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Physician compliance with multidisciplinary tumor board recommendations for managing gynecological cancers

Radiation Therapy Department, Limoges University Hospital, Limoges, 87000, France

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Jerome Laloze

Reconstructive Surgery Department, Limoges University Hospital, Limoges, 87000, France

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Sophie Leobon

Medical Oncology Department, Limoges University Hospital, Limoges, 87000, France

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Tristan Gauthier

Gynecological Department, Limoges University Hospital, Limoges, 87000, France

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Aymeline Lacorre

Gynecological Department, Limoges University Hospital, Limoges, 87000, France

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Jacques Monteil

Nuclear Medicine Department, Limoges University Hospital, Limoges, 87000, France

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Laurence Venat

Medical Oncology Department, Limoges University Hospital, Limoges, 87000, France

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Elise Deluche

*Author for correspondence: Tel.: +33 5 55 05 61 00;

E-mail Address: elise.deluche@chu-limoges.fr

https://orcid.org/0000-0001-8474-3116

Medical Oncology Department, Limoges University Hospital, Limoges, 87000, France

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Published Online:26 May 2023https://doi.org/10.2217/fon-2022-1183

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Abstract

Aims: Evaluation of compliance with gynecological multidisciplinary tumor board (MTB) recommendations and its impact. Patients & methods: All patient records discussed in our MTB from 2018 to 2020 were analyzed. Results: We analyzed 437 MTB recommendations concerning 166 patients. Each patient was discussed an average of 2.6 (1.0–4.2) times. Of the 789 decisions, the decision was not followed 102 times (12.9%), corresponding to 85 MTB meetings (19.5%). Of these, 72 recommendations concerned therapeutic changes (70.5%), and 30 concerned non-therapeutic changes (29.5%). Of these 85 MTB decisions, 60 (71%) led to a new MTB submission. Noncompliance with MTB decisions decreased the overall survival (46 vs 138 months; p = 0.003). Conclusion: Improving compliance with MTB decisions is crucial to enhance patient outcomes.

Plain language summary

In multidisciplinary tumor board (MTB) meetings, a team of experts discuss the diagnosis and management of cancer patients. While MTB treatment decisions and the reasoning behind them are well documented, the application of these decisions in practice and the associated impact on survival are unknown. This study evaluated compliance with recommendations made during gynecological weekly MTB meetings and the resulting impact on patient management. Between 2018 and 2020, 166 patients were discussed in 437 MTB meetings (each patient was discussed an average of 2.6 times during this period). Noncompliance with the MTB recommendations affected 85/437 MTB meetings (19.5%). Of these, 57 recommendations were therapeutic changes (67.1%) and 28 were non-therapeutic changes (32.9%). In 60 cases (71%), noncompliance with the MTB led to resubmission of the patient data to the MTB. Noncompliance with the board recommendations led to a decrease in patient survival (46 vs 138 months; p = 0.003). This study is expected to raise awareness among practitioners. Considered an essential part of the delivery of high-quality cancer treatment, the implementation of MTB decisions requires further verification.

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Considered an essential component in the delivery of high-quality oncology treatment, the implementation of multidisciplinary tumor board decisions requires verification.

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Papers of special note have been highlighted as: • of interest; •• of considerable interest

References

1. Taylor C, Munro AJ, Glynne-Jones R et al. Multidisciplinary team working in cancer: what is the evidence? BMJ 340, c951 (2010). • Description of the implementation of multidisciplinary teams in cancer services and review of the international evidence for their effectiveness.
MedlineGoogle Scholar
2. National Cancer Institute (France). The Cancer Plan 2003–2007. www.e-cancer.fr/Institut-national-du-cancer/Strategie-de-lutte-contre-les-cancers-en-France/Les-Plans-cancer/Le-Plan-cancer-2003-2007 (Accessed 22 May 2023).
Google Scholar
3. Bydder S, Nowak A, Marion K, Phillips M, Atun R. The impact of case discussion at a multidisciplinary team meeting on the treatment and survival of patients with inoperable non-small cell lung cancer. Intern. Med. J. 39(12), 838–841 (2009).
Medline CASGoogle Scholar
4. Tamburini N, Maniscalco P, Mazzara S et al. Multidisciplinary management improves survival at 1 year after surgical treatment for non-small-cell lung cancer: a propensity score-matched study. Eur. J. Cardiothorac. Surg. 53(6), 1199–1204 (2018).
MedlineGoogle Scholar
5. Stone E, Rankin N, Kerr S et al. Does presentation at multidisciplinary team meetings improve lung cancer survival? Findings from a consecutive cohort study. Lung Cancer. 124, 199–204 (2018).
MedlineGoogle Scholar
6. Gaba RC, Kallwitz ER, Parvinian A et al. Imaging surveillance and multidisciplinary review improves curative therapy access and survival in HCC patients. Ann. Hepatol. 12(5), 766–773 (2013).
MedlineGoogle Scholar
7. MacDermid E, Hooton G, MacDonald M et al. Improving patient survival with the colorectal cancer multi-disciplinary team. Colorectal Dis. 11(3), 291–295 (2009).
Medline CASGoogle Scholar
8. Munro A, Brown M, Niblock P, Steele R, Carey F. Do multidisciplinary team (MDT) processes influence survival in patients with colorectal cancer? A population-based experience. BMC Cancer 15, 686 (2015).
MedlineGoogle Scholar
9. 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. 13(12), 1361–1369 (2011).
Medline CASGoogle Scholar
10. Lu J, Jiang Y, Qian M, Lv L, Ying X. The improved effects of a multidisciplinary team on the survival of breast cancer patients: experiences from China. Int. J. Environ. Res. Public Health 17(1), 277 (2019).
MedlineGoogle Scholar
11. Iyer NG, Chua MLK. Multidisciplinary team meetings – challenges of implementation science. Nat. Rev. Clin. Oncol. 16(4), 205–206 (2019). •• The authors propose an approach for cancer centers to transform these limitations into improvements in the quality control of oncological care and into research opportunities.
MedlineGoogle Scholar
12. Samarasinghe A, Chan A, Hastrich D et al. Compliance with multidisciplinary team meeting management recommendations. Asia Pac. J. Clin. Oncol. 15(6), 337–342 (2019).
MedlineGoogle Scholar
13. Pons-Tostivint E, Daubisse-Marliac L, Grosclaude P et al. Multidisciplinary team meeting and EUSOMA quality indicators in breast cancer care: a French regional multicenter study. Breast 46, 170–177 (2019).
Medline CASGoogle Scholar
14. Ameratunga M, Miller D, Ng W et al. A single-institution prospective evaluation of a neuro-oncology multidisciplinary team meeting. J. Clin. Neurosci. 56, 127–130 (2018).
MedlineGoogle Scholar
15. Chaouki W, Mimouni M, Boutayeb S, Hachi H, Errihani H, Benjaafar N. [Evaluation of multidisciplinary team meeting; the example of gynecological mammary cancers in a tertiary referral center in Morocco]. Bull. Cancer 104(7-8), 644–651 (2017).
MedlineGoogle Scholar
16. Huo Yung Kai S, Delpierre C, Gaudin C et al. Completeness and quality of multidisciplinary team meetings: the example of prostate cancer in the mid-Pyrenees region. Prog. Urol. 21(12), 879–886 (2011).
MedlineGoogle Scholar
17. Guillem P, Bolla M, Courby S, Descotes J-L, Laramas M, Moro-Sibilot D. [Multidisciplinary team meetings in cancerology: setting priorities for improvement]. Bull. Cancer 98(9), 989–998 (2011).
MedlineGoogle Scholar
18. Castel P, Tassy L, Lurkin A et al. [Multidisciplinarity and medical decision, impact for patients with cancer: sociological assessment of two tumour committees' organization]. Bull. Cancer 99(4), E34–E42 (2012).
MedlineGoogle Scholar
19. Brunner M, Gore SM, Read RL et al. Head and neck multidisciplinary team meetings: effect on patient management. Head Neck 37(7), 1046–1050 (2015).
MedlineGoogle Scholar
20. Hollunder S, Herrlinger U, Zipfel M et al. Cross-sectional increase of adherence to multidisciplinary tumor board decisions. BMC Cancer 18(1), 936 (2018).
Medline CASGoogle Scholar
21. Acher PL, Young AJ, Etherington-Foy R, McCahy PJ, Deane AM. Improving outcomes in urological cancers: the impact of ‘multidisciplinary team meetings’. Int. J. Surg. 3(2), 121–123 (2005).
MedlineGoogle Scholar
22. Du C-Z, Li J, Cai Y, Sun Y-S, Xue W-C, Gu J. Effect of multidisciplinary team treatment on outcomes of patients with gastrointestinal malignancy. World J. Gastroenterol. 17(15), 2013–2018 (2011).
MedlineGoogle Scholar
23. Erickson BK, Martin JY, Shah MM, Straughn JM, Leath CA. Reasons for failure to deliver National Comprehensive Cancer Network (NCCN)-adherent care in the treatment of epithelial ovarian cancer at an NCCN cancer center. Gynecol. Oncol. 133(2), 142–146 (2014).
MedlineGoogle Scholar
24. van Walree IC, Bretveld R, van Huis-Tanja LH, Louwers JA, Emmelot-Vonk MH, Hamaker ME. Reasons for guideline non-adherence in older and younger women with advanced stage ovarian cancer. Gynecol. Oncol. 157(3), 593–598 (2020).
Medline CASGoogle Scholar
25. van Walree IC, van Soolingen NJ, Hamaker ME, Smorenburg CH, Louwers JA, van Huis-Tanja LH. Treatment decision-making in elderly women with ovarian cancer: an age-based comparison. Int. J. Gynecol. Cancer 29(1), 158–165 (2019).
Medline CASGoogle Scholar
26. Kidger J, Murdoch J, Donovan JL, Blazeby JM. Clinical decision-making in a multidisciplinary gynaecological cancer team: a qualitative study. BJOG 116(4), 511–517 (2009).
Medline CASGoogle Scholar
27. Look Hong NJ, Gagliardi AR, Bronskill SE, Paszat LF, Wright FC. Multidisciplinary cancer conferences: exploring obstacles and facilitators to their implementation. J. Oncol. Pract. 6(2), 61–68 (2010). • This exploratory study used qualitative interviews and observations to explore the experiences in implementing multidisciplinary tumor boards.
MedlineGoogle Scholar
28. Lamb B, Payne H, Vincent C, Sevdalis N, Green JSA. The role of oncologists in multidisciplinary cancer teams in the UK: an untapped resource for team leadership? J. Eval. Clin. Pract. 17(6), 1200–1206 (2011). • This study raises the question of whether re-evaluation of the leadership of multidisciplinary teams is required.
MedlineGoogle Scholar
29. Stairmand J, Signal L, Sarfati D et al. Consideration of comorbidity in treatment decision making in multidisciplinary cancer team meetings: a systematic review. Ann. Oncol. 26(7), 1325–1332 (2015).
Medline CASGoogle Scholar
30. Lamb BW, Sevdalis N, Arora S, Pinto A, Vincent C, Green JSA. Teamwork and team decision-making at multidisciplinary cancer conferences: barriers, facilitators, and opportunities for improvement. World J. Surg. 35(9), 1970–1976 (2011). • Evaluation of multidisciplinary tumor board members’ experiences with and attitudes toward multidisciplinary cancer conferences.
MedlineGoogle Scholar
31. 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. 18(13), 3535–3543 (2011).
Medline CASGoogle Scholar
32. Hamilton DW, Heaven B, Thomson RG, Wilson JA, Exley C. Multidisciplinary team decision-making in cancer and the absent patient: a qualitative study. BMJ Open 6(7), e012559 (2016).
Medline CASGoogle Scholar
33. Dronkers EAC, Mes SW, Wieringa MH, van der Schroeff MP, Baatenburg de Jong RJ. Noncompliance to guidelines in head and neck cancer treatment; associated factors for both patient and physician. BMC Cancer 15(1), 1–10 (2015).
MedlineGoogle Scholar
34. Uyl-de Groot CA, Heine R, Krol M, Verweij J. Unequal access to newly registered cancer drugs leads to potential loss of life-years in Europe. Cancers 12(8), 2313 (2020).
MedlineGoogle Scholar
35. Yang X, Huang J, Zhu X, Shen K, Zhu J, Chen X. Compliance with multidisciplinary team recommendations and disease outcomes in early breast cancer patients: an analysis of 4501 consecutive patients. Breast 52, 135–145 (2020).
MedlineGoogle Scholar

Vol. 19, No. 13

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History

Received 27 November 2022

Accepted 10 May 2023

Published online 26 May 2023

Published in print April 2023

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Supplementary data

To view the supplementary data that accompany this paper please visit the journal website at: www.futuremedicine.com/doi/suppl/10.2217/fon-2023-1183

Author contributions

Conceptualization: E Deluche; methodology: E Deluche, S Leobon; formal analysis: C Naessens; writing – original draft preparation: E Deluche, C Naessens; writing – review and editing: C Naessens, J Laloze, S Leobon, T Gauthier, A Lacorre, J Monteil, L Venat, E Deluche; validation: C Naessens, J Laloze, S Leobon, T Gauthier, A Lacorre, J Monteil, L Venat, E Deluche; supervision: E Deluche. All authors have read and agreed to the published version of the manuscript.

Acknowledgments

The authors thank Textcheck for assistance with English-language editing. The English in this document has been checked by at least two professional editors, both native speakers of English.

Financial & competing interests disclosure

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

The authors state that they have obtained appropriate institutional review board approval or have followed the principles outlined in the Declaration of Helsinki for all human or animal experimental investigations. In addition, for investigations involving human subjects, informed consent has been obtained from the participants involved.

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