The impact of a supranetwork multidisciplinary team (SMDT) on decision-making in testicular cancers: a 10-year overview of the Anglian Germ Cell Cancer Collaborative Group (AGCCCG)

Abstract

Background The germ cell supranetwork multidisciplinary team (SMDT) for the Anglian Network covers a population of 7.5 million. Methods We reviewed 10 years of SMDT discussion and categorised them into five domains ((1) overall outcome, (2) chemotherapy regimens—untreated disease and salvage therapy, (3) radiology, (4) pathology and (5) complex cases) to assess the impact of the SMDT. Results A total of 2892 new cases were reviewed. In the first 5 years, patients with good prognosis disease had poorer survival in low-volume vs high-volume centres (87.8 vs 95.3, p = 0.02), but the difference was no longer significant in the last 5 years (93.3 vs 95.1, p = 0.30). Radiology review of 3206 scans led to rejection of the diagnosis of progression in 26 cases and a further 10 cases were down-staged. There were 790 pathology reviews by two specialised uropathologists, which lead to changes in 75 cases. 18F-fluorodeoxyglucose (18FDG) PET-CT was undertaken during this time period but did not help to predict who would have viable cancer. A total of 26 patients with significant mental health issues who were unable to give informed consent were discussed. Conclusion SMDT working has led to an improvement in outcomes and refining of treatment in patients with germ cell tumours.

Quality improvement for cancer multidisciplinary teams: lessons learned from the Anglian Germ Cell Cancer Collaborative Group

“…Although changes to radiological and pathological reports and recommendations for patient management were seldom made (3, 5.4, and 6.4%, respectively), other benefits of the supra-regional network are apparent. 2 Overall survival at lower-volume centres (87.8-93.3%) increased to that of higher-volume centres (95%). Improvements arose from standardisation of chemotherapy regimens, increased adoption of novel regiments, and more equitable access to such treatments.…”

“…An additional benefit of the SMDT was as a focus to improve the outcome of smaller centres as an alternative to further centralisation of services. 2 The data presented by Shamash and colleagues 2 also gives an insight into the organisation of a complex but well-functioning network covering numerous sites and different specialists over a significant geographical location. This group had put into practice the suggestions set out in the Gore report 1 years ahead of publication.…”

“…Importantly, a standardised proforma was developed and used for submission of patient details to the SMDT, which also formed the basis of data submitted for their manuscript. 2 Between 2007 and 2017, 2892 new cases of germ-cell tumour were reviewed by the SMDT. Although changes to radiological and pathological reports and recommendations for patient management were seldom made (3, 5.4, and 6.4%, respectively), other benefits of the supra-regional network are apparent.…”

“…unusual subtype of disease, failure of previous treatment, significant comorbidities, and social or psychological problems. 2 These patients often do not fit guidelines, are not eligible for clinical trials, and can be challenging to engage in healthcare services. Shamash et al 2 highlight patients with learning difficulties or mental health problems and those with late relapses each present problem that are less commonly addressed and require tailored individualised treatment plans.…”

“…2 These patients often do not fit guidelines, are not eligible for clinical trials, and can be challenging to engage in healthcare services. Shamash et al 2 highlight patients with learning difficulties or mental health problems and those with late relapses each present problem that are less commonly addressed and require tailored individualised treatment plans. These findings are in line with the recent study on what constitute a complex case for MDT discussion, mirroring those found to be indicators of complexity across a range of tumour types.…”