S Shah, S Arora, T Athanasiou, G Atkin, R Glynne-Jones, P Mathur, A Darzi, N Sevdalis
Imperial College London, Barnet Hospital, Mount Vernon Cancer Centre
INTRODUCTION: Over the last few decades, decision-making in colorectal cancer management has evolved from individual surgeons and oncologists, to Multi-Disciplinary treatment planning. There is almost universal approval for this strategy, despite the fact that to date, there is little evidence for its effectiveness in improving outcomes. The aims of this review and meta-analysis were to identify the available literature on Colorectal Cancer Multidisciplinary teams. Specific questions concerned identifying studies that investigated tumor board processes and implementation of decisions, as well as the impact of tumor boards on decisions and clinical outcomes.
METHODS AND PROCEDURES: Systematic literature searches of Embase, Medline, PsycINFO and Cochrane Library were undertaken. Search terms included “colorectal”, “cancer”, “multidisciplinary” and relevant MESH derivatives. Reference lists and the grey literature were also searched. Only empirical articles were included by two independent reviewers, with any discordant decisions arbitrated by a third reviewer. After title screening, abstract and full text review (according to PRISMA guidelines), 26 articles were finally included in the review. Data abstracted from the included papers included population size, patient characteristics, healthcare professional characteristics, setting of the tumor board, study design, and study findings. The studies were divided into three groups – studies that presented data on tumor board running and implementation, the impact of tumor boards on pre-treatment decisions, and the impact of tumor boards on patient outcomes. Meta-analysis of three separate sub-groups was undertaken – use of MRI/TRUS for staging in rectal cancer, positive margins and 3 year overall survival rates. Random effects meta-analysis was used to aggregate the data, and the odds ratio (OR) was the summary statistic used.
RESULTS: A total of 3116 articles were retrieved. Application of the inclusion criteria excluded 3092 articles. 6 further articles were identified from hand-searching, and of these 2 fitted the inclusion criteria. A final list of 26 included articles from 8 countries was completed, published in peer reviewed journals between 2003 and 2012 inclusive. Reported data suggested that not all hospitals had weekly tumor boards, and attendance of core members was often low. However clinicians found working within tumor boards useful, and it positively affected pre-treatment decisions such as use of appropriate imaging and adherence to guidelines. Furthermore there was some improvement in clinical outcomes dependent upon the tumor board meeting. Meta-analysis demonstrated a significant association between the introduction of tumor boards and improved use of MRI / TRUS for local staging in rectal cancer (four studies, 965 patients, OR 7.62, 95% CI 2.07 to 28.02), the decrease of positive resection margins (three studies, 823 patients, OR 0.33, 95% CI 0.17 to 0.67) and improved overall survival at 3 years (three studies, 1375 patients, OR 1.81, 95% CI 1.13 to 2.91).
CONCLUSION(S): Colorectal cancer tumor boards are becoming increasingly popular with evidence to suggest they have improved colorectal cancer care and survival. Early involvement of the multi-disciplinary team and discussion of patients at tumor board meetings maybe an optimal strategy for delivering cancer care fit for the 21st Century.
Session: Podium Presentation
Program Number: S044