The role of multidisciplinary teams in decision making

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The role of multi-disciplinary teams in decision making for patients with recurrent malignant disease

The role of multi-disciplinary teams in decision making for patients with recurrent malignant disease S Strong 1, 2, NS Blencowe 1, 2, T Fox 1, C Reid 3 , T Crosby 4, H. Ford 5, J M Blazeby 1, 2 1 School 2 Division of Social and Community Medicine, Canynge Hall, University of Bristol, Bristol UK. of Surgery, Head & Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, UK. 3 Division of Specialised Services, University Hospitals Bristol NHS Foundation Trust, Bristol, UK. 4 Velindre 5 Addenbrooke’s NHS Trust, Unit 2 Charnwood Court, Nantgarw, Cardiff Department of Oncology & Cambridge Cancer Trials Centre, Cambridge

MDT meetings • Picture of mdt team

MDT meetings • Picture of mdt team

UGI cancer survival 1. Allum et al. Journal of Clinical Oncology. 2009

UGI cancer survival 1. Allum et al. Journal of Clinical Oncology. 2009

Aims 1. investigate role MDT in decision-making for patients with disease recurrence 2. Consider

Aims 1. investigate role MDT in decision-making for patients with disease recurrence 2. Consider how issues addressed nationally

Methods • Sequential MDT records screened • Patients with possible recurrence identified • Notes

Methods • Sequential MDT records screened • Patients with possible recurrence identified • Notes reviewed and info recorded about: symptoms reason for referral & source treatment decision & implementation

Results • 54 MDT meetings, Patients discussed n=304 Suspected recurrence n=34 • 1181 discussions

Results • 54 MDT meetings, Patients discussed n=304 Suspected recurrence n=34 • 1181 discussions about 304 pts • Recurrence confirmed in 29 pts Confirmed recurrence n=29 Local n=19 Mets n=9

Results, n=29 • Mostly surgical referrals (n=25) • Symptoms pain (n=8), dysphagia (n=7), weight

Results, n=29 • Mostly surgical referrals (n=25) • Symptoms pain (n=8), dysphagia (n=7), weight loss (n=7)

Results, n=29 • MDT treatment decisions, best supportive care (n=10), chemo (n=9), stent (n=5),

Results, n=29 • MDT treatment decisions, best supportive care (n=10), chemo (n=9), stent (n=5), radio (n=3), surgery (n=2) • 19 (65. 5%) reviewed by oncologist after MDT

Results, n=29 • 25 (86. 2%) recommendations implemented • Reasons for non-implementation were; declining

Results, n=29 • 25 (86. 2%) recommendations implemented • Reasons for non-implementation were; declining health (n=2) patient preference (n=2)

Summary • 29 patients (9%) of new MDT patients recurrence discussed • Majority 19

Summary • 29 patients (9%) of new MDT patients recurrence discussed • Majority 19 (66%) were offered further treatments and all received CNS support • Pts with recurrence benefit from MDT

Implications • Should discussion of pts with recurrence at MDT be mandatory? • Uncertain

Implications • Should discussion of pts with recurrence at MDT be mandatory? • Uncertain which type of MDT is optimal