Volume 196 - Issue 1
Uptake of oncology multidisciplinary meeting recommendations
Authors: George H Au-Yeung, Ahmad Aly, Andrew Bui, Carmel M Vermeltfoort and Ian D Davis
Med J Aust 2012; 196 (1): 36-37. || doi: 10.5694/mja11.10975
Published online: 16 January 2012
Published online: 16 January 2012
To the Editor: Multidisciplinary meetings (MDMs) are recognised as crucial to best practice in oncology, and governments have designated MDMs as key priorities in cancer care.1,2 Improvement in overall survival has been promoted as a potential benefit of multidisciplinary care, with little supporting evidence. However, consensus MDM decisions are worthless unless action is subsequently implemented. This retrospective audit aimed to assess whether MDM recommendations were implemented, as an indirect measure of the MDM process on patient outcomes.
MDM records for patients discussed at the Austin Health (Melbourne) Uro-Oncology, Upper GI (gastrointestinal) and Colorectal Cancer MDMs between February and April 2010 were reviewed, and consensus recommendations were compared with treatment plans documented in the medical record. Reasons for change in management were classified as (1) new clinical information unavailable to MDM; (2) patient’s choice; (3) comorbidities or patient performance status; or (4) not otherwise specified.
The Box summarises the results. Overall concordance was 76% (152/201 records). In 41 records (20%) in which an MDM discussion was documented, data were not available due to missing or incomplete MDM documentation in the medical record. Excluding records where data were unavailable, concordance was 95% (152/160 records), with discordance due to new clinical information (5), comorbidities or performance status (2) and patient choice (1).
These results highlight a few issues. Documentation of MDM discussion and consensus decision is required for the MDM recommendations to be delivered to patients and communicated to other clinicians. This documentation may have been missed due to differences in recording systems (paper versus electronic; designated person recording) or MDM structure (pre-specified agenda versus ad-hoc discussion), which need to be addressed.
The high concordance rate (where documentation was available) suggests that MDM management recommendations are being delivered and acted upon, and so effectively promote high-quality, evidence-based care. This assumes that the MDM always uses evidence-based medicine and includes all relevant members of the treating team. This aspect was not analysed as part of this audit.
However, in support of this assumption, we found that neoadjuvant chemotherapy for stage T3 or greater muscle-invasive bladder cancer was not given before institution of MDMs in 2007 (0/19 potential patients), but is now regularly discussed at the Uro-Oncology MDM and is administered where appropriate (7/20 patients between 2007 and 2010). This suggests a positive effect of this MDM on access to a therapy known to improve survival.
Our findings suggest that MDM recommendations are usually acted upon and improve patients’ access to appropriate treatment.3
Competing interests
No relevant disclosures.
Acknowledgements
We thank the North Eastern Metropolitan Integrated Cancer Service staff for providing administrative support and access to the Austin Health MDM database. Ian Davis is supported by a National Health and Medical Research Council Practitioner Fellowship.
References
- Achieving best practice cancer care. A guide for implementing multidisciplinary care. Melbourne: Victorian Government Department of Human Services, 2007. 0_i1095911
- Manual for cancer services 2004. London: United Kingdom Department of Health, 2004. 0_i1095913
- Wright FC, De Vito C, Langer B, Hunter A; Expert Panel on Multidisciplinary Cancer Conference Standards. Multidisciplinary cancer conferences: a systematic review and development of practice standards. Eur J Cancer 2007; 43: 1002-1010. doi: 10.1016/j.ejca.2007.01.025. 0_i1095915