The Impact of Multidisciplinary Team Meetings on Patient Management in Oncologic Thoracic Surgery: A Single-Center Experience

Our plain-English summary of The Impact of Multidisciplinary Team Meetings on Patient Management in Oncologic Thoracic Surgery: A Single-Center Experience, by F. Petrella, D. Radice, J. Guarize, et al (Cancers, 2021).

The study

• Authors: F. Petrella, D. Radice, J. Guarize, G. Piperno, C. Rampinelli, F. de Marinis, L. Spaggiari
• Journal: Cancers
• Published: 2021;13(2)
• Cited by: 18 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: the aim of this paper is to quantify multidisciplinary team meeting (MDT) impact on the decisional clinical pathway of thoracic cancer patients, assessing the modification rate of the initial out-patient evaluation.

Methods: the impact of MDT was classified as follows: confirmation: same conclusions as out-patient hypothesis; modification: change of out-patient hypothesis; implementation: definition of a clear clinical track/conclusion for patients that did not receive any clinical hypothesis; further exams required: the findings that emerged in the MDT meeting require further exams.

Results: one thousand consecutive patients evaluated at MDT meetings were enrolled. Clinical settings of patients were: early stage lung cancer (17.4%); locally advanced lung cancer (27.4%); stage IV lung cancer (9.8%); mesothelioma (1%); metastases to the lung from other primary tumors (4%); histologically proven or suspected recurrence from previous lung cancer (15%); solitary pulmonary nodule (19.2%); mediastinal tumors (3.4%); other settings (2.8%).

Conclusions: MDT meetings impact patient management in oncologic thoracic surgery by modifying the out-patient clinical hypothesis in 10.6% of cases; the clinical settings with the highest decisional modification rates are "solitary pulmonary nodule" and "proven or suspected recurrence" with modification rates of 14.6% and 13.3%, respectively.

In plain English

This single-center study from the European Institute of Oncology in Milan, Italy, looked at how often a weekly multidisciplinary team meeting changed the plan made at a patient's first out-patient visit. The meeting brought together surgeons, oncologists, radiotherapists, pulmonologists and radiologists. The study included 1,000 consecutive patients discussed in 2019. Across all patients, the meeting confirmed the out-patient plan in 58%, modified it in 10.6% and asked for more tests in 8%. In another 23.4%, it set a clear plan for patients who, at the out-patient visit, lacked needed exams or needed more investigation first. Ten patients had mesothelioma. Four of those 10 had their plan modified (40.0%, 95% CI 12.1 to 73.8%), and the authors stated that no clinical conclusion can be drawn for so small a group. Modification rates were 14.6% for solitary pulmonary nodules and 13.3% for proven or suspected recurrence of lung cancer. The authors concluded that the meetings modified the out-patient hypothesis in 10.6% of cases. They noted there was no comparison group of patients who were not discussed. The study did not examine asbestos exposure.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective single-center study of consecutive patients discussed at multidisciplinary team meetings
• Who was studied: 1,000 consecutive patients evaluated at the multidisciplinary team meetings of the Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy, in 2019. There were 590 men and 410 women. Clinical settings included lung cancer at various stages, solitary pulmonary nodules, recurrence, mediastinal tumors and mesothelioma (10 patients).
• Exposure: Discussion of the patient's case at a weekly multidisciplinary team meeting after an out-patient evaluation. No asbestos or fiber exposure was studied.
• Main results:
  • Among all 1,000 patients, the meeting confirmed the out-patient plan in 580 (58%) and modified it in 106 (10.6%). In 234 (23.4%) it set a clear plan, a category the authors call 'implementation': patients who lacked required exams at the out-patient visit or needed further investigation first. A further 80 (8%) were sent for more exams.
  • In the mesothelioma setting, the plan was modified for 4 of 10 patients (40.0%, 95% CI 12.1 to 73.8%).
  • For solitary pulmonary nodule patients, the modification rate was 14.6% (95% CI 9.9 to 20.4%).
  • For patients with histologically proven or suspected recurrence from previous lung cancer, the modification rate was 13.3% (95% CI 8.3 to 19.8%).
  • Among the 224 patients whose histology was available at the out-patient visit, those with pulmonary carcinoid had a 0% modification rate. This was significantly lower than for other histologies (p = 0.03).
  • In the locally advanced lung cancer setting, multivariable analysis linked modification with histology being available at the out-patient visit (OR 5.55, 95% CI 2.23 to 13.7, p less than 0.001). It was also linked with the number of days between the out-patient visit and the meeting (OR 1.04, 95% CI 1.02 to 1.07).
  • Of the 80 patients sent for further exams, the out-patient plan was afterwards confirmed in 38 (47.5%), modified in 24 (30%) and implemented in 18 (22.5%).
• The authors' conclusion: The authors concluded that multidisciplinary team meetings modified the out-patient clinical hypothesis in 10.6% of cases, similar to reports from other cancer specialties. In their view, solitary pulmonary nodule and proven or suspected recurrence had the highest modification rates.
• Limitations the authors state:
  • There was no comparison group of patients who were not discussed at the meeting, so effects on survival or other outcomes could not be assessed.
  • Because the population was heterogeneous, the authors could not compare disease outcomes between patients whose plans were changed and those whose plans were not.
  • Some settings, such as mesothelioma, had so few patients that no clinical conclusion can be drawn for them.
  • The study focused on first-diagnosed cancer, so post-treatment complications were not evaluated.

Topics

Medical terms in this study, explained in our Lexicon: Multidisciplinary Team, Thoracic Surgery, Lung Cancer, Mesothelioma.

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