Enhancing Cancer Care delivery through Multidisciplinary Approaches
The “First Lebanese Oncology Forum” in Mount Lebanon Hospital – Gharios Medical Center, a leading provider of cancer care in the Middle East and Lebanon , was held on the 27th and 28th of January, 2017. This forum, in collaboration with the Lebanese University – Faculty of Medical Sciences, the Lebanese Urology Society, and the Lebanese Society of Medical Oncology addressed the latest challenges faced by oncologists and recent advances in the field. It gathered physicians from Mount Lebanon Hospital and other institutions to encourage collaboration among healthcare providers.
This state of the art program addressed several oncological topics such as breast, colorectal, lung, and prostatic cancers which were presented by expert speakers. Many top cancer care management techniques were tackled through multidisciplinary approaches, in addition to quality improvement techniques delivered through dedicated programs.
The opening ceremony took place in the presence of The representative of the Minister of Health Mr. Ghassan Hasbani, Dr Fadia Elias, the President of the Syndicate of Hospitals in Lebanon, Dr. Sleiman Haroun, the President of the Lebanese Order of Physicians, Dr. Raymond Sayegh, Mount Lebanon hospital President and director general, Dr Nazih Gharios, and the general director and Medical Director of Mount Lebanon Hospital, Dr. Elie Gharios.
The first session of the forum discussed advances in the field of breast cancer:
Dr. Adel Tabchy, specialist in genomics and personalized medicine in breast cancer focused his presentation on recent updates from the renowned San Antonio Breast Cancer meeting held in December 2016 in the USA. He discussed the recent advances in molecular and genomic testing in breast cancer as well as their direct impact on clinical decision making and their prognostic and predictive value. Moreover, he elaborated on the most recent clinical trials (biomarkers and genomics in cancer).
Dr. Colette Hanna’s talk focused on the widespread use of adjuvant systemic therapy and its contribution in to reducing breast cancer mortality rates. Adjuvant systemic therapies, including endocrine therapy, anti-HER2 therapy and chemotherapy, are effective in reducing the risk of distant and local recurrence, even in low risk patients. Key milestones in the evolution of adjuvant systemic therapy in general and adjuvant chemotherapy in particular were discussed as well.
The second session was held to discuss the advancements in colorectal cancer care. Dr. Nagib Geahchan showed the differences of outcomes in the surgery and multidisciplinary care of right and left colic cancer.
Dr. Fadi Farhat discussed how multidisciplinary teams (MDTs) are now widely accepted as a gold-standard for quality control and as a model for various approaches to cancer care in various countries. They help improve clinical decision-making as well as the outcomes, experiences and quality of life of patients with various cancers. Establishing MDTs for treating patients with colorectal cancer has considerably influenced current medical practice.
The third session of the forum discussed all advances in lung cancer:
Dr. Nasr pointed out that Lung cancer is one of the main cancers for which immunotherapy is currently in development. He also highlighted the role of the Cancer Research Institute in bringing effective immunotherapy to patients with this form of cancer. Although conventional treatment options including surgery, chemotherapy, and radiation significantly improve survival and provide symptom relief, it still can’t heal patients with advanced disease (stage IIIb/IV). Immunotherapy is a new promising alternative.
Dr. Fadi EL Karak held a session regarding lung cancer and the prognosis of metastatic Non-Small Cell Lung Cancer (NSCLC). He indicated that multiple treatment options are now available for the treatment of this disease; the latest being immunotherapy. He reviewed the key studies that led to the approval of immunotherapy in spite of the major toxicities of these new drugs. Moreover, he reviewed how radiologists should evaluate patient responses to this treatment.
In his lecture, Dr. Dany Abou Abdallah reviewed the Endobronchial Ultrasound (EBUS) bronchoscopy technique while focusing on its added-value in the diagnosis and staging of lung cancer.
Dr. Caroline Samaha Jabbour presented a session about radiotherapy in lung cancer treatment. The initial part of the talk discussed the difficulties in the selection of eligible subgroups of patients that can benefit from re-irradiation. She later on covered the new treatment approach for selected stage IV oligo metastatic NSCLC patients where the trend in treatment is shifting from simply palliative to curative in a selected subgroup of patients.
The following session discussed the improvements related to health quality:
Mrs. Roula Zahar General Director at Mount Lebanon Hospital, member of the National Accreditation committee outlined the steps performed by Mount Lebanon Hospital task force for the analysis, development, and implementation of an oncology database. Critical elements for successful implementation as well as the various roles achieved by different key players to install the best practices, and adequate workflow were presented simultaneously.
Mrs Rouba Rassi El-Khoury, Doctor in Pharmacy, President of the Lebaese Society for Healthcare Quality, presented a session describing how healthcare providers can learn from errors in order to implement successful strategies to reduce risks and improve patient safety. Reporting errors is a helpful learning tool to identify and eliminate “error traps”. Identifying unsafe procedures or behaviors, analyzing and setting recommendations to avoid them has an immediate impact on improving patient safety.
During the conference, Dr. Fadia Elias, representative of the minister of health discussed the financial burden of cancer drug treatment in Lebanon. The Ministry of Public Health (MOPH) in Lebanon provides cancer drugs free of charge for uninsured patients who account for more than half the total case-load. Other categories of cancer care are subsidized under more stringent eligibility criteria
At the end of the second day of the conference, a discussion panel which included numerous specialist doctors was convened to discuss the challenges facing the Lebanese healthcare system.
The second day of the forum presented the improvement of prostate cancer care through the multidisciplinary approach:
Dr. Raghid Khoury discussed the impact of multidisciplinary approach on prostate cancer and its advantages, such as survival improvement, increase in the rate of active surveillance for low-risk prostate cancer, and reduced overtreatment in patients with low life expectancy.
Dr. Feras Chehade introduced the PET tracers in prostate cancer. He explained how small-molecule Prostate-Specific Membrane Antigen (PSMA) radiotracers, labeled with a variety of radionuclides for Positron Emission Tomography (PET) imaging applications, have been developed and explored in recent studies. PSMA-targeted PET tracers are mainly indicated for patients with biochemical recurrence: they proved to have the highest sensitivity for localizing the site of recurrence.
Dr. Fouad Aoun informed the people attending the conference that the detection paradigm of prostate cancer has changed with new technological advances such as multiparametric MRI and MRI targeted biopsy. They now provide accurate targeting of the index lesion, and clinical added value in different scenarios.
Dr. Georges Assaf revealed the contribution of functional imaging, such as multi-parametric MRI, (PET)-CT scan, and WB-MRI in improving the diagnosis of oligo-metastatic prostate cancer (a previously unknown disease). He also noted that the treatment of advanced prostate cancers is shifting toward a more aggressive approach.
Prostate cancer has always been a social and economic burden, and its treatment has recently seen many advances with new hormonal treatments and important developments in radiation therapy techniques. Dr. Georges Farha focused his presentation on these novel techniques, especially Intensity-Modulated Radiation Therapy (IMRT) and Stereotactic Body Radiation Therapy (SBRT), while insisting on the importance of image guidance radiation therapy (IGRT) with such techniques and the new fractionation schemes (CHHiP and PROFIT trials).
Dr. Joseph Kattan informed that sequencing therapy in Castration-Resistant Prostate Cancer (CRPC) is very crucial to ensure proper therapy. Moreover, immunotherapy offers promising results with checkpoint inhibitors in second line after the failure of TKIs. The largest experience and success has been achieved with Nivolumab.
Dr. Ali Shamseddine highlighted the management of hormone sensitive metastatic prostate cancer. He discussed a study that has been raised as to whether the association of chemotherapy to standard hormonal treatment for men with prostate cancer before symptomatic disease progression can improve the duration and quality of patient survival.
Dr. Nehme Raad explained that prostate cancer is a disease in which a multidisciplinary approach is mandatory. He presented a case of prostate cancer and followed the patient through the different steps of the evolution process of his disease to emphasize the importance of MDTs.
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