Benefits and Limitations of a Multidisciplinary Approach in Cancer Patient Management

Figures & data

Figure 1 Multidisciplinary tumor board.

Figure 2 PRISMA.

Table 1 Pros and Cons of the Multidisciplinary Approach

Pros

Cons

Adherence to clinical guidelines^Citation10,Citation21,Citation23,Citation25–-^Citation29,Citation31 Mechanism for review of quality of professional care^Citation24 Management of rare tumors and/or with clinical guidelines lacking^Citation30,Citation48–-^Citation50,Citation57––^Citation61 Improvement of ability to reach decisions, quality of information presentation and quality of teamwork^Citation32,Citation47 Improvement in patient outcomes^Citation29,Citation35–-^Citation39 Change in diagnostic or treatment plans^Citation23,Citation28,Citation29,Citation40–-^Citation46 Improvement in follow-up accuracy^Citation51,Citation52 Improvement in clinical trial screening and patient recruitment^Citation45,Citation53

Not a significant impact on outcomes^Citation21,Citation28 High time expenditure and economic cost^Citation28 Low quality of information and lack of fundamental reports presented to MTBs^Citation32,Citation62,Citation63 Excessive not strictly clinical information might lead to contrasting opinions^Citation62 Legal issues related to responsibilities in confidentiality and anonymity of every patient presented to MTBs^Citation24 Accessibility to national networks and MTBs, owing to geographic origin and socioeconomic conditions^Citation44,Citation60,Citation64,Citation65 Risk of treatment delays^Citation30

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

 PubMed Web of Science ®Google Scholar

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.19.94422876151

 PubMed Web of Science ®Google Scholar

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.2010.00002921358950

 PubMedGoogle Scholar

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.2013.01.00323566964

 PubMed Web of Science ®Google Scholar

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.2018.165830101009

 PubMed Web of Science ®Google Scholar

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/mdx78129324970

 PubMed Web of Science ®Google Scholar

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.37.2.883102006

 PubMed Web of Science ®Google Scholar

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.2017.07.02328774861

 PubMed Web of Science ®Google Scholar

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.2019.06.00331229365

 PubMed Web of Science ®Google Scholar

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.2017.06.1429201453

 PubMedGoogle Scholar

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/s10434-009-0615-119609619

 PubMed Web of Science ®Google Scholar

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.2019.06.00531248634

 PubMed Web of Science ®Google Scholar

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.2013.04.03523891067

 PubMed Web of Science ®Google Scholar

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.18.0058731260384

 PubMed Web of Science ®Google Scholar

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.2017.02.040.28283421

 PubMed Web of Science ®Google Scholar

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.e271822539013

 PubMed Web of Science ®Google Scholar

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.2016.11.00227916436

 PubMed Web of Science ®Google Scholar

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.2226616998942

 PubMed Web of Science ®Google Scholar

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

 PubMed Web of Science ®Google Scholar

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.07-139017873180

 PubMed Web of Science ®Google Scholar

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-z31827794

 PubMed Web of Science ®Google Scholar

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/s10434-008-9929-7.18461404

 PubMed Web of Science ®Google Scholar

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.2009.12.00520042225

 PubMed Web of Science ®Google Scholar

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/s12885-017-3768-529149872

 PubMedGoogle Scholar

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.1219224674013

 PubMed Web of Science ®Google Scholar

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-z28779354

 PubMed Web of Science ®Google Scholar

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.2017.12.01229395437

 PubMed Web of Science ®Google Scholar

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

 Google Scholar

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

 PubMed Web of Science ®Google Scholar