Uro‐oncology multidisciplinary meetings at an Australian tertiary referral centre – impact on clinical decision‐making and implications for patient inclusion

Abstract

ObjectivesTo analyse the impact of the uro-oncology multidisciplinary meeting (MDM) at an Australian tertiary centre on patient management decisions, and to develop criteria for patient inclusion in MDMs. MethodsOver a 3-month period, all cases presented at our weekly uro-oncology MDM were prospectively assessed, by asking the presenting clinician to state their provisional management plans and comparing this with the subsequent consensus decision. The impact of the MDM was graded as high if there was a major change in the management plan or if a plan was developed where there was none. ResultsOver the study period, 120 discussions about 107 patients were recorded. Prostate, urothelial, kidney and testis cancer represented 46 (38.3%), 36 (30%), 26 (21.6%) and 12 (10%) of the discussions, respectively. The MDM made high impact changes to the original plan in 32 (26.7%) cases. High impact changes were nearly twice as likely to occur in patients with metastatic disease as in those without metastases (P < 0.05). Primary cross referral between disciplines occurred in 40 (33.3%) cases, including 66.7% of testicular and 42% of bladder cancers but only 26% of prostate and 19% of kidney cancers (P < 0.02). ConclusionsThe uro-oncology MDM alters management plans in about one-quarter of cases. Additionally, MDMs also serve other purposes, such as cross-referral or consideration for clinical trials. Patients should be discussed in MDMs if multimodal therapy may be required, clinical trial eligibility is being considered or if metastasis or recurrence is noted.

Knowledge, attitudes and beliefs towards management of men with locally advanced prostate cancer following radical prostatectomy: an Australian survey of urologists

“…However, nearly one-third believed the urological surgeon is best placed suggesting there may be some inconsistency in engagement with a multidisciplinary approach to cancer care despite evidence that it leads to improved survival, adherence to guidelines [45], reduced time to diagnosis and treatment and increased enrolment in clinical trials, in addition to improved patient satisfaction [46]. A recent single-centre Australian study [47] found that discussion of patients at a uro-oncology multidisciplinary meeting resulted in substantial changes to the clinician's original treatment plan in more that one quarter of cases presented. That study additionally reported that where there was no original plan, multidisciplinary discussion increased cross-referral between clinical disciplines, a significant finding given that only one per cent of urologists in our survey sample agreed a radiation oncologist is best placed to decide upon the most appropriate post-operative treatment.…”

Development of an International Prostate Cancer Outcomes Registry

“…It stipulates that each jurisdiction be responsible for the ethical management and governance of their local registry database. Governance structures were developed in accordance with the Operating Principles and Technical Standards for Australian Clinical Quality Registries as detailed previously [19], and include guidelines on data handling, storage, and access.…”

“…The group comprised of radiation oncologists, urologists, epidemiologists, and research scientists; four members being Directors of cancer registries. The group was provided with a comprehensive list of data items collected by each State/Territory cancer registry [20], and by prostate cancer-specific registries in South Australia [21], Victoria [19] and United States [22]. Feasibility and utility of collecting each of the data items at a population level was considered in developing the minimum data list for collection by the PCOR-ANZ.…”

“…In additional, New Zealand and Northern Territory have recently agreed to participate in the registry. Each jurisdiction has formed a local Steering Committee for local governance as detailed previously [19], and is establishing the necessary infrastructure to support rapid rollout of site and patient recruitment, data collection, and data transfer.…”

Evaluating the impact of the genitourinary multidisciplinary tumour board: Should every cancer patient be discussed as standard of care?

“…There is discrepancy in the literature about the effectiveness of MTBs in the field of urology. One study reports only 1.6% of genitourinary tract (GU) cancer patients experienced a change in their treatment decision following MTB discussion 10 , while others report rates as high as 26.7-32.3% 3,11 . As such, current NCCN guidelines limit recommendations to only select GU oncology patients 2 .…”