Improving patient survival with the colorectal cancer multi‐disciplinary team

Abstract

Objective There is little information on the impact of the colorectal multi-disciplinary team (MDT) in the United Kingdom. Our single operator presented his patients before and after the inception of an MDT meeting in June 2002. The aim of this study was to assess the effect of this on his patients' survival, and trends in the use of adjuvant chemotherapy.Method Data were collected on all patients (n = 310) undergoing colectomy for colorectal cancer by one surgeon. Excluding patients with Dukes A stage, the pre-MDT cohort from January 1997 to May 2002 was 176 and the post-MDT cohort from June 2002 to December 2005 was 134. Three-year survival rates were calculated using Kaplan-Meier life table analysis. Prognostic factors were analysed using Cox-proportional hazard regression, and chemotherapy data analysed using the chi-squared test. Independent prognostic indicators of chemotherapy prescription were examined using binary logistic testing.Results MDT status was shown to be an independent predictor of survival on hazard regression analysis (P = 0.044). A significantly greater number of patients were prescribed adjuvant chemotherapy in the post-MDT cohort (P = 0.0002). MDT status was shown to be a significant prognostic indicator of chemotherapy prescription (P < 0.0001). Three-year survival for Dukes C patients was 58% in the pre-MDT group, and 66% in the post-MDT group (P = 0.023).Conclusion There was a significant increase in patients undergoing adjuvant postoperative chemotherapy after the inception of the MDT. This was associated with a significant survival benefit in patients with Dukes C disease. The data suggest that the MDT process has resulted in an increase in the prescription of adjuvant chemotherapy, with 3-year survival being greater after its inception.

Management of colon cancer in the elderly: a population‐based study

“…However, MDT evaluation might allow for a careful and individualized decision on surgical strategy. Furthermore, routine MDT conferences have been shown to increase the use of chemotherapy and improve survival [15]. In the present study, fewer elderly patients were adequately staged and fewer were evaluated at a MDT conference prior to elective surgery, suggesting a difference in the management of elderly patients having routine care.…”

Communication in and clinician satisfaction with multidisciplinary team meetings in neuro-oncology

“…12 Improvements in staging accuracy and survival associated with MDT meetings from other tumour streams have been observered. 14,15 Attending clinicians felt that the neuro-oncology MDT meeting and its documentation were extremely or very important, and 94% thought that the MDT meeting was effective in communication and documentation of plans. This represents clear clinician support for the neuro-oncology MDT meeting.…”

The proliferation of multidisciplinary team meetings (MDTMs): how can radiology departments continue to support them all?

“…Kesson et al [5] in a unique study conducted in the West of Scotland region found that the introduction of multidisciplinary care in breast cancer patients resulted in an 18 % lower breast cancer mortality at 5 years and 11 % lower all-cause mortality at 5 years in comparison with the control group. Smaller studies have shown similar trends towards increased survival through MDT support of more radical and optimised treatment options in breast [6,7], urological [8], gynaecological [9,10], lung [11,12] and rectal malignancies [13][14][15].…”

“…At present, the MDTM is the forum in which all cancer patients are discussed and subsequent treatment decisions made and reviewed [4]. Studies have shown improved survival outcomes associated with cancer care delivered through a MDTM [5][6][7][8][9][10][11][12][13][14][15].…”