Elsevier

Journal of Clinical Neuroscience

Volume 56, October 2018, Pages 127-130
Journal of Clinical Neuroscience

Clinical study
A single-institution prospective evaluation of a neuro-oncology multidisciplinary team meeting

https://doi.org/10.1016/j.jocn.2018.06.032Get rights and content

Highlights

  • Many cases (35%) in neuro-oncology MDTs have substantial treatment plan changes.

  • Treatment decisions made at neuro-oncology MDTs are largely adhered to.

  • Treatment plan changes were associated with longer discussion time at MDTs.

Abstract

Multi-disciplinary team meetings (MDTs) are considered essential to quality cancer care. For some malignancies, MDTs have been associated with improved outcomes, but data regarding the neuro-oncology MDT is limited. We prospectively described the MDT at our institution and evaluated its impact on clinical management. Cases were discussed amongst the treating team and a pre-MDT plan and reason for discussion (RFD) was documented before the MDT. Patient specific clinical data was captured prospectively, with further pathological and radiological information captured during the MDT. Subsequently, the MDT consensus decision was recorded. High impact decisions (HID) were those in which the pre-MDT plan was substantially modified. A HID rate of >10% was considered clinically significant. Adherence to MDT recommendations was recorded. Seventy-nine cases were discussed at the MDT. Fifty-two cases (66%) were male. The median age was 53 (17–84). Thirty-three cases were new diagnoses and the remainder were relapsed/progressive disease. Thirty-nine cases were primary brain tumours, 25 were metastatic tumours and 15 were other. Twenty-eight (35%) had HID. No RFDs were statistically significantly associated with a HID (p = 0.265). Adherence data was collected for 95% (75) of cases. Treatment concordance with the MDT plan occurred in 90% (67) of cases. For cases of non-concordance, six out of eight (75%) were due to patient choice. Overall, a clinically significant proportion of treatment modifications are made at the neuro-oncology MDT. There were no case types which did not benefit from MDT discussion. MDT recommendations were largely adhered to, and in cases of non-concordance, were largely due to patient choice.

Section snippets

Background

Tumour board meetings or multidisciplinary team meetings (MDTs) are a core component of clinical cancer management [1], and have been advocated to ensure timely clinical input on complex oncological cases by multiple specialists with relevant expertise [2]. They often comprise of nurses, allied health professionals, surgeons, radiation oncologists, medical oncologists, radiologists and pathologists and their importance has been recognised for facilitating communication, coordinating management

Methods

All cases discussed over a three-month period at the neuro-oncology MDT were prospectively evaluated for the impact of the MDT on clinical decision making. All cases were discussed prior to the meeting by representatives of the referring teams (MA, WN, DM), and a pre-MDT plan was documented prior to the meeting. Cases were also categorised according to the major reason for discussion (RFD), with standard categories including routine review of tissue from operations performed in the previous

Results

The neuro-oncology MDT at our institution consists of neurosurgeons, neuro-oncologists, radiation oncologists, neuro-radiologists, pathologists, clinical nurse consultant and trainees. Cases are typically drawn from within the institution, with a meeting agenda circulated at least 24 h prior to the meeting. Occasional cases are referred from external sites for an expert or second opinion. All neurosurgical procedures performed for oncology cases within the hospital are typically discussed at

Discussion

In this prospective study we evaluated a neuro-oncology MDT at a tertiary Australian referral centre. This study allowed valuable insights into the typical caseload of the MDT, the rate of HID, the factors influencing HID and the time taken for discussion as well as rates of concordance to MDT recommendations.

We found that the MDT impacted significantly on decision-making in just over a third of cases discussed, with most changes to treatment plans involving a change in the treatment modality.

References (19)

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1

Contributed equally.

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