Aim:
It has been recommended that all newly diagnosed cancer patients have their case discussed at a multidisciplinary team meeting (MDT) with the aim of improving consistency of care and outcomes. The aim of this review was to analyse the patterns of MDT presentation and treatment of all newly diagnosed breast cancer patients in the Barwon South Western Region (BSWR) of Victoria.
Methods:
The Evaluation of Cancer Outcomes Registry records clinical information on cancer patients for the BSWR. From 2010 to 2012 there were 829 newly diagnosed breast cancer patients for the region with 401(48%) discussed at an MDT.
Results:
Stage was recorded in the medical history for 69% of patients presented to an MDT and only 56% of patients not presented (p<0.01). Cases were predominately presented through the Barwon Health weekly one hour MDT – typically with a full agenda. Patients presented to an MDT had a higher proportion of stage II and III disease (Stage I (29%), II (24%), III (13%) and IV (3%)) compared to those not presented [Stage I (28%), II (17%), III (9%) and IV (2%), (p<0.01). Patients with MDT discussion more commonly received all three modalities of surgery, radiotherapy and chemotherapy (MDT 25% versus no MDT 18%, p<0.01). Presentation at an MDT did not appear to affect survival (HR 0.96 95%CI 0.59-1.57, p=0.88) after adjusting for age, tumour stage, treatment and number of comorbidities (as extracted from admission data).
Conclusion:
During the study period roughly 50% of patients were discussed at an MDT. Patients with higher risk disease requiring more complex treatment appeared more likely to be discussed suggesting that with constrained resources clinicians may select patients for MDT discussion based on clinical and other factors. Survival does not appear to be affected by MDT presentation in breast cancer.