448 SYSTEMATIC IMPLEMENTATION OF A REGIONAL MULTIDISCIPLINARY TEAM MEETING IMPROVES PROGNOSIS FOR ESOPHAGEAL CANCER PATIENTS.

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
J Luijten ◽  
V Haagsman ◽  
M Luyer ◽  
F Heesakkers ◽  
R Schrauwen ◽  
...  
Keyword(s):  
Decision Making ◽  
Overall Survival ◽  
Esophageal Cancer ◽  
The Netherlands ◽  
Multidisciplinary Team ◽  
Multidisciplinary Team Meeting ◽  
Curative Intent ◽  
Team Meeting ◽  
Netherlands Cancer Registry ◽  
The Impact

Abstract   Surgery for esophageal cancer (EC) has been centralized in the Netherlands. However, patients are still diagnosed in referral centers and not all patients are discussed with a resection center. The aim of this study was to examine the impact of the implementation of the regional Upper-GI video multidisciplinary team meeting (MDT) in the Eindhoven region in which all regional patients should be discussed, on the decision-making process, treatment, and survival of patients with EC. Methods All patients diagnosed between 2012 and 2018 with EC, in hospitals currently working together with the Catharina hospital, were selected from the Netherlands Cancer Registry (n = 1119). The regional MDT was implemented in 2 hospitals in May 2014 and the other hospitals gradually joined. The primary outcome of this study was the proportion of patients discussed in any MDT. Secondary outcomes were involvement of a resection center in MDT, treatment and survival. Outcomes were described prior to and after participation in the regional MDT and analyzed by chi-square tests. Kaplan–Meier curves and log-rank tests were used to compare overall survival. Results Since participation in the regional MDT more patients were discussed in any MDT (80%-89%, p < 0.0001) and involvement of a resection center during the MDT almost doubled (43%-82%, p < 0.0001). The proportion of patient who underwent treatment with a curative intent remained the same (75%). However, esophagectomy (41%-43%) and endoscopic resections (2%-6%) were performed more often and the use of definitive chemoradiation therapy decreased (31%-25%)(p = 0.049). The use of palliative systemic therapy increased (39%-52%, p < 0.001). Three-year overall survival for all EC patients increased significantly (24%-32%, p < 0.02)(Figure). A non-significant increase in 3-year survival in potentially curable patients (38%-48%, p = 0.09) and 1-year survival in palliative patients (18%-26%, p = 0.13) was observed. Conclusion After implementation of the regional MDT more EC patients were discussed during a MDT and also more often with the involvement of a resection center. This is the first study showing an association of the implementation of a regional MDT with an improved survival. Hypothetically, the implementation of the regional tumor specific video MDT could have had a positive effect on the quality and effectiveness of decision making in patients diagnosed with EC.

774 TEAM DYNAMICS AND CLINICIAN’S PERSONAL BELIEVES IN TREATMENT OPTIONS INFLUENCE MULTIDISCIPLINARY TREATMENT DECISION-MAKING DURING AN ONCOLOGIC UPPER GASTROINTESTINAL MULTIDISCIPLINARY TEAM-MEETING

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Josianne Luijten ◽  
Marjan Westerman ◽  
Pauline Vissers ◽  
Rob Verhoeven ◽  
Grard Nieuwenhuijzen
Keyword(s):  
Decision Making ◽  
Multidisciplinary Team ◽  
Clinical Decision Making ◽  
Multidisciplinary Treatment ◽  
Patient Characteristics ◽  
Team Dynamics ◽  
Multidisciplinary Team Meeting ◽  
Curative Intent ◽  
Team Meeting ◽  
Esophagogastric Cancer

Abstract   The probability of undergoing treatment with curative intent according to the hospital of diagnosis has been shown to vary considerately for esophagogastric cancer affecting survival negatively. Little is known which factors attribute to this variation. The aim of this study is to investigate the possible differences in clinical decision-making (CDM) during the multidisciplinary team meeting (MDTM). Methods A mixed method study design consisting of quantitative and qualitative data was conducted in which thematic content analysis of the current sub-study focused on the 16 MDTM observations and transcripts of 30 semi-structured interviews with clinicians was performed. Interviews were transcribed ad verbatim and coded. Seven focus groups were held to enrich, further explore and validate the gathered data. Results Clinician’s personality traits including ambition and the intention to be innovative were mentioned as facilitators, whereas hierarchy was mentioned as a barrier in CDM. Physician’s believes in a certain treatment and previous experiences with treatment outcomes and team dynamics within the MDTM influenced CDM. A continuum was identified in which at one end hospitals tended to be more guideline and evidence minded and at the other end of the continuum hospitals tended to search for boundaries maximizing chances of curation. All hospitals took patient characteristics in consideration. Conclusion Mechanisms influencing decision-making consisted of following guidelines, using evidence-based medicine, searching for boundaries, and taking patient characteristics into consideration. Nevertheless, the extend in which hospitals involved these mechanisms in their CDM differed. Variation in team dynamics was observed and awareness should be created that these factors attribute to CDM during an MDTM.

The multidisciplinary team meeting improves staging accuracy and treatment selection for gastro-esophageal cancer

2006 ◽  
Vol 19 (6) ◽  
pp. 496-503 ◽  
Author(s):  
A. R. Davies ◽  
D. A. C. Deans ◽  
I. Penman ◽  
J. N. Plevris ◽  
J. Fletcher ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Multidisciplinary Team ◽  
Treatment Selection ◽  
Multidisciplinary Team Meeting ◽  
Team Meeting ◽  
Staging Accuracy ◽  
Selection For

Treatment decision-making in breast cancer: role of the multidisciplinary team meeting in a breast unit

2015 ◽  
Vol 4 (3) ◽  
pp. 121-123
Author(s):  
Daniele Generali ◽  
Camillo Rossi ◽  
Alberto Bottini
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Multidisciplinary Team ◽  
Treatment Decision ◽  
Multidisciplinary Team Meeting ◽  
Team Meeting ◽  
Treatment Decision Making ◽  
Breast Unit

PTU-081 The impact of a nurse co-ordinated ibd multidisciplinary team meeting in enhancing safety and reducing cost

Gut ◽  
2015 ◽  
Vol 64 (Suppl 1) ◽  
pp. A96.1-A96 ◽  
Author(s):  
C Stansfield ◽  
A Robinson ◽  
S Lal
Keyword(s):  
Multidisciplinary Team ◽  
Multidisciplinary Team Meeting ◽  
Team Meeting ◽  
The Impact

scholarly journals Decision making of a specialist Aortovascular multidisciplinary team meeting

2021 ◽  
Vol 0 ◽  
pp. 0-0
Author(s):  
Martin T. Yates ◽  
Ana Lopez-Marco ◽  
Michelle Lee ◽  
Benjamin Adams ◽  
John Yap ◽  
...  
Keyword(s):  
Decision Making ◽  
Multidisciplinary Team ◽  
Multidisciplinary Team Meeting ◽  
Team Meeting

Tu1092 The Impact of a Nurse Co-Ordinated IBD Multidisciplinary Team Meeting in Enhancing Safety and Reducing Cost

2015 ◽  
Vol 148 (4) ◽  
pp. S-786
Author(s):  
Catherine J. Stansfield ◽  
Simon Lal ◽  
Robinson Andrew ◽  
Peter Paine
Keyword(s):  
Multidisciplinary Team ◽  
Multidisciplinary Team Meeting ◽  
Team Meeting ◽  
The Impact

546 INTENSIVE SURVEILLANCE AFTER CURATIVE INTENT SURGERY FOR ESOPHAGEAL CANCER: INITIAL RESULTS OF THE ENSURE STUDY

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Jessie A Elliott ◽  
Sheraz R Markar ◽  
Fredrik Klevebro ◽  
Melody Zhifang Ni ◽  
Magnus Nilsson ◽  
...  
Keyword(s):  
Overall Survival ◽  
Esophageal Cancer ◽  
Oncologic Outcome ◽  
Independent Effect ◽  
Curative Intent ◽  
Postoperative Surveillance ◽  
Imaging Surveillance ◽  
The Impact ◽  
Disease Free ◽  
Intensive Surveillance

Abstract   Emerging data demonstrate long-term survival after salvage interventions for local or oligometastatic recurrence after planned curative resection for esophageal cancer, providing rationale for postoperative surveillance. However, the impact of intensive surveillance on oncologic outcome is unknown. This multicenter collaborative study aimed to characterize oncologic surveillance protocols across esophageal cancer centers internationally and determine the independent effect of intensive surveillance on oncologic outcome. Methods The ENSURE international multicenter study included consecutive patients who underwent surgery with curative intent for cTxNxM0 esophageal cancer from June 2009 to June 2015. Intensive surveillance was defined as use of cross-sectional imaging, at least annually, during the first three postoperative years. The estimated sample size of 4425 provided 90% power to detect a 5% increase in 5-year overall survival (OS, primary outcome measure). Secondary outcome measures included disease-free (DFS) and disease-specific survival (DSS), surveillance strategies, incidence of oligometastatic recurrence, treatment strategies, and HRQOL. The study was registered on ClinicalTrials.gov (NCT03461341). Results 4597 patients were included. The participating 27 centres undertook mean(SD) 52.3(17.1) esophageal cancer resections annually between 3.5 ± 1.3 attending surgeons. 37%, 11% and 19% centers utilized postoperative surveillance CT, PET-CT and endoscopy, respectively. Among all patients, intensive surveillance was associated with improved OS (HR0.92 [0.85–0.99]) but not DSS (HR0.93 [0.85–1.01]) or DFS (HR0.97 [0.90–1.04]), and on multivariable analysis, intensive surveillance did not provide oncologic benefit (OS HR1.10 [0.99–1.22], DSS HR1.12 [1.00–1.25]), but reduced observed DFS (HR1.19 [1.08–1.31]). Evaluating surveillance modalities, neither surveillance endoscopy nor laboratory tests improved oncologic outcome, however flexible nasolaryngoscopy was associated with improved OS (HR0.84 [0.69–1.0]). Conclusion ENSURE, the first study powered to assess the impact of postoperative surveillance protocols on oncologic outcome in esophageal cancer, demonstrated no overall survival benefit following intensive imaging surveillance, with reduced observed disease-free survival time. However, routine assessment for secondary aerodigestive malignancies may be of oncologic benefit. The present data do not support the use of intensive imaging surveillance among all patients following esophageal cancer surgery. Further reports detailing subgroup analyses and HRQOL impact are anticipated.

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