Compliance with multidisciplinary team recommendations and disease outcomes in early breast cancer patients: An analysis of 4501 consecutive patients

Abstract

Background Multidisciplinary team (MDT) discussions are widely held to facilitate the diagnosis and treatment of breast cancer, but patient compliance with the MDT recommendations and the impact of compliance on disease outcome are uncertain. Methods We conducted a retrospective review of data from a prospective database of breast cancer patients treated at Shanghai Ruijin Hospital between April 2013 and August 2018. MDT discussions were held for all patients before they started adjuvant therapy. The patients were classified into compliant and non-compliant groups according to whether they received the MDT-recommended regimens. We also analyzed which clinicopathological factors were associated with compliance and prognosis. Results Of 4501 breast cancer patients, 3681 (81.8%) and 820 (18.2%) were included in the compliant and non-compliant groups, respectively. Age >70 years ( P < 0.001), invasive ductal carcinoma ( P < 0.001), and histological grade III ( P = 0.011) were independently associated with higher risk of non-compliance, whereas Ki-67 labeling index ≥14% and history of benign breast disease were independently associated with compliance. Disease-free survival (hazard ratio [HR] 1.813, 95% confidence interval [CI] 1.367–2.405, P < 0.001) and overall survival (HR 2.478, 95% CI 1.431–4.291, P < 0.001) were worse in the non-compliant group. Conclusions Several clinicopathological factors were associated with non-compliance with MDT recommendations for early breast cancer patients. Non-compliance was associated with worse disease outcome.

The Effects of Multidisciplinary Team Meetings on Clinical Practice for Colorectal, Lung, Prostate and Breast Cancer: A Systematic Review

“…Forty-one articles investigated the effect of MDTMs on cancer care pathways in colorectal cancer (21/41) , lung cancer (10/41) [38][39][40][41][42][43][44][45][46][47], prostate cancer (6/41) [48][49][50][51][52][53] and breast cancer (4/41) [54][55][56][57] (Table 1). All studies were conducted in adults (total n = 82,073, range 42-32,569 study subjects per study, mean 2002), with studies originating from in Oceania (8/41) [20,26,29,38,39,43,45,52], Asia (9/41) [18,21,23,35,41,46,50,56,57], Europe (13/41) [17,19,24,25,27,31,32,34,36,37,44,…”

“…All studies were conducted in adults (total n = 82,073, range 42-32,569 study subjects per study, mean 2002), with studies originating from in Oceania (8/41) [20,26,29,38,39,43,45,52], Asia (9/41) [18,21,23,35,41,46,50,56,57], Europe (13/41) [17,19,24,25,27,31,32,34,36,37,44,48,49], North America (10/41) [22,28,30,33,40,42,47,51,53,54] or Africa (1/41) [55]. Studies were performed in multicenter (6/41) [34,37,38,40,41,56] or single-center (35/41) [17][18]…”

“…The frequency of MDTMs ranged from 4 times a week [21], to weekly [17,19,20,[22][23][24][25]29,[33][34][35][36]38,39,[42][43][44][45][46]49,[52][53][54][55] to biweekly [26,28,30,40,47,48]. Ten articles provided limited or no information on the frequency of MDTMs [18,27,31,32,37,41,50,51,56,57]. The outcomes measured in the articles were changes in or differences between: (1) process outcomes (9/41), (2) patient management (34/41) and (3) patient outcomes (18/41).…”

“…Studies using a before-after study design (12/41) [17,23,24,26,28,32,[34][35][36]44,46,55] or a casecontrol study design (13/41) [18,20,25,27,31,33,[37][38][39][40]43,47,56] investigated a combination of all three outcome groups. When a cohort study design (16/41) [19,21,22,29,30,41,42,45,[48][49][50][51][52][53][54]57] was used, most investigated patient management (13/16).…”

A Smartphone-Based App to Improve Adjuvant Treatment Adherence to Multidisciplinary Decisions in Patients With Early-Stage Breast Cancer: Observational Study (Preprint)

“…It could be conducive to evidence-based decisions for clinicians and provide a convenient medical treatment process for patients [15,16]. Our previous studies demonstrated that MDT discussion could also lower the relative risk of relapse by 16% and the risk of death by 11% in patients with breast cancer [7]. However, a major difficulty after the MDT meeting and during the treatment process was maintaining patient compliance.…”