Effect of process standards on survival of patients with head and neck cancer in the south and west of England

Birchall, Martin A.; Bailey, David M.; King, P Poon

doi:10.1038/sj.bjc.6602118

Cited by 97 publications

(66 citation statements)

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“…Birchall et al 5 and many others have compared outcomes of cancer patients before and after implementation of the team approach and found that patients assessed at mccs experienced improved survival compared with patients who were not so assessed. Whether the improvement is solely a result of discussion at the mccs is unknown; many confounding variables-such as patient heterogeneity and advances in diagnosis and treatments, among others-were not accounted for.…”

Section: Discussionmentioning

confidence: 99%

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Multidisciplinary Management of Cancer Patients: Chasing a Shadow or Real Value? An Overview of the Literature

Croke

El-Sayed

2012

Current Oncology

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Purpose: Multidisciplinary cancer conferences (mccs) are designed to optimize patient outcomes. It appears intuitive that mccs are essential to clinical decision-making and patient management; however, it is unclear whether that belief is supported by evidence. Our objectives were to assess the currently published literature addressing the impact of mccs on clinical decision-making and patient outcomes. Methods: Ovid medline was searched from 1950 to June 2010 using these keywords: “multidisciplinary/interdisciplinary/clinical meeting$/conference$/round$/team$,” “decision making,” “neoplasms$/cancer$/oncology/tumo(u)r conference$/board$/meeting$,” “multidisciplinary/interdisciplinary cancer conference$/meeting$.” All trials, guidelines, metaanalyses, reviews, and prospective and retrospective studies were included. Results: The keywords retrieved 595 abstracts, and 30 manuscripts were obtained. Most of the studies assessed the impact of mccs on clinical decision-making rather than on patient outcomes. Conclusions: Available evidence supports the belief that mccs significantly influence clinical decision-making and treatment recommendations. In contrast, scant evidence suggests that mccs improve patient outcomes. Unfortunately, the current literature is substantially heterogeneous and therefore does not allow for firm conclusions.

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Section: Discussionmentioning

confidence: 99%

“…A limited number of studies assessed impact of mccs on patient outcomes [4][5][6]15,23,29 . The common conclusion drawn was that multidisciplinary clinics and mdts are associated with improved survival.…”

Section: Discussionmentioning

confidence: 99%

Multidisciplinary Management of Cancer Patients: Chasing a Shadow or Real Value? An Overview of the Literature

Croke

El-Sayed

2012

Current Oncology

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“…There were seventeen case series that involved 38-3119 patients, two rcts that included 478 and 791 patients, and one case-control study that included 177 cases and 162 controls 4,7,[15][16][17][18][19][20][21][22][23][24][25][26][31][32][33][34][35][36] . The update of the literature search identified 823 citations in which patient outcomes related to diagnostic assessment units were described for colorectal cancer in four studies [27][28][29][30] , head-and-neck cancer in two studies 37,38 , lung cancer in two studies 39,40 , gynecologic cancers in three studies [41][42][43] , neurologic cancers in one study 44 , lymph node cancers in one study 45 , and upper gastrointestinal cancers in one study 46 . Study designs included one small rct (88 patients), seven prospective cohort studies (359-3637 patients), and six retrospective studies (69-930 patients) [27][28][29][30][37][38][39][40][41][42]…”

Section: Search Resultsmentioning

confidence: 99%

“…The update of the literature search identified 823 citations in which patient outcomes related to diagnostic assessment units were described for colorectal cancer in four studies [27][28][29][30] , head-and-neck cancer in two studies 37,38 , lung cancer in two studies 39,40 , gynecologic cancers in three studies [41][42][43] , neurologic cancers in one study 44 , lymph node cancers in one study 45 , and upper gastrointestinal cancers in one study 46 . Study designs included one small rct (88 patients), seven prospective cohort studies (359-3637 patients), and six retrospective studies (69-930 patients) [27][28][29][30][37][38][39][40][41][42][43][44][45][46] . Elements of the Downs and Black quality assessment scale for observational studies 14 were used to assess the quality of relevant studies included in the updated review.…”

Section: Search Resultsmentioning

confidence: 99%

“…For the updated systematic review, all studies but one were undertaken in the United Kingdom and included the National Health Service referral guidelines as a quality performance indicator for improving timely access [27][28][29][30][37][38][39][40][41][43][44][45][46] . Only one study evaluated the cost of follow-up visits to general practitioners in an rct evaluating a centralized two-stop rapid assessment unit against conventional routine diagnostic evaluation 39 .…”

Section: Discussionmentioning

confidence: 99%

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Cancer Diagnostic Assessment Programs: Standards for the Organization of Care in Ontario

et al. 2009

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BackgroundImproving access to better, more efficient, and rapid cancer diagnosis is a necessary component of a highquality cancer system. How diagnostic services ought to be organized, structured, and evaluated is less understood and studied. Our objective was to address this gap. MethodsAs a quality initiative of Cancer Care Ontario's Program in Evidence-Based Care, the Diagnostic Assessment Standards Panel, with representation from clinical oncology experts, institutional and clinical administrative leaders, health service researchers, and methodologists, conducted a systematic review and a targeted environmental scan of the unpublished literature. Standards were developed based on expert consensus opinion informed by the identified evidence. Through external review, clinicians and administrators across Ontario were given the opportunity to provide feedback. ResultsThe body of evidence consists of thirty-five published studies and fifteen unpublished guidance documents. The evidence and consensus opinion consistently favoured an organized, centralized system with multidisciplinary team membership as the optimal approach for the delivery of diagnostic cancer assessment services. Independent external stakeholders agreed (with higher mean values, maximum 5, indicating stronger agreement) that dap standards are

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

Boxer

Vinod

Shafiq

et al. 2011

Cancer

160

163

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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...

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Effect of process standards on survival of patients with head and neck cancer in the south and west of England

Cited by 97 publications

References 10 publications

Multidisciplinary Management of Cancer Patients: Chasing a Shadow or Real Value? An Overview of the Literature

Multidisciplinary Management of Cancer Patients: Chasing a Shadow or Real Value? An Overview of the Literature

Cancer Diagnostic Assessment Programs: Standards for the Organization of Care in Ontario

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

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