CONCLUSION

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.


Continue Reading

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.

Disclosure

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]


References

1. El Saghir NS, Keating NL, Carlson RW, Khoury KE, Fallowfield L. 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

2. Blamey RW, Cataliotti L. EUSOMA accreditation of breast units. Eur J Cancer. 2006;42(10):1331–1337. doi:10.1016/j.ejca.2006.04.003

3. National Cancer Institute. Defınition of tumor board review. Available from: http://www.cancer.gov/dictionary?cdrid=322893.

4. Dickhoff C, Dahele M. The multidisciplinary lung cancer team meeting: increasing evidence that it should be considered a medical intervention in its own right. J Thorac Dis. 2019;11(3):311–314. doi:10.21037/jtd.2019.01.14

5. Vlasto Milligan. Further reports on cases exhibited before the section at previous meetings, session 1921–1922. Proc R Soc Med. 1922;15:i.1–vii.1.

6. O’Brien JC. History of tumor site conferences at Baylor University Medical Center. Proc (Bayl Univ Med Cent). 2006;19(2):130–131. doi:10.1080/08998280.2006.11928145

7. Munro AJ, Swartzman S. What is a virtual multidisciplinary team (vMDT)? Br J Cancer. 2013;108(12):2433–2441. doi:10.1038/bjc.2013.231

8. Hermes-Moll K, Dengler R, Riese C, Baumann W. Tumor boards from the perspective of ambulant oncological care. Oncol Res Treat. 2016;39:377–383. doi:10.1159/000446311

9. Horlait M, Baes S, Dhaene S, Van Belle S, Leys M. How multidisciplinary are multidisciplinary team meetings in cancer care? An observational study in oncology departments in Flanders, Belgium. J Multidiscip Healthc. 2019;12:159–167. doi:10.2147/JMDH.S196660

10. Takeda T, Takeda S, Uryu K, et al. Multidisciplinary lung cancer tumor board connecting eight general hospitals in Japan via a high-security communication line. JCO Clin Cancer Inform. 2019;3:1–7. doi:10.1200/CCI.18.00115

11. El Saghir NS, Charara RN, Kreidieh FY, et al. Global practice and efficiency of multidisciplinary tumor boards: results of an American Society of Clinical Oncology International Survey. J Glob Oncol. 2015;1(2):57–64. doi:10.1200/JGO.2015.000158

12. El Saghir NS, El-Asmar N, Hajj C. Survey of utilization of multidisciplinary management tumor boards in Arab countries. Breast. 2011;20(Suppl 2):70–74. doi:10.1016/j.breast.2011.01.011

13. Lumenta DB, Sendlhofer G, Pregartner G, et al. Quality of teamwork in multidisciplinary cancer team meetings: a feasibility study. PLoS One. 2019;14(2):e0212556. doi:10.1371/journal.pone.0212556

14. Choy E, Chiu A, Butow P, Young J, Spillane A. A pilot study to evaluate the impact of involving breast cancer patients in the multidisciplinary discussion of their disease and treatment plan. Breast. 2007;16:178–189. doi:10.1016/j.breast.2006.10.002

15. Butow P, Harrison J, Choy E, Young J, Spillane A, Evans A. Health professional and consumer views on involving breast cancer patients in the multidisciplinary discussion of their disease and treatment plan. Cancer. 2007;110:1937–1944. doi:10.1002/cncr.23007

16. Siddique O, Yoo ER, Perumpail RB, et al. The importance of a multidisciplinary approach to hepatocellular carcinoma. J Multidiscip Healthc. 2017;Volume 10(10):95–100. doi:10.2147/JMDH.S128629

17. Rainone F. Treating adult cancer pain in primary care. J Am Board Fam Pract. 2004;17(Suppl 1):S48–56. doi:10.3122/jabfm.17.suppl_1.S48

18. Johnston MJ, King D, Arora S, et al. Smartphones let surgeons know WhatsApp: an analysis of communication in emergency surgical teams. Am J Surg. 2015;209(1):45–51. doi:10.1016/j.amjsurg.2014.08.030

19. Mascia D, Rinninella E, Pennacchio NW, Cerrito L, Gasbarrini A. It’s how we communicate! Exploring face-to-face versus electronic communication networks in multidisciplinary teams. Health Care Manage Rev. 2019. doi:10.1097/HMR.0000000000000246

20. Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg. 2010;8:336–431. doi:10.1016/j.ijsu.2010.02.007

21. 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(4):e232–8. doi:10.3747/co.19.944

22. Kabat GC, Matthews CE, Kamensky V, Hollenbeck AR, Rohan TE. Adherence to cancer prevention guidelines and cancer incidence, cancer mortality, and total mortality: a prospective cohort study. Am J Clin Nutr. 2015;101(3):558–569. doi:10.3945/ajcn.114.094854

23. Jury RP, Nadeau L, Wasvary H, Levine R, Robertson J. Implementing a multidisciplinary open-access clinic at a private practice-based community hospital. J Oncol Pract. 2010;6(6):e38–41. doi:10.1200/JOP.2010.000029

24. Gross GE. The role of the tumor board in a community hospital. CA Cancer J Clin. 1987;37(2):88–92. doi:10.3322/canjclin.37.2.88

25. Riquet M, Mordant P, Henni M, et al. Should all cases of lung cancer be presented at tumor board conferences? Thorac Surg Clin. 2013;23(2):123–128. doi:10.1016/j.thorsurg.2013.01.003

26. Hollunder S, Herrlinger U, Zipfel M, et al. Cross-sectional increase of adherence to multidisciplinary tumor board decisions. BMC Cancer. 2018;18(1):936. doi:10.1186/s12885-018-4841-4

27. Shah BA, Qureshi MM, Jalisi S, et al. Analysis of decision making at a multidisciplinary head and neck tumor board incorporating evidence-based National Cancer Comprehensive Network (NCCN) guidelines. Pract Radiat Oncol. 2016;6(4):248–254. doi:10.1016/j.prro.2015.11.006

28. Brauer DG, Strand MS, Sanford DE, et al. Utility of a multidisciplinary tumor board in the management of pancreatic and upper gastrointestinal diseases: an observational study. HPB. 2017;19(2):133–139. doi:10.1016/j.hpb.2016.11.002

29. Ioannidis A, Konstantinidis M, Apostolakis S, Koutserimpas C, Machairas N, Konstantinidis KM. Impact of multidisciplinary tumor boards on patients with rectal cancer. Mol Clin Oncol. 2018;9(2):135–137. doi:10.3892/mco.2018.1658

30. Basse C, Thureau S, Bota S, et al. Multidisciplinary tumor board decision making for postoperative radiotherapy in thymic epithelial tumors: insights from the RYTHMIC prospective cohort. J Thorac Oncol. 2017;12(11):1715–1722. doi:10.1016/j.jtho.2017.07.023

31. Somashekhar SP, Sepúlveda MJ, Puglielli S, et al. Watson for Oncology and breast cancer treatment recommendations: agreement with an expert multidisciplinary tumor board. Ann Oncol. 2018;29(2):418–423. doi:10.1093/annonc/mdx781

32. Lamb BW, Green JS, Benn J, Brown KF, Vincent CA, Sevdalis N. Improving decision making in multidisciplinary tumor boards: prospective longitudinal evaluation of a multicomponent intervention for 1,421 patients. J Am Coll Surg. 2013;217(3):412–420. doi:10.1016/j.jamcollsurg.2013.04.035

33. Shah S, Arora S, Atkin G, et al. Decision-making in colorectal cancer tumor board meetings: results of a prospective observational assessment. Surg Endosc. 2014;28(10):2783–2788. doi:10.1007/s00464-014-3545-3

34. Jalil R, Akhter W, Lamb BW, et al. Validation of team performance assessment of multidisciplinary tumor boards. J Urol. 2014;192(3):891–898. doi:10.1016/j.juro.2014.03.002

35. Serper M, Taddei TH, Mehta R, et al.; VOCAL Study Group. Association of provider specialty and multidisciplinary care with hepatocellular carcinoma treatment and mortality. Gastroenterology. 2017;152(8):1954–1964. doi:10.1053/j.gastro.2017.02.040.

36. Agarwal PD, Phillips P, Hillman L, et al. Multidisciplinary management of hepatocellular carcinoma improves access to therapy and patient survival. J Clin Gastroenterol. 2017;51(9):845–849. doi:10.1097/MCG.0000000000000825

37. Liu JC, Kaplon A, Blackman E, Miyamoto C, Savior D, Ragin C. The impact of the multidisciplinary tumor board on head and neck cancer outcomes. Laryngoscope. 2019;130:946–950.

38. Blay JY, Soibinet P, Penel N, et al. Improved survival using specialized multidisciplinary board in sarcoma patients. Ann Oncol. 2017;28(11):2852–2859. doi:10.1093/annonc/mdx484

39. Kesson EM, Allardice GM, George WD, Burns HJ, Morrison DS. Effects of multidisciplinary team working on breast cancer survival: retrospective, comparative, interventional cohort study of 13 722 women. BMJ. 2012;344:e2718. doi:10.1136/bmj.e2718

40. Newman EA, Guest AB, Helvie MA, et al. Changes in surgical management resulting from case review at a breast cancer multidisciplinary tumor board. Cancer. 2006;107(10):2346–2351. doi:10.1002/cncr.22266

41. Lee B, Kim K, Choi JY, et al. Efficacy of the multidisciplinary tumor board conference in gynecologic oncology: a prospective study. Medicine. 2017;96(48):e8089. doi:10.1097/MD.0000000000008089

42. Wheless SA, McKinney KA, Zanation AM. A prospective study of the clinical impact of a multidisciplinary head and neck tumor board. Otolaryngol Head Neck Surg. 2010;143:650–654. doi:10.1016/j.otohns.2010.07.020

43. AlFarhan HA, Algwaiz GF, Alzahrani HA, et al. Impact of GI tumor board on patient management and adherence to guidelines. J Glob Oncol. 2018;4:1–8. doi:10.1200/JGO.17.00164

44. 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(10):1463–1469. doi:10.1007/s00384-017-2871-z

45. Pawlik TM, Laheru D, Hruban RH, et al.; Johns Hopkins Multidisciplinary Pancreas Clinic Team. Evaluating the impact of a single-day multidisciplinary clinic on the management of pancreatic cancer. Ann Surg Oncol. 2008;15(8):2081–2088. doi:10.1245/s10434-008-9929-7.

46. Deressa BT, Cihoric N, Tefesse E, Assefa M, Zemenfes D. Multidisciplinary Cancer Management of Colorectal Cancer in Tikur Anbessa Specialized Hospital, Ethiopia. J Glob Oncol. 2019;5:1–7. doi:10.1200/JGO.19.00014

47. Solomon D, DeNicola N, Feferman Y, et al. Assessing the Implementation of American College of Surgeons Quality Indicators for Pancreatic Cancer Across an Integrated Health System. J Oncol Pract. 2019;15(8):e739–e745. doi:10.1200/JOP.18.00587

48. Wotman M, Ghaly M, Massaro L, et al. Management of the neck after definitive chemoradiation in patients with HPV-associated oropharyngeal cancer: an institutional experience. Am J Otolaryngol. 2019;40(5):684–690. doi:10.1016/j.amjoto.2019.06.003

49. Herlemann A, Washington SL, Cooperberg MR. Health care delivery for metastatic hormone-sensitive prostate cancer across the globe. Eur Urol Focus. 2019;5(2):155–158. doi:10.1016/j.euf.2018.12.003

50. Fazio N, Ungaro A, Spada F, et al. The role of multimodal treatment in patients with advanced lung neuroendocrine tumors. J Thorac Dis. 2017;9(Suppl 15):S1501–S1510. doi:10.21037/jtd.2017.06.14

51. Rubins J, Unger M, Colice GL; American College of Chest Physicians. Follow-up and surveillance of the lung cancer patient following curative intent therapy: ACCP evidence-based clinical practice guideline (2nd edition). Chest. 2007;132(3):355S–367S. doi:10.1378/chest.07-1390

52. Gambazzi F, Frey LD, Bruehlmeier M, et al. Image analysis in posttreatment non-small cell lung cancer surveillance: specialists’ interpretations reviewed by the thoracic multidisciplinary tumor board. Multidiscip Respir Med. 2019;14:34. doi:10.1186/s40248-019-0198-z

53. Kuroki L, Stuckey A, Hirway P, et al. Addressing clinical trials: can the multidisciplinary tumor board improve participation? A study from an academic women’s cancer program. Gynecol Oncol. 2010;116(3):295–300. doi:10.1016/j.ygyno.2009.12.005

54. van de Velde CJ, Boelens PG, Borras JM, et al. EURECCA colorectal: multidisciplinary management: European consensus conference colon & rectum. Eur J Cancer. 2014;50(1):1–e1. doi:10.1016/j.ejca.2013.06.048

55. Mañós M, Giralt J, Rueda A, et al. Multidisciplinary management of head and neck cancer: first expert consensus using Delphi methodology from the Spanish Society for Head and Neck Cancer (part 1). Oral Oncol. 2017;70:58–64. doi:10.1016/j.oraloncology.2017.04.004

56. Rueda A, Giralt J, Mañós M, et al. Multidisciplinary management of head and neck cancer: first expert consensus using Delphi methodology from the Spanish Society for Head and Neck Cancer (part 2). Oral Oncol. 2017;70:65–72. doi:10.1016/j.oraloncology.2017.04.005

57. Bajetta E, Celio L, Platania M, et al. Single-institution series of early-stage Merkel cell carcinoma: long-term outcomes in 95 patients managed with surgery alone. Ann Surg Oncol. 2009;16(11):2985–2993. doi:10.1245/s10434-009-0615-1

58. Taddei TH. A multidisciplinary approach: group dynamics. J Clin Gastroenterol. 2013;47:S27–9. doi:10.1097/MCG.0b013e31829331de

59. Asghar AH, Abbasi AN, Jamal A, Haider G, Rizvi S. City tumour board Karachi: an innovative step in multidisciplinary consensus meeting and its two years audit. J Pak Med Assoc. 2013;63(12):1534–1535.

60. Sandrucci S, Naredi P, Bonvalot S. Centers of excellence or excellence networks: the surgical challenge and quality issues in rare cancers. Eur J Surg Oncol. 2019;45(1):19–21. doi:10.1016/j.ejso.2017.12.012

61. Bui NQ, Wang DS, Hiniker SM. Contemporary management of metastatic soft tissue sarcoma. Curr Probl Cancer. 2019;43(4):289–299. doi:10.1016/j.currproblcancer.2019.06.005

62. Hahlweg P, Didi S, Kriston L, Härter M, Nestoriuc Y, Scholl I. Process quality of decision-making in multidisciplinary cancer team meetings: a structured observational study. BMC Cancer. 2017;17(1):772. doi:10.1186/s12885-017-3768-5

63. Ung KA, Campbell BA, Duplan D, Ball D, David S. Impact of the lung oncology multidisciplinary team meetings on the management of patients with cancer. Asia Pac J Clin Oncol. 2016;12(2):e298–304. doi:10.1111/ajco.12192

64. Zekri J, Dreosti LM, Ghosn M, et al. Multidisciplinary management of clear-cell renal cell carcinoma in Africa and the Middle East: current practice and recommendations for improvement. J Multidiscip Healthc. 2015;27(8):335–344. doi:10.2147/JMDH.S85538

65. Fayet Y, Coindre JM, Dalban C, et al. Geographical accessibility of the referral networks in France. Intermediate results from the IGéAS research program. Int J Environ Res Public Health. 2018;15(10):2204. doi:10.3390/ijerph15102204

66. Walsh S, de Jong EEC, van Timmeren JE, et al. Decision support systems in oncology. JCO Clin Cancer Inform. 2019;3:1–9. doi:10.1200/CCI.18.00001

67. Krupinski EA, Comas M; Gallego LG on behalf of the GISMAR Group. A new software platform to improve multidisciplinary tumor board workflows and user satisfaction: a pilot study. J Pathol Inform. 2018;9:26. doi:10.4103/jpi.jpi_16_18

68. Gallagher SA, Smith AB, Matthews JE, et al. Roadmap for the development of the University of North Carolina at Chapel Hill Genitourinary OncoLogy Database–UNC GOLD. Urol Oncol. 2014;32(1):32–e1. doi:10.1016/j.urolonc.2012.11.019

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

READ FULL ARTICLE Curated publisher From DovePress