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. 2022 Nov;127(8):1557-1564.
doi: 10.1038/s41416-022-01922-3. Epub 2022 Aug 8.

Patient attrition in Molecular Tumour Boards: a systematic review

Hannah Frost  1   2 , Donna M Graham  3   4   5 , Louise Carter  4   5 , Paul O'Regan  3 , Dónal Landers  3 , André Freitas  3   6   7
Affiliations

Patient attrition in Molecular Tumour Boards: a systematic review

Hannah Frost et al. Br J Cancer. 2022 Nov.

Abstract

Background: Molecular Tumour Boards (MTBs) were created with the purpose of supporting clinical decision-making within precision medicine. Though in use globally, reporting on these meetings often focuses on the small percentages of patients that receive treatment via this process and are less likely to report on, and assess, patients who do not receive treatment.

Methods: A literature review was performed to understand patient attrition within MTBs and barriers to patients receiving treatment. A total of 51 papers were reviewed spanning a 6-year period from 11 different countries.

Results: In total, 20% of patients received treatment through the MTB process. Of those that did not receive treatment, the main reasons were no mutations identified (27%), no actionable mutations (22%) and clinical deterioration (15%). However, data were often incomplete due to inconsistent reporting of MTBs with only 55% reporting on patients having no mutations, 55% reporting on the presence of actionable mutations with no treatment options and 59% reporting on clinical deterioration.

Discussion: As patient attrition in MTBs is an issue which is very rarely alluded to in reporting, more transparent reporting is needed to understand barriers to treatment and integration of new technologies is required to process increasing omic and treatment data.

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Conflict of interest statement

This work is funded in part through a grant awarded by AstraZeneca. Hannah Frost, Donna M. Graham and Louise Carter are all authors of a paper used in this review. Dónal Landers is a director of DeLondra Oncology Ltd., which provides Pharmaceutical Medicine consultancy to Astrazeneca Ltd and Athenex plc.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram for the systematic review of patient attrition in Molecular Tumour Boards, detailing the number of abstracts and full texts screened culmulating in 51 retrieved full texts.
Fig. 2
Fig. 2. Process flow for MTBs globally with common reasons for attrition.
As not all studies reported on all the reasons outlined in this review, percentages were calculated out of the studies where the data was available. The patient flow was created by incorporating the individual flows from the literature; not all papers provided these. The only part of the flow that changed between MTBs were the need for a review prior to the MTB to determine suitability for genomic testing, the frequency of the MTB and how results were disseminated. MTB Molecular Tumour Board.
Fig. 3
Fig. 3. Flow of patients in all studies through an MTB, numbers and percentage are not cumulative as some studies did not report on all reasons for attrition.
Clinical deterioration occurred at any stage of the patient journey, and it was not possible to separate these stages out.
See this image and copyright information in PMC

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