Setup of multidisciplinary team discussions for patients with cholangiocarcinoma: current practice and recommendations from the European Network for the Study of Cholangiocarcinoma (ENS-CCA)

Abstract

Background: Cholangiocarcinomas (CCAs) are a rare group of malignancies characterized by dismal prognosis. There are currently no standardized guidelines for multidisciplinary teams (MDTs) in CCAs.

Material and methods: An online survey was built with the aim of defining the current practice of MDTs in CCAs and identifying possible areas of improvement, providing minimum standards of practice for an ideal CCA MDT. Analysis of the replies regarding current and ideal MDT practice was carried out by calculating weighted average (WA) of likelihood of every item. The survey was shared with members of the European Network for the Study of Cholangiocarcinoma and other medical centers with expertise in biliary tract cancer part of the EURO-CHOLANGIO-NET (European Cholangiocarcinoma Network: https://eurocholangionet.eu/) COST Action CA18122 initiative.

Results: The role of the MDT coordinator was a recognized priority in an ideal well-functioning MDT (WA 3.31/4), together with providing minimum clinical information before the meeting to secure adequate case preparation (WA 3.54/4). Optimal frequency of MDT meetings was weekly according to 76.92% of the participants; 73.06% believed that ideally all newly diagnosed patients and each new treatment should be discussed, although that happened only in less than half of the MDTs (46.15%) in current practice. Most participants stated that they always (46.15%) or often (50.00%) used guidelines, mainly international (61.00%) (European and American), followed by national/local (39.00%). We defined the ideal setup of a CCA MDT, identifying specialists whose presence is mandatory with WA >3.0 (oncologist, clinician responsible for patient's care, surgeon, diagnostic and interventional radiologist, hepatologist, pathologist, endoscopist and gastroenterologist) and those whose presence would be recommended with a WA <3.0 (palliative care, nurse, dietitian, basic researcher, psychologist and social worker).

Conclusions: Our identified minimum requirements should be taken into account at the time of CCA MDT setup and quality assessment.

Keywords: Europe; cholangiocarcinoma; current practice; multidisciplinary team; survey.

Figure 1

Use of guidelines. (A) Use of guidelines in cholangiocarcinoma (CCA) multidisciplinary teams (MDTs). Summary of the main guidelines used in the MDTs. European guidelines were the most frequently used. (B) Weighted average (WA) of local, national and international guidelines in an ideal scenario. AIOM, Associazione Italiana Di Oncologia Medica; ASCO, American Society of Clinical Oncology; AISF, Associazione Italiana Per Lo Studio Del Fegato; DGVS, Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten; EASL, European Association for the Study of the Liver; ESMO, European Society for Medical Oncology; ILCA, The International Liver Cancer Association; NCCN, The National Comprehensive Cancer Network; TNCD, Thesaurus National De Cancerologie Digestive.

Figure 2

Current and ideal representation of different specialties in cholangiocarcinoma (CCA) multidisciplinary team (MDT). The presence of some specialist was considered mandatory and well established [ideal weighted average (WA) >3; ΔWA between 0.11 and 0.4] in current practice of CCA MDTs (i.e., clinician responsible, oncologist, hepatologist, gastroenterologist, surgeon and radiologist). The presence of some specialists (i.e., endoscopist, psychologist and pathologist) seemed to be only acceptably established in current practice (ΔWA between 0.41 and 0.9). The presence of palliative care, dietitian and social workers should be considered areas for improvement and in need of urgent attention (ΔWA >0.9).

Figure 3

Take home messages. Summary of the European Network for the Study of Cholangiocarcinoma (ENS-CCA) recommendations for a well-functioning multidisciplinary team (MDT). Items already consolidated in current practice are shown in green, those only acceptably set in olive green and items to which attention should be paid in burgundy.