Impact of multidisciplinary discussion on therapeutic decision in cancer patients: a prospective observational study.

Abstract

e18243 Background: Continued and rapid evolution of diagnosis and staging methods along with the development of new treatments has changed decision-making process of cancer patient into a more complex task. We evaluated the impact of multidisciplinary tumor board meetings (MTM) in the final decision of cancer patients approach in comparison to the initial decision based on clinical oncologist’s individual choice. Methods: Between April 2016 and January 2017, data were collected prospectively during the MTM held daily at the Antônio Ermírio de Moraes Cancer Center, Sao Paulo, Brazil. Data were gathered by filling out a questionnaire. The therapeutic plan initialy proposed by the physician was compared to the proposal offered by the multidisciplinary team. We evaluated data from breast, gastrointestinal (GI) and lung cancer MTM. Results: We evaluated 100 questionnaires: 39% GI tumors, 34% lung cancer, 27% breast cancer. The main theme for discussion was selection of systemic therapy (65%). The rate of change in therapy choice was 24.6%. The recommendation suggested by the MTM surgeons and radio-oncologists showed disagreement with the one initially proposed in 21 cases. The majority of discordant cases was related to the choice of therapeutic method (57%) with 42% changes in the chemotherapy protocol. Eight patients were submitted to genetic test and mutations search. Only two cases were recommended for clinical trial enrollment. Conclusions: The rate of therapy plan change after MTM is in accordance with international studies. The largest volume of discussions on systemic therapies reflects the large number of new therapies as well as new treatment strategies. This research highlights the potential of multidisciplinary discussions in changing decision-making in cancer cases, allowing a more comprehensive care with the patient. In addition, a MTM allows the access of more patients to new medications made available through clinical trials and protocols. The small number of patients referred to a clinical study reflects the lack of clinical protocols available in Brazil, a problem that needs to be acknowledged and become a priority for Brazilian medical societies and regulatory agencies.

Factors influencing treatment decision‐making for cancer patients in low‐ and middle‐income countries: A scoping review

“…One study described gender bias in the treatment of osteosarcoma and the neglect of female patients 66 . Other factors included treatment toxicities, 46,48,49,51,53,54,56,57,63,66,70,74,79,80,85,87,89,93,98,100–103 specific disease features, 50,51,56,57,59,64,76,77,80,96,98,104 the results of diagnostic workup, 65,75,77,80 and access to cancer‐directed treatment and supportive care resources and personnel 46,49–51,54–56,61,62,65,66,68,70,73–75,77,78,80–84,86–88,94,98,102–105 …”

“…Factors related to professional interaction and communication were described in 25% of articles. 45 , 46 , 49 , 50 , 51 , 54 , 55 , 56 , 61 , 62 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 Factors related to professional interaction and communication in articles that focused on the perspective of patients and families included the invitation to participate in decision‐making, 54 , 62 , 65 , 70 , 88 trust, 70 , 73 , 81 or distrust 49 , 51 , 86 in their healthcare providers, variable quality of patient‐healthcare team communication, 79 , 86 , 87 including disempowerment of patients, lack of patient understanding of therapy or therapeutic options, an...…”

“… 86 Contextual factors also may include government policies, such as visa regulations 75 or national policies that impact access to resources or personnel, 55 or the political climate, including war. 50 , 55 , 75 , 104 Physicians report variable access to resources and information to help guide decision‐making, including treatment guidelines or protocols, 68 , 77 , 80 multidisciplinary tumor boards 65 , 68 , 72 , 77 , 78 , 80 or knowledgeable colleagues. 68 , 74 A country's economic status may further limit resource allocation, directly and indirectly impacting treatment decision‐making.…”

“…Note: "Other" article type includes letter to editor, case report, perspective, and a poster presentation.T A B L E 2 (Contiunes) treatment and supportive care resources and personnel 46,[49][50][51][54][55][56]61,62,65,66,68,70,[73][74][75]77,78,[80][81][82][83][84][86][87][88]94,98,[102][103][104][105]. …”