Is it worth reorganising cancer services on the basis of multidisciplinary teams (MDTs)? A systematic review of the objectives and organisation of MDTs and their impact on patient outcomes

Highlights

• MDTs resulted in better clinical and process outcomes for cancer patients.

• Rationale behind MDTs embraces the process of cancer care as a whole.

• Consistence of the communication between team and patient arises as a key issue.

Abstract

Multidisciplinary teams (MDTs) are considered the gold standard of cancer care in many healthcare systems, but a clear definition of their format, scope of practice and operational criteria is still lacking. The aims of this review were to assess the impact of MDTs on patient outcomes in cancer care and identify their objectives, organisation and ability to engage patients in their care. We conducted a systematic review of the literature in the Medline database. Fifty-one peer-reviewed papers were selected from November 2005 to June 2012. MDTs resulted in better clinical and process outcomes for cancer patients, with evidence of improved survival among colorectal, head and neck, breast, oesophageal and lung cancer patients in the study period. Also, it was observed that MDTs have been associated with changes in clinical diagnostic and treatment decision-making with respect to urological, pancreatic, gastro-oesophageal, breast, melanoma, bladder, colorectal, prostate, head and neck and gynaecological cancer. Evidence is consistent in showing positive consequences for patients’ management in multiple dimensions, which should encourage the development of structured multidisciplinary care, minimum standards and exchange of best practices.

Introduction

Optimal decision-making in the diagnosis, treatment and support of cancer patients is increasingly associated with multidisciplinary teams (MDTs) [1], an approach validated by experts at the EU level [2], pursued as a key objective in many cancer plans [3], and addressed by the European Commission through the European Partnership for Action Against Cancer (EPAAC) [4], [5]. EPAAC addressed multidisciplinary care from a policy perspective in order to define the core elements that all tumour-based MDTs should include [4], [5], in part in response to the significant variability observed in the aims, roles and organisational implications of MDTs, as well as differences in performance and access [6], [7]. Indeed, the growing number of multidisciplinary care studies overlap with evidence on the importance of caseload concentration [8], [9], [10], [11], raising questions regarding the best approach to cancer care.

In this context, a review of the published studies on MDT clinical practice and organisation was undertaken for the purpose of assessing the evidence supporting this approach. An initial, comprehensive review of all papers published until 2005 had already been undertaken by Cancer Care Ontario (CCO) [12], a study which gave rise to the creation of a standards document on multidisciplinary cancer conferences. However, while the multidisciplinary approach was documented as influential in changing patient management plans, only limited evidence for the efficacy of multidisciplinary care demonstrated improved clinical outcomes [12]. The aims of this study were to assess the impact of MDTs on patient outcomes in cancer care and identify their objectives, organisation and ability to engage patients in the care process. The present paper sought to update this first review, including all the literature published subsequently up to June 2012.