Pakistani Endeavors in the Establishment of Site Specific MDT Tumour Boards in the region

Presentation Acknowledgement :

All T.E.F.F. Colleagues

Compiled by Dr Agha Hammad Khan

TUMOR BOARD SAVES LIVES

1

21/09/2021 4:52 pm

Q# 01 =Do we really have the evidence ?

…OF MANDATORY SITE SPECIFIC MDT TUMOR BOARDS ???

TUMOR BOARD SAVES LIVES

2

21/09/2021 4:52 pm

Q#01�Do we really have the evidence ?

• Learners Resource Book

​

• 87 pub med cited studies

​

• PAKISTANI PUBLISHED ITEMS = 26

TUMOR BOARD SAVES LIVES

3

21/09/2021 4:52 pm

CITY Tumour Board �Karachi

• Independent
• Non-territorial
• Non-Institutional

• Sunday 0800am
• Neutral Venue
• Other Cities can follow this example (Faisalabad CTB: April 2021)

​

TUMOR BOARD SAVES LIVES

4

21/09/2021 4:52 pm

Across Pakistan

• Pak map

• Almost all cancer institutes are doing MDT Tumour Boards
• e.g. 19 Atomic Energy Centers
• Hospitals
• University Centers
• etc,etc,etc

TUMOR BOARD SAVES LIVES

5

21/09/2021 4:52 pm

Q# 02 = Why Site Specific ?

TUMOR BOARD SAVES LIVES

6

21/09/2021 4:52 pm

TUMOR BOARD SAVES LIVES

7

21/09/2021 4:52 pm

J Clin Oncol. 2012 Sep 1;30(25):3071-6. doi: 10.1200/JCO.2012.42.8466. Epub 2012 Jul 30.

Multidisciplinary care and pursuit of active surveillance in low-risk prostate cancer.

​

The role of radiological-pathological correlation in diagnosing early breast cancer: the pathologist's perspective.

Tot T, Tabár L.

Bull Cancer. 2012 Apr 1;99(4):E34-42. doi: 10.1684/bdc.2012.1559.

Multidisciplinarity and medical decision, impact for patients with cancer: sociological assessment of two tumour committees' organization.

​

​

TUMOR BOARD SAVES LIVES

8

21/09/2021 4:52 pm

Bull Cancer. 2012 Apr 1;99(4):E34-42. doi: 10.1684/bdc.2012.1559.

Multidisciplinarity and medical decision, impact for patients with cancer: sociological assessment of two tumour committees' organization.

​

Br J Cancer. 2011 Apr 12;104(8):1246-8. doi: 10.1038/bjc.2011.92. Epub 2011 Mar 29.

Impact of multidisciplinary team management in head and neck cancer patients.

Friedland PL¹, Bozic B, Dewar J, Kuan R, Meyer C, Phillips M.

​

TUMOR BOARD SAVES LIVES

9

21/09/2021 4:52 pm

Int J Gynecol Cancer. 2009 Dec;19(9):1470-2. doi: 10.1111/IGC.0b013e3181bf82df.

The multidisciplinary tumor conference in gynecologic oncology--does it alter management?

Cohen P¹, Tan AL, Penman A

​

Chin Med J (Engl). 2012 Jan;125(2):172-7.

Impact of multidisciplinary team working on the management of colorectal cancer.

​

TUMOR BOARD SAVES LIVES

10

21/09/2021 4:52 pm

Systematic review

​

Changes to diagnostic reports ( stage, site, histo, grades) - Upto 35%

​

Change Surgical management plan change

Minor upto 60%

Major upto 12.4%

​

CONCLUSION:

MDT meetings Significant impact upon patient

• Assessment
• Management practices

OUR PAKISTANI PUBLICATIONS ON SITE SPECIFIC MDT TUMOUR BOARDS

TUMOR BOARD SAVES LIVES

11

21/09/2021 4:52 pm

OUR PAKISTANI PUBLICATIONS ON SITE SPECIFIC MDT TUMOUR BOARDS

TUMOR BOARD SAVES LIVES

12

21/09/2021 4:52 pm

OUR PAKISTANI PUBLICATIONS ON SITE SPECIFIC MDT TUMOUR BOARDS

TUMOR BOARD SAVES LIVES

13

21/09/2021 4:52 pm

Q# 03 = Do We Need To Bring �A Cultural Change ?

TUMOR BOARD SAVES LIVES

14

21/09/2021 4:52 pm

Work among medical students�

TUMOR BOARD SAVES LIVES

15

21/09/2021 4:52 pm

TUMOR BOARD SAVES LIVES

16

21/09/2021 4:52 pm

TUMOR BOARD SAVES LIVES

17

21/09/2021 4:52 pm

Team TEFF

STUDENTS CHAPTER

TUMOR BOARD SAVES LIVES

18

21/09/2021 4:52 pm

X2 SESSIONS

& 2018

3^rd - SESSION 2019

COMING SOON

Medical Students Survey�Huzefa Jibril et al

TUMOR BOARD SAVES LIVES

19

21/09/2021 4:52 pm

Poster in� International conferences �Multidisciplinary Team: Awareness among medical undergraduates 

TUMOR BOARD SAVES LIVES

20

21/09/2021 4:52 pm

Pakistanis at� International Arena

TUMOR BOARD SAVES LIVES

21

21/09/2021 4:52 pm

Map of Our Village

TUMOR BOARD SAVES LIVES

22

21/09/2021 4:52 pm

Emory – Atlanta

Long Beach SF

PMH -Toronto

Sunnybrook

Royal Marsden,London

Christie , Manchester

Gemille ART(ROME)

IAEA TRAINER

NCCS

ROYAL COLLEGE EXAMINER

BEZMI ALAM, TURKEY

Tawan,john hopkin

King Faisal and Fahad Saudia

PAKISTANI CAMP AT EUROPEAN SOCIETY OF TH. R.O. - ESTRO - 2019

TUMOR BOARD SAVES LIVES

23

21/09/2021 4:52 pm

Our Pakistani Books on this topic

TUMOR BOARD SAVES LIVES

24

21/09/2021 4:52 pm

1. Shaukat F, Mansha MA, Ali N, Khan AMH, Abbasi ANN. Incidental Renal Cell Carcinoma in Pelvic Malignancies. Cureus. 2019;11(1):e3829.
2. Qureshi BM, Mansha MA, Karim MU, Hafiz A, Ali N, Mirkhan B, et al. Impact of Peer Review in the Radiation Treatment Planning Process: Experience of a Tertiary Care University Hospital in Pakistan. J Glob Oncol. 2019;5:1-7.
3. Mansha MA, Ali N, Ali S, Azam N, Khan AMH. Malignant Pleural Mesothelioma: A Multi-Disciplinary Approach. Gulf J Oncolog. 2019;1(30):76-80.
4. Hafiz A, Karim MU, Qureshi BM, Jabbar AA, Ahmad Z. Solitary Brain Metastasis: A Rare Initial Presentation of Prostate Carcinoma. Cureus. 2019;11(6):e4804.
5. Fatima N, Zaman MU, Zaman A, Zaman U, Tahseen R, Zaman S. Predictors of metabolic response in propensity-matched lymphoma patients on interim (18)F-fluorodeoxyglucose positron-emission tomography/computed tomography using standardized imaging and reporting protocol: Do we really have one? World J Nucl Med. 2019;18(2):154-9.
6. Fatima N, Zaman MU, Zaman A, Zaman U, Tahseen R, Zaman S. Staging and Response Evaluation to Neo-Adjuvant Chemoradiation in Esophageal Cancers Using 18FDG PET/ CT with Standardized Protocol. Asian Pac J Cancer Prev. 2019;20(7):2003-8.
7. Abbasi AN, Khan AMH, Qureshi BM. Radiomics - Using Artificial Intelligence in the Quest towards Personalised Radiation Treatment. J Coll Physicians Surg Pak. 2019;29(2):99-100.
8. Zaman MU, Fatima N, Zaman A, Zaman U, Tahseen R, Zaman S. Massive Tumor Thrombus in Left Renal Vein and Inferior Vena Cava in Renal Cell Carcinoma on 18-fluorodeoxyglucose Positron Emission Tomography/computerized Tomography: "Suspension Bridge Sign". World J Nucl Med. 2018;17(2):120-2.
9. Zaman MU, Fatima N, Zaman A, Zaman U, Tahseen R, Zaman S. Higher event rate in patients with high-risk Duke Treadmill Score despite normal exercise-gated myocardial perfusion imaging. World J Nucl Med. 2018;17(3):166-70.
10. Shuja M, Nazli S, Mansha MA, Iqbal A, Mohamed R, Tunio MA, et al. Bleeding in Locally Invasive Pelvic Malignancies: Is Hypofractionated Radiation Therapy a Safe and Effective Non-Invasive Option for Securing Hemostasis? A Single Institution Perspective. Cureus. 2018;10(2):e2137.
11. Mir Khan B, Mansha MA, Ali N, Abbasi ANN, Ahmed SM, Qureshi BM. Hidradenocarcinoma: Five Years of Local and Systemic Control of a Rare Sweat Gland Neoplasm with Nodal Metastasis. Cureus. 2018;10(6):e2884.
12. Mansha MA, Khan AMH, Abbasi ANN, Tariq MUU, Mushtaq N, Tariq M, et al. Glioblastoma Multiforme Involving Conus Medullaris in a Child. Cureus. 2018;10(6):e2863.
13. Khalid F, Abbasi AN. Challenges Faced by Pakistani Healthcare System: Clinician's Perspective. J Coll Physicians Surg Pak. 2018;28(12):899-901.
14. Karim MU, A DA, Khan AMH, Abbasi AN. Importance of International Exchange Programme in Postgraduate Training. J Coll Physicians Surg Pak. 2018;28(12):981-2.
15. Islam A, Shah AA, Jadoon H, Fawad A, Javed M, Abbasi AN. A Two-Year Analysis Of Uterine Rupture In Pregnancy. J Ayub Med Coll Abbottabad. 2018;30(Suppl 1)(4):S639-S41.
16. Hussain A, Khan Y, Ali N, Jangda AQ, Siddiqui S, Muhammad W, et al. Unusual occurrence reporting system: Sharing a ten years experience from a tertiary care JCIA accredited university hospital. Cancer Radiother. 2018;22(3):248-54.
17. Ali N, Valimohammad AT, Abbasi AN, Mansha MA, Hafiz A, Qureshi BM. Chemoradiation and the Role of Adjuvant Chemotherapy in Lymph Nodal-Metastatic Cervical Cancer. J Glob Oncol. 2018;4:1-4.
18. Abrar S, Ali N, Qureshi BM, Abbasi AN. Extramedullary plasmacytoma: rare neoplasm of parotid gland. BMJ Case Rep. 2018;2018.
19. Waqas M, Abbasi AN. Establishment of site specific multi-disciplinary tumour boards in Pakistan: Sharing experience of neuro oncology team based at a tertiary care university hospital. J Pak Med Assoc. 2017;67(3):486.
20. Qureshi BM, Abbasi AN, Ali N, Hafiz A, Khaskheli B. In Regard to Amdur. Int J Radiat Oncol Biol Phys. 2017;99(5):1307-8.
21. Qureshi BM, Abbasi AN, Ali N, Hafiz A. Nasopharyngeal carcinoma (NPC)-issues in the inclusion of cervical nodal region in radiation treatment volume. Br J Radiol. 2017;90(1069):20160726.
22. Parkes J, Hess C, Burger H, Anacak Y, Ahern V, Howard SC, et al. Recommendations for the treatment of children with radiotherapy in low- and middle-income countries (LMIC): A position paper from the Pediatric Radiation Oncology Society (PROS-LMIC) and Pediatric Oncology in Developing Countries (PODC) working groups of the International Society of Pediatric Oncology (SIOP). Pediatr Blood Cancer. 2017;64 Suppl 5.
23. Karim MU, Nadeem Abbasi A, Ali N, Hafiz A, Qureshi BM, Mir B. Postgraduate Training in a Low- and Middle-income Country: Sharing Experience from a Joint Commission International Accreditation-accredited University Hospital. Clin Oncol (R Coll Radiol). 2017;29(9):636-7.
24. Ali N, Mansha MA, Abbasi AN, Qureshi BM. Role of metastasectomy and chemotherapy in carcinoma of uterine cervix. BMJ Case Rep. 2017;2017.
25. Abbasi AN, Qureshi BM. A Suggested Plan for Specialist Doctor's Professional Growth and Development. J Coll Physicians Surg Pak. 2017;27(12):741-2.
26. Abbasi AN, Kiziltan HS. Implementation of Quality Measures in Site-Specific Multidisciplinary Tumour Boards. J Coll Physicians Surg Pak. 2017;27(6):388.
27. Abbasi AN, Karim MU, Qureshi BM, Hafiz A, Ali N. Comment on: Are we training the next generation of proficient Radiation Oncologists, or just better examination candidates? J Med Imaging Radiat Oncol. 2017;61(1):156.
28. Zaman MU, Fatima N, Zaman A, Zaman U, Tahseen R. Significantly Low Effective Dose from 18FDG PET/CT Scans Using Dose Reducing Strategies: "Lesser is Better". Asian Pac J Cancer Prev. 2016;17(7):3465-8.
29. Uz Zaman M, Fatima N, Zaman A, Zaman U, Tahseen R. Comparison of Hemodynamic Effects and Negative Predictive Value of Normal Adenosine Gated Myocardial Perfusion Scan With or Without Caffeine Abstinence. World J Nucl Med. 2016;15(3):190-5.
30. Mansha MA, Abbasi AN, Ali N, Hafiz A, Qureshi BM. Correspondence on review article published in Oral Oncology (Vol. 59, August 2016): "Evaluation of the benefit and use of multidisciplinary teams in the treatment of head and neck cancer.". Oral Oncol. 2016;63:e6.
31. Ali N, Abbasi AN, Mansha MA. Correspondence on the article: "Patients treated with neoadjuvant chemotherapy + radical surgery + adjuvant chemotherapy in locally advanced cervical cancer: long-term outcomes, survival and prognostic factors in a single-center 10-year follow-up". Med Oncol. 2016;33(11):127.
32. Abbasi AN, Mansha MA, Qureshi BM, Hafiz A, Ali N. In Regard to Takiar et al. Int J Radiat Oncol Biol Phys. 2016;96(3):708-9.
33. Abbasi AN, Karim MU, Ali N, Hafiz A, Qureshi BM. Multidisciplinary Team Tumour Boards are a Lifeline for Our Cancer Patients in Lower and Middle Income Countries. Clin Oncol (R Coll Radiol). 2016;28(12):799.
34. Abbasi AN. Establishment and Maintenance of Quality of Site-Specific Multidisciplinary Tumor Boards in Pakistan. J Coll Physicians Surg Pak. 2016;26(10):805-7.
35. Zaman MU, Fatima N, Zaman U, Sajjad Z, Zaman A, Tahseen R. Predictive value of pyramidal lobe, percentage thyroid uptake and age for ablation outcome after 15 mCi fixed dose of radioiodine-131 in Graves' disease. Indian J Nucl Med. 2015;30(4):309-13.
36. Zaman MU, Fatima N, Sajjad Z, Zaman U, Zaman A, Tahseen R. "Pseudo-thyroid lobe": A diagnostic conundrum caused by ossified anterior longitudinal ligament on bone scan. Indian J Nucl Med. 2015;30(1):78-9.
37. Karim MU, Khan K, Ali N, Ikram M. Sino-nasal mucosal malignant melanoma. BMJ Case Rep. 2015;2015.
38. Hafiz A, Abbasi AN, Ali N, Khan KA, Qureshi BM. Frequency and Severity of Acute Toxicity of Pelvic Radiotherapy for Gynecological Cancer. J Coll Physicians Surg Pak. 2015;25(11):802-6.
39. Badar Q, Masood N, Abbasi AN. Everolimus induced Pneumonitis. Gulf J Oncolog. 2015;1(18):18-24.
40. Abbasi AN, Hafiz A, Qureshi BM, Ali N. Re: Impact of comorbidity in staging & management decision making of nasopharyngeal Ca (NPC). Radiother Oncol. 2015;115(3):435.
41. Abbasi AN, Hafiz A, Ali N. In regard to Zhou et al. Int J Radiat Oncol Biol Phys. 2015;91(4):878.
42. Uz Zaman M, Fatima N, Sajjad Z, Zaman U, Tahseen R, Zaman A. 18FDG synthesis and supply: a journey from existing centralized to future decentralized models. Asian Pac J Cancer Prev. 2014;15(23):10057-9.
43. Khan KA, Abbasi AN, Ali N. Treatment updates regarding anaplastic oligodendroglioma and anaplastic oligoastrocytoma. J Coll Physicians Surg Pak. 2014;24(12):935-9.
44. Asghar AH, Abbasi AN, Jamal A, Haider G, Rizvi S. City tumour board Karachi: an innovative step in multidisciplinary consensus meeting and its two years audit. J Pak Med Assoc. 2013;63(12):1534-5.
45. Abbasi AN, Hafiz A, Ali N, Khan KA. Plan dose evaluation of three dimensional conformal radiotherapy planning (3D-CRT) of nasopharyngeal carcinoma (NPC): experience of a tertiary care University Hospital in Pakistan. Asian Pac J Can Prev. 2013;14(10):5989-93.
46. Abbasi AN. Development of cancer services:potential specific complexities in the perspective of health economic evaluation. J Coll Physicians Surg Pak.2013;23(3):171-2.
47. Ali N, Karsan F, Abbasi AN, Khan ZR. FIGO IVB (para-aortic lymph adenopathy) squamous cell carcinoma of uterine cervix associated with a left pelvic kidney: a therapeutic challenge. J Pak Med Assoc. 2012;62(6):615-6.
48. Abbasi AN, Zahid S. Latest update on the clinical features and management of Merkel cell carcinoma. J Pak Med Assoc. 2012;62(3):262-8.
49. Shaikh AJ, Bawany SA, Masood N, Khan AA, Abbasi AN, Niamutullah SN, et al. Incidence and impact of baseline electrolyte abnormalities in patients admitted with chemotherapy induced febrile neutropenia. J Cancer. 2011;2:62-6.
50. Abbasi AN, Zahid S, Bhurgri Y, Ali N, Karsan F. Nasopharyngeal carcinoma - an update of treatment and acute radiation induced reactions from a tertiary-care hospital in Pakistan. Asian Pac J Cancer Prev. 2011;12(3):735-8.
51. Abbasi AN. Cancer management is a multidisciplinary team work. J Coll Physicians Surg Pak. 2011;21(5):259-61.
52. Badar Q, Ali N, Abbasi N, Ashraf S, Karsan F, Hashmi R. Ewing's sarcoma/PNET of kidney in 13-year-old girl. J Pak Med Assoc. 2010;60(4):314-5.
53. Abbasi AN, Zahid S, Karsan F, Ali N, Bhurgri Y. Lymphoma cases referred to the radiation oncology service of a tertiary referral university hospital in Karachi, Pakistan: a retrospective study. Asian Pac J Cancer Prev. 2010;11(1):107-10.
54. Ali N, Abbasi AN, Karsan F, Hashmi R, Badar QA, Sheikh AJ. A case of finger clubbing associated with nasopharyngeal carcinoma in a young girl, and review of pathophysiology. J Pak Med Assoc. 2009;59(4):253-4.
55. Abbasi AN. Clinical features and management of Merkel cell carcinoma. J Pak Med Assoc. 2007;57(7):368-71.
56. Abbas A, Tunio MA, Ali N. Neoadjuvant chemo-irradiation in un-resectable carcinoma of rectum. J Ayub Med Coll Abbottabad. 2004;16(2):24-9.
57. Rahman SU, Ali N, Ali M, Mansoor S, Mahmood T. Adenocarcinoma of rectosigmoid junction metastatic to testis. J Pak Med Assoc. 2003;53(1):38-9.
58. Ali N, ur-Rehman S, Ali M, Sabir I, Azhar R, Mansoor S. Skin metastasis from prostate adenocarcinoma. J Coll Physicians Surg Pak. 2003;13(1):53-4.
59. Abbas A, Ali N, Hameed S, Shah MA. Resectability rates in locally advanced esophageal carcinoma following neo-adjuvant chemoradiotherapy. J Ayub Med Coll Abbottabad. 2003;15(4):13-6.
60. Ali N, Hameed S, Shah MA. Parotid sparing irradiation for the head and neck cancers. J Ayub Med Coll Abbottabad. 2002;14(4):45-8.
61. Abbasi AN. Important considerations in the estimation of organ doses in pelvic external-beam radiation therapy after gynecologic brachytherapy. Radiology. 1999;213(2):618-9.
62. Abbasi AN. Self-reported comprehensive health status of adult brain tumor patients using the Health Utilities Index. Cancer. 1998;82(5):995-6.

TUMOR BOARD SAVES LIVES

25

21/09/2021 4:52 pm

87 PUB MED CITED PUBLICATIONS

International Publications �from Pakistan

If we are aiming for Patient’s Safety & High Quality Treatment

• We have to offer ‘’BOTH’’ ;

1) MULTI-DISCIPLINARY PROCESS OF:

SITE SPECIFIC TUMOR BOARDS

AND

2)INTRA-DISCIPLINARY PROCESS OF:

PEER REVIEW OF ALL CASES

TUMOR BOARD SAVES LIVES

26

21/09/2021 4:52 pm

• 116 plans
• Recommended for changes
• TOTAL-26 (22.4%)
• Minor changes
• 15 (12.9%)
• Major change
• 10 (8.6%)
• Radical >palliative
• (92.3% v 7.7%)
• Site - head and neck
• (42.3%)

TUMOR BOARD SAVES LIVES

27

21/09/2021 4:52 pm

Onco Learners Forum� Slogan

TUMOR BOARD SAVES LIVES

28

21/09/2021 4:52 pm

Site Specific MDT Tumor Boards at AKU �( Updated 21 Sep 2021)

3 PER WEEK – MON/WED/FRI

• HAEM DEPT. MDT TUMOUR BOARD

WEEKLY

• BREAST
• GIT
• GYNAECOLOGY
• HEAD & NECK
• LIVER
• NEURO
• UROLOGY
• GENERAL

​

FORTNIGHTLY

• LYMPHOMA
• NPC
• ORBITAL

( Adult & Paediatric)

• THORACIC

​

MONTHLY

• BRACHYTHERAPY
• CLINICAL ENGINEERING

(Video Link: with VC & Faculty of NED University)

• ORTHOPAEDIC
• PAIN MDT
• PITUITARY
• RADIOMICS
• SKIN
• THERANOSTICS
• THYROID
• INTERVENTIONAL BRACHYTHERAPY

(Video Link: Univ. Cat. SC Rome Italy)

• SBRT

(Video Link: Bezmialem Univ. Istanbul, Turkey)

• PAEDIATRIC CNS

(Video Link: Sick Kids Hospital, Toronto, Canada)

• PAEDIATRIC HAEM
• PAEDIATRIC SARCOMA
• PAEDIATRIC SOLID TUMORUS

Purple & Green

TUMOR BOARD SAVES LIVES

30

21/09/2021 4:52 pm