Surgeons strive to deliver the highest quality care to their patients. Achieving this goal generally involves following best practices and adopting the latest evidence-based methods. However, we all struggle to keep up with advances due to multiple demands on our time. Unfortunately, some institutions and payors seem to place an emphasis on volume and productivity rather than on quality of care. We also can be overwhelmed by time-consuming federal regulations, and, regrettably, continuing medical education often gets pushed to the back burner. On top of all these time management-related challenges, surgeons are often drowning in daily e-mail blasts, many of which are not applicable to our practices. How do we keep up?
What is the Dissemination and Implementation Committee?
The American College of Surgeons Clinical Research Program (ACS CRP), in conjunction with the Alliance for Clinical Trials in Oncology, has established a Dissemination and Implementation Committee that is charged with making it easier for surgeons to get the information they need to provide quality, leading-edge care. The U.S. Department of Health and Human Services (HHS) defines dissemination as “the targeted distribution of information and intervention materials to a specific public health or clinical practice audience. The intent is to spread (‘scale-up’) and sustain knowledge and the associated evidence-based interventions.”1 HHS defines implementation as “the use of strategies to adopt and integrate evidence-based health interventions and change practice patterns within specific settings.” According to HHS, dissemination and implementation research is designed “to bridge the gap between public health, clinical research, and everyday practice by building a knowledge base about how health information, interventions, and new clinical practices and policies are transmitted and translated for public health and health care service use in specific settings.”1
The gap between research and new clinical practices is often striking in oncology. Results of oncology clinical trials may take up to 15 years before being fully integrated into clinical practice throughout the U.S. The mission of the Dissemination and Implementation Committee is to shorten this delay and bring practice-changing results of the Alliance and other national clinical trial groups to the broadest audience in formats that are most likely to facilitate thoughtful adoption into clinical practice.
The ACS CRP Education Committee provides up-to-date information about the latest clinical trials in surgical oncology through Panel Sessions presented at the annual ACS Clinical Congress, investigator meetings at national surgical society meetings, and via this column in the Bulletin. The Dissemination and Implementation Committee seeks to disseminate clinical trial information at a more granular level, and to do this successfully, the committee needs your help.
As a first step, we are including questions in the upcoming membership survey to determine your preferences regarding how you want to receive information about clinical trials and national guidelines for oncology. Second, we are developing a series of short videos explaining the results and clinical implications of recently completed clinical trials. These 10- to 15-minute videos could be useful for viewing at local tumor board meetings, and may provide inspiration for quality improvement projects for Commission on Cancer (CoC) sites.
The Dissemination and Implementation Committee is seeking volunteers who can help pilot this video project. Volunteers would be provided with the short video, questions to be asked of the audience before the video is viewed, suggested discussion questions for immediately after the video is viewed, and questions that would be asked six months after the video is viewed and discussed. The latter will be useful in assessing whether surgeons change their practice patterns as a result of the educational endeavor and whether the video and discussion were the inspiration for a quality improvement project at the institution.
The first video in the series will focus on ways to implement clinical trial results regarding axillary staging for breast cancer. For instance, the American College of Surgeons Oncology Group (ACOSOG) Z0011 trial showed that axillary lymph node dissection could be safely omitted in early-stage breast cancer patients undergoing breast conservation who have one or two positive sentinel lymph nodes.2
Implementing Z1071 trial results
The ACOSOG Z1071 trial examined the accuracy of sentinel lymph node surgery in patients with positive nodes who were treated with neoadjuvant chemotherapy.3 This study, together with the sentinel lymph node biopsy in patients with breast cancer before and after neoadjuvant chemotherapy (SENTINA) trial and the sentinel node biopsy after neoadjuvant chemotherapy in biopsy-proven node-positive breast cancer, the SN FNAC (Sentinel Node Following Neoadjuvant Chemotherapy) study, demonstrated many important points that need dissemination, such as the superiority of using both blue dye and radioactive tracer for sentinel lymph node biopsy after chemotherapy in node-positive patients.4,5 Z1071, together with additional work in this area, has shown that placing a clip in a lymph node when percutaneous biopsy is done before chemotherapy and ensuring removal of that “clipped” node after chemotherapy are useful techniques to improve the accuracy of sentinel lymph node surgery in this setting.
Thoughtful implementation of these trials is important to ensure that trial results are not applied in circumstances excluded from the trial or in populations of patients who were ineligible for the trial.
Abigail Caudle, MD, FACS, a breast surgeon at the University of Texas MD Anderson Cancer Center, Houston, will kick off the video pilot project by creating a video describing the implementation of Z1071 findings, which is intended to help local tumor boards start a discussion on how to implement these findings into clinical practice.
We are looking for CoC sites that would be interested in participating in the pilot by having the video presented at their tumor board and reviewing the outcomes of the presentation. If you are interested in volunteering to use this video-based educational tool, contact Amanda Francescatti, MS, Manager, ACS CRP, at email@example.com.
- Department of Health and Human Services. Part 1: Overview information dissemination and implementation research in health (R01). Available at: grants.nih.gov/grants/guide/pa-files/PAR-13-055.html. Accessed April 18, 2017.
- Giuliano AE, Ballman K, McCall L, et al. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: Long-term follow-up from the American College of Surgeons Oncology Group (Alliance) ACOSOG Z0011 randomized trial. Ann Surg. 2016;264(3):413-420.
- Boughey JC, Suman VJ, Mittendorf EA, et al. Alliance for Clinical Trials in Oncology. Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: The ACOSOG Z1071 (Alliance) clinical trial. JAMA. 2013;310(14):1455-1461.
- Kuehn T, Bauerfeind I, Fehm T, et al. Sentinel lymph node biopsy in patients with breast cancer before and after neoadjuvant chemotherapy (SENTINA): A prospective, multicenter cohort study. Lancet Oncol. 2013;14(7):609-618.
- Boileau JF, Poirier B, Basik M, et al. Sentinel node biopsy after neoadjuvant chemotherapy in biopsy-proven node-positive breast cancer: The SN FNAC study. J Clin Oncol. 2015;33(3):258-264.