Impact of a Prostate Multidisciplinary Clinic Program on Patient Treatment Decisions and on Adherence to NCCN Guidelines

Abstract

The establishment of a GU MDC improved the quality of care for cancer patients as demonstrated by improved adherence to National Comprehensive Cancer Network guidelines, and a broadening of treatment choices made available.

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

“…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. MDTs contributed to changing clinical diagnostic and treatment decisionmaking with respect to urological [14], pancreatic [16], gastro-oesophageal [19,35], breast [20], melanoma [25], bladder [27], colorectal [22], prostate [42], head and neck [33] and gynaecological [35] cancer patients. The other 22 studies focused on the structure and functions related to MDT organisation by identifying how the format, data management and professional roles of MDTs impacted positively on care coordination for professionals and patients (Table 2).…”

“…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.…”

“…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].…”

“…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].…”

“…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]. Finally, online conferences made use of specific web-based software to organise and conduct online tumour board meetings among clinicians within a given hospital [16] or nationwide [18].…”