Multidisciplinary meetings

From Cancer Guidelines Wiki

Background

Multidisciplinary team meetings, or tumour boards, where initiated in the mid-to-late 1990s in response to perceptions of inadequate and inequitable cancer treatment.[1] Most national and regional guidelines now suggest that all new colorectal cancer cases should be discussed at a multidisciplinary team meeting, with rectal cancers being discussed pre-operatively.[2][3][4][5][6][7][8]

Overview of evidence (non-systematic literature review)

No systematic reviews were undertaken for this topic. Practice points were based on selected published evidence. See Guidelines development process.

No randomised controlled trials (RCTs) were identified examining the effect of multidisciplinary team meetings on patient outcomes in colorectal cancer. However, many studies have concluded that multidisciplinary team meetings are beneficial, sometimes with limited evidence.[9] Eight papers have examined the effect of multidisciplinary team meetings on patient survival[10][11][12][13][14][15][16][17] in colorectal cancer and have reported an association with improved survival in patients discussed at a multidisciplinary team meeting. Many of these studies compared historical cohorts before and after introduction of a multidisciplinary team meeting. Thus, improved outcomes could possibly reflect other improvements in patient care such as better staging, more extensive surgery particularly of liver metastases and more effective chemotherapy.[17]

A recent Australian study[18] has suggested that their multidisciplinary team meeting rarely changed management in routine colon cancer cases, but management did change in 50% of complex cases. These included pre-operative assessments of rectal cancer, recurrence of colorectal cancer, metastatic disease and malignant polyps. The authors suggest a two-tier system for colorectal multidisciplinary team meetings, where all patients are listed, but only complex cases are discussed in detail. This is supported by a recent New Zealand study, which suggested that patients with stage 1 and 2 colorectal cancers rarely had their management impacted after discussion at an multidisciplinary team meeting.[19]

Multidisciplinary team meetings certainly have other benefits, including better communication among clinicians,[20], provision of most up-to-date treatments,[21] education and training, and improved coordination of care. They are an important part of care for colorectal cancer patients, although the resources required to run them are significant and need to be factored into service planning.[22]
Practice pointA recommendation on a subject that is outside the scope of the search strategy for the systematic review, based on expert opinion and formulated by a consensus process.Question mark transparent.png

Ideally, all patients with newly diagnosed colorectal cancer should be discussed at a multidisciplinary team meeting.

Practice pointA recommendation on a subject that is outside the scope of the search strategy for the systematic review, based on expert opinion and formulated by a consensus process.Question mark transparent.png

Discussion at a multidisciplinary team meeting is mandatory for high-risk and complex cases such as patients with preoperative rectal cancers, metastatic disease or recurrent disease.

Next section: perioperative anaemia management
Back to top

References

  1. Expert Advisory Group on Cancer,. A policy framework for commissioning cancer services – the Calman–Hine Report. A Report by the Expert Advisory Group on Cancer to the Chief Medical Officers of England and Wales. London, UK: Department of Health; 1995.
  2. Association of Coloproctology of Great Britain and Ireland,. Guidelines for the Management of Colorectal Cancer. London: Association of Coloproctology of Great Britain and Ireland; 2007.
  3. Department of Health WA. Colorectal Model of Care. Western Australia, Australia: WA Cancer & Palliative Care Network, Department of Health; 2008 [cited 2016 Dec 16].
  4. Cancer Council Victoria. Optimal care pathway for people with colorectal cancer.; 2014 Available from: www.cancer.org.au/ocp.
  5. Oncology GGPi. Evidence-based Guideline for Colorectal Cancer. Berlin, Germany; 2014.
  6. Chang GJ, Kaiser AM, Mills S, Rafferty JF, Buie WD, Standards Practice Task Force of the American Society of ColonThe main part of the large bowel, which absorbs water and electrolytes from undigested food (solid waste). Its four parts are the ascending colon, transverse colon, descending colon and sigmoid colon. and Rectal Surgeons.. Practice parameters for the management of colon cancer. Dis ColonThe main part of the large bowel, which absorbs water and electrolytes from undigested food (solid waste). Its four parts are the ascending colon, transverse colon, descending colon and sigmoid colon. RectumThe final section of the large bowel, ending at the anus. 2012 Aug;55(8):831-43 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/22810468.
  7. Monson JR, Weiser MR, Buie WD, Chang GJ, Rafferty JF, Buie WD, et al. Practice parameters for the management of rectal cancer (revised). Dis ColonThe main part of the large bowel, which absorbs water and electrolytes from undigested food (solid waste). Its four parts are the ascending colon, transverse colon, descending colon and sigmoid colon. RectumThe final section of the large bowel, ending at the anus. 2013 May;56(5):535-50 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/23575392.
  8. National Collaborating Centre for Cancer. The Diagnosis and Management of Colorectal Cancer - Evidence review United Kingdom: National Institute for Health and Care Excellence; 2011.; 2017 Nov 20.
  9. Meagher AP. Colorectal cancer: are multidisciplinary team meetings a waste of time? ANZ J Surg 2013 Mar;83(3):101-3 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/23586096.
  10. MacDermid E, Hooton G, MacDonald M, McKay G, Grose D, Mohammed N, et al. Improving patient survival with the colorectal cancer multi-disciplinary team. ColorectalReferring to the large bowel, comprising the colon and rectum. Dis 2009 Mar;11(3):291-5 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/18477019.
  11. Lordan JT, Karanjia ND, Quiney N, Fawcett WJ, Worthington TR. A 10-year study of outcome following hepatic resection for colorectal liver metastases - The effect of evaluation in a multidisciplinary team setting. Eur J Surg Oncol 2009 Mar;35(3):302-6 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/18328668.
  12. Du CZ, Li J, Cai Y, Sun YS, Xue WC, Gu J. Effect of multidisciplinary team treatment on outcomes of patients with gastrointestinal malignancy. World J Gastroenterol 2011 Apr 21;17(15):2013-8 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/21528081.
  13. Palmer G, Martling A, Cedermark B, Holm T. Preoperative tumour staging with multidisciplinary team assessment improves the outcome in locally advanced primary rectal cancer. ColorectalReferring to the large bowel, comprising the colon and rectum. Dis 2011 Dec;13(12):1361-9 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/20958913.
  14. Ye YJ, Shen ZL, Sun XT, Wang ZF, Shen DH, Liu HJ, et al. Impact of multidisciplinary team working on the management of colorectal cancer. Chin Med J (Engl) 2012 Jan;125(2):172-7 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/22340540.
  15. Wille-Jørgensen P, Sparre P, Glenthøj A, Holck S, Nørgaard Petersen L, Harling H, et al. Result of the implementation of multidisciplinary teams in rectal cancer. ColorectalReferring to the large bowel, comprising the colon and rectum. Dis 2013 Apr;15(4):410-3 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/22958614.
  16. Munro A, Brown M, Niblock P, Steele R, Carey F. Do Multidisciplinary Team (MDT) processes influence survival in patients with colorectal cancer? A population-based experience. BMC Cancer 2015 Oct 13;15:686 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26463599.
  17. 17.017.1 Lan YT, Jiang JK, Chang SC, Yang SH, Lin CC, Lin HH, et al. Improved outcomes of colorectal cancer patients with liver metastases in the era of the multidisciplinary teams. Int J ColorectalReferring to the large bowel, comprising the colon and rectum. Dis 2016 Feb;31(2):403-11 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26662193.
  18. Ryan J, Faragher I. Not all patients need to be discussed in a colorectal cancer MDT meeting. ColorectalReferring to the large bowel, comprising the colon and rectum. Dis 2014 Jul;16(7):520-6 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/24617857.
  19. Fernando C, Frizelle F, Wakeman C, Frampton C, Robinson B. Colorectal multidisciplinary meeting audit to determine patient benefit. ANZ J Surg 2015 Nov 3 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26525919.
  20. Segelman J, Singnomklao T, Hellborg H, Martling A. Differences in multidisciplinary team assessment and treatment between patients with stage IV colon and rectal cancer. ColorectalReferring to the large bowel, comprising the colon and rectum. Dis 2009 Sep;11(7):768-74 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/18662241.
  21. Scott NA, Susnerwala S, Gollins S, Myint AS, Levine E. Preoperative neo-adjuvant therapy for curable rectal cancer--reaching a consensus 2008. ColorectalReferring to the large bowel, comprising the colon and rectum. Dis 2009 Mar;11(3):245-8 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/18637934.
  22. Prades J, Remue E, van Hoof E, Borras JM. Is it worth reorganising cancer services on the basis of multidisciplinary teams (MDTs)? A systematic review of the objectives and organisation of MDTs and their impact on patient outcomes. Health Policy 2015 Apr;119(4):464-74 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/25271171.
Back to top