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      The Multidisciplinary Team (MDT) Approach and Quality of Care


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          The core function of a multidisciplinary team (MDT) is to bring together a group of healthcare professionals from different fields in order to determine patients' treatment plan. Most of head and neck cancer (HNC) units are currently led by MDTs that at least include ENT and maxillofacial surgeons, radiation and medical oncologists. HNC often compromise relevant structures of the upper aerodigestive tract involving functions such as speech, swallowing and breathing, among others. The impairment of these functions can significantly impact patients' quality of life and psychosocial status, and highlights the crucial role of specialized nurses, dietitians, psycho-oncologists, social workers, and onco-geriatricians, among others. Hence, these professionals should be integrated in HNC MDTs. In addition, involving translational research teams should also be considered, as it will help reducing the existing gap between basic research and the daily clinical practice. The aim of this comprehensive review is to assess the role of the different supportive disciplines integrated in an MDT and how they help providing a better care to HNC patients during diagnosis, treatment and follow up.

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          The Vulnerable Elders Survey: a tool for identifying vulnerable older people in the community.

          To develop a simple method for identifying community-dwelling vulnerable older people, defined as persons age 65 and older at increased risk of death or functional decline. To assess whether self-reported diagnoses and conditions add predictive ability to a function-based survey. Analysis of longitudinal survey data. A nationally representative community-based survey. Six thousand two hundred five Medicare beneficiaries age 65 and older. Bivariate and multivariate analyses of the Medicare Current Beneficiary Survey; development and comparison of scoring systems that use age, function, and self-reported diagnoses to predict future death and functional decline. A multivariate model using function, self-rated health, and age to predict death or functional decline was only slightly improved when self-reported diagnoses and conditions were included as predictors and was significantly better than a model using age plus self-reported diagnoses alone. These analyses provide the basis for a 13-item function-based scoring system that considers age, self-rated health, limitation in physical function, and functional disabilities. A score of >or=3 targeted 32% of this nationally representative sample as vulnerable. This targeted group had 4.2 times the risk of death or functional decline over a 2-year period compared with those with scores <3. The receiver operating characteristics curve had an area of.78. An alternative scoring system that included self-reported diagnoses did not substantially improve predictive ability when compared with a function-based scoring system. A function-based targeting system effectively and efficiently identifies older people at risk of functional decline and death. Self-reported diagnoses and conditions, when added to the system, do not enhance predictive ability. The function-based targeting system relies on self-report and is easily transported across care settings.
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            Use of comprehensive geriatric assessment in older cancer patients: recommendations from the task force on CGA of the International Society of Geriatric Oncology (SIOG).

            As more and more cancers occur in elderly people, oncologists are increasingly confronted with the necessity of integrating geriatric parameters in the treatment of their patients. The International Society of Geriatric Oncology (SIOG) created a task force to review the evidence on the use of a comprehensive geriatric assessment (CGA) in cancer patients. A systematic review of the evidence was conducted. Several biological and clinical correlates of aging have been identified. Their relative weight and clinical usefulness is still poorly defined. There is strong evidence that a CGA detects many problems missed by a regular assessment in general geriatric and in cancer patients. There is also strong evidence that a CGA improves function and reduces hospitalization in the elderly. There is heterogeneous evidence that it improves survival and that it is cost-effective. There is corroborative evidence from a few studies conducted in cancer patients. Screening tools exist and were successfully used in settings such as the emergency room, but globally were poorly tested. The article contains recommendations for the use of CGA in research and clinical care for older cancer patients. A CGA, with or without screening, and with follow-up, should be used in older cancer patients, in order to detect unaddressed problems, improve their functional status, and possibly their survival. The task force cannot recommend any specific tool or approach above others at this point and general geriatric experience should be used.
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              Squamous cell carcinoma of the head and neck: EHNS-ESMO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up.


                Author and article information

                Front Oncol
                Front Oncol
                Front. Oncol.
                Frontiers in Oncology
                Frontiers Media S.A.
                20 March 2020
                : 10
                [1] 1Medical Oncology Department, Catalan Institute of Oncology (ICO), ONCOBELL, IDIBELL, L'Hospitalet de Llobregat , Barcelona, Spain
                [2] 2Psicooncology Department, Catalan Institute of Oncology (ICO), IDIBELL, L'Hospitalet de Llobregat , Barcelona, Spain
                [3] 3Department of Odontostomatology, Faculty of Medicine and Health Sciences (Dentistry), University of Barcelona , Barcelona, Spain
                [4] 4Oral Health and Masticatory System Group (Bellvitge Biomedical Research Institute) IDIBELL, L'Hospitalet de Llobregat, University of Barcelona , Barcelona, Spain
                [5] 5Oncogeriatrics Unit, Catalan Institute of Oncology, L'Hospitalet de Llobregat , Barcelona, Spain
                [6] 6Clinical Nutrition Unit, Catalan Institute of Oncology (ICO), IDIBELL, L'Hospitalet de Llobregat, University of Barcelona , Barcelona, Spain
                [7] 7Head and Neck Nurse, Head and Neck Functional Unit, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat , Barcelona, Spain
                [8] 8Expert SLP in Oncologic Patients, Head of SLP's Department, Atos Medical Spain , Barcelona, Spain
                [9] 9Medical Oncology Department, Catalan Institute of Oncology (ICO), B-ARGO , Barcelona, Spain
                Author notes

                Edited by: Andreas Dietz, Leipzig University, Germany

                Reviewed by: Markus Brunner, Medical University of Vienna, Austria; Jan Baptist Vermorken, University of Antwerp, Belgium

                *Correspondence: Miren Taberna mtaberna@ 123456iconcologia.net

                This article was submitted to Head and Neck Cancer, a section of the journal Frontiers in Oncology

                Copyright © 2020 Taberna, Gil Moncayo, Jané-Salas, Antonio, Arribas, Vilajosana, Peralvez Torres and Mesía.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                Page count
                Figures: 5, Tables: 3, Equations: 0, References: 139, Pages: 16, Words: 12474

                Oncology & Radiotherapy
                head and neck cancer,head and cancer unit,multidisciplinary team,tumor board,quality of care


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