Multidisciplinarity and medical decision, impact for patients with cancer: sociological assessment of two tumour committees’ organization

Castel, Patrick; Tassy, Louis; Lurkin, Antoine; Blay, Jean‐Yves; Méeus, Pierre; Mignotte, H.; Faure, C.; Ranchère-Vince, Dominique; Bachelot, Thomas; Guastalla, Jean‐Paul; Sunyach, Marie‐Pierre; Guérin, N.; Treilleux, Isabelle; Marec‐Bérard, Perrine; Thiesse, Philippe; Ray‐Coquard, Isabelle

doi:10.1684/bdc.2012.1559

Cited by 16 publications

(12 citation statements)

References 28 publications

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“…Our results demonstrate, we believe for the first time, that head and neck multidisciplinary team meetings lead to changes in management in almost a third of cases. Published changes in management have ranged from 30% in breast cancer and sarcoma, to 77% in gastric cancer . At odds is a study of 124 urological cancer cases reported by Acher et al identifying no change in management in over 98% of patients.…”

Section: Discussionmentioning

confidence: 99%

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Head and neck multidisciplinary team meetings: Effect on patient management

et al. 2014

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Section: Discussionmentioning

confidence: 99%

“…However, the evidence base for this assumption is not strong and is sometimes conflicting. The majority of the studies performed in a wide range of malignancies other than head and neck cancer, show that multidisciplinary team meetings change management and improve outcome, although these results could not be reproduced in all studies …”

Section: Introductionmentioning

confidence: 99%

Head and neck multidisciplinary team meetings: Effect on patient management

et al. 2014

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“…TBs bring together clinicians from different specialties (oncologists, pathologists, surgeons, radiotherapists), often specialising on a particular, organ‐defined form of cancer, who discuss difficult cases to reach a collective, consensus‐based therapeutic decision (Castel et al . , Kuroki et al . ).…”

Section: Mtbs a Novel Institution For Precision Oncologymentioning

confidence: 99%

“…In France, this has become mandatory since 2003. TBs bring together clinicians from different specialties (oncologists, pathologists, surgeons, radiotherapists), often specialising on a particular, organ-defined form of cancer, who discuss difficult cases to reach a collective, consensusbased therapeutic decision (Castel et al 2012, Kuroki et al 2010. In recent years, the development of 'precision oncology' has led to the emergence of a new kind of TBs, generally referred to as 'molecular tumour boards' (MTBs).…”

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confidence: 99%

Genomic expertise in action: molecular tumour boards and decision‐making in precision oncology

Bourret

Cambrosio

2019

Sociology Health & Illness

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The recent development of cancer precision medicine is associated with the emergence of ‘molecular tumour boards’ (MTBs). Attended by a heterogenous set of practitioners, MTBs link genomic platforms to clinical practices by establishing ‘actionable’ connections between drugs and molecular alterations. Their activities rely on a number of evidential resources – for example databases, clinical trial results, basic knowledge about mutations and pathways – that need to be associated with the clinical trajectory of individual patients. Experts from various domains are required to master and align diverse kinds of information. However, rather than examining MTBs as an institution interfacing different kinds of expertise embedded in individual experts, we argue that expertise is the emergent outcome of MTBs, which can be conceptualised as networks or ‘agencements’ of humans and devices. Based on the ethnographic analysis of the activities of four clinical trial MTBs (three in France and an international one) and of two French routine‐care MTBs, the paper analyses how MTBs produce therapeutic decisions, centring on the new kind of expertise they engender. The development and activities of MTBs signal a profound transformation of the evidentiary basis and processes upon which biomedical expertise and decision‐making in oncology are predicated and, in particular, the emergence of a clinic of variants.

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“…This type of organization presents several advantages. Firstly, the national cancer plan requires that a multidisciplinary committee be consulted to facilitate collective decisions on care [3]. With the IRFC-FC, each individual treatment strategy can be decided on by a multidisciplinary team.…”

Section: Introductionmentioning

confidence: 99%

Organizing medical oncology care at a regional level and its subsequent impact on the quality of early breast cancer management: a before-after study

Voidey

Pivot

Woronoff³

et al. 2014

BMC Health Serv Res

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BackgroundOne of the main measures of the French national cancer plan is to encourage physicians to work collectively, and to minimize territorial inequities in access to care by rethinking the geographical distribution of oncologists. For this reason, cancer care services are currently being reorganized at national level. A new infrastructure for multidisciplinary cancer care delivery has been put in place in our region. Patients can receive multidisciplinary health care services nearer their homes, thanks to a mobile team of oncologists. The objective of our study was to assess, using a quality approach, the impact on medical management and on the costs of treating early breast cancer, of the new regional structure for cancer care delivery.MethodsBefore-and-after study performed from 2007 to 2010, including patients treated for early breast cancer in three hospitals in the region of Franche-Comté in Eastern France. The main outcome measures were quality criteria, namely delayed treatment (>12 weeks), dose-intensity and assessment of adjuvant chemotherapy. Other outcomes were 24-month progression-free survival (PFS) and economic evaluation.ResultsThis study included 667 patients. The rate of chemotherapy tended to decrease, but not significantly (49.3% before versus 42.2% after, p=0.07), while the use of taxanes increased by 38% across all centres (59.6% before versus 98.0% after, p < 0.0001). There was a non-significant reduction in the time between surgery and adjuvant chemotherapy (6.0 ± 3.0 weeks before versus 5.6 ± 3.6 weeks after, p=0.11). Dose-dense chemotherapy improved slightly, albeit non significantly (86.3% versus 91.1% p=0.22) and time to treatment tended to decrease. The new regional infrastructure did not change 24-month PFS, which remained at about 96%. The average cost of treatment was estimated at €7000, with no difference between the two periods.ConclusionsDespite a shortage of oncologists, the new organization put in place in our region for the provision of care for early breast cancer makes it possible to maintain local community-based treatment, without negative economic consequences. This new structure for cancer care delivery offers cancer services of similar quality with no modification of 24-month PFS in early breast cancer.

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Multidisciplinarity and medical decision, impact for patients with cancer: sociological assessment of two tumour committees’ organization

Cited by 16 publications

References 28 publications

Head and neck multidisciplinary team meetings: Effect on patient management

Head and neck multidisciplinary team meetings: Effect on patient management

Genomic expertise in action: molecular tumour boards and decision‐making in precision oncology

Organizing medical oncology care at a regional level and its subsequent impact on the quality of early breast cancer management: a before-after study

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