Since its introduction in clinical oncology, multidisciplinary management and specifically MTBs have met with increasing enthusiasm as ways to improve the quality of patient care. Moreover, MTB implementation in everyday clinical practice should lead theoretically to increased knowledge, awareness, and reduction of anxiety for members who participate in discussions of MTBs. Although several guidelines suggest that MTBs are crucial in different settings (particularly in rare cancer types), there is a lack of general consensus on what can be done to assess properly whether MTB determines a real improvement in cancer survival and which methods can be used to prove MTB effectiveness. Our review has shown that almost all published papers agree on the fact that adherence to guidelines is one of the main factors that is encouraged by the implementation of MTB discussions. Since we believe that adherence to guidelines is the factor that is more strongly associated with quality of treatment (ie, offering what is generally considered as must for each patient), we believe that this factor should be the one used to check whether MTBs are working in an adequate (or not) fashion.

Interestingly, though adherence of guidelines was maintained, benefit in overall survival was usually less described, and sometimes adherence to guidelines did not determine any change whatsoever in survival outcomes between patients discussed in MTBs vs those who were managed outside the setting of MTBs. This can be partly explained by the fact that MTBs take into account decisions based on data that are actually presented in the discussions. There are a few factors (patient preference, social and financial status, and presence/lack of adequate caregiver) that are rarely discussed in the meetings (owing also to the lack of studies inquiring about the real weight of these factors in influencing treatment decisions). These factors can lead to changes in the proposed treatment plan, particularly when the disease that is treated is not a rare cancer type, thus reducing the impact of a multidisciplinary meeting recommendation.

Our review has also highlighted that though published papers do support a benefit in implementation of MTB discussion, there are a few limitations that should be taken into account to optimize this treatment modality. First of all, MTBs are not a substitute for expertise, and it is required that experience in the management of that specific disease is proven for all members who participate in the MTB. For some instances, such as in the case of rare cancer types, this means that MTBs for the management of these tumor types should only be present in high-volume centers where such cases are concentrated.

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Furthermore, there is a common misconception concerning MTBs regarding costs. It is usually hypothesized that sharing knowledge during the course of MTBs should lead to improvement in patient survival just for the sake of improvement of management of the patient, with no additional cost. All papers focusing on this matter highlighted that MTB implementation leads to an increase in costs, due to more efficiency (and thus better access to diagnostic resources or treatment options, with an increase in costs). Moreover, there is also a cost in terms of additional hours spent in MTB meetings, a cost that is usually outside that considered necessary for everyday patient care. Finally, MTBs occupy a gray area concerning their role in the patient–physician relationship. Strictly speaking, from a legal point of view there are a few unsolved issues in terms of responsibility. When a treatment decision that was issued by the MTB (and was “wrong”) and was supported by the treating physician results in damage to the patient, who is to blame? Is it the responsibility of the primary treating physician or of the MTB itself?

These issues will have to be resolved, particularly in the setting of medical oncology, where owing to the increasing complexity of the disease, it is foolish to believe that the oncologist by themselves is able to make all the adequate treatment choices for each patient. Nonetheless, as supported by the data that we have reported, MTBs are also improving with the times, and we believe that with the implementation of novel methods of computational analysis, they could offer a wider range of possibilities and more evidence-based treatment choices for patients who come to ask for our help.


Rossana Berardi reports grants from Astra Zeneca, Novartis, Merck Sharp & Dohme, and Lilly and personal fees from Otsuka, Boehringer, Merck Sharp & Dohme, and Lilly outside the submitted work. The other authors report no conflicts of interest in this work.

Rossana Berardi, Francesca Morgese, Silvia Rinaldi, Mariangela Torniai, Giulia Mentrasti, Laura Scortichini, Riccardo Giampieri

Clinica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, Ancona, Italy

Correspondence: Rossana Berardi
Clinica Oncologica, Università Politecnica Delle Marche, AOU Ospedali Riuniti Di Ancona via Conca 71, Ancona 60126, Italy
Tel +39 071 596-5715
Fax +39 071 5965053
Email [email protected]


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Source: Cancer Management and Research.
Originally published September 30, 2020.

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