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

Abstract

Simple SummaryAlthough the role of multidisciplinary team meetings (MDT) in thoracic oncology is well established, its real impact on decisional process is not well known yet. The aim of this paper is to quantify the MDT impact on the decisional clinical pathway, assessing the modification rate of the initial out-patient evaluation. Our results show a mean modification rate of 10.6%; the clinical settings “solitary pulmonary nodule” and “proven or suspected recurrence” disclosed higher modification rates (14.6% and 13.3%, respectively). When histology is available at out-patient evaluation, “pulmonary carcinoid” is the group with the lowest modification rate when compared to other histologies. In the light of our results, we suggest multidisciplinary discussion even in departments where MDT is not always routinely performed. Moreover, when discussing clinical perspectives with patients belonging to groups with a higher modification rate, physicians should emphasize the possible decisional variability in order to prevent patients’ disorientation or controversies.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.