Is there a Benefit of Multidisciplinary Cancer Team Meetings for Patients with Gastrointestinal Malignancies?

Abstract

Background: Multidisciplinary cancer team meetings are intended to optimize the diagnosis of a patient with a malignancy. The aim of this study was to assess the number of correct diagnoses formulated by the multidisciplinary team (MDT) and whether MDT decisions were implemented.

Methods: In a prospective study, data of consecutive patients discussed at gastrointestinal oncology MDT meetings were studied, and MDT diagnoses were validated with pathology or follow-up. Factors of influence on the correct diagnosis were identified by use of a Poisson regression model. Electronic patient records were used to assess whether MDT decisions were implemented, and reasons to deviate from these decisions were hand-searched within these records.

Results: In 74 MDT meetings, 551 patients were discussed a total of 691 times. The MDTs formulated a correct diagnosis for 515/551 patients (93.4 %), and for 120/551 (21.8 %) patients the MDT changed the referral diagnosis. Of the MDT diagnoses, 451/515 (87.6 %) were validated with pathology. Patients presented to the MDT by their treating physician were 20 % more likely to receive a correct diagnosis [relative risk (RR) 1.2, 95 % confidence interval (CI) 1.1-1.5], while the number of patients discussed or the duration of the meeting had no influence on this (RR 1.0, 95 % CI 0.99-1.0; RR 1.0, 95 % CI 0.9-1.1; resp.). MDT decisions were implemented in 94.4 % of cases. Deviations of MDT decisions occurred when a patient's wishes or physical condition were not taken into account.

Conclusions: MDTs rectify 20 % of the referral diagnoses. The presence of the treating physician is the most important factor to ensure a correct diagnosis and adherence to the treatment plan.

Fig. 1

Diagnoses formulated by the MDT. In total, the MDT formulated a diagnosis for 545 patients—515 (93.5 %) accurate diagnoses, of which 451 were validated with pathology, and 30 inaccurate diagnoses. The MDT formulated a new diagnosis for these patients after review of additional information. Eventually, 14 patients who had previously received a malignant diagnosis turned out to have benign disease. *Diagnosis uncertain and treatment never initiated. MDT multidisciplinary team

Fig. 2

Changes in referral diagnosis. Of the 551 patients referred, the MDT diagnosis was the same as the referral diagnosis in 431 patients. Eleven patients were referred without a diagnosis, and the MDT diagnosed all these patients; three were diagnosed with a cholangiocarcinoma, of which one patient also had liver metastasis, two patients had a benign diagnosis, and the remaining six patients had various malignancies. Patients referred without a diagnosis were suspected of having a malignancy. For 67 patients the diagnosis alone was changed; of these patients, 33 had a benign diagnosis. Dx diagnosis, M± change in staging of disease, MDT multidisciplinary team