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Adherence to Multidisciplinary Tumor Board Recommendations in Patients With Curable Esophageal and Gastric Cancers
Background Multidisciplinary tumor board (MDT) discussion is standard practice in the management of Upper Gastrointestinal (UGI) cancers. However, poor adherence to MDT recommendations may account for the lack of improved oncological outcomes with MDTs. We aim to quantify adherence rates and compare...
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| Published in: | Journal of gastrointestinal cancer 2023-06, Vol.54 (2), p.614-622 |
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| Language: | English |
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| container_end_page | 622 |
| container_issue | 2 |
| container_start_page | 614 |
| container_title | Journal of gastrointestinal cancer |
| container_volume | 54 |
| creator | Soon, Joel Jia Yi Zhao, Yue Shannon, Nicholas Brian Tan, Jeremy Tian Hui |
| description | Background
Multidisciplinary tumor board (MDT) discussion is standard practice in the management of Upper Gastrointestinal (UGI) cancers. However, poor adherence to MDT recommendations may account for the lack of improved oncological outcomes with MDTs. We aim to quantify adherence rates and compare outcomes between adherent and non-adherent patients.
Methods
We included all patients with potentially curable primary UGI carcinomas who were discussed at UGI MDT from 2017 to 2018. MDT recommendations were compared to actual treatment received. Oncological and survival outcomes were compared between both groups.
Results
Amongst 153 patients, 64 (41.8%) were non-adherent to MDT recommendations. Reasons for non-adherence were patient refusal (50.0%), treatment-related complications (31.3%), disease factors (17.2%) and clinician decision (1.56%). Univariate analysis showed that non-adherent patients were older (71.6 vs 65.2 years,
p
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| doi_str_mv | 10.1007/s12029-022-00847-7 |
| format | article |
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Multidisciplinary tumor board (MDT) discussion is standard practice in the management of Upper Gastrointestinal (UGI) cancers. However, poor adherence to MDT recommendations may account for the lack of improved oncological outcomes with MDTs. We aim to quantify adherence rates and compare outcomes between adherent and non-adherent patients.
Methods
We included all patients with potentially curable primary UGI carcinomas who were discussed at UGI MDT from 2017 to 2018. MDT recommendations were compared to actual treatment received. Oncological and survival outcomes were compared between both groups.
Results
Amongst 153 patients, 64 (41.8%) were non-adherent to MDT recommendations. Reasons for non-adherence were patient refusal (50.0%), treatment-related complications (31.3%), disease factors (17.2%) and clinician decision (1.56%). Univariate analysis showed that non-adherent patients were older (71.6 vs 65.2 years,
p
< 0.001), with higher clinical stage at point of diagnosis (
p
= 0.028), pathological stage after resection (
p
< 0.001) and were more likely to be recommended for multimodal therapy. No significant factors were associated with non-adherence at multivariate analysis. Non-adherent patients had worse median overall survival (19.5 months) compared to adherent patients (not reached at follow-up) with both unmatched and propensity-score matched analysis. Patients who received only part of the intended adjuvant chemotherapy course had worse median overall survival and disease-free survival compared to patients who completed or did not initiate adjuvant chemotherapy.
Conclusions
Non-adherence to MDT recommendations was associated with advanced age and tumor stage, and potentially contributes to the worse oncological outcomes in a group of patients already predisposed to poor outcomes.</description><identifier>ISSN: 1941-6628</identifier><identifier>EISSN: 1941-6636</identifier><identifier>DOI: 10.1007/s12029-022-00847-7</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Cancer Research ; Gastroenterology ; Internal Medicine ; Medicine ; Medicine & Public Health ; Oncology ; Original Research ; Radiotherapy</subject><ispartof>Journal of gastrointestinal cancer, 2023-06, Vol.54 (2), p.614-622</ispartof><rights>The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c275t-fce0a8f06c3a133a4a8daed8e4e176d547bdf56f4a636cb5fc081387e4e3deb93</cites><orcidid>0000-0001-7943-2954</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,786,790,27957,27958</link.rule.ids></links><search><creatorcontrib>Soon, Joel Jia Yi</creatorcontrib><creatorcontrib>Zhao, Yue</creatorcontrib><creatorcontrib>Shannon, Nicholas Brian</creatorcontrib><creatorcontrib>Tan, Jeremy Tian Hui</creatorcontrib><title>Adherence to Multidisciplinary Tumor Board Recommendations in Patients With Curable Esophageal and Gastric Cancers</title><title>Journal of gastrointestinal cancer</title><addtitle>J Gastrointest Canc</addtitle><description>Background
Multidisciplinary tumor board (MDT) discussion is standard practice in the management of Upper Gastrointestinal (UGI) cancers. However, poor adherence to MDT recommendations may account for the lack of improved oncological outcomes with MDTs. We aim to quantify adherence rates and compare outcomes between adherent and non-adherent patients.
Methods
We included all patients with potentially curable primary UGI carcinomas who were discussed at UGI MDT from 2017 to 2018. MDT recommendations were compared to actual treatment received. Oncological and survival outcomes were compared between both groups.
Results
Amongst 153 patients, 64 (41.8%) were non-adherent to MDT recommendations. Reasons for non-adherence were patient refusal (50.0%), treatment-related complications (31.3%), disease factors (17.2%) and clinician decision (1.56%). Univariate analysis showed that non-adherent patients were older (71.6 vs 65.2 years,
p
< 0.001), with higher clinical stage at point of diagnosis (
p
= 0.028), pathological stage after resection (
p
< 0.001) and were more likely to be recommended for multimodal therapy. No significant factors were associated with non-adherence at multivariate analysis. Non-adherent patients had worse median overall survival (19.5 months) compared to adherent patients (not reached at follow-up) with both unmatched and propensity-score matched analysis. Patients who received only part of the intended adjuvant chemotherapy course had worse median overall survival and disease-free survival compared to patients who completed or did not initiate adjuvant chemotherapy.
Conclusions
Non-adherence to MDT recommendations was associated with advanced age and tumor stage, and potentially contributes to the worse oncological outcomes in a group of patients already predisposed to poor outcomes.</description><subject>Cancer Research</subject><subject>Gastroenterology</subject><subject>Internal Medicine</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Oncology</subject><subject>Original Research</subject><subject>Radiotherapy</subject><issn>1941-6628</issn><issn>1941-6636</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><recordid>eNp9kDFPwzAQhSMEEqXwB5g8sgRsx4nTsVRQkIpAqIjRutiX1lViFzsZ-PcYihiZ7kn33p2-l2WXjF4zSuVNZJzyWU45zymthczlUTZhM8Hyqiqq4z_N69PsLMYdpZUoGZtkYW62GNBpJIMnT2M3WGOjtvvOOgifZD32PpBbD8GQV9S-79EZGKx3kVhHXpJEN0TyboctWYwBmg7JXfT7LWwQOgLOkCXEIVhNFpDehHienbTQRbz4ndPs7f5uvXjIV8_Lx8V8lWsuyyFvNVKoW1rpAlhRgIDaAJoaBTJZmVLIxrRl1QpIhLopW01rVtQy7QuDzayYZleHu_vgP0aMg-oTGXYdOPRjVLyqmRCUSZ6s_GDVwccYsFX7YPvErxhV3wWrQ8EqFax-ClYyhYpDKCaz22BQOz8Gl5D-S30BfoOArw</recordid><startdate>20230601</startdate><enddate>20230601</enddate><creator>Soon, Joel Jia Yi</creator><creator>Zhao, Yue</creator><creator>Shannon, Nicholas Brian</creator><creator>Tan, Jeremy Tian Hui</creator><general>Springer US</general><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-7943-2954</orcidid></search><sort><creationdate>20230601</creationdate><title>Adherence to Multidisciplinary Tumor Board Recommendations in Patients With Curable Esophageal and Gastric Cancers</title><author>Soon, Joel Jia Yi ; Zhao, Yue ; Shannon, Nicholas Brian ; Tan, Jeremy Tian Hui</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c275t-fce0a8f06c3a133a4a8daed8e4e176d547bdf56f4a636cb5fc081387e4e3deb93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Cancer Research</topic><topic>Gastroenterology</topic><topic>Internal Medicine</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Oncology</topic><topic>Original Research</topic><topic>Radiotherapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Soon, Joel Jia Yi</creatorcontrib><creatorcontrib>Zhao, Yue</creatorcontrib><creatorcontrib>Shannon, Nicholas Brian</creatorcontrib><creatorcontrib>Tan, Jeremy Tian Hui</creatorcontrib><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of gastrointestinal cancer</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Soon, Joel Jia Yi</au><au>Zhao, Yue</au><au>Shannon, Nicholas Brian</au><au>Tan, Jeremy Tian Hui</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Adherence to Multidisciplinary Tumor Board Recommendations in Patients With Curable Esophageal and Gastric Cancers</atitle><jtitle>Journal of gastrointestinal cancer</jtitle><stitle>J Gastrointest Canc</stitle><date>2023-06-01</date><risdate>2023</risdate><volume>54</volume><issue>2</issue><spage>614</spage><epage>622</epage><pages>614-622</pages><issn>1941-6628</issn><eissn>1941-6636</eissn><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><abstract>Background
Multidisciplinary tumor board (MDT) discussion is standard practice in the management of Upper Gastrointestinal (UGI) cancers. However, poor adherence to MDT recommendations may account for the lack of improved oncological outcomes with MDTs. We aim to quantify adherence rates and compare outcomes between adherent and non-adherent patients.
Methods
We included all patients with potentially curable primary UGI carcinomas who were discussed at UGI MDT from 2017 to 2018. MDT recommendations were compared to actual treatment received. Oncological and survival outcomes were compared between both groups.
Results
Amongst 153 patients, 64 (41.8%) were non-adherent to MDT recommendations. Reasons for non-adherence were patient refusal (50.0%), treatment-related complications (31.3%), disease factors (17.2%) and clinician decision (1.56%). Univariate analysis showed that non-adherent patients were older (71.6 vs 65.2 years,
p
< 0.001), with higher clinical stage at point of diagnosis (
p
= 0.028), pathological stage after resection (
p
< 0.001) and were more likely to be recommended for multimodal therapy. No significant factors were associated with non-adherence at multivariate analysis. Non-adherent patients had worse median overall survival (19.5 months) compared to adherent patients (not reached at follow-up) with both unmatched and propensity-score matched analysis. Patients who received only part of the intended adjuvant chemotherapy course had worse median overall survival and disease-free survival compared to patients who completed or did not initiate adjuvant chemotherapy.
Conclusions
Non-adherence to MDT recommendations was associated with advanced age and tumor stage, and potentially contributes to the worse oncological outcomes in a group of patients already predisposed to poor outcomes.</abstract><cop>New York</cop><pub>Springer US</pub><doi>10.1007/s12029-022-00847-7</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0001-7943-2954</orcidid></addata></record> |
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| subjects | Cancer Research Gastroenterology Internal Medicine Medicine Medicine & Public Health Oncology Original Research Radiotherapy |
| title | Adherence to Multidisciplinary Tumor Board Recommendations in Patients With Curable Esophageal and Gastric Cancers |
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