Evaluating the Effectiveness of Multidisciplinary Tumour Board on Clinical Outcomes in Genitourinary Malignancies
CUA Online Library. Johnson B. 06/22/13; 31387; UP-08
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Abstract
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Multidisciplinary tumour boards (MTB) have widely been adopted as a venue to discuss difficult clinical dilemmas. We sought to prospectively evaluate the effectiveness of a Genitourinary (GU) MTB on the disease management of GU malignancies.
At our tertiary care university-affiliated hospital all patients with a GU cancer diagnosis are discussed at a MTB consisting of doctors and nurses from urology, radiation and medical oncology, and pathology. Doctors were contacted prior to MTB to determine the treatment plan for their patients and their opinion on the likelihood for a change in management. We assessed for changes in management after MTB, cost to the patient and the possibility for enrollment into clinical trials.
Information was collected on 247 patients over a 9-month period. Approximately 24 patients were presented at each MTB. Mean patient age was 66.8 (range 20-92) years old with 206 (83.4%) patients being male. Physicians predicted treatment would be unlikely to change in 87% of patients. No change in management was seen in 92.7% of patients. In 18 cases where there was a change, the physician thought their original plan was unlikely to be altered 78% of the time. Enrollment in a clinical trial was considered in 10.1% of patients and regard for the cost to the patient was discussed in 3 patients (1.2%). Of those where a change occurred, there was a trend toward patients with higher grade and stage disease. Patient age, type of cancer, or surgeon experience was all not predictive of a change in plan.
Routine discussion of all GU oncology cases at MTB does not appear to alter management in the majority of cases. Although physicians are not reliable in predicting those patients where management may be altered, it may be more efficient to discuss those patients with a higher grade or stage of disease or when true uncertainty exists.
At our tertiary care university-affiliated hospital all patients with a GU cancer diagnosis are discussed at a MTB consisting of doctors and nurses from urology, radiation and medical oncology, and pathology. Doctors were contacted prior to MTB to determine the treatment plan for their patients and their opinion on the likelihood for a change in management. We assessed for changes in management after MTB, cost to the patient and the possibility for enrollment into clinical trials.
Information was collected on 247 patients over a 9-month period. Approximately 24 patients were presented at each MTB. Mean patient age was 66.8 (range 20-92) years old with 206 (83.4%) patients being male. Physicians predicted treatment would be unlikely to change in 87% of patients. No change in management was seen in 92.7% of patients. In 18 cases where there was a change, the physician thought their original plan was unlikely to be altered 78% of the time. Enrollment in a clinical trial was considered in 10.1% of patients and regard for the cost to the patient was discussed in 3 patients (1.2%). Of those where a change occurred, there was a trend toward patients with higher grade and stage disease. Patient age, type of cancer, or surgeon experience was all not predictive of a change in plan.
Routine discussion of all GU oncology cases at MTB does not appear to alter management in the majority of cases. Although physicians are not reliable in predicting those patients where management may be altered, it may be more efficient to discuss those patients with a higher grade or stage of disease or when true uncertainty exists.
Multidisciplinary tumour boards (MTB) have widely been adopted as a venue to discuss difficult clinical dilemmas. We sought to prospectively evaluate the effectiveness of a Genitourinary (GU) MTB on the disease management of GU malignancies.
At our tertiary care university-affiliated hospital all patients with a GU cancer diagnosis are discussed at a MTB consisting of doctors and nurses from urology, radiation and medical oncology, and pathology. Doctors were contacted prior to MTB to determine the treatment plan for their patients and their opinion on the likelihood for a change in management. We assessed for changes in management after MTB, cost to the patient and the possibility for enrollment into clinical trials.
Information was collected on 247 patients over a 9-month period. Approximately 24 patients were presented at each MTB. Mean patient age was 66.8 (range 20-92) years old with 206 (83.4%) patients being male. Physicians predicted treatment would be unlikely to change in 87% of patients. No change in management was seen in 92.7% of patients. In 18 cases where there was a change, the physician thought their original plan was unlikely to be altered 78% of the time. Enrollment in a clinical trial was considered in 10.1% of patients and regard for the cost to the patient was discussed in 3 patients (1.2%). Of those where a change occurred, there was a trend toward patients with higher grade and stage disease. Patient age, type of cancer, or surgeon experience was all not predictive of a change in plan.
Routine discussion of all GU oncology cases at MTB does not appear to alter management in the majority of cases. Although physicians are not reliable in predicting those patients where management may be altered, it may be more efficient to discuss those patients with a higher grade or stage of disease or when true uncertainty exists.
At our tertiary care university-affiliated hospital all patients with a GU cancer diagnosis are discussed at a MTB consisting of doctors and nurses from urology, radiation and medical oncology, and pathology. Doctors were contacted prior to MTB to determine the treatment plan for their patients and their opinion on the likelihood for a change in management. We assessed for changes in management after MTB, cost to the patient and the possibility for enrollment into clinical trials.
Information was collected on 247 patients over a 9-month period. Approximately 24 patients were presented at each MTB. Mean patient age was 66.8 (range 20-92) years old with 206 (83.4%) patients being male. Physicians predicted treatment would be unlikely to change in 87% of patients. No change in management was seen in 92.7% of patients. In 18 cases where there was a change, the physician thought their original plan was unlikely to be altered 78% of the time. Enrollment in a clinical trial was considered in 10.1% of patients and regard for the cost to the patient was discussed in 3 patients (1.2%). Of those where a change occurred, there was a trend toward patients with higher grade and stage disease. Patient age, type of cancer, or surgeon experience was all not predictive of a change in plan.
Routine discussion of all GU oncology cases at MTB does not appear to alter management in the majority of cases. Although physicians are not reliable in predicting those patients where management may be altered, it may be more efficient to discuss those patients with a higher grade or stage of disease or when true uncertainty exists.
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