In an MTB, the “core team” is usually composed of oncologists, surgeons of different subspecialties, pathologists, radiotherapists, and other specialists, according to the type of cancer (eg, head and neck, breast, gastrointestinal, genitourinary). They are open to other members, too (“non–core team”), such as palliative-care physicians, medical students, psychologists, physicians in training or nursing-staff specialists, research nurses, and coordinators. Some countries consider the role of nurse staff to be crucial in influencing treatment decisions and have decided to include nurses in the core team rather than the non–core team1,8,13 (Figure 1).

Few studies have addressed the issue of patient participation in MTBs. Choy et al conducted a very interesting pilot study to assess the usefulness of involvement of breast cancer patients in multidisciplinary meetings, participating in their own treatment planning: 22 of 30 selected patients agreed to take part, seven refused, and another agreed, but was not present at the time of the meeting. The authors reported that patient involvement did not increase their anxiety and was helpful in improving their understanding of treatment choices. Even health-care professionals were satisfied with this involvement, although some admitted that patient participation in MTBs compelled them to be more alert and adjust their language so as to allow understanding of the dialogues by patients.14 In another paper, Butow et al found that physicians had some reservations about patients participating in MTBs, because they had to adjust their language for all participants, constraining discussion and delaying meetings.15 Finally, patient involvement may contribute to the diagnostic process and therapeutic choice, particularly when treatment decisions have a deep impact on their quality of life. In early prostate cancer, for example, patients are able to express their preference among treatments of similar value.8

Primary-care physicians are not considered an integral part of MTB. However, they can have a meaningful role in early identification of cancer, introducing patients to the team, and follow-up after hospital discharge. In addition, they are primarily involved in the management of a series of unrelated comorbidities and symptoms (such as pain) when the patient is at home, and their involvement can help in prompting identification of treatment-related side effects when the patient is discharged from hospital.16,17


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Despite technology being able to provide valuable help in physicians’ interactions, it promotes a different way of communication that might influence MTB effectiveness. Mascia et al focused on this peculiar issue, comparing face-to-face vs electronic-based communication among members of an Italian MTB taking place at the Fondazione Policlinico Universitario Agostino Gemelli IRCCS, an Italian research hospital, treating hepatocellular carcinoma patients since 2007. The authors demonstrated that physicians still prefer face-to face communication to exchange work-related information, particularly if they belong to the same clinical unit and the same hospital building, highlighting that physical proximity helps in better knowledge exchange. Among new communication tools, MTB specialists seem to prefer WhatsApp messages, particularly members of the same clinical unit, probably given the informal relationship between workers and members with different expertise. As stated by Johnston et al, WhatsApp acts as a tool capable of relating junior and senior colleagues.18 Based on performance, Mascia et al underlined that members using face-to face communication showed better capability to coordinate and manage the implementation of discussed cases more promptly. Although easy to use, these tools might hamper the quality of MTB discussion.19

Figure 1

METHODS

We conducted a systematic literature search for available evidence on the benefits and limitations of a multidisciplinary approach in cancer patients. The aim of the present evaluation of the current evidence was to describe the multidisciplinary approach in terms of adherence to clinical guidelines, treatment outcomes, and overall improvement in the decision-making process. Selection was undertaken by searching PubMed for clinical practice guidelines, original articles, manuscript reviews and prospective and retrospective studies in English published from 1987 to November 2019. The search term used was “multidisciplinary tumor board”. This systematic review adheres to PRISMA guidelines.20 After analysis, we identified 194 potentially relevant articles: 126 were excluded due to not being in English, impertinence, duplicatation, unavailablility of the full article, and being case reports, studies on pediatric cancer patients, or surveys. Figure 2.

Figure 2

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