
Ivrea
Biella N
O Negrar
Aviano
TS
SS
Olbia
SondaloBZ
Taormina
TA
TN
TN
Treviglio
UD
VB
GE
FIPI
LIValdarno A
R
Empoli
CA
CT
AG
TP
ME
PA
BNN
A
CZ
RC
Tropea
Rionero in VultureP
Z
Altamura
Castellaneta
LE
BR
Manduria
S.G. Rotondo
BA
AN
PU
Lanciano
Penne
S.Omero (v.Vibrata)
AQ
PE
Cittàdella Pieve
Città di Castello
LT
FE
Forlì
BO
MO
Carpi
PC
RA
VC V
RPD
CB
IS
AO
RE
CR
GO
PO
Nocera Inf.
Alba
Asolo
BLSO
BS
CS
ROMA
TE
S.Severino Marche
chemotherapy
surgery
radiation
“logical” patient
“virtual” patient
“real” patient
Who is moving in a network?
pathologic diagnosismultidisciplinary strategic decision
surgeryhi-tech resources
virtual sharing!
rationalization!
Distant patient sharing
Teleconsulting…
McAleer JJA et al.Broadcast quality teleconferencing for oncology.The Oncologist 2001; 6: 459
GIST Synovial Sarcoma
Leiomyosarcoma Cellular Schwannoma
Extra medical time!
020406080
100
12 24 36 48 mos
Cost shift
healthsystem
REGIONE
LOMBARDIA
PHARMACIES
HEALTH & SOCIAL
ASSISTANCE
GENERAL
PRACTITIONERS
LOCAL HEALTH
CARE UNITS
CITIZENS
HOSPITALS
REGIONE
LOMBARDIA
FARMACIE
ASSI
MMG/PLS AZIENDE
SANITARIE LOCALI
CITTADINI
ENTI EROGATORI
< x >name = “value”
Patient discharge reportOutpatient clinic visit report
Patient discharge reportOutpatient clinic visit report
Patient cancer historyPatient non-cancer historyTreatment program in the current phase of diseaseTreatment donePatient state
< x >name = “value”
“ROL-doc”
Patient cancer historyPatient non-cancer historyTreatment program in the current phase of diseaseTreatment donePatient state
Patient cancer historyPatient non-cancer historyTreatment program in the current phase of diseaseTreatment donePatient state
diseases
tumors
Disease “phase”
Disease “phase”
localized metastasis terminaldisease (1st CT) (2nd CT) disease
Disease phases
localized metastasis terminaldisease (CT 1st l) (CT 2nd l) disease
Disease phases
localized metastasis terminaldisease (CT 1st l) (CT 2nd l) disease
clinical practiceguidelines
Clinical practice guidelines
Stadiazione
Metastasi
Exeresi> ampiaconserv.fattibile
Demolizione fattibile
Exeresiampia
Sarcoma t.molli tipico
adultoG2-3
M. avanzata
Resezioneradicale
Demolizione
>5 cm CT
Sì
Sì
Sì
Rifiutodemolizio
neSì No
Sì
No
No
No
Follow-upG2-3 NED
AccettaCT SìSì
No
No
>5 cm CT + RTAccettaCT SìSì
RTNo
No
M. locoreg.inoperabile
Exeresimarginale
fattibile
Sì
No
Virtual tissue banking
Data protection regulations!
The medical semantics!
In brief...Multidisciplinarity is imposed by the multimodal approach to most solid cancersMultidisciplinarity implies an integrated cooperation of specialists, not just their involvement one by oneIt is a challenge for cancer centers and physiciansIt will be more and more played within collaborative networksRare cancers are a priority for national and cross-nation networkingBut networking is spreading to manage cancer care in general also at a regional levelIn the end, multidisciplinarity within a hospital, or a comprehensive cancer center, or a network, or a health system, needs money, which will pay off, certainly in the society perspective
