Do multidisciplinary team meetings make a difference in the management of lung cancer?

Abstract

BACKGROUND: There is limited evidence regarding the effectiveness of multidisciplinary team (MDT) meetings in lung cancer. The objective of this study was to compare the patterns of care for patients with newly diagnosed lung cancer who were presented at a lung cancer MDT meeting with the patterns of care for patients who were not presented. METHODS: All patients who had lung cancer newly diagnosed in South West Sydney (SWS) between December 1, 2005, and December 31, 2008, were identified from the local Clinical Cancer Registry. Patient and tumor characteristics and treatment receipt were compared between patients who were and were not presented at MDT meetings. A logistic regression model was constructed to determine predictors for receiving treatment and survival. RESULTS: In total, there were 988 patients, including 504 patients who were presented at MDT meetings and 484 who were not presented at MDT meetings. The median patient age was 69 years and 73 years in the MDT group and the non-MDT group, respectively (P < .01). There was no pathologic diagnosis for 13% of non-MDT patients compared with 4% of MDT patients (P < .01). Treatment receipt for MDT patients versus non-MDT patients was 12% versus 13%, respectively, for surgery (P value nonsignificant); 66% versus 33%, respectively, for radiotherapy (P < .001); 46% versus 29%, respectively, for chemotherapy (P < .001); and 66% versus 53%, respectively, for palliative care (P < .001). In patients with good performance status, the MDT group had significantly better receipt of radiotherapy among patients with stage I through IV nonsmall cell lung cancer (NSCLC) and had significantly better receipt of chemotherapy among patients with stage IV NSCLC. MDT discussion was an independent predictor of receiving radiotherapy, chemotherapy, and referral to palliative care but did not influence survival. CONCLUSIONS: MDT discussion was associated with better treatment receipt, which potentially may improve quality of life for patients with lung cancer. However, it did not improve survival. Cancer 2011;117:5112-20. V C 2011 American Cancer Society.KEYWORDS: chemotherapy, lung neoplasms, multidisciplinary teams, palliative care, radiotherapy.Multidisciplinary team (MDT) meetings are becoming increasingly common in the management of complex diseases. These meetings are gatherings of health care professionals with or without patients with the purpose of discussing individual cases and recommending a management plan. Cancer is an example of this process in which input from multiple health care professionals is required.Studies have demonstrated that the management of cancer patients in an MDT setting improves outcomes. In breast cancer, MDTs reportedly decreased the time from diagnosis to treatment and improved patient satisfaction.1 In rectal cancer, MDT discussion of staging with magnetic resonance imaging and subsequent preoperative treatment recommendations significantly reduced the rate of positive surgical margins.2 In head and neck cancers, MDTs were cost effective 3 an...

Is it worth reorganising cancer services on the basis of multidisciplinary teams (MDTs)? A systematic review of the objectives and organisation of MDTs and their impact on patient outcomes

“…All studies concluded that a multidisciplinary setting resulted in improved patient outcomes in terms of diagnosis and/or treatment planning [14][15][16][18][19][20][21][22][25][26][27][28][29][31][32][33][35][36][37]40,42], improvements in survival [15,17,21,23,[28][29][30]36,39,41], patient satisfaction [24,31,38] and clinician satisfaction as a consequence of teamwork communication and cooperation [15,34]. Evidence of improved survival was found for colorectal [15,17,28,36], head and neck [29,41], breast [39], oesophageal [21] and lung [30] cancer.…”

“…The studies documented two motivating principles: firstly, MDTs ensure more appropriate treatment through a preoperative review of imaging and pathology results [19,20,22,25,26,40,42]; and secondly, a multidisciplinary approach guarantees the most up-todate treatment for all cancer patients seen at the facility or discussed online [16,18,21,23,32,33,35,[38][39][40][41]53]. Other clinical-based goals included improving patients' quality of life [24,32,42,[53][54][55] and setting up a structured followup care plan [53,[59][60][61].…”

“…Secondary objectives also included providing a teaching environment for healthcare professionals and junior doctors [18,20,24,30,32,34,54]; acting as a quality improvement group [22,34,50,54]; and increasing enrolment in the tumour registry [16].…”

“…Essentially, there were three types of formats in clinical practice. Firstly, there were meetings, which lasted anywhere from 30 min to 2 h and included either all or a selection of diagnosed and/or referred patients; patients were selected by the specialist in charge based on the case's level of complexity or the wide range of therapeutic possibilities, prearranged team criteria, or triage by the clinical coordinator [27,30,[32][33][34]46,48,50]. A second MDT format was the multidisciplinary clinic, where patients were not only seen but also simultaneously examined [16,38,40,53,54] or remotely coordinated by all board members [42].…”

“…Several papers differentiated team composition by identifying three levels of involvement, i.e., "core", "allied" (or "extended") and "expert support" membership. Core and allied members included radiologists, pathologists, surgeons, radiation and medical oncologists, oncology nurses, palliative care physicians, head and neck specialists, nuclear medicine specialists, respiratory disease physicians, gastrointestinal disease physicians and anaesthesiologists, some of whom were frequently sub-specialised by tumour site [20,29,30,[32][33][34]42,43,45,52,53]. The support members included psychologists, nutritionists, dieticians, plastic surgeons, speech therapists, patients' GPs, physiotherapists, practitioners of complementary medicine, orthopaedic specialists, medical physicists, odontologists, faith counsellors, biologists, data managers, genetic counsellors, hospital pharmacists, social workers and occupational therapists [24,27,40,45,49,54,55].…”