Cochrane Special Collection | 17 March 2021| Brain tumour diagnosis and management
This Special Collection provides up-to-date evidence in these key clinical priority areas of brain tumour research. It includes Cochrane Reviews that address several areas identified by the Neuro-Oncology James Lind Alliance Priority Setting Partnership in the UK as important to the brain tumour community. In addition to reviews included in this Special Collection, Cochrane Gynaecological, Neuro-oncology and Orphan Cancers has published a protocol on ‘Diagnostic test accuracy and cost-effectiveness of tests for codeletion of chromosomal arms 1p and 19q in people with glioma’.[1] The reviews in this Collection provide evidence towards clinical priority areas for research, and their funding, and therefore, are important for consumers, clinicians, healthcare providers and funders.
IQVIA Institute | March 2021 | Cancer won’t wait: building resilience in cancer screening and diagnostics in Europe based on lessons from the pandemic
This report, from The IQVIA Institute for Human Data Science, highlights some of the approaches already being taken to address the ongoing impact of COVID-19 on health services across Europe has in most cases led to significant reductions in cancer screening, testing and diagnosis. The resultant delays in diagnosis are impacting cancer treatment and survival. The publication also makes a number of suggestions for what should be done going forward. It considers different stakeholders – from local pharmacies to national and international organisations – and their roles, as well as multi-stakeholder collaboration and cooperation. It aims to highlight initiatives adopted in some countries that can be shared more widely. It is also intended to provide a platform for additional activity during 2021 focused on specific types of cancer and expanded local, country-specific initiatives.
Reduced screening and testing causes
Source: IQVIA Institute for Human Data Science
Key points
Reduced screenings and testing can be attributed to both health system issues and patient concerns
Re-prioritisation of health system resources has caused a reduction in capacity and significant disruption to the provision of health services
Patient attitudes and concerns about engaging with the health system, especially for asymptomatic conditions and preventative measures, have also triggered the steep decline in screenings and testing
Recommendations
The response to the COVID-19 pandemic has already shown that much can be achieved by embracing innovation and adapting quickly
There is an ongoing need for collaboration at all levels and for organisations to learn quickly and share good practice
There is a shared responsibility to take action, which will require leadership, flexibility and cultural change in order for the lessons from this pandemic to be learned and to achieve greater resilience going forward
Registration required to download the report Cancer won’t wait: building resilience in cancer screening and diagnostics in Europe based on lessons from the pandemic
NICE | March 2021 | Pembrolizumab with pemetrexed and platinum chemotherapy for untreated, metastatic, non-squamous non-small-cell lung cancer
Today (10 March 2021) NICE has published final guidance on a potentially life-extending treatment for some people with non-squamous, non-small-cell lung cancer (NSCLC); the treatment will now be available on the NHS following its approval.
Evidence-based recommendations on pembrolizumab (Keytruda) with pemetrexed and platinum chemotherapy for untreated, metastatic, non-squamous non-small-cell lung cancer (NSCLC) in adults whose tumours have no epidermal growth factor receptor (EGFR)- or anaplastic lymphoma kinase (ALK)-positive mutations.
NIHR | March 2021 | To improve team decision-making in cancer care: streamline workload, shorten meetings, address logistics and keep a gender balance on the team
A multi-disciplinary approach to decision making in cancer care is recognised as being the ‘gold-standard’, although evidence of its effectiveness remains unclear. Authors of this study set out to test, for the first time, the functional perspective of group DM in cancer MDTs, operationalized as two specific hypotheses: (H1) the interaction process, the internal factors, external circumstances, and case complexity will impact on the quality of DM for patients; and (H2) there will be a difference in the interaction process, internal and external factors, and quality of DM between the first and second half of a MDT meeting. The researchers followed three MDTs at university hospitals in Greater London and Derbyshire. Each MDT comprised around 14-15 members and specialised in breast, colorectal and gynaecological cancers. Between 2015-16, the researchers videoed 30 meetings in which more than 800 patients were discussed. Some patients had complex cancer; others had suspected cancer or benign disease (Source: NIHR & Soukop, et al. 2021).
Key findings:
decision-making was better in larger teams, in those which had a balance of genders, and when more complex cases were being discussed (since these discussions involved more team members). Question-and-answer style communication was helpful
barriers to decision-making during the meetings included antagonism, tension, and lack of acknowledgement of other members’ contributions; gender imbalance; and logistical issues with administration, equipment and meeting attendance
time and workload pressures hindered decision-making. The longer the meeting, and the more cases discussed, the worse the quality of decision-making and communication. The optimal number of patients discussed was 20. Beyond that, the quality of decision-making went down with every treatment recommendation made and negative reactions increased.
first versus second half of the meeting had different challenges. Patients discussed in the first half of the meeting had more complex needs. In the second half, cases were more straightforward, but less time was spent discussing them as team members became tired. They also started to leave so the remaining group had less broad expertise.
Following the research, the team recommend:
Streamlining MDT workload to help reduce the time all MDT members spend in the meetings. Only patients with complex needs requiring input from various specialists should be discussed. The MeDiC tool may help to select patients.
A maximum limit on the number of cases discussed at a single meeting.
A mandatory short break during the meeting.
Better preparation to smooth out logistical issues ahead of meetings, for example, using a checklist to ensure all information is readily available.
An MDT meeting chair who does not contribute to the clinical discussion could steer the team through the workload by reducing tensions, promoting positive interaction and communication, and ensuring a more uniform decision-making process.
Staff selection for MDTs should factor in gender. (Source: NIHR)
Abstract
Background
Multidisciplinary teams (MDT) formulate expert informed treatment recommendations for people with cancer. We set out to examine how the factors proposed by the functional perspective of group decision making (DM), that is, interaction process, internal factors (factors emanating from within the group such as group size), external circumstances (factors coming from the outside of the team), and case‐complexity affect the quality of MDT decision making.
Methods
This was a cross‐sectional observational study. Three cancer MDTs were recruited with 44 members overall and 30 of their weekly meetings filmed. Validated observational instruments were used to measure quality of DM, interactions, and complexity of 822 case discussions.
Results
The full regression model with the variables proposed by the functional perspective was significant, R2 = 0.52, F(20, 801) = 43.47, P < .001, adjusted R2 = 0.51. Positive predictors of DM quality were asking questions (P = .001), providing answers (P = .001), team size (P = .007), gender balance (P = .003), and clinical complexity (P = .001), while negative socioemotional reactions (P = .007), gender imbalance (P = .003), logistical issues (P = .001), time‐workload pressures (P = .002), and time spent in the meeting (P = .001) were negative predictors. Second half of the meetings also saw significant decrease in the DM quality (P = .001), interactions (P = .001), group size (P = .003), and clinical complexity (P = .001), and an increase in negative socioemotional reactions (P = .001) and time‐workload pressures (P = .001).
Discussion
To the best of our knowledge, this is the first study to attempt to assess the factors proposed by the functional perspective in cancer MDTs. One novel finding is the effect of sociocognitive factors on team DM quality, while another is the cognitive‐catch 22 effect: while the case discussions are significantly simpler in the second half of the meeting, there is significantly less time left to discuss the remaining cases, further adding to the cognitive taxation in teams who are now rapidly attempting to close their time‐workload gap. Implications are discussed in relation to quality and safety.
Image source: Soukup, et al. 2021
Graphical representation of the functional perspective of group decision making as applied to cancer multidisciplinary team meetings. Note. Reprinted with permission from Soukup, 2017.52
NHS | February 2021 | NHS patients to benefit from first full access deal in Europe for new CAR-T therapy recommended by NICE
NHS patients are to be among the first in the world to be offered access to a cutting-edge cancer treatment after NICE recommended its use.
NHS clinicians in England will now be able to consider the treatment for some patients with a form of lymphoma, a cancer that attacks the immune system.
Cancer Services News 