Cross-sectional increase of adherence to multidisciplinary tumor board decisions

Abstract

BackgroundCancer research has made great progress in the recent years. With the increasing number of options in diagnosis and therapy the implementation of tumorboards (TUBs) has become standard procedure in the treatment of cancer patients. Adherence tests on tumor board decisions are intended to enable quality assurance and enhancement for work in tumor boards in order to continuously optimize treatment options for cancer patients.MethodsSubject of this study was the adherence of the recommendations made in three of 14 tumorboards, which take place weekly in the Center for Integrated Oncology (CIO) at the University Hospital Bonn. In total, therapy recommendations of 3815 patient cases were checked on their implementation. A classification into four groups has been made according to the degree of implementation. A second classification followed regarding the reasons for differences between the recommendation and the therapy which the patient actually received.ResultsThe study showed that 80.1% of all recommendations in the three TUBs were implemented. 8.3% of all recommendations showed a deviance. Most important reasons for the deviances were patient wish (36.5%), patient death (26%) and doctoral decision, due to the patient’s comorbidities or side effects of the treatment (24.1%).Interestingly, deviance in all three tumor boards in total significantly decreased over time.ConclusionsAim of the study was to clarify the use of tumor boards and find approaches to make them more efficient. Based on the results efficiency might be optimized by increased consideration of patients` preferences, improved presentation of patient-related data, more detailed documentation and further structuring of the tumor board meetings.

Higher number of multidisciplinary tumor board meetings per case leads to improved clinical outcome

“…The long recruitment period is also a hazard concerning possible general changes in diagnoses and treatment during this time period. Even though the adherence to MTB recommendations is comparably high with a shrinking deviance in recent years [15], it was not considered in our study and could be a factor. We matched as closely as possible by using diagnosis, staging, sex, age and a minimum followup time, but a pre selection bias by the treating physician to rather present severe cases in a multidisciplinary tumor board meeting cannot be totally ruled out.…”

<p>Benefits and Limitations of a Multidisciplinary Approach in Cancer Patient Management</p>

“…The study evaluated the degree of therapeutic recommendation implementation after MTB evaluation: 80% of all recommendations were implemented, with 8.3% of indications showing deviance, due to patient wishes (36.5%), patient death (26%), and physicians' decisions, based to patient age, comorbidities, or adverse effects of the treatment (24.1%). 26 A recent retrospective study on patients with head and neck cancers treated in a single urban academic medical center analyzed the level of concordance between a multidisciplinary team's therapeutic indications and National Comprehensive Cancer Network (NCCN)guideline recommendations. Adherence to NCCN guidelines was observed in about 98% of patients assessed in the MTB, while only 80% evaluated by a single specialist received a therapeutic indication in accordance with NCCN guidelines.…”

Health literacy and patient participation in multidisciplinary tumor conferences in breast cancer care: a multilevel modeling approach

“…Many decisions in breast cancer care are preference-sensitive, especially in metastatic breast cancer treatment [14]. Therefore, incorporating patient preferences in MTCs is a central factor in treatment decision-making to achieve higher-quality decisions [15] and to possibly optimize adherence efficiency of MTC decisions [16].…”