For optimal oncological care it is recommended to discuss every patient with cancer in a multidisciplinary team meeting (MDTM). Due to increasing incidence and prevalence of cancer and emergence of dedicated tumour specific MDTMs, the number of patients that needs to be discussed rises, and the time- and financial burden is growing. This leads to a growing demand to change the current workflow. We aimed to investigate the number of patients discussed in current daily practice of MDTMs and aimed to identify characteristics that associate with not being discussed.
Data of patients with a newly diagnosed solid malignant tumour in 2015 and 2016 were analyzed through the nationwide population-based Netherlands Cancer Registry (NCR). We clustered all different tumour types in 8 groups that were frequently discussed within a tumour specific MDTM; 1. upper gastro-intestinal- , 2. hepato-pancreatic-biliary- , 3. colorectal-, 4. gynaecological- , 5.central nervous system-, 6. head and neck-, 7. breast- and 8. prostate cancers. Tumour types without information about MDTMs in the NCR were excluded. Multivariable logistic regression analyses were used to analyze which factors were associated with not being discussed in a MDTM.
Out of 105.305 patients, 91% were discussed in a MDTM; varying from 74%-99% between the different tumour groups. Significantly less frequently discussed were patients aged ≥ 75 years (OR = 0.7, 95%CI=0.6-0.7), diagnosed with disease stage I (OR = 0.5, 95%CI=0.5-0.6), IV (OR = 0.4, 95%CI=0.4-0.4) or unknown (OR = 0.2, 95%CI=0.2-0.2), and patients that received no treatment (OR = 0.3, 95%CI=0.3-0.3). Patients that received a multidisciplinary treatment were more likely to be discussed compared to patients with a monodisciplinary treatment (OR = 4.6, 95%CI=4.2-5.1).
In general most cancer patients are actually discussed in a MDTM in the Netherlands, although differences were observed between tumour groups. Factors associated with not being discussed may, at least partially, reflect the absence of a multidisciplinary question. These results form a starting point for debate towards a more durable and efficient new MDTM strategy.
The authors.
Has not received any funding.
V.E.P.P. Lemmens: Research grant / Funding (institution): Roche. R.H.A. Verhoeven: Research grant / Funding (self): Roche; Research grant / Funding (self): Bristol-Myers Squibb. All other authors have declared no conflicts of interest.