Cancer Multidisciplinary Meetings Research Articles

Implementation of streamlining measures in selecting and prioritising complex cases for the cancer multidisciplinary team meeting: a mini review of the recent developments.

In January 2020, NHS England and NHS Improvement, in the United Kingdom, issued a permissive framework for streamlining cancer multidisciplinary (MDT) meetings. Streamlining is defined as a process whereby complex cases are prioritized for full discussion by an MDT in an MDT meeting (MDM), while the management of straightforward cases is expedited using Standards of Care (SoC). SoC are points in the pathway of patient management where there are recognized guidelines and clear clinical consensus on the options for management and should be regionally agreed and uniformly applied by regional Cancer Alliances. While this report marks the first major change in cancer MDT management since the Calman-Hine report in 1995, its implementation, nationally, has been slow with now nearly four years since its publication. It is argued however that streamlining is a necessary step in ensuring the viability of MDT processes, and therefore maintaining patient care in the current socioeconomic context of rising workload and cancer incidence, financial pressures, and workforce shortages. In this mini review, we offer a succinct summary of the recent developments around the implementation of the 2020 streamlining framework, including challenges and barriers to its implementation, and the potential future directions in this field, which we propose should increase utilisation of implementation science. We conclude that ensuring successful implementation of the framework and the SOC requires securing a buy-in from key stakeholders, including MDTs and hospital management teams, with clearly defined (a) management approaches that include triage (e.g. through a mini MDT meeting), (b) assessment of case complexity (something that directly feeds into the SOC), and (c) roles of the MDT lead and the members, while acknowledging that the SOC cannot be universally applied without the consideration of individual variations across teams and hospital Trusts.

The impact of multidisciplinary cancer meetings in guiding treatment intent in patients with upper tract urothelial carcinoma.

Patient presentation at multidisciplinary cancer meetings (MDMs) is a key quality indicator in cancer care and may have particular utility in rare malignancies, such as upper tract urothelial carcinoma (UTUC). This study aims to investigate what proportion of patients diagnosed with UTUC had treatment intent changed at MDM, the nature of these changes, and what patient factors may correlate with a suggested change. This study analyzed patients diagnosed with UTUC between 2015 and 2020 at an Australian tertiary referral center. MDM discussion rate and suggested treatment intent changes were analyzed. Patient factors that may prompt change, including age, estimated glomerular filtration rate (eGFR), Charlson Comorbidity Index (CCI), and Eastern Cooperation Oncology Group performance status (ECOG PS), were assessed. Seventy-five patients were diagnosed with UTUC of whom 71 (94.6%) were discussed at an MDM upon diagnosis. Change to palliative intent was suggested in 8/71 (11%) patients. Patients for whom change to palliative treatment was suggested had a higher age (median 85 vs. 78 years, p<.01), CCI (median 7 vs. 4, p<.005), ECOG PS (median 2 vs. 0, p<.002), and lower eGFR (mean 31 vs. 66mL/min/1.73m2, p< .0001), compared to those who underwent radical treatment. No patient had an MDM recommendation to change from palliative to curative treatment. MDM discussion resulted in clinically important changes of treatment intent in a substantial proportion of patients with UTUC, potentially sparing futile treatments. Several patient factors were associated with suggested changes, highlighting the requirement for accurate, in-depth patient information at MDM discussion.

Impact of multidisciplinary team meetings on the management of patients with breast cancer in a large private healthcare facility.

Multidisciplinary meetings (MDMs) play a crucial role in decision-making in breast cancer patient care. This study aimed to firstly assess the impact of breast cancer MDMs in decision-making for breast cancer patients and secondly to determine the concordance between MDM recommendations and implementation of clinical practice. Patient cases to be presented at the weekly breast cancer MDMs were identified and prospectively enrolled. Management plans were predicted by the treating surgeon with the pre-MDM management plans then compared to MDM recommendations. Changes in decision-making were assessed in the following domains: further surgery, systemic therapy (endocrine, chemotherapy or targeted), radiotherapy, enrolment in a clinical trial, further investigations, and referral to other specialists or services. Patient records were subsequently reviewed at 3 months post-MDM to assess the rate of implementation of MDM recommendations and any reasons for discordance. Out of 50 cases, 66% (CI 53-79%; p<.005) experienced a change in management plan as a result of MDM discussion, with a total of 66 episodes of recorded change per decision-making domain affecting the following: further surgery (7.6%), endocrine therapy (4.5%), chemotherapy (19.7%), targeted therapy (4.5%), radiotherapy (18.2%), enrolment for a clinical trial (12.1%), additional investigations (22.7%), and further referrals (10.6%). MDM recommendations were implemented in 83.7% of cases. The breast cancer MDMs were found to substantially impact on the management plans for breast cancer patients, with 83.7% of MDM recommendations being implemented into clinical practice. This study reinforces the importance of MDMs in the management of these patients, as well as highlighting the need for further investigating and addressing the potential barriers to the implementation of MDM recommendations.

Breaking the general practice-hospital divide: Engaging primary care practitioners in multidisciplinary cancer care.

To integrate primary care into multidisciplinary cancer meetings and improve communication between hospital- and community-based care providers. A 12-week pilot study was conducted at Western Health, implementing a model of care, where two general practitioners (GPs) were recruited from the local community to attend weekly breast and lung multidisciplinary meetings in a liaison role as a primary care representative (PCR). Community GPs and hospital specialists were surveyed at the end of the study to assess the impact of this model of care. All stakeholders agreed that two-way communication between hospital- and community-based care was improved. The role of the PCR enabled better engagement of GPs in cancer care, allowing them to manage their patients with more confidence. Patient information contributed by GPs provided a wider context for hospital specialist treatment planning and decision making. This project has demonstrated an effective model to integrate primary care practitioners in multidisciplinary cancer care, as it enables timely and relevant two-way communication between the community and hospital care.

Understanding Patients' Attitudes Toward Cancer Multidisciplinary Meetings: A Mixed Methods Study.

Multidisciplinary cancer meetings (MDMs) are an integral component of quality care; however, little research exists regarding patients' views on this model of care. We aimed to explore and understand the attitudes of patients toward MDMs. A mixed methods exploratory design was used. Qualitative data from patients with a current or previous diagnosis of cancer were collected and analyzed using a grounded theory approach. Results informed the development of a questionnaire survey that was administered to patients with a current or previous diagnosis of cancer. Results were analyzed using descriptive statistics. Nine patients participated in 3 focus groups, and 152 patients (response rate, 90%) completed the questionnaire. Patients were strongly supportive of MDMs and thought that all patients with cancer should be routinely discussed. More than 90% of surveyed patients believed MDMs were reassuring, meant all treatment modalities were considered, and led to evidence-based treatment recommendations. Patients wanted MDMs to focus on medical treatment planning rather than psychosocial issues, and 87% regarded the meeting as confidential. Patients described a preference for doctor-led decision making, and most (84%) wanted MDM treatment decisions to be discussed with them in a subsequent consultation, with 73% of patients also wanting this in a written format. Patients strongly endorse MDMs as a means to develop an evidence-based, medical treatment plan agreed to by consensus. They want to be purposely informed of the meeting and its outcomes. Results from this study can help inform future guidelines on the conduct of MDMs.

What do doctors value about attending multi-disciplinary cancer case discussions?

e18324 Background: Discussion of cancer cases at multi-disciplinary meetings (MDMs) for treatment planning is expected standard care in Australia. There has been rapid uptake of MDMs in the last 10 - 15 years and in the state of Victoria approximately 70% of cancer cases are discussed. MDMs have strong support from medical staff and we investigated their motivation in attending MDMs. Methods: Over 12 months, Austin Health in Melbourne, Victoria, hosted 452 cancer MDMs discussing 5943 patients. MDMs covered 15 tumour areas: 11 solid tumour, one lymphoma and three haematological. Over a 4-week period, medical staff attending MDMs were surveyed and asked to rank what they valued most about cancer MDMs, over and above the benefits for patients. Results: Responses were received from 84% of the 285 medical staff surveyed, which included consultants as well as trainees (registrars and fellows). For 75% of respondents the highest ranking was given to multi-disciplinary communication, 9% gave the highest ranking to quality assurance and governance, 5% ongoing learning for consultants, 5% collegiate relationships, 2% learning and teaching for non-consultant staff, 2% peer support 1% job satisfaction and 1% clinical trials engagement. Similar results were obtained for consultant staff and for registrars / fellows. For consultant medical staff, if multidisciplinary communication was excluded, 44% of respondents gave the highest ranking to quality assurance and governance, 23% to collegiate relationships, 20% ongoing learning for consultants, 10% peer support and 3% clinical trials engagement. Conclusions: When we asked doctors what they valued most about attending cancer MDMs, besides the benefits for patients, communication between disciplines was clearly the most valued aspect. The benefits for quality and governance was the next most valued, then collegiate relationships and peer support, and ongoing learning.

Case discussion at cancer multidisciplinary meetings: What resourcing is required?

e18026 Background: Discussion of cancer cases at multi-disciplinary meetings (MDMs) is expected standard care in Australia. To our knowledge there are no local, and few international, data on the resourcing required for MDMs. Methods: Data covering 12 months of MDM activity at Austin Health, Victoria, were obtained retrospectively. Prospective data were also collected over 4 weeks focusing on time required for preparation and post-meeting activities. Capital, maintenance and general overhead costs were not included. Results: MDMs covered 15 tumour areas: 11 solid tumour, one lymphoma and 3 haematological. Over 12 months 452 MDMs were held, discussing 5943 patients with highest case volume for hepatoma (1243), breast (1084) and hepato-biliary (HPB, 679). On average 12 cases (range 3.5 – 38.3) were discussed per meeting, with average 3.8 minutes spent per case. An average of 3 imaging studies were reviewed per case and 60% of cases in the high volume MDMs required access to external imaging. Imaging consultants spent an average of 2.9 minutes preparation per imaging study, registrars 5.2 minutes and external imaging required 7.8 minutes per study. Pathologists spent an average of 6.8 minutes preparation per case, which rose to 9.4 minutes for external cases (making up between 3% - 30% of cases per MDM). Pathology administration time was 53 minutes per meeting. The mean cost of medical staff was AUD 1617 per meeting (range $532-$2860), and 78% of the cost was for consultant medical staff. The mean cost for diagnostic staff attendance was $216, and preparation $327. MDM and pathology administrative costs were $273. The MDMs with the highest annual total costs were breast, lung and HPB ($152,904 - $207,289). The overall mean cost for a meeting varied between $847 - $4080. The cost per case discussed varied from $106 - $422, with generally lower per-case costs for the high case volume MDMs. The average per case cost was $255. Conclusions: Data on staff time and costs associated with conducting cancer MDMs were able to be obtained. The average cost per case discussed was $255 (USD 184). These data may be useful in planning to extend MDM discussion to include a higher proportion of cancer cases and in seeking additional funding.

'Pretty fit and healthy': The discussion of older people in cancer multidisciplinary meetings.

Cancer multidisciplinary meetings (MDMs) are central to treatment decision making. The language used in MDMs may influence treatment decisions, yet has received little research attention. This study aimed to examine the terminology used to describe non-cancer items in the discussion of older people within cancer MDMs. MDMs of four tumour streams were attended over twelve weeks. For each person aged 70 or older discussed, the following was hand recorded: age, gender, and phrases describing non-cancer items and patient views. A qualitative thematic analysis was employed to examine the text. Twenty cancer MDMs were attended, at which 71 people aged 70 or older were discussed. Age, comorbid medical conditions, and general descriptors emerged as the areas in which non-cancer information was presented. In contrast to the medical terminology used to describe comorbid medical conditions, non-specific general descriptors, such as 'fit', 'well', and 'good', were used to describe other aspects of older people. Adverbs, including 'very', 'pretty', and 'quite', often accompanied general descriptors. The, often subtle, intonation and context associated with these adverbs resulted in markedly different meanings. Non-objective, potentially ambiguous general descriptors were commonly used to encompass non-disease aspects of older people in cancer MDMs. These descriptors may have the potential to sway treatment recommendations. However, their frequent use suggests team members recognise that non-disease aspects of a person, aside from chronological age, are considerations in treatment recommendations. Therefore, strategies to increase discussion of non-cancer items in a more objective manner may be acceptable to MDM attendees.

Development of a peer‐review framework for cancer multidisciplinary meetings

There is no mechanism in place for monitoring or quality improvement of cancer multidisciplinary meetings (MDM) in Australia. To develop a peer-review process for quality improvement of MDM. This project involved three phases: (i) development of a draft peer-review framework, supporting documents and peer-review process; (ii) consultation with key stakeholders; (iii) refinement of the framework, documents and processes following a pilot study with three MDM. Feedback indicated that specific standards included in the framework needed to allow the peer reviewers to be flexible relative to the circumstances of the individual MDM. Conversely, feedback identified the need for clear, evidence-based clinical practice guidelines for the conduct of MDM, with accepted standards and objective measures of performance. MDM members were divided about the need to employ peer reviewers from the tumour stream of the MDM under review but agreed that closer involvement of the team under review to support the implementation of recommendations is warranted. We developed an adaptable peer-review framework and process using the current available evidence and guidance. While further research is needed to establish what constitutes best practice in MDM and which processes contribute to improved patient outcomes, the structured peer-review process we describe, when modified using the disease-relevant evidence, could be utilised more broadly as a quality improvement tool.

PUB068 The Applicability of Comorbidity Indices in Predicting Chemo toxicity in Non-Small Cell Lung Cancer

Lung cancer is one of the commonest cancer worldwide contributing to 13% of the total number of cancers.1 It is the leading cause of cancer related death in the United Kingdom with poor 10 year survival rate of 5%.2 Advanced age and the presence of comorbid conditions are associated with poor survival rate. The use of Platinum based chemotherapy in advanced non-small cell lung cancer (NSCLC) has improved survival rate and improve the quality of life. However, these effects are limited by the chemotherapy induced toxicity. Prior to commencement of chemotherapy, there is no current method which can be used to predict the development of unacceptable level of chemo-toxicity that might subsequently result in reducing or stopping the chemotherapy treatment. This study aims to correlate platinum-based chemotherapy haematological and non-haematological toxicities in patients with NSCLC against two commonly used comorbidity indices namely Charlson Comorbidity Index (CCI) and the Adult comorbidity Evaluation 27 (ACE 27). Case note review for patients with cytologically or histologically confirmed NSCLC, aged between 18 and 85 with a World Health Organisation performance status (WHO PS) of < 2, eligible for platinum based chemotherapy and have a life expectancy > 3months. Exclusion criteria include the presence of an active infection and those who received platinum- based chemotherapy previously. Patients were identified from the combined lung cancer clinics and multidisciplinary meetings and were invited to participate in the study. Baseline demographic data (age, sex, PS, cancer stage and type) was obtained. CCI and ACE 27 tools were used to score baseline comorbid conditions for each patient with and without the inclusion of the disease. After each chemotherapy cycle, haematological and non-haematological toxicity data was 61 cases were identified, 10 were excluded from final analysis due to change of diagnosis or missing consent form. The median age at diagnosis was 68 years (range 45-85year). 57% were men. Most patients had WHO PS of 1, diagnosis of adenocarcinoma and had stage VI cancer. 67% of patients developed severe toxicities (grade 3 or above). There was no correlation between higher comorbidity scores (ACE≥2 & CCI ≥ 3) and risk of severe toxicities (p >0.005). The presence of comorbid conditions was not associated with severe chemotherapy- induced toxicity.

P3.07-019 AMDAT Lung, An Ideal Lung Cancer MDT Dataset: Topic: Other – Geographical Differences

Background: The role of multidisciplinary teams (MDTs) is central to lung cancer care in Australia with support at policy level and with the development of a nation-wide lung cancer MDT directory from Lung Foundation Australia. In parallel, the importance of accessible, clinically relevant information from routine data collection in lung cancer (as well as other tumor streams) is receiving increased recognition. MDT meetings increasingly act as central hubs for the co-ordination of lung cancer care and therefore have the opportunity to focus on quality assurance as well as analyses of patterns of care and identification and targeting of evidence-practice gaps. MDT meetings can act as central sources of data collection and analysis and as such a standardized approach to lung cancer MDT data collection in Australia is warranted. This study will present the results of a modified Delphi study, surveying Australian lung cancer clinicians, aiming to finalize an ideal clinical dataset for collection through lung cancer multidisciplinary meetings. Methods: A 17-item survey has been circulated to a broad, representative sample of lung cancer clinicians, medical and allied health, in Australia. Clinicians were identified and contacted either as (1) part of a purposive sample or (2) through MDT lead clinicians identified through convenience or through the Lung Foundation Australia Lung Cancer MDT registry. Results of an initial survey will be analyzed and a second-round survey will be circulated to an expert panel drawn from the first-round participants prior to finalization of the dataset. Results: The first round of the survey is reaching completion at the time of abstract submission. A total of 98 responses have been received across the two sampling strategies in the 4 weeks since surveys were distributed. Initial data analysis showed a predominance of pulmonary physicians, attendance at MDT weekly more than fortnightly, support for inclusion of most of the variables presented in the survey and a leaning towards MDT presentation of complex/multimodality therapy and stage IIIA cases rather than all cases of lung cancer. Conclusion: The findings of the study will support the development of a standard dataset for collection at lung cancer MDT meetings. This dataset will be utilized in future planned studies across multiple sites for targeted data intervention and feedback strategies and analysis of effect on lung cancer outcomes.

EPID-04. TUMOR BOARD CONFERENCES IN NEURO-ONCOLOGY: A NATIONWIDE PROVIDER SURVEY

Tumor board or multidisciplinary cancer meetings (MCM) are the centerpiece of coordinated specialized neuro-oncology care. Little is known on how these meetings are implemented. Benefits of MCM include coordination, direction for complicated cases, education, and a forum for communication, emerging technology, and clinical trials. This study identifies participation and utilization of neuro-oncology MCM with the goal of improving practice patterns and establishing models for high value care. A cross-sectional descriptive internet survey was used. 85 neuro-oncology centers were identified by the Society for Neuro-Oncology and the American Brain Tumor Association. In addition, NCI designated cancer centers, participants in the Adult Brain Tumor Consortium, or the Brain Tumor Trials Collaborative were asked to participate. 46 centers completed the survey. All centers reviewed primary brain tumors, 93% discussed neoplastic spine disease, 89% metastatic brain lesions, 40% paraneoplastic disease. 98% discuss “challenging cases”, 96% recurrent disease, 82% undiagnosed or pre-surgical cases, 89% utilize radiology review. 100% of MCM included Neuro-Oncologists, Neurosurgery, and Radiation Oncology; Radiologist 98%, Pathologist 96%, and clinical trials 64%. Geneticist, Behavioral Health, and Social Work less than 15%. 76% reviewed Pathology. 80% meet weekly, and 36% include satellite centers. Individual preparation time varied 15-300 minutes. 94% value MCM for clinical decision-making, access to clinical trials 69%, and education 89%. Only 13% document MCM in the medical record. 38% of centers use a molecular tumor board, however many commented with uncertainty as to how this is defined. Neuro-oncology MCMs at leading U.S. institutions show high congruity of core disciplines, cases discussed, and perceived value. There is strong agreement on the role of clinical decision making and education, but the implementation of recommendations varies widely. We identified marked variability in preparation time, documentation, and high uncertainty as to the definition and application of a molecular tumor board.

The anatomy of clinical decision-making in multidisciplinary cancer meetings: A cross-sectional observational study of teams in a natural context.

In the UK, treatment recommendations for patients with cancer are routinely made by multidisciplinary teams in weekly meetings. However, their performance is variable.The aim of this study was to explore the underlying structure of multidisciplinary decision-making process, and examine how it relates to team ability to reach a decision.This is a cross-sectional observational study consisting of 1045 patient reviews across 4 multidisciplinary cancer teams from teaching and community hospitals in London, UK, from 2010 to 2014. Meetings were chaired by surgeons.We used a validated observational instrument (Metric for the Observation of Decision-making in Cancer Multidisciplinary Meetings) consisting of 13 items to assess the decision-making process of each patient discussion. Rated on a 5-point scale, the items measured quality of presented patient information, and contributions to review by individual disciplines. A dichotomous outcome (yes/no) measured team ability to reach a decision. Ratings were submitted to Exploratory Factor Analysis and regression analysis.The exploratory factor analysis produced 4 factors, labeled “Holistic and Clinical inputs” (patient views, psychosocial aspects, patient history, comorbidities, oncologists’, nurses’, and surgeons’ inputs), “Radiology” (radiology results, radiologists’ inputs), “Pathology” (pathology results, pathologists’ inputs), and “Meeting Management” (meeting chairs’ and coordinators’ inputs). A negative cross-loading was observed from surgeons’ input on the fourth factor with a follow-up analysis showing negative correlation (r = −0.19, P < 0.001). In logistic regression, all 4 factors predicted team ability to reach a decision (P < 0.001).Hawthorne effect is the main limitation of the study.The decision-making process in cancer meetings is driven by 4 underlying factors representing the complete patient profile and contributions to case review by all core disciplines. Evidence of dual-task interference was observed in relation to the meeting chairs’ input and their corresponding surgical input into case reviews.

Cancer treatment decision-making processes for older patients with complex needs: a qualitative study

ObjectivesAlthough older people can experience complex health and social care needs alongside a primary cancer diagnosis, little is understood about how cancer treatment decisions are made for this population. This...

Improving the pre-screening of eligible patients in order to increase enrollment in cancer clinical trials.

BackgroundThe performance of randomized controlled trials (RCTs) is often hindered by recruitment difficulties. This study aims to explore the pre-screening phase of four prostate cancer RCTs to identify the impact of a systematic pre-selection of eligible patients for RCT recruitment.MethodsThe pre-screening of four RCTs opened at the Comprehensive Cancer Center in Rennes was analyzed retrospectively (French Genitourinary Tumor Group (GETUG) 14, 15, 16, and 17). Data were extracted from electronic multidisciplinary cancer (MDC) reports and manually completed by physicians and medical secretaries. These data were the main source of information for clinicians to discuss treatment alternatives during MDC sessions. The pre-screening decisions made by the clinicians during these MDC meetings were compared with those made after a systematic review of the MDC reports by a clinical research assistant (CRA). Any inconsistencies in decisions between the CRA and the MDC physicians were corrected by the principal investigator (PI).ResultsThe pre-screening rate was 9.1% during the MDC meetings, while it was estimated to be 12.9% after the final review by the PI, and 29% after the systematic review by the CRA. The study showed that 77% and 67% of the MDC reports did not mention clinical and pathological Tumor, lymph node and metastasis classification of malignant tumors (TNM) staging, respectively, and that 35 of the CRA’s 47 proposals rejected by the PI concerned implicit information (not specified in the MDC reports). Only one patient was proposed by the PI, and none by the CRA.ConclusionsThese results confirm that pre-screening could be improved by a systematic review of the medical reports. They also highlight the fact that missing data in electronic MDC reports leads to over-enrollment of non-eligible patients, but not to over-exclusion of eligible patients. Thus, our study confirms the potential gain in using semi-automated pre-selection of MDC reports, in order to avoid missing out on patients eligible for RCTs.Trial registrationThe trials evaluated in this study were previously registered with clinicaltrials.gov (registration number: NCT00104741 on 3 March 2005; NCT00104715 on 3 March 2005; NCT00423475 on 16 January 2007; and NCT00667069 on 24 April 2008).

Multidisciplinary Lung Cancer Meetings: Improving the practice of radiation oncology and facing future challenges

Clinical guidelines widely recognize the importance of multidisciplinary meetings (MDM) in the optimal care of lung cancer patients. The published literature suggest that dedicated Lung Cancer MDM lead to increased treatment utilization rates and improved survival outcomes for patients with lung cancer. For radiation oncologists, Lung Cancer MDM have been proven to support evidence-based practice and improve the utilization of radiotherapy. Lung Cancer MDM also allow for education and promotion of specialty radiotherapy services. The fast pace of modern medicine is also presenting new challenges for the multidisciplinary lung cancer team, and technological advances are likely to lead to new changes in the structure of traditional Lung Cancer MDM.

Multidisciplinary breast cancer teams and proposed standards.

Multidisciplinary approach is recommended for the diagnosis and treatment of cancer, in order to optimize quality of life and survival. Multidisciplinary cancer teams that are used for this purpose enable communication between professionals. Multidisciplinary cancer meetings are pre-programmed regular meetings where cancer patients are evaluated on an individual basis, and where the multidisciplinary treatment of patients is planned based on evidence. Currently, application of appropriate treatment in a timely manner carries as great significance as early diagnosis. For this purpose, standards of multidisciplinary approach are significant. Disease specific multidisciplinary breast cancer meetings are essential in the treatment of breast cancer. The standards and organization of these teams have been scientifically determined. It is recommended that these multidisciplinary breast cancer meetings should be held regularly and the required infrastructure should be provided.

Otorhinolaryngologists’ personal treatment preferences (total laryngectomy or laryngeal preservation) when faced with advanced stage laryngeal cancer

ObjectiveTo analyse the treatment options that otorhinolaryngologists would consider if faced with advanced stage laryngeal cancer amenable to total laryngectomy or an organ preservation protocol. Material and methodsProspective study conducted in a French Teaching Hospital based on questionnaires filled in by 163 otorhinolaryngologists in 2012, studying the percentage chance of cure that they would be prepared to trade-off to preserve their larynx, defining the additional information that they would like to receive and identifying any statistical associations between these parameters and various medical and socioeconomic variables. ResultsA total of 42.3% of otorhinolaryngologists would not consider the slightest trade-off to preserve their larynx and preferred to undergo total laryngectomy. In the group of otorhinolaryngologists who would consider a larynx preservation protocol (57.6%), the percentage chance of cure that they would be willing to trade-off to preserve their larynx ranged between 5 to 100% (median: 15%) and 4.2% of them were willing to trade-off all chances of cure (100%) to avoid total laryngectomy. The percentage of otorhinolaryngologists who would not consider trading off the slightest chance of survival to preserve their larynx increased from 29.3 to 49.5% (P=0.01) when they participated in multidisciplinary consultation meetings. In the group of otorhinolaryngologists who would consider a larynx preservation protocol, the median percentage survival trade-off that they would consider in order to preserve their larynx (i) decreased from 20 to 10% (P=0.004) when they participated in multidisciplinary consultation meetings and (ii) increased regularly with their number of years of practice (P=0.03) and their age (P=0.025). Finally, 25.1% of otorhinolaryngologists wanted to receive additional information, although none of the variables analysed affected this desire for more information. ConclusionTreatment options considered by otorhinolaryngologists faced with advanced stage laryngeal cancer were almost equally divided between total laryngectomy and larynx preservation. Number of years of practice and regular participation in head and neck cancer multidisciplinary consultation meetings were variables that significantly influenced this choice.

P094 Treatment recommendations by cancer multidisciplinary meetings: Do they get implemented? A systematic review

P094 Treatment recommendations by cancer multidisciplinary meetings: Do they get implemented? A systematic review

Geriatric assessment domains and age: How are these discussed in cancer multidisciplinary meetings?

Geriatric assessment domains and age: How are these discussed in cancer multidisciplinary meetings?