What is the role of a specialist regional mesothelioma multidisciplinary team meeting? A service evaluation of one tertiary referral centre in the UK

Our plain-English summary of What is the role of a specialist regional mesothelioma multidisciplinary team meeting? A service evaluation of one tertiary referral centre in the UK, by A.C. Bibby, K. Williams, S. Smith, et al (BMJ Open, 2016).

The study

• Authors: A.C. Bibby, K. Williams, S. Smith, N. Bhatt, N.A. Maskell
• Journal: BMJ Open
• Published: 2016;6(9):e012092
• Cited by: 14 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Multidisciplinary team meetings are standard care for cancer in the UK and Europe. Professional bodies recommend that mesothelioma cases should be discussed at specialist multidisciplinary team meetings. However, no evidence exists exploring the role of the specialist mesothelioma multidisciplinary team meeting.

Objectives: To evaluate the clinical activity of 1 specialist mesothelioma multidisciplinary team meeting and to determine how often a definitive diagnosis was made, whether the core requirements of the meeting were met and whether there was any associated benefit or detriment.

Design And Setting: A service evaluation using routinely collected data from 1 specialist mesothelioma multidisciplinary team meeting in a tertiary referral hospital in the South-West of England.

Participants: All cases discussed between 1/1/2014 and 31/12/2015.

Outcome Measures: The primary outcome measure was whether a definitive diagnosis was made. Secondary outcomes included whether treatment advice was offered, information on clinical trials provided or further investigations suggested. Additional benefits of the multidisciplinary team meeting and time taken from referral to outcome were also collected.

Results: A definitive diagnosis was reached in 171 of 210 cases discussed (81%). Mesothelioma was diagnosed in 153/210 (73%). Treatment advice was provided for 127 of 171 diagnostic cases (74%) and further investigations suggested for all 35 non-diagnostic cases. 86/210 cases (41%) were invited to participate in a trial, of whom 43/86 (50%) subsequently enrolled. Additional benefits included the avoidance of postmortem examination if the coroner was satisfied with the multidisciplinary team decision. The overall process from referral to outcome dispatch was <2 weeks in 75% of cases.

Conclusions: This specialist mesothelioma multidisciplinary team meeting was effective at making diagnoses and providing recommendations for further investigations or treatment. The core requirements of a specialist mesothelioma multidisciplinary team meeting were met. The process was timely, with most outcomes returned within 2 weeks of referral.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

In plain English

This service evaluation looked at one specialist mesothelioma multidisciplinary team (MDT) meeting at a referral hospital in the South-West of England. The authors reviewed routine records of all 210 case discussions (194 patients) held in 2014 and 2015. A definitive diagnosis was reached in 171 of 210 cases (81%); in 22 of these 171 the original diagnosis was overturned. Mesothelioma was diagnosed in 153 of the 171, including 5 peritoneal mesotheliomas. Further tests were advised in all 35 non-diagnostic cases. Treatment advice was given in 127 of the 171 diagnostic cases. Of 210 cases, 86 were invited into a clinical trial and 43 enrolled. Among 149 cases with a recorded dispatch date, the median time from referral to sending the outcome was 8 days. A coroner's arrangement removed the need for postmortems in 47 patients, and compensation advice was given in 4 cases. Asbestos exposure and survival were not studied. The authors concluded such meetings can add value without significant delays, noting it was a single-centre study.

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: Service evaluation using routinely collected records from one specialist mesothelioma MDT meeting, analysed with descriptive statistics
• Who was studied: All 210 case discussions, representing 194 patients, held at one specialist mesothelioma MDT meeting in a tertiary referral hospital in the South-West of England between 1/1/2014 and 31/12/2015. 184/210 cases (87.6%) were male. Mean age was 74 years (range 50 to 93).
• Exposure: Not applicable. The study did not examine asbestos or any other exposure. It evaluated what happened when cases were discussed at a specialist mesothelioma MDT meeting.
• Main results:
  • A definitive diagnosis was reached in 171 of 210 cases (81%).
  • Among the 171 diagnostic cases, the diagnosis made by the local MDT was confirmed in 127 (74%).
  • Among the 171 diagnostic cases, the original diagnosis was overturned and a different diagnosis made in 22 (13%).
  • Mesothelioma was diagnosed in 153 of the 171 diagnostic cases (89%).
  • Among the 171 diagnostic cases, the table lists 90 (53%) epithelioid and 28 (16%) sarcomatoid mesotheliomas. It also lists 5 (3%) peritoneal mesotheliomas.
  • Further investigations were advised in all 35 non-diagnostic cases. Most often this was a repeat pleural biopsy (19/35; 54%).
  • Both radiology and pathology were reviewed in 185/210 cases (88%).
  • Treatment advice was provided in 127 of 171 diagnostic cases (74%).
  • Of 210 cases, 86 (41%) were invited to take part in a clinical trial. Of those 86, 43 (50%) enrolled.
  • 179 of 210 cases (85%) were discussed within 14 days of referral.
  • The dispatch date was available for 149 of 210 cases (71%). For those cases, the median time from receipt of referral to dispatch of the outcome was 8 days (IQR 7 to 14).
  • In 15 of 210 cases (7%), the meeting offered additional benefit. This included compensation advice in 4 of 210 cases (2%).
  • Under an agreement with the coroner covering part of the region, diagnoses ratified at the meeting meant postmortem examination was not automatically required. Over the 2-year study period this removed the need for postmortems in 47 patients.
• The authors' conclusion: The authors concluded that evaluation of this single-centre meeting suggests specialist mesothelioma MDT meetings can add value to patient care without introducing significant time delays.
• Limitations the authors state:
  • It was a single-centre study, so the results may not be generalisable.
  • Dispatch dates were missing for many cases, mostly those discussed before November 2014. The authors state that the newer electronic system probably sped up dispatch, so bias may have been introduced into the timing results.
  • Cases were identified retrospectively.
  • Mesothelioma cases not referred to the regional meeting were not included.
  • The study did not assess survival or patient satisfaction.
  • The study did not evaluate the role of allied health professionals in the meeting.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Mesothelioma, Multidisciplinary Team, Clinical Trial.

Related studies

• Radical Hemiscrotectomy and En Bloc Orchidectomy: Surgical Technique and Perioperative and Oncologic Outcomes of a Supra-Regional UK Referral Centre — C.D. Fankhauser, A. Issa, et al. (2021)
• The usefulness of expert opinion in medicolegal referrals of malignant mesothelioma — D.L. Dixon, K.M. Griggs, et al. (2013)
• The Impact of Multidisciplinary Team Meetings on Patient Management in Oncologic Thoracic Surgery: A Single-Center Experience — F. Petrella, D. Radice, et al. (2021)
• Feasibility and safety of outpatient medical thoracoscopy at a large tertiary medical center: a collaborative medical-surgical initiative — Z.S. DePew, D. Wigle, et al. (2014)
• 18F-FDG PET/CT in the management of patients with malignant pleural mesothelioma being considered for multimodality therapy: experience of a tertiary referral center — H.S. Elliott, U. Metser, et al. (2018)
• An Evaluation Into the Robustness of Grading of Pleural Mesothelioma Outside of Specialist Centres — S. Prabhakaran, A.J. Hocking, et al. (2025)

Browse more research in BMJ Open, or return to medical research.