Multidisciplinary team in colorectal cancer treatment – analysis of our patients in 2017

Česká verzia

Authors: J. Pudil ¹; L. Petruželka ²; S. Batko ³; J. Barkmanová ²; M. Rousek ¹ ; J. Pažin ¹; D. Langer ¹; J. Malík ⁴; P. Mináriková ⁵; P. Hrabal ⁶; M. Ryska ¹
Authors place of work: Chirurgická klinika 2. lékařské fakulty Univerzity Karlovy a Ústřední vojenská nemocnice – Vojenská fakultní nemocnice Praha ¹; Onkologická klinika 1. lékařské fakulty Univerzity Karlovy a Ústřední vojenská nemocnice – Vojenská fakultní nemocnice Praha ²; Onkologická klinika 2. lékařské fakulty Univerzity Karlovy a Fakultní nemocnice Motol ³; Radiodiagnostické oddělení Ústřední vojenská nemocnice – Vojenská fakultní nemocnice Praha ⁴; Interní klinika 1. lékařské fakulty Univerzity Karlovy a Ústřední vojenská nemocnice – Vojenská fakultní nemocnice Praha ⁵; Oddělení Patologie Ústřední vojenská nemocnice – Vojenská fakultní nemocnice Praha ⁶
Published in the journal: Rozhl. Chir., 2019, roč. 98, č. 10, s. 414-417.
Category: Original articles

Summary

Introduction: Multidisciplinary teams (MDTs) have become a standard part of treating oncological patients. Based on the available data, they have lead to significantly higher survival rates in the treatment of colorectal cancer (CRC). Reported negatives include potentially longer times between diagnoses and the start of appropriate treatment, and the lack of quality controls over the MTDs’ actions. This report aims to assess the benefits of MDTs using our own data set for 2017.

Methods: Year 2010 saw the institution of an MDT at the Central Military University Hospital in Prague, with the obligation to refer CRC patients to the MDT before the start of treatment. Having standardized the registration, we have implemented a simple procedure to track the quality of our MDT’s involvement and its patient benefits: number of patients, number of referrals with proposed diagnostic and therapeutic procedure, frequency and reason of changes to original strategies, and the frequency of variations from the MDT’s conclusions.

Results: 405 CRC patients were referred to the MDT in 2017; we have found 499 referrals in this group. The data set was formed predominantly by men (61%), with the mean age of 63 (21–91), and the median age of 64.5 years. Surgical treatment was the most commonly proposed procedure (59%), followed by systemic treatment or, as the case may be, radiotherapy. In 24% of the cases, the conclusion did not match the originally proposed procedure. The decision not to go through with the proposed surgical treatment was the most common change (66 %). We have found a difference in the quality of referral in patients examined specifically by the referring doctor, as opposed to patients whose medical records have just been sent in. We have found therapeutic variation in the MTD’s conclusions in less than 5% of patients.

Conclusion: Having analyzed our data for CRC patients referred to the MDT in 2017, we have found out that in 24% of the patients, the MDT referral leads to a change in the originally proposed diagnostic and therapeutic procedure. Consensus among the MDT’s members on the CRC patient’s treatment guarantees an optimum procedure. What is fundamental is that the referring doctor knows the patient. Constant tracking of the MDT’s outputs forms a condition for sustaining the quality of its work and a base for assessing its benefits to the patients.

Keywords:

colorectal cancer – colorectal liver metastases – multidisciplinary team

Zdroje

Lamb BW, Brown KF, Nagpal K, et al. Quality of care management decisions by multidisciplinary cancer teams: a systematic review. Ann Surg Oncol. 2011;18:2116–25. doi: 10.1245/s10434-011-1675-6.
Ryska M, Duda M, Antoš F. Současná onkochirurgie a kód multidisciplinárního týmu. Rozhl Chir. 2011;90:667–8.
Munro A, Brown M, Niblock P, et al. Do multidisciplinary team (MDT) processes influence survival in patients with colorectal cancer? A population-based experience. BMC Cancer 2015;15:686. doi: 10.1186/s12885-015-1683-1.
Ye YJ, Shen ZL, Sun X, et al. Impact of multidisciplinary team working on the management of colorectal cancer. Chin Med J. (Engl) 2012;125:172−7.
Homayounfar K, Bleckmann A, Helms HJ, et al. Discrepancies between medical oncologists and surgeons in assessment of resectability and indication for chemotherapy in patients with colorectal liver metastases. Br J Surg. 2014;101:550−7. doi: 10.1002/bjs.9436.
Nikolovski Z, Watters DAK, Stupart D, et al. Colorectal multidisciplinary meetings: how do they affect the timeliness of treatment? ANZ J Surg. 2017;87:E112−E115. doi: 10.1111/ans.13144.
Lamb BW, Brown KF, Nagpal K, et al. Quality of care management decisions by multidisciplinary cancer teams: a systematic review. Ann Surg Oncol. 2011;18:2116−25. doi: 10.1245/s10434-011-1675-6.
Croke JM, El-Sayed S. Multidisciplinary management of cancer patients: chasing a shadow or real value? An overview of the literature. Curr Oncol. 2012;19:e232−8. doi: 10.3747/co.19.944.
MacDermid E, Hooton G, MacDonald M, et al. Improving patient survival with the colorectal cancer multi-disciplinary team. Colorectal Dis. 2009;11:291−5. doi: 10.1111/j.1463-1318.2008.01580.x.
Ryska M. Současná účinná léčba jaterních metastáz kolorektálního karcinomu v rámci multioborového týmu. Cas Lek Ces. 2014;153:213–5.
Ryska M. Multidisciplinární týmy: jak dál? Rozhl Chir. 2018;97:147−8.
El Saghir NS, Keating NL, Carlson RW, et al. Tumor boards: optimizing the structure and improving efficiency of multidisciplinary management of patients with cancer worldwide. Am Soc Clin Oncol Educ Book 2014:e461−6. doi: 10.14694/EdBook_AM.2014.34.e461.
Marshall CL, Petersen NJ, Naik AD, et al. Implementation of a regional virtual tumor board: a prospective study evaluating feasibility and provider acceptance. Telemed J E Health 2014;20:705−11. doi: 10.1089/tmj.2013.0320.
Wood JJ, Metcalfe C, Paes A, et al. An evaluation of treatment decisions at a colorectal cancer multi -disciplinary team. Colorectal Dis. 2008;10:769−72. doi: 10.1111/j.1463-1318.2007.01464.x.
Ryan J, Faragher I. Not all patients need to be discussed in a colorectal cancer MDT meeting. Colorectal Dis. 2014;16:520−6. doi: 10.1111/codi.12581.
Segelman J, Singnomklao T, Hellborg, et al. Differences in multidisciplinary team assessment and treatment between patients with stage IV colon and rectal cancer. Colorectal Dis. 2009;11:768−74. doi: 10.1111/j.1463-1318.2008.01648.x.
Adam R, Kitano Y. Multidisciplinary approach of liver metastases from colorectal cancer. Ann Gastroenterol Surg. 2019;3:50−6. doi: 10.1002/ags3.12227.
Engstrand J, Kartalis N, Strömberg C. The impact of a hepatobiliary multidisciplinary team assessment in patients with colorectal cancer liver metastases: A population-based study. Oncologist 2017;22:1067−74. doi: 10.1634/theoncologist.2017-0028.
Lowes M, Kleiss M, Lueck R, et al. The utilization of multidisciplinary tumor boards (MDT) in clinical routine: results of a health care research study focusing on patients with metastasized colorectal cancer. Int J Colorectal Dis. 2017;32:1463−9. doi: 10.1007/s00384-017-2871-z.
Schiergens TS, von Einem J, Thomas MN, et al. Multidisciplinary treatment of colorectal liver metastases. Minerva Med. 2017;108:527−46. doi: 10.23736/S0026-4806.17.05371-X.
De Greef K, Rolfo C, Russo A, et al. Multidisciplinary management of patients with liver metastasis from colorectal cancer. World J Gastroenterol. 2016;22:7215−25. doi: 10.3748/wjg.v22.i32.7215.
Juez I, Rubio C, Figueras J. Multidisciplinary approach of colorectal liver metastases. Clin Transl Oncol. 2011;13:721−7. doi: 10.1007/s12094-011-0722-x.
Adam R, De Gramont A, Figueras J, et al. The oncosurgery approach to managing liver metastases from colorectal cancer: a multidisciplinary international consensus. Oncologist 2012;17:1225−39. doi: 10.1634/theoncologist.2012-0121.