Multidisciplinary management of colorectal cancer enhances access to multimodal therapy and compliance with National Comprehensive Cancer Network (NCCN) guidelines

Abstract

Purpose: Multidisciplinary teams have become increasingly desirable for managing complex disease but little objective data exist to support this approach. The aim of our study was to determine the impact of a multidisciplinary clinic on the management of colorectal cancer.

Methods: Data were prospectively collected on all patients with newly diagnosed colorectal cancer referred to the multidisciplinary clinic at our institution in 2009 and compared to a control group of all patients managed outside the clinic from 2008 to 2009. Comprehensiveness of preoperative evaluation was determined by frequency of abdominal and chest CT, CEA testing, and transrectal ultrasound. Access to multimodal care was measured by frequency of oncology consultation and treatment, advanced pathology testing, genetics counseling, and trial enrollment.

Results: Two hundred eighty-eight patients met inclusion criteria; 88 patients were referred to the clinic (40 preoperative, 48 postoperative) and 200 patients were managed outside. Complete preoperative evaluation was accomplished three times more frequently in clinic patients (85 vs. 23 %, p < 0.0001) with significant improvements in all parameters. Enhanced access to multimodal therapy was demonstrated in clinic patients by increased frequency of oncology consultation (98.9 vs. 61.5 %, p < 0.0001) and treatment (62.5 vs. 41.5 %, p = 0.02), advanced pathology testing (29.6 vs. 10.6 %, p = 0.0001), and genetics counseling (6.8 vs. 1.6 %, p = 0.28). Clinic patients also received significantly higher rates of neoadjuvant therapy for stage II or greater rectal cancer (82.6 vs. 30.9 %, p = 0.0001).

Conclusions: Multidisciplinary clinic management of colorectal cancer is associated with a significantly more complete preoperative evaluation as well as improved access to multimodal therapy.