Impact of an Inter-Professional Clinic on Pancreatic Cancer Outcomes: A Retrospective Cohort Study.

Background: Pancreatic ductal adenocarcinoma (PDAC) presents significant challenges in diagnosis, staging, and appropriate treatment. Furthermore, patients with PDAC often experience complex symptomatology and psychosocial implications that require multi-disciplinary and inter-professional supportive care management from health professionals. Despite these hurdles, the implementation of inter-professional clinic approaches showed promise in enhancing clinical outcomes. To assess the effectiveness of such an approach, we examined the impact of the Wallace McCain Centre for Pancreatic Cancer (WMCPC), an inter-professional clinic for patients with PDAC at the Princess Margaret Cancer Centre (PM). Methods: This retrospective cohort study included all patients diagnosed with PDAC who were seen at the PM before (July 2012-June 2014) and after (July 2014-June 2016) the establishment of the WMCPC. Standard therapies such as surgery, chemotherapy, and radiation therapy remained consistent across both time periods. The cohorts were compared in terms of survival rates, disease stage, referral patterns, time to treatment, symptoms, and the proportion of patients assessed and supported by nursing and allied health professionals. Results: A total of 993 patients were included in the review, comprising 482 patients pre-WMCPC and 511 patients post-WMCPC. In the multivariate analysis, adjusting for ECOG (Eastern Cooperative Oncology Group) and stage, it was found that post-WMCPC patients experienced longer median overall survival (mOS, HR 0.84, 95% CI 0.72-0.98, p = 0.023). Furthermore, the time from referral to initial consultation date decreased significantly from 13.4 to 8.8 days in the post-WMCPC cohort (p < 0.001), along with a reduction in the time from the first clinic appointment to biopsy (14 vs. 8 days, p = 0.022). Additionally, patient-reported well-being scores showed improvement in the post-WMCPC cohort (p = 0.02), and these patients were more frequently attended to by nursing and allied health professionals (p < 0.001). Conclusions: The implementation of an inter-professional clinic for patients diagnosed with PDAC led to improvements in overall survival, patient-reported well-being, time to initial assessment visit and pathological diagnosis, and symptom management. These findings advocate for the adoption of an inter-professional clinic model in the treatment of patients with PDAC.

Prognostic factors influencing survival following re-resection for isocitrate dehydrogenase (IDH) -wildtype glioblastoma multiforme - Data from a national neuro-oncology registry.

The role of surgical resection in recurrent Glioblastoma Multiforme (GBM) remains unclear. We aimed to investigate survival outcomes and associated prognostic factors in patients undergoing surgical re-resection for recurrent IDH-wildtype GBM in a national neuro-oncology center. We evaluated all patients who underwent re-resection for recurrent GBM following adjuvant treatment between 2015 and 2018. 32 patients were eligible for inclusion. 19 (59%) were male,median age at re-resection was 53. Median time from initial surgery to re-resection was 13.5 months. Median overall survival (OS) was 28.6 months from initial surgery and 9.5 months from re-resection. MGMT methylation was significantly associated with improved OS from initial surgery, 40 months versus 19.1 months, (p = 0.004), and from re-resection, 9.47 months versus 6.93 months, (p = 0.028). A late re-resection was associated with improved OS compared to an early re-resection, 44.1 months versus 15.7 months, (p = 0.002). There was a trend for improved outcomes in younger patients, median OS from initial surgery 44.1 months for <53 years compared to 21.7 months for patients ≥53, (p = 0.099). Higher Karnofsky Performance Status (KPS) at re-resection was associated with improved median OS, 9.5 months versus 4.1 months for KPS ≥70 and <70 respectively, (p = 0.013). Furthermore, there was a trend for improved OS with greater extent of re-resection, however this did not reach statistical significance, possibly due to small sample size. Re-resection for recurrent GBM was associated with improved OS in those with good performance status and could be considered in carefully selected cases.

Chemotherapy in the Covid-19 era: the patient's perception.

BACKGROUND: The Covid-19 pandemic poses significant challenges for the management of patients with cancer. In our institution, we adapted our delivery of outpatient systemic anti-cancer therapy (SACT) by introducing a number of 'risk-reducing' measures including pre-assessment screening. AIMS: We sought to evaluate the experience and perceptions of patients with cancer undergoing SACT during the Covid-19 pandemic. METHODS: Patients on SACT during the Covid-19 pandemic were eligible for participation. Data were collected by anonymous survey over a 1 week period during the most intensive phase of government restrictions. Patients were asked questions under three headings: perceived risk of infection exposure, changes to treatment plan and psychological impact of Covid-19. RESULTS: One hundred patients were assessed, 60% were male, 41% were > 65 years of age and 67% had advanced cancer. Eleven percent of patients were living alone. Fifty-seven percent reported feeling at increased risk in general of contracting Covid-19. Sixty-eight percent of patients did not feel worried about contracting Covid-19 in the hospital. Ninety-two percent of patients reported wanting to continue on SACT as originally planned. Fifty-eighty percent felt isolated and 40% reported increased anxiety. CONCLUSION: Though patients on active treatment for cancer during the Covid-19 pandemic reported increased anxiety and feelings of isolation due to Covid-19, the majority of patients wanted to continue SACT as originally planned. Patients would benefit from enhanced psycho-oncological supports in the event of a prolonged Covid-19 pandemic.