Abbasi, Ahmed Nadeem

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eCommons@AKU Department of Radiation Oncology Medical College, Pakistan 2-2020 The pivotal role of patient-centred approaches in successful outcome of evidence-based high quality cancer care Ahmed Nadeem Abbasi Follow this and additional works at: https://ecommons.aku.edu/pakistan_fhs_mc_radiat_oncol  Part of the Oncology Commons, and the Radiation Medicine Commons Development of high quality evidence-based cancerservice is a great challenge. Focusing the actual needsof cancer patients, which eventually translates intodesirable patient outcomes, is only possible via a holisticapproach adaptation during the planning phases of thisservice. The establishment of the cancer service is ateamwork. Treatment is only a component of the overallcomprehensive cancer care and control plan.  Site-specific multidisciplinary team (MDT) tumor boardis the foundation of cancer management. The multi-disciplinary team works closely together, keepingpatients’ well-being in the centre in order to make arecommendation, which may not attract cent percentconsensus among the experts, who are designated asthe essential core site-specific specialists. In developingcountries, this task is indeed an endeavour whichrequires voluntary commitment of all participatingclinicians, who are conducting these site-specific MDTtumor boards, conducted on a non-mandatory basis. Weshared our own experience of establishment of anindependent non-institutional board, named as CityTumor Board, Karachi in a manuscript published inDecember 2013 in which audit findings were presented.1In almost every single case discussed at the City TumorBoard, we end up discussing the solution of financialconstraints, which majority of cancer patients living inlow and middle income countries (LMIC) face right fromday one of their treatment. We opt for evidence-basedmanagement option for our patients and wish to deliverit in a cost-effective and cost-efficient manner. Limitedstudies are being published in LMIC on the subject ofpatient-centred approaches in cancer management.Some inferences can be drawn from studies performedin the West, addressing the sections of population whoresemble our social conditions; thus we can extractsome meaningful relevant inferences from their originalwork. I would like to quote a study which was conductedin the Knowledge Institute of St Michael's Hospital,Toronto, Canada. Concept mapping was used as a toolin order to make a comparison of opinions made bystakeholders in the utilisation of screening in earlydetection of cancer in South Asian population. This is anexample of learning from the scientific work done in theWest on similar, if not the same, cohort of individualswho are our target population as well. South Asianpopulation showed a different pattern of acceptance ofthese screening services. This inference needs to bestudied further via more innovative studies.2A comprehensive cancer care service revolves around apatient-centred approach. We follow international guide-lines. These clinical practice guidelines, in the NationalComprehensive Cancer Network (NCCN), is beingrevised and updated on a regular basis. In the 2019NCCN guidelines, it is mentioned that it is being updatedby 53 expert panels, each of which is being comprised ofspecialists who are involved in site-specific practice in28 different NCCN member institutions.3These clinical guidelines assume that a site-specificmultidisciplinary expert team is in place which isdeliberating and documenting recommendations formanagement plan of each and every case which isdiscussed in a mandatory tumor board. Once weestablish a site-specific MDT tumor board, only then wecan safely and confidently apply recommendations fortreatment as per clinical practice guidelines.3Concept mapping of a patient-centred approach canplay a pivotal role in the strategic visioning of cancerservice planning.2 In developing countries, the role andrationale of these site-specific MDT tumor boards getmore imperative weightage. In one of our corres-pondence published in Journal of Clinical Oncology, weinsisted on identifying these site-specific MDT meetingsas lifeline of our cancer patients.4The more we emphasise on this patient-centredapproach, the better for our quality of recommendationsproduced at the end of site-specific MDT tumor boarddeliberations. We can learn from any well-establishedhealthcare system. As we cannot work in isolation, sowe strongly recommend international exchange pro-grammes, which are based on pre-defined learningobjectives. In addition to clinical training, a leadershipskill-development component is also required. Inter-national exchange programmes also play a facilitatoryrole in this regard.5Journal of the College of Physicians and Surgeons Pakistan 2020, Vol. 30 (2): 111-112 111EDITORIALThe Pivotal Role of Patient-centred Approaches inSuccessful Outcome of Evidence-based High Quality Cancer CareAhmed Nadeem AbbasiDepartment of Oncology, The Aga Khan University Hospital, Karachi, PakistanCorrespondence to: Dr. Ahmed Nadeem Abbasi, Department ofOncology, The Aga Khan University Hospital, Stadium Road,Karachi, PakistanE-mail: nadeem135@gmail.comReceived: December 30, 2019;   Revised: January 7, 2020;Accepted: January 7, 2020Further improvement in clinical outcome of cancerpatients getting treatment in LMIC is heavily dependenton our commitments towards making a strategic team-plan for the cancer service development in a holisticmanner, keeping in view the needs of our cancerpatients. Conceptual modelling of patients' own experien-ces is also an innovative area which needs our attentionfor further learning and idea exploration.6Patient is the key beneficiary of any endeavour which isbased on open and independent multidisciplinaryapproach. In our scenario, Tumor Board establishmentis one of the best process-developments, which can beconsidered as a starting point of improvement in cancercare planning. This notion is more true in developingcountries, which are still in the process of developmentof a national cancer plan. In developing countries likePakistan and other LMIC, the implementation of mostappropriate economic healthcare model will ensurefinancial sustainability of cancer care service. We doexplore and consider cost-efficient ways in order tomaximise our service scope and to offer treatment in asustainable environment. The quest of achieving thisgoal of offering the best treatment to our cancer patients,as per international standards, is going on and willcontinue keeping in mind that this quest is a journey andnot a destination. There are ways to assess the overalloutcome of any such model at tertiary care service level.All components of cancer care service provision can bemonitored and evaluated via clinical quality indicators.7The guidelines published by the National Institute ofHealth and Care Excellence (NICE) of United Kingdomare also a source of knowledge, which can givedirections to healthcare policy-makers. NICE guidelinescover directions pertaining to economic evaluationmodels as well.8In future, we would be witnessing an enhancement ofour clinical acumen and understanding of better cancercare via development of a better patient-centered conceptmapping based on a multidisciplinary team approach.The more we reflect on this approach, we can get thebetter outcome of treatment parameters. In fact, thisimprovement in outcome will definitely translate into abetter professional accomplishment for the clinicians andthe whole healthcare team involved in the compre-hensive holistic care of cancer patients.REFERENCES1. Asghar AH, Abbasi AN, Jamal A, Haider G, Rizvi S. City tumorboard Karachi: An innovative step in multidisciplinaryconsensus meeting and its two years audit. J Pak Med Assoc2013; 63:1534-5. 2. Lobb R, Pinto AD, Lofters A. Using concept mapping in theknowledge-to-action process to compare stakeholder opinionson barriers to use of cancer screening among South Asians.Implement Sci 2013; 8:37.3. National Comprehensive Cancer Network.  2019 clinical practiceoncology guidelines. https://www.nccn.org/professionals/default.aspx [Accessed on 6 January 2020].4. Abbasi AN, Karim MU, Ali N, Hafiz A, Qureshi BM. Multi-disciplinary team tumor boards are a lifeline for our cancerpatients in lower and middle income countries. Clin Oncol2016; 28:799.5. Karim MU, D Aviero A, Khan AMH, Abbasi AN. Importance ofinternational exchange program in postgraduate training. J CollPhysicians Surg Pak 2018; 28:981-2.6. Herman JM, Kitchen H, Degboe A, Aldhouse NVJ, Trigg A,Hodgin M, et al. Exploring the patient experience of locallyadvanced or metastatic pancreatic cancer to inform patient-reported outcomes assessment. Qual Life Res 2019; 28:2929-39.7. Clauser SB, Johnson MR, O'Brien DM, Beveridge JM, Fennell ML,Kaluzny AD. Improving clinical research and cancer caredelivery in community settings: Evaluating the NCI communitycancer centers program. Implement Sci 2009; 4:63.8. National Institute for Health and Care Excellence, United Kingdom.https://www.nice.org.uk. [Accessed on 6 January 2020].Ahmed Nadeem Abbasi112 Journal of the College of Physicians and Surgeons Pakistan 2020, Vol. 30 (2): 111-112

The pivotal role of patient-centred approaches in successful outcome of evidence-based high quality cancer care

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The pivotal role of patient-centred approaches in successful outcome of evidence-based high quality cancer care

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