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Background Centralization of pancreatic cancer surgery aims to improve postoperative outcomes. Consequently, patients with pancreatic cancer may undergo pancreatic surgery in an expert centre and adjuvant chemotherapy in a local hospital (network treatment). The aim of this study was to assess whether network treatment has an impact on time to chemotherapy, failure to complete adjuvant chemotherapy, and survival. Second, whether these parameters varied between pancreatic networks was studied. Methods This retrospective study included all patients diagnosed with non-metastatic pancreatic ductal adenocarcinoma who underwent pancreatic surgery and adjuvant chemotherapy, registered in the Netherlands Cancer Registry (2015–2020). Time to chemotherapy was defined as the time between surgery and the start of adjuvant chemotherapy. Completion of adjuvant chemotherapy was defined as the receipt of 12 cycles of FOLFIRINOX or six cycles of gemcitabine. Analysis was performed with linear mixed models and multilevel logistic regression models. Cox regression analyses were performed for survival. Results In total, 1074 patients were included. Network treatment was observed in 468 patients (43.6 per cent) and was not associated with longer time to chemotherapy (0.77 days, standard error (s.e.) 1.14, P = 0.501), failure to complete adjuvant chemotherapy (odds ratio (OR) = 1.140, 95 per cent c.i. 0.86 to 1.52, P = 0.349), and overall survival (hazards ratio (HR) = 1.04, 95 per cent c.i. 0.88 to 1.22, P = 0.640). Significant variation between the networks was observed for time to chemotherapy (range 40.5–63 days, P < 0.0001) and completion of adjuvant chemotherapy (range 19–52 per cent, P = 0.030). Adjusted for case mix, time to chemotherapy significantly differed between networks. Conclusion In this nationwide analysis, network treatment in patients with resected pancreatic cancer was not associated with longer time to chemotherapy, failure to complete adjuvant chemotherapy, and worse survival. Significant variation between pancreatic cancer networks was found for time to chemotherapy.

Contains fulltext : 288214.pdf (Publisher’s version ) (Open Access) BACKGROUND: Due to the centralization of pancreatic surgery, patients with suspected pancreatic cancer may undergo diagnostic workup in both a non-pancreatic centre and a pancreatic centre, i.e. multicentre workup. This retrospective study assessed whether multicentre diagnostic workup is associated with repeated diagnostics, delayed time-to-diagnosis, delayed time-to-treatment, survival and whether variation existed among pancreatic cancer networks. METHODS: This nationwide study included all patients diagnosed with non-metastatic pancreatic ductal adenocarcinoma (PDAC) in 2015, registered by the Netherlands Cancer Registry. A delayed time-to-diagnosis was defined as ≥3 weeks from initial hospital visit to final diagnosis. A delayed time-to-treatment was defined as ≥6 weeks from the first hospital visit to start of first tumour treatment. Multilevel logistic regression analyses and survival analyses were performed. RESULTS: In total, 931 patients with non-metastatic PDAC were included. Overall, 175 patients (19%) underwent a multicentre diagnostic workup, which was significantly associated with repeated diagnostic investigations (OR = 6.31, 95% CI 4.13-9.64, P

INTRODUCTION: With the accumulating evidence on the added value on prediction of outcomes of geriatric assessment (GA) in older patients with cancer, the question shifts from whether performing a GA is useful, to how to implement this into standard practice in a feasible and effective way. The effect of implementing GA, and assessment of patient preferences on treatment recommendations by an onco-geriatric multidisciplinary team (MDT), was compared to the recommendation previously made by the tumor board (care as usual).METHODS: Patients aged 70 years and older with a solid malignancy who were referred to a tertiary care center for diagnosis and treatment recommendations, as provided by a tumor board, were included. The intervention consisted of: a nurse-led GA and assessment of patient preferences prior to the start of oncological treatment, discussing this in an onco-geriatric MDT, and weighing all this information in a structured, stepwise manner. Treatment recommendations formulated by this onco-geriatric MDT were compared to the treatment recommendations by the tumor board.RESULTS: Of 236 eligible patients, 197 were included. For 27%, treatment recommendations from the onco-geriatric MDT differed from the recommendations formulated by the tumor board. These modifications were mostly towards less intensive curative or palliative treatment. Thirteen percent of patients were subsequently referred to a geriatrician in order to reach a treatment recommendation.DISCUSSION: Implementing an onco-geriatric care trajectory, using GA and assessment of patient preferences, resulted in an adjustment of treatment recommendations for a quarter of patients. Thirteen percent needed subsequent referral to a geriatrician.

BACKGROUND Oncological health care services are challenged by the increasing number of cancer survivors, long-term follow-up care, and fragmentation of care. Digital care platforms are potential tools to deliver affordable, patient-centered oncological care. Previous reviews evaluated only one feature of a digital care platform or did not evaluate the effect on enhancement of information, self-efficacy, continuity of care, or patient- and health care provider–reported experiences. Additionally, they have not focused on the barriers and facilitators for implementation of a digital care platform in oncological care. OBJECTIVE The aim of this systematic review was to collect the best available evidence of the effect of a digital care platform on quality of care parameters such as enhancement of available information, self-efficacy, continuity of care, and patient- and health care provider–reported experiences. Additionally, barriers and facilitators for implementation of digital care platforms were analyzed. METHODS The PubMed (Medline), Embase, CINAHL, and Cochrane Library databases were searched for the period from January 2000 to May 2020 for studies assessing the effect of a digital care platform on the predefined outcome parameters in oncological patients and studies describing barriers and facilitators for implementation. Synthesis of the results was performed qualitatively. Barriers and facilitators were categorized according to the framework of Grol and Wensing. The Mixed Methods Appraisal Tool was used for critical appraisal of the studies. RESULTS Seventeen studies were included for final analysis, comprising 8 clinical studies on the effectiveness of the digital care platform and 13 studies describing barriers and facilitators. Usage of a digital care platform appeared to enhance the availability of information and self-efficacy. There were no data available on the effect of a digital care platform on the continuity of care. However, based on focus group interviews, digital care platforms could potentially improve continuity of care by optimizing the exchange of patient information across institutes. Patient-reported experiences such as satisfaction with the platform were considerably positive. Most barriers for implementation were identified at the professional level, such as the concern for increased workload and unattended release of medical information to patients. Most facilitators were found at the patient and innovation levels, such as improved patient-doctor communication and patient empowerment. There were few barriers and facilitators mentioned at the economic and political levels. CONCLUSIONS The use of digital care platforms is associated with better quality of care through enhancement of availability of information and increased self-efficacy for oncological patients. The numerous facilitators identified at the patient level illustrate that patients are positive toward a digital care platform. However, despite these favorable results, robust evidence concerning the effectiveness of digital care platforms, especially from high-quality studies, is still lacking. Future studies should therefore aim to further investigate the effectiveness of digital care platforms, and the barriers and facilitators to their implementation at the economic and political levels.

Background Over the past decades, health care services for pancreatic surgery were reorganized. Volume norms were applied with the result that only a limited number of expert centers perform pancreatic surgery. As a result of this centralization of pancreatic surgery, the patient journey of patients with pancreatic tumors has become multi-institutional. To illustrate, patients are referred to a center of expertise for pancreatic surgery whereas other parts of pancreatic care, such as chemotherapy, take place in local hospitals. This fragmentation of health care services could affect continuity of care (COC). The aim of this study was to assess COC perceived by patients in a pancreatic care network and investigate correlations with patient-and care-related characteristics. Methods This is a pilot study in which patients with (pre) malignant pancreatic tumors discussed in a multidisciplinary tumor board in a Dutch tertiary hospital were asked to participate. Patients were asked to fill out the Nijmegen Continuity of Care-questionnaire (NCQ) (5-point Likert scale). Additionally, their patient-and care-related data were retrieved from medical records. Correlations of NCQ score and patient-and care-related characteristics were calculated with Spearman’s correlation coefficient. Results In total, 44 patients were included (92% response rate). Pancreatic cancer was the predominant diagnosis (32%). Forty percent received a repetition of diagnostic investigations in the tertiary hospital. Mean scores for personal continuity were 3.55 ± 0.74 for GP, 3.29 ± 0.91 for the specialist and 3.43 ± 0.65 for collaboration between GPs and specialists. Overall COC was scored with a mean 3.38 ± 0.72. No significant correlations were observed between NCQ score and certain patient-or care-related characteristics. Conclusion Continuity of care perceived by patients with pancreatic tumors was scored as moderate. This outcome supports the need to improve continuity of care within multi-institutional pancreatic care networks.

Purpose For the safety and success of an ultrasound-guided percutaneous liver biopsy, needle visibility and needle tip identification are critical. The aim of this pilot study was to evaluate the influence of an innovative echogenic sheath placed over a standard biopsy needle on needle visibility in ultrasound imaging. Materials and methods Ultrasound videos of three sheaths with different coating characteristics (echogenicity) and one conventional liver biopsy needle were recorded at two angles (30° and 60°) and two depths (5 and 10 cm) in a human cadaver. The videos were blinded for needle type and presented to five independent radiologists who used Likert-scale scoring to rank each video for six characteristics on needle visibility. In addition, a phantom model was used to acquire standardized images for quantitative evaluation of the ultrasound visibility. Comparative statistical analysis consisted of a one-way ANOVA. Results The three prototype sheaths were ranked higher than the control needle at 60° with 5 cm depth, with an equal performance for the other conditions. The radiologists expressed more confidence in taking a biopsy with the echogenic sheaths than with the control needle, with 1 Likert score difference at 30°. Contrast analysis in the phantom model showed a statistically significant effect of a sheath (p = 0.004) on echogenic intensity. Conclusion This pilot study suggests that the use of an echogenic sheath may increase needle visibility, particularly for trajectories requiring steeper insertion angles. To investigate the superiority of the echogenic sheath over conventional needles, a clinical study is necessary.

Contains fulltext : 248249.pdf (Publisher’s version ) (Open Access) CONTEXT: Focal therapy is a promising, minimally invasive strategy to selectively treat localized prostate cancer. A previous systematic review indicated that there is growing evidence for favorable functional outcomes, but that oncological effectiveness was yet to be defined. OBJECTIVE: To assess the effectiveness of focal therapy in patients with localized prostate cancer in terms of functional and oncological outcomes. EVIDENCE ACQUISITION: PubMed, Embase, and The Cochrane Library were searched for studies between October 2015 and December 31, 2020. In addition, the research stages were acquired according to the Idea, Development, Exploration, Assessment, Long-term study (IDEAL) recommendations. Ongoing studies were identified through clinical trial registries. EVIDENCE SYNTHESIS: Seventy-two studies were identified exploring eight different sources of energy to deliver focal therapy in 5827 patients. Twenty-seven studies reported on high-intensity focused ultrasound (HIFU), nine studies on irreversible electroporation, 11 on cryoablation, eight on focal laser ablation and focal brachytherapy, seven on photodynamic therapy (PDT), two on radiofrequency ablation, and one on prostatic artery embolization. The majority of studies were prospective development stage 2a studies (n = 357). PDT and HIFU, both in stage 3, showed promising results. Overall, HIFU studies reported a median of 95% pad-free patients and a median of 85% patients with no clinically significant cancer (CSC) in the treated area. For PDT, no changes in continence were reported and a median of 90% of patients were without CSC. Both treatments were well tolerated. CONCLUSIONS: Over the past 5 yr, focal therapy has been studied for eight different energy sources, mostly in single-arm stage 2 studies. Although a first randomized controlled trial in focal therapy has been performed, more high-quality evaluations are needed, preferably via multicenter randomized controlled trials with long-term follow-up and predefined assessment of oncological and functional outcomes and health-related quality-of-life measures. PATIENT SUMMARY: Focal treatment (FT) of prostate cancer has potential, considering that it has less impact on continence and potency than radical treatment. Our systematic review indicates that despite the method being studied extensively over the past half decade, the majority of studies remain in an early research stage. The techniques high-intensity focused ultrasound and photodynamic therapy have shown most progression toward advanced research stages and show favorable results. However, more high-quality evidence is required before FT can become available as a standard treatment.