The initiation of the second-step intradisciplinary tumor board discussion and its impact on treatment decision. Retrospective data analysis of 12 years' experience in a tertiary oncology center

Abstract

Background: Multidisciplinary team (MDT) meetings are generally accepted forums for the quality of cancer care, however, there is an ongoing discussion about the substantial role of MDTs in reaching optimal treatment decisions. In our tertiary oncology center, a second-step intradisciplinary seu oncotherapy tumor board (OTT) discussion system was introduced to increase the adherence of MDT's decision making with the knowledge of patients' preference and tolerance, and to partially relieve MDT's overwork in the purely adjuvant and the palliative treatment settings. Over the real-world tumor board data elaboration, the primary aim of this observational study was to present the impact of OTT meetings on treatment decisions.

Methods: The data of 33,056 cases of 27,227 patients were retrospectively analyzed with using a regular expression-based word search algorithm. Subsequent modifications of OTT decisions were defined as "minor", when only some additional suggestions were introduced, "moderate" when the treatment items were significantly modified, and "major" when the direction of the treatment was fully transformed.

Results: During the 12-year observation period (2007-2019) the number of patients and case discussions, average age of the patients, percentage of sophisticated treatment methods, and the number of treatment lines/decisions made for the same patient had been continuously increased. The average percentage of minor, moderate and major modifications were 2.28, 6.4 and 8.92%, respectively, implying a remarkably high modification rate of the primary recommendations.

Conclusion: Considering the growing complexity and multiplicity of oncology care, regular OTT board meetings can increase the accuracy of MDT's work and treatment decisions without any overwork of the related disciplines and can also serve as an additive/alternative teamwork forum in the adjuvant, multiple line, and palliative care settings.

Keywords: cancer care; intradisciplinary; multidisciplinary; treatment decision; tumor board.

Figure 1

Workflow of the two-level tumor board system. OT, oncotherapy; MDT, multidisciplinary tumor board; OTT, oncotherapy team; PT, palliative team; P, patient.

Figure 2

The number of OTT discussions (red bars) and number of patients (gray bars) between Nov. 2007 and Nov. 2019 at the Institute of Oncotherapy, University of Pécs. Considering both patient and case numbers, a continuous increase can be observed, with p values of 0.0021 and 0.0035, comparing the data of the first and the last 4-year periods.

Figure 3

Ratio of OTT decisions regarding the same patient in the study period. The average number of oncotherapy tumor board (OTT) discussions for the same patient continuously increased over the years.

Figure 4

Ratio of decision changes in OTT discussions. The 12-year averages of minor, moderate and major alterations in decisions were 2.28, 6.4 and 8.92%, respectively. The continuous decrease in the ratios of decision modifications can be explained as a “team learning effect”.