Impact of the Interdisciplinary Tumor Board of the Cooperative Ewing Sarcoma Study Group on local therapy and overall survival of Ewing sarcoma patients after induction therapy

Kreyer, Justus; Ranft, Andreas; Timmermann, Beate; Juergens, Heribert; Jung, Susanne; Wiebe, Karsten; Boelling, T.; Schuck, Andreas; Vieth, Volker; Streitbuerger, Arne; Hardes, Jendrik; Heinemann, Melina; Dirksen, Uta

doi:10.1002/pbc.27384

Cited by 29 publications

(44 citation statements)

References 38 publications

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“…In the present study, there was a high incidence of metastatic disease at presentation (50.70%). Pakos et al 30 , in an international OS compilation, where OS Brazilian Group was included, showed 13% of the patients with metastatic disease, the same could be seen in the OS Children Oncology Group (COG) (27%) and Cooperative Ewing Sarcoma Study (CESS) group (30%) [30][31][32][33][34] . Patients arrived at INCA with advanced disease and this characteristic probably influenced in their pain status in all follow-up moments.…”

Section: Discussionmentioning

confidence: 73%

Self-assessment pain control in end-of-life children with bone tumors: a cohort study

Andrade

Valete

et al. 2021

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BACKGROUND: INCA estimated, for 2020 – 2022, Brazil would have 8,460 new pediatric cancer cases and 5% are bone cancer. Pain is the most prevalent symptom and is present in 75% - 90%. Advanced ill patients have 40% pain undertreated. OBJECTIVE: This study was to evaluate pain in pediatric bone cancer patients and investigate if there was a difference between those who survived and those at end-of-life. PROCEDURE: Patients were registered at INCA Pediatric Department, January 2011 – October 2016, with the diagnosis confirmed of primary bone cancer and under 19 years old. Pain was evaluated and registered at three moments during their treatment: at registration, three months after and the last visit before the end of this study or patients death, using pain scores. RESULTS: 157 patients were bone cancer, 15 (9.6%) had lost the follow up; 142 were analyzed, osteosarcoma 69.7% and Ewing sarcoma 30.3%, metastatic patients 50.7%. At the registration 53.5% had pain, 69.71% were receiving pain treatment and 42.25% had pain medications changed. Comparison of the three study moments was observed a decrease of pain status, with the absence of excruciating pain, and an increased use of opioids. There was no difference (p = 0.68) in pain status between groups of who survived and who died (39.4%). CONCLUSION: Pain management resulted in reduction of pain complaint and reduction in pain intensity, together with increasing opioid use. End-of-life patients did not have more pain than others, but disease progression was associated to more pain.

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Section: Discussionmentioning

confidence: 73%

Self-assessment pain control in end-of-life children with bone tumors: a cohort study

Andrade

Valete

et al. 2021

Preprint

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“…We have shown there is almost universal use of MDT discussion, and adoption of a wide range of existing treatment protocols. Wide discussion outside the treating MDT, for example in a national forum or with another centre is not usual in the majority of countries, although the EICESS 92 experience indicates that a more unified approach could be explored to determine if it will improve outcomes for patients and has been adopted by the CESS group in Germany [ 4 , 10 ]. The wider adoption of national or international MDT discussions has some intuitive appeal but demands further evidence.…”

Section: Discussionmentioning

confidence: 99%

Seeking international consensus on approaches to primary tumour treatment in Ewing sarcoma

et al. 2020

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Background The local treatment of Ewing sarcoma of bone involves surgery, radiotherapy or both. The selection of treatment depends on the anatomical extent of the tumour, the effectiveness of the proposed treatment, its morbidity, and the expectation of cure. However, not only are there variations in the approach to local treatment between individual patients, but also between treatment centres and countries. Our aim was to explore variation in practice and develop consensus statements about local treatment. Methods A three stage modified Delphi technique was used with international collaborators. This involved an expert panel to identify areas of controversy, an online survey of international collaborators and a consensus meeting in London, UK in June 2017. In the consensus meeting, teams of clinicians discussed the local management of selected cases and their responses were collected with electronic voting. Results Areas of greater or less consensus were identified. The lack of evidence underpinning different approaches was noted and areas for collaborative research became apparent. Conclusion This has demonstrated that there is an international consensus around many aspects of the local treatment of Ewing sarcoma of bone, including the use of specialist MultiDisciplinary Team (MDT) meetings with access to all appropriate treatments. However, considerable variation remains including the use of different staging investigations, decision making, definitions of response, and radiotherapy doses and timing. Further collaborative work should be undertaken to determine the impact of these variations in order to define best practice.

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“…There is evidence that utilization of a specialized IDTB improves relapse-free survival in sarcoma patients [14]. A study in patients with Ewing sarcoma showed increased overall survival when using a specialized reference board [19]. We were not able to measure the use of specialized sarcoma boards in German sarcoma patients directly and only measured that of IDTB in general.…”

Section: Tumor Board Utilizationmentioning

confidence: 96%

Utilization of Interdisciplinary Tumor Boards for Sarcoma Care in Germany: Results from the PROSa Study

et al. 2021

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Background: Data on institutional structures of sarcoma care in Germany are scarce. The utilization of an interdisciplinary tumor board (IDTB) is an essential part of modern cancer care. We investigated to which extent and when IDTB are used in sarcoma care. We hypothesized that IDTB before treatment initiation were used more often at certified cancer centers and at high-volume centers and that IDTB utilization increased over time. Methods: From 2017 to 2020 we conducted a prospective cohort study, undertaking major efforts to include the whole spectrum of sarcoma treatment facilities. To analyze potential predictors of IDTB utilization, we calculated multivariable logistic regressions. Results: Patients and survivors (n = 1,309) from 39 study centers (22 tertiary referral hospitals, 9 other hospitals, and 8 office-based practices) participated; 88.3% of the patients were discussed at some stage of their disease in an IDTB (56.1% before treatment, 78% after therapy, and 85.9% in metastatic disease). Hypotheses were confirmed regarding the utilization of IDTB in certified cancer centers (vs. all others: OR = 5.39; 95% CI 3.28–8.85) and the time of diagnosis (2018/2019 vs. until 2013: OR = 4.95; 95% CI 2.67–9.21). Conclusion:Our study adds to the evidence regarding the institutional structures of sarcoma care in Germany. Utilization of a tumor board before therapy seems to be in an implementation process that is making progress but is far from complete. Certification is a possible tool to accelerate this development.

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Impact of the Interdisciplinary Tumor Board of the Cooperative Ewing Sarcoma Study Group on local therapy and overall survival of Ewing sarcoma patients after induction therapy

Abstract: As a reference center for a rare disease, recommendations from our ITB impacted local therapy and led to higher OAS in patients with metastatic disease. To our knowledge, this is the first analysis that examines the value of a reference tumor board on a rare disease.

Cited by 29 publications

References 38 publications

Self-assessment pain control in end-of-life children with bone tumors: a cohort study

Self-assessment pain control in end-of-life children with bone tumors: a cohort study

Seeking international consensus on approaches to primary tumour treatment in Ewing sarcoma

Utilization of Interdisciplinary Tumor Boards for Sarcoma Care in Germany: Results from the PROSa Study

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