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Clinical and digital teamwork experiences applied to oral cancer and special care: from diagnosis to integrated therapy

Olga Di Fede1* and Vera Panzarella1
  • 1 Università degli Studi di Palermo, Department of Surgical, Oncological and Oral Sciences, Italy

Multidisciplinary team (MTD) approach has a crucial role in the oral care of patients with special needs (i.e. geriatric and/or frail and/or with cancer): oral health is essential for general health and quality of life. Thanks to an increasing of the incidence and the survival of patients with several chronic diseases (i.e. cancers), physicians and general dentists are interested to care a larger number of older and/or more complex patients at higher risk for oral complications. The management of these complications require a teamwork in order to optimize oral clinical decision-making, assess and manage the comorbidities, mitigating the risk of polypharmacy. All this could be facilitated by innovative technologies: IT (Information Technology) systems and web-based technologies. Objective To show the importance of teamwork for the management of oral diseases in geriatric and cancer patients by means dedicated clinical and digital networks, named “OloHealth” and “GOTeC” [“Gruppo Oncologico Testa e Collo” (Head&Neck cancer group)]. Methods OloHealth has been created in 2018, thanks to the PSN project named “Network per la medicina orale nel paziente anziano (oncologico e fragile)”. It is based on HUB/SPOKE model; the HUB is the Sector of Oral Medicine (Palermo) and it is connected to several SPOKES (geriatric and oncological units) in Sicily. Every spoke can log in and use the modern and user-friendly platform, requiring teleconsultation (live or on demand) or second opinion (Figure 1). In order to carry out the live consultation, the HUB and SPOKE are simultaneously connected to the OloHealth platform, and the patient’s images are reported by an intraoral camera (i.e. Gendex GXC-300). The live consultation ends with a diagnosis or a temporary diagnosis, medical therapy prescription; whereas necessary, a direct visit should be planned at the HUB center. GOTeC, an interdisciplinary group founded in in 2009, has been created to give a preferential care path (from diagnosis to management) for H&N cancer patients and to perform a research group. Many specialties are involved: Oral Medicine, Otolaryngology, Plastic and Reconstructive Surgery, Oncology, Pathology, Radiology, Microbiology, Speech Therapy and Psyco-Oncology. H&N cancer patient should be firstly evaluated by one of GOTeC specialist which will provide to submit him or her report to platform that is a specific software and dedicated WebApp useful for consultation of patients’ list and clinical and imaging data (Figure 2). Results From April 2018 to date, OloHealth permits connection of HUB and 4 SPOKES (Oncological Units dislocated in 3 different Sicilian countries). During six months of activity, 18 teleconsultations for oncological patients (38.10% with breast cancer, 33.33% with prostatic tumor, 4.76% with breast and ovarian cancer, 4.76% with melanoma, 4.76% with gastric adenocarcinoma, 4.76% with thyroid cancer and 9.52% with lung cancer) at risk of Medication-Related Osteonecrosis of the Jaw (MRONJ) are carried out: 15/18 are cancer patients in pre-treatment phase with drugs related to ONJ; 3/18 are suspected for the presence of ONJ in cancer patients already in treatment with related drug. One has made as live consultation. All 18 teleconsultations are performed within 48 hours from SPOKE request and management protocols (according to the recommendations of SIPMO/SICMF https://www.hindawi.com/journals/bmri/2018/2684924/) have been applied for everyone. About GOTeC platform, from 2009 to date, almost 1000 patients with H&N cancers have been managed. Most of them (about 80%) have completed diagnostic/therapeutic pathway within 1 month. Conclusions OloHealth is a teledentistry platform that could be comparable to face-to-face examination for oral screening by means intra-oral camera. Oral consultations are quickly provided within 48 hours and, for the suspected MRONJ cases the timing of the access to center of management has been greatly reduced. GOTeC is the first group in Sicily that has developed an innovative model for diagnostic-therapeutic process of H&N cancers patient, warranting very short time for treatment and a better post-treatment quality of life. MDT method has stated several benefits for patients, including: coordination of diagnosis and staging pathway, better-quality survival, optimized treatment planning, adherence to modern clinical guidelines and more cost-effective care. This gives improves clinician value and patient satisfaction. Moreover, the use of the WebApp allowed the immediate exchange of patient’s clinical and instrumental data among the specialists, supporting a more timely and targeted treatment.

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References

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Keywords: Head and neck cancer patient, Oral care, Digital networks, Multidisciplinary teamwork, Quality of Life

Conference: 5th National and 1st International Symposium of Italian Society of Oral Pathology and Medicine., Ancona, Italy, 19 Oct - 20 Oct, 2018.

Presentation Type: oral presentation

Topic: Oral Diseases

Citation: Di Fede O and Panzarella V (2019). Clinical and digital teamwork experiences applied to oral cancer and special care: from diagnosis to integrated therapy. Front. Physiol. Conference Abstract: 5th National and 1st International Symposium of Italian Society of Oral Pathology and Medicine.. doi: 10.3389/conf.fphys.2019.27.00095

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Received: 28 Nov 2018; Published Online: 09 Dec 2019.

* Correspondence: Prof. Olga Di Fede, Università degli Studi di Palermo, Department of Surgical, Oncological and Oral Sciences, Palermo, Sicily, 90127, Italy, olga.difede@unipa.it