Do Multidisciplinary Team (MDT) processes influence survival in patients with colorectal cancer? A population-based experience

BMC Cancer

Research Article

Frank Carey¹  Alastair Munro²  Paddy Niblock²  Mhari Brown³  Robert Steele⁴ 

[1] Ninewells Hospital and Medical School, DD1 9SY, Dundee, UK;Tayside Cancer Centre, Ninewells Hospital and Medical School, DD1 9SY, Dundee, UK;University of Dundee Ninewells Hospital and Medical School, DD1 9SY, Dundee, UK;University of Dundee Ninewells Hospital and Medical School, Mailbox 4 Level 7, DD1 9SY, Dundee, UK;

关键词: Colorectal Cancer;    Hazard Rate;    Electronic Patient Record;    Hospital Information System;    Socioeconomic Deprivation;   

DOI  :  10.1186/s12885-015-1683-1

 received in 2015-06-26, accepted in 2015-10-06,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundMDT (multidisciplinary team) meetings are considered an essential component of care for patients with cancer. However there is remarkably little direct evidence that such meetings improve outcomes. We assessed whether or not MDT (multidisciplinary team) processes influenced survival in a cohort of patients with colorectal cancer.MethodsObservational study of a population-based cohort of 586 consecutive patients with colorectal cancer diagnosed in Tayside (Scotland) during 2006 and 2007.ResultsRecommendations from MDT meetings were implemented in 411/586 (70.1 %) of patients, the MDT+ group. The remaining175/586 (29.9 %) were either never discussed at an MDT, or recommendations were not implemented, MDT- group. The 5-year cause-specific survival (CSS) rates were 63.1 % (MDT+) and 48.2 % (MDT-), p < 0.0001. In analysis confined to patients who survived >6 weeks after diagnosis, the rates were 63.2 % (MDT+) and 57.7 % (MDT-), p = 0.064. The adjusted hazard rate (HR) for death from colorectal cancer was 0.73 (0.53 to 1.00, p = 0.047) in the MDT+ group compared to the MDT- group, in patients surviving >6 weeks the adjusted HR was 1.00 (0.70 to 1.42, p = 0.987). Any benefit from the MDT process was largely confined to patients with advanced disease: adjusted HR (early) 1.32 (0.69 to 2.49, p = 0.401); adjusted HR(advanced) 0.65 (0.45 to 0.96, p = 0.031).ConclusionsAdequate MDT processes are associated with improved survival for patients with colorectal cancer. However, some of this effect may be more apparent than real – simply reflecting selection bias. The MDT process predominantly benefits the 40 % of patients who present with advanced disease and conveys little demonstrable advantage to patients with early tumours. These results call into question the current belief that all new patients with colorectal cancer should be discussed at an MDT meeting.

【 授权许可】

CC BY   
© Munro et al. 2015