Abstract
Background
In most jurisdictions, a minority of patients are discussed at multidisciplinary cancer conference (MCC) despite recommendations for such reviews. We assessed the impact of MCC review of gastrointestinal (GI) cancers at a stand-alone cancer center.
Methods
Patient data were prospectively collected on consecutive cases presented at a GI MCC during a 6-month period. Original treatment plans were collected confidentially before presentation and compared to post-MCC treatment plans. We defined changes in management plans as major (change in treatment modality) or minor (testing prior to original plan).
Results
A total of 149 cases were evaluated: 115 upper GI (gastric/small bowel—10 %, liver—32 %, pancreaticobiliary—36 %), and 34 lower GI (23 %). Reasons for presentation were: questions regarding progression/metastases (44 %), management (26 %), diagnosis (21 %), pathology (15 %), and resectability (7 %). Physicians were certain of their original plans being the final recommendations in 84 % (n = 125). Change in management was recommended in 36 %; 72 % were major and 28 % were minor. Patients underwent all recommended treatments at our institution in 77 % of cases, a portion in 5 %, and no recommended treatments in 18 %. On multivariate analysis, physician degree of certainty for original management plan was not predictive of a change in management plan (p = 0.61).
Conclusions
Although certainty of prediscussion treatment plan is high, changes in treatment recommendations occurred in more than one-third of patients after GI MCC. This prospective study demonstrates the value of MCC in GI cancer sites, even at a stand-alone cancer center.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Fleissig A, Jenkins V, Catt S, Fallowfield L. Multidisciplinary teams in cancer care: are they effective in the UK? Lancet Oncol. 2006;7(11):935-943. doi: 10.1016/S1470-2045(06)70940-8
Haward RA. The Calman–Hine Report: a personal retrospective on the UK’s first comprehensive policy on cancer services. Lancet Oncol. 2006;7(4):336-46. doi: 10.1016/S1470-2045(06)70659-3
National Comprehensive Cancer Network. NCCN guidelines for treatment by cancer site. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp#site. Updated 2014. Accessed April 2014.
Lamb BW, Sevdalis N, Mostafid H, Vincent C, Green JSA. Quality improvement in multidisciplinary cancer teams: an investigation of teamwork and clinical decision-making and cross-validation of assessments. Ann Surg Oncol. 2011;18(13):3535-43. doi:10.1245/s10434-011-1773-5.
Pawlik TM, Laheru D, Hruban RH, et al. Evaluating the impact of a single-day multidisciplinary clinic on the management of pancreatic cancer. Ann Surg Oncol. 2008;15(8):2081-8. doi: 10.1245/s10434-008-9929-7.
Chang JH, Vines E, Bertsch H, et al. The impact of a multidisciplinary breast cancer center on recommendations for patient management: the University of Pennsylvania experience. Cancer. 2001;91(7):1231-7. doi: 10.1002/1097-0142(20010401)91:7<1231::AID-CNCR1123>3.0.CO;2-K
Burton S, Brown G, Daniels IR, Norman AR, Mason B, Cunningham D. MRI directed multidisciplinary team preoperative treatment strategy: the way to eliminate positive circumferential margins? Br J Cancer. 2006;94(3):351-7. doi: 10.1038/sj.bjc.6602947
Palmer G, Martling A, Cedermark B, Holm T. Preoperative tumour staging with multidisciplinary team assessment improves the outcome in locally advanced primary rectal cancer. Colorectal Dis. 2011;13(12):1361-9. doi: 10.1111/j.1463-1318.2010.02460.x
Wille-Jørgensen P, Sparre P, Glenthøj A, et al. Result of the implementation of multidisciplinary teams in rectal cancer. Colorectal Dis. 2013;15(4):410-3. doi: 10.1111/codi.12013
Abraham NS, Gossey JT, Davila JA, Al-Oudat S, Kramer JK. Receipt of recommended therapy by patients with advanced colorectal cancer. Am J Gastroenterol. 2006;101(6):1320-8. doi:10.1111/j.1572-0241.2006.00545.x
Augestad KM, Lindsetmo RO, Stulberg J, et al. International preoperative rectal cancer management: Staging, neoadjuvant treatment, and impact of multidisciplinary teams. World J Surg. 2010;34(11):2689-700.
Levine RA, Chawla B, Bergeron S, Wasvary H. Multidisciplinary management of colorectal cancer enhances access to multimodal therapy and compliance with national comprehensive cancer network (NCCN) guidelines. Int J Colorectal Dis. 2012;27(11):1531-8. doi: 10.1007/s00384-012-1501-z
Swellengrebel HAM, Peters EG, Cats A, et al. Multidisciplinary discussion and management of rectal cancer: a population-based study. World J Surg. 2011;35(9):2125-33. doi: 10.1007/s00268-011-1181-9
MacDermid E, Hooton G, Macdonald M, et al. Improving patient survival with the colorectal cancer multi-disciplinary team. Colorectal Dis. 2009;11(3):291-5. doi: 10.1111/j.1463-1318.2008.01580.x
Blazeby JM, Wilson L, Metcalfe C, Nicklin J, English R, Donovan JL. Analysis of clinical decision-making in multi-disciplinary cancer teams. Ann Oncol. 2006;17(3):457-60. doi: 10.1093/annonc/mdj102
Keating NL, Landrum MB, Lamont EB, Bozeman SR, Shulman LN, McNeil BJ. Tumor boards and the quality of cancer care. J Natl Cancer Inst. 2013;105(2):113-21. doi:10.1093/jnci/djs502
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Oxenberg, J., Papenfuss, W., Esemuede, I. et al. Multidisciplinary Cancer Conferences for Gastrointestinal Malignancies Result in Measureable Treatment Changes: A Prospective Study of 149 Consecutive Patients. Ann Surg Oncol 22, 1533–1539 (2015). https://doi.org/10.1245/s10434-014-4163-y
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-014-4163-y