Implementation of the measure of case discussion complexity to guide selection of prostate cancer patients for multidisciplinary team meetings

Abstract

Background: Multidisciplinary team meetings (MDTMs) provide an integrated team approach to ensure individualized and evidence-based treatment recommendations and best expert advice in cancer care. A growing number of patients and more complex treatment options challenge MDTM resources and evoke needs for case prioritization. In this process, decision aids could provide streamlining and standardize evaluation of case complexity. We applied the recently developed Measure of Case Discussion Complexity, MeDiC, instrument with the aim to validate its performance in another healthcare setting and diagnostic area as a means to provide cases for full MDTM discussions.

Methods: The 26-item MeDiC instrument evaluates case complexity and was applied to 364 men with newly diagnosed prostate cancer in Sweden. MeDiC scores were generated from individual-level health data and were correlated with clinicopathological parameters, healthcare setting, and the observed clinical case selection for MDTMs.

Results: Application of the MeDiC instrument was feasible with rapid scoring based on available clinical data. Patients with high-risk prostate cancers had significantly higher MeDiC scores than patients with low or intermediate-risk cancers. In the total study, population affected lymph nodes and metastatic disease significantly influenced MDTM referral, whereas comorbidities and age did not predict MDTM referral. When individual patient MeDiC scores were compared to the clinical MDTM case selection, advanced stage, T3/T4 tumors, involved lymph nodes, presence of metastases and significant physical comorbidity were identified as key MDTM predictive factors.

Conclusions: Application of the MeDiC instrument in prostate cancer may be used to streamline case selection for MDTMs in cancer care and may complement clinical case selection.

Keywords: comorbidity; decision aid; multidisciplinary team; prostate cancer; tumor board.

FIGURE 1

Percentage distribution of scores for the various MeDiC parameters in relation to patients that were selected for MDT‐based case discussions (orange) or not (blue). The items have different weight from 1 (lowest) to 4 (highest), in relation to their scope of case complexity, for example, metastatic disease 4 points, significant comorbidity 3 points, conflict of opinion in MDT 3 points .The scoring of items 2, 6, and 9 are matched with prostate cancer risk groups.

FIGURE 2

Importance of MeDiC factors for the clinical selection of patients for MDTM discussions. High‐risk tumors in blue to the left and low/intermediate‐risk tumors in yellow to the right.

FIGURE 3

Proportion of patients with different MeDiC score discussed in Multidisciplinary Tumor Meetings, all patients (black graph), low/intermediate risk tumors (blue graph), and high‐risk tumors (orange graph). MeDiC scores were grouped in intervals to ensure at least three patients in each data point. Please note that some points in the diagram represent intervals of MeDiC score, for example “12‐” represent any score ≥ 12. Only few high scores were observed in the low/Intermediate‐risk group.