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Lowes M, Kleiss M, Lueck R, Detken S, Koenig A, Nietert M, Beissbarth T, Stanek K, Langer C, Ghadimi M, Conradi LC, Homayounfar K. The utilization of multidisciplinary tumor boards (MDT) in clinical routine: results of a health care research study focusing on patients with metastasized colorectal cancer. Int J Colorectal Dis 2017; 32:1463-1469. [PMID: 28779354 PMCID: PMC5596058 DOI: 10.1007/s00384-017-2871-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/25/2017] [Indexed: 02/04/2023]
Abstract
PURPOSE Multidisciplinary tumor boards (MDT) have been advocated as standard of care in modern oncology. German guidelines for metastasized colorectal cancer (mCRC) recommend MDT discussion of colon cancer patients after completion of primary tumor therapy but stage IV colon cancer as well as rectal cancer patients prior to any therapy. In this health care research study, we evaluated application and decisional consequences of this approach in clinical routine. METHODS All major institutions providing oncological care in southern Lower Saxony and Northern Hesse (N = 11) were invited. Patients with mCRC diagnosed between 01/2011 and 12/2013 were eligible. Data were collected using a standardized patient report form and stored in a GCP-conform EDC-system (secuTrial®). RESULTS A university medical center, four teaching hospitals, one communal hospital, and three oncological focus practices participated in the study. In total, 470 patients with a median age of 70 years were enrolled. Guideline conform MDT discussion was performed in 63% of operated colon cancer patients, 38% of stage IV colon cancer patients and 47% of rectal cancer patients, respectively. Resection of metastases was performed in 41% of cases. Patients ≥70 years (n = 250) received significantly more often treatment following MDT discussion (86 versus 64%, p = 0.0002). Not the resection rate (48 versus 57%, p = 0.1574) but indication for preoperative chemotherapy (57 versus 33%, p = 0.0056) significantly differed when patients with single organ metastases experienced MDT discussion. CONCLUSIONS MDT discussion is not as established as advocated by national guidelines. Treatment decisions differ especially in older patients and those with single organ metastases.
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Affiliation(s)
- Markus Lowes
- Department of General, Visceral and Pediatric Surgery, University Medical Center Georg-August-University, Robert-Koch-Strasse 40, 37075, Göttingen, Germany
| | - Mathias Kleiss
- Department of Interdisciplinary Oncology, Red Cross Hospital Kassel, Kassel, Germany
| | - Rainer Lueck
- Department of General and Visceral Surgery, Sana-Klinikum Hameln-Pyrmont, Hameln, Germany
| | - Sven Detken
- Outpatient Clinic for Hematology and Oncology Northeim, Northeim, Germany
| | - Alexander Koenig
- Department of Gastroenterology and Gastrointestinal Oncology, University Medical Center Goettingen, Goettingen, Germany
| | - Manuel Nietert
- Department of Medical Statistics, University Medical Center Goettingen, Goettingen, Germany
| | - Tim Beissbarth
- Department of Medical Statistics, University Medical Center Goettingen, Goettingen, Germany
| | - Kathrin Stanek
- Department of General, Visceral and Pediatric Surgery, University Medical Center Georg-August-University, Robert-Koch-Strasse 40, 37075, Göttingen, Germany
| | - Claus Langer
- Department of General, Visceral, Thoracic and Minimal-Invasive Surgery, Protestant Hospital Weende, Goettingen, Germany
| | - Michael Ghadimi
- Department of General, Visceral and Pediatric Surgery, University Medical Center Georg-August-University, Robert-Koch-Strasse 40, 37075, Göttingen, Germany
| | - Lena-Christin Conradi
- Department of General, Visceral and Pediatric Surgery, University Medical Center Georg-August-University, Robert-Koch-Strasse 40, 37075, Göttingen, Germany
| | - Kia Homayounfar
- Department of General, Visceral and Pediatric Surgery, University Medical Center Georg-August-University, Robert-Koch-Strasse 40, 37075, Göttingen, Germany.
- Department of General, Visceral and Endocrine Surgery, Red Cross Hospital Kassel, Kassel, Germany.
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