The Value of Multidisciplinary Team Meetings for Patients with Gastrointestinal Malignancies: A Systematic Review

Abstract

IntroductionThe incidence of gastrointestinal (GI) cancer is rising and most patients with GI malignancies are discussed by a multidisciplinary team (MDT). We performed a systematic review to assess whether MDTs for patients with GI malignancies can correctly change diagnosis, tumor stage and subsequent treatment plan, and whether the treatment plan was implemented.MethodsWe performed a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We conducted a search of the PubMed, MEDLINE and EMBASE electronic databases, and included studies relating to adults with a GI malignancy discussed by an MDT prior to the start of treatment which described a change of initial diagnosis, stage or treatment plan. Two researchers independently evaluated all retrieved titles and abstracts from the abovementioned databases.ResultsOverall, 16 studies were included; the study quality was rated as fair. Four studies reported that MDTs changed the diagnoses formulated by individual physicians in 18.4–26.9% of evaluated cases; two studies reported that MDTs formulated an accurate diagnosis in 89 and 93.5% of evaluated cases, respectively; nine studies described that the treatment plan was altered in 23.0–41.7% of evaluated cases; and four studies found that MDT decisions were implemented in 90–100% of evaluated cases. The reasons for altering a treatment plan included the patient’s wishes, and comorbidities.ConclusionsMDT meetings for patients with a GI malignancy are responsible for changes in diagnoses and management in a significant number of patients. Treatment plans formulated by MDTs are implemented in 90–100% of discussed patients. All patients with a GI malignancy should be discussed by an MDT.Electronic supplementary materialThe online version of this article (doi:10.1245/s10434-017-5833-3) contains supplementary material, which is available to authorized users.

Outcomes of multidisciplinary treatment planning in US cancer care settings

“…Our results also demonstrate that MTP is associated with improvements in timeliness, surgical technique, and survival, although statistically significant effects were not consistently observed. Our findings are comparable to those reported when MTP effectiveness was evaluated in health systems in other countries and align with the conclusions of reviews that addressed MTP only in the context of a single disease site or MTP outcome . Taken together, these results add to the body evidence supporting MTP as a critical element in US standards of cancer care…”

“…Only 2 studies addressed cost. Although MTP is relatively inexpensive and reduces expenditures during diagnosis/staging, 2 recent systematic reviews concluded that evidence of MTP cost effectiveness remains sparse. Second, comorbidities and palliative care were rarely incorporated into MTP.…”

“…More than a dozen systematic reviews have appraised the evidence regarding MTP. However, the strength of the conclusions that can be drawn from these reports with respect to the effects of MTP on outcomes in US cancer care settings is restricted by the inclusion of studies conducted outside the United States, a broad emphasis on multidisciplinary care rather than treatment planning , focus on a specific cancer site or a narrower outcome, such as cost or comorbidity . Our systematic review extends the conclusions of prior reviews by: 1) focusing on MTP effectiveness and outcomes solely in US cancer care settings, 2) simultaneously examining a comprehensive set of outcomes (eg, guideline concordance, timeliness, and cost) across multiple disease sites and delivery formats, and 3) incorporating recently published studies.…”

The impact of tumor board on cancer care: evidence from an umbrella review

“…The number of studies included in each review varied, ranging from 16 to 51 studies. Sixteen studies were included in the systematic review focused on lung cancer [33]; 16 in the review concerning gastrointestinal cancers [34]; and 51 [31], 27 [32] and 37 [30] studies were included in the other 3 reviews. Some of the articles included were found in two or more of the reviews considered.…”

“…Some of the articles included were found in two or more of the reviews considered. More precisely, one study was cited in four out of five reviews [30][31][32]34] and three studies were shared by three reviews (one study in common by Prades [31], Pillay [32] and Basta [34]; one by Prades [31], Pillay [32] and Lamb [30] and one by Pillay [32], Basta [34] and Lamb [30]). Other primary studies were common to two reviews.…”