TY - JOUR
T1 - Implementation of a regional video multidisciplinary team meeting is associated with an improved prognosis for patients with oesophageal cancer A mixed methods approach
AU - Luijten, Josianne C. H. B. M.
AU - Haagsman, Vera C.
AU - Luyer, Misha D. P.
AU - Vissers, Pauline A. J.
AU - Nederend, Joost
AU - Huysentruyt, Clément
AU - Creemers, Geert-Jan
AU - Curvers, Wouter
AU - van der Sangen, Maurice
AU - Heesakkers, Fanny B. M.
AU - Schrauwen, Ruud W. M.
AU - Jürgens, Matthias C.
AU - Buster, Erik H. C. J.
AU - Vincent, Jeroen
AU - Kneppelhout, Jan Kees
AU - Verhoeven, Rob H. A.
AU - Nieuwenhuijzen, Grard A. P.
N1 - Funding Information: The authors acknowledge and thank the registration team of the Netherlands Comprehensive Cancer Organization (IKNL) for the collection of data for the NCR. The authors also acknowledge the efforts of all members of the region for their support in providing the necessary culture and infrastructure for the success of this regional MDTM. Because of the sensitive nature of the data collected for this study, requests to access the dataset from qualified researchers trained in human subject confidentiality protocols may be sent to the Netherlands Comprehensive Cancer Organization. No preregistration exists for the reported studies reported in this article. Publisher Copyright: © 2021 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology
PY - 2021/12/1
Y1 - 2021/12/1
N2 - Background: Studies have shown that multidisciplinary team meetings (MDTM) improve diagnostic work-up and treatment-decisions. This study aims to evaluate the influence of implementing a regional-video-Upper-GI-MDTM (uMDTM) for oesophageal cancer (OC) on the number of patients discussed, treatment-decisions, perspectives of involved clinicians and overall survival (OS) in the Eindhoven Upper-GI Network consisting of 1 resection hospital and 5 referring hospitals. Methods: Between 2012 and 2018, patients diagnosed with OC within this region, were selected from the Netherlands Cancer Registry(n = 1119). From 2014, an uMDTM was gradually implemented and a mixed-method quantitative and qualitative design was used to analyse changes. Quantitative outcomes were described before and after implementation of the uMDTM. Clinicians were interviewed to assess their perspectives regarding the uMDTM. Results: After participation in the uMDTM more patients were discussed in an MDTM (80%–89%,p < 0.0001) and involvement of a resection centre during the uMDTM increased (43%–82%,p < 0.0001). The proportion of patients diagnosed with potentially curable OC (cT1-4a-x, any cN, cM0) remained stable (59%–61%, p = 0.452). Endoscopic or surgical resections were performed more often (28%–34%,p = 0.034) and the use of best supportive care decreased (21%–15%,p = 0.018). In the qualitative part an improved knowledge, collaboration and discussion was perceived due to implementation of the uMDTM. Three-year OS for all OC patients increased after the implementation of the uMDTM (24%–30%,p = 0.025). Conclusions: Implementation of a regional Upper-GI MDTM was associated with an increase in patients discussed with a resection centre, more curative resections and a better OS. It remains to be elucidated which factors in the clinical pathway explain this observed improved survival.
AB - Background: Studies have shown that multidisciplinary team meetings (MDTM) improve diagnostic work-up and treatment-decisions. This study aims to evaluate the influence of implementing a regional-video-Upper-GI-MDTM (uMDTM) for oesophageal cancer (OC) on the number of patients discussed, treatment-decisions, perspectives of involved clinicians and overall survival (OS) in the Eindhoven Upper-GI Network consisting of 1 resection hospital and 5 referring hospitals. Methods: Between 2012 and 2018, patients diagnosed with OC within this region, were selected from the Netherlands Cancer Registry(n = 1119). From 2014, an uMDTM was gradually implemented and a mixed-method quantitative and qualitative design was used to analyse changes. Quantitative outcomes were described before and after implementation of the uMDTM. Clinicians were interviewed to assess their perspectives regarding the uMDTM. Results: After participation in the uMDTM more patients were discussed in an MDTM (80%–89%,p < 0.0001) and involvement of a resection centre during the uMDTM increased (43%–82%,p < 0.0001). The proportion of patients diagnosed with potentially curable OC (cT1-4a-x, any cN, cM0) remained stable (59%–61%, p = 0.452). Endoscopic or surgical resections were performed more often (28%–34%,p = 0.034) and the use of best supportive care decreased (21%–15%,p = 0.018). In the qualitative part an improved knowledge, collaboration and discussion was perceived due to implementation of the uMDTM. Three-year OS for all OC patients increased after the implementation of the uMDTM (24%–30%,p = 0.025). Conclusions: Implementation of a regional Upper-GI MDTM was associated with an increase in patients discussed with a resection centre, more curative resections and a better OS. It remains to be elucidated which factors in the clinical pathway explain this observed improved survival.
KW - Esophageal cancer
KW - Multidisciplinary team meeting
KW - Survival
UR - http://www.scopus.com/inward/record.url?scp=85121282410&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.ejso.2021.04.020
DO - https://doi.org/10.1016/j.ejso.2021.04.020
M3 - Article
C2 - 33926781
SN - 0748-7983
VL - 47
SP - 3088
EP - 3096
JO - European Journal of Surgical Oncology
JF - European Journal of Surgical Oncology
IS - 12
ER -