Multidisciplinary team meetings in Oncology: first analysis of benefits and evaluation of activity in a Dermatology unit in France

Abstract

Improving Multi-Disciplinary Meetings (MDM) is one of the 70 clauses of the French Cancer Plan of 2003-2007. The French High Authority of Health (HAS) and the National Cancer Institute (INCa) have established guidelines to standardize MDM concerning cancer care. No objective assessment of cutaneous cancer (dermato-oncology) MDM has been published yet, despite the growing numbers in the incidence of skin cancers. This study aims to analyze two of our center's MDM concerns: its decisions and its compliance with HAS guidelines. A retrospective study of all skin tumors discussed in MDM held at Amiens University Hospital between 2006-2007 analyzed epidemiological data, MDM decisions (recommendations), and their compliance. 349 MDM conclusion reports concerning 228 patients were analyzed. The cases consisted of 132 melanomas, 27 basal cell carcinomas, 19 squamous cell carcinomas, 5 Merkel cell carcinomas, 8 sarcomas, 16 cutaneous lymphomas, and 21 other tumors. 45.7% of MDM had at least 3 different specialists present. Patients were present in 49.4% of discussions. 88% of the MDMs' recommendations were implemented. More than 94% of these decisions were according to the guidelines. MDM recommendations contributed to: making 13.6% of diagnoses, 74.7% of treatment decisions, 45.6% of investigations requested, and 48.2% of long-term follow-up decisions. Treatment recommendations were: surgery in 50.6% of patients, chemotherapy in 45.0% and radiotherapy in 12.5%. The MDM's therapeutic decisions tended to follow the specialty of the referring physician; e.g. patients were likely to have surgery when referred by a surgeon, etc (p < 0.0001). Dermato-oncology MDM at Amiens University Hospital comply with most of the guidelines, however, patient attendance at MDM, participation of different specialists and the formal function and structure, all have room for improvement.