Refocusing cancer multidisciplinary team meetings in the United Kingdom: comparing urology with other specialties

Abstract

Introduction Multidisciplinary team (MDT) meetings have been the gold standard of cancer care in the UK since the 1990s. We aimed to identify the views of urology cancer MDT members in the UK on improving the functioning of meetings and compare them with those of other specialties to manage the increasing demand on healthcare resources and enhance the care of complex cancer cases. Methods We analysed data from 2 national surveys distributed by Cancer Research UK focusing on the views of 2,294 and 1,258 MDT members about cancer MDT meetings. Findings Most breast, colorectal, lung and urology cancer MDT members felt meetings could be improved in the following areas: time for meeting preparation in job plans, streamlining of patients, auditing meeting decisions and prioritising complex cases. Most urology respondents (87%) agreed some patients could be managed outside a full MDT discussion, but this was lower for other specialties (lung 78%, breast 75%, colorectal 64%). Conclusions To facilitate decisions on which patients require discussion in an MDT meeting, factors adding to case complexity across all tumour types were identified, including rare tumour type, cognitive impairment and previous treatment failure. This study confirms that urology MDT members are supportive of changing from reviewing all new cancer diagnoses to discussing complex cases but managing others with a more protocolised pathway. The mechanisms for how to do this and how to ensure the safety of patients require further clarification.

The cancer multidisciplinary team meeting: in need of change? History, challenges and future perspectives

“…Evidence to support this initiative has been provided by several studies across different tumour types, which have reported reduced number of cases discussed at MDTMs and a reduction in MDTM duration. Two national surveys distributed by Cancer Research UK have shown that 87% of urologists agree that some patients could be managed outside of full MDT discussion [39]. Streamlining has be trialled in Urology across a number of NHS Trusts in the UK, with benefits becoming apparent [21, 31, 33].…”

Mapping Current Organizational Structure and Improvement Points of Breast Cancer Multidisciplinary Team Meetings – An Interview Study

“…4 However in the literature, one of the suggestions for changes in the MDTM organization was to streamline patients, which was defined as “discussing the cancer cases that do not follow well-established clinical pathways while discussing other cases more briefly or not at all”. 14 , 15 However, objections to this approach were based on inequality of treatment and worries for quality and safety of care. 14 Furthermore, reducing the number of discussed cases was not correlated to higher quality discussions according to a study by Lamb et al, hence leaving out patients that do conform to standardized pathways may not be the optimal solution for optimizing MDT logistics.…”

“…Therefore, the amount of time allocated to preparation should match the role of the attendee during the MDTM since the amount of needed preparation can vary. 15 , 19 …”

The Impact of Multidisciplinary Team Meetings on Patient Management in Oncologic Thoracic Surgery: A Single-Center Experience

“…We have to point out some limitations of the study: as all of our patients are routinely presented and widely discussed at MDT meetings, we did not have any case-control group of patients not receiving MDT discussion, to search for an additional MDT value in terms of overall survival, disease-free survival or other clinical indicators, as reported in previous similar studies ( Table 6 ) [ 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ].…”