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The integration of multidisciplinary team meetings (MDTMs) for neurosurgical care has been accepted worldwide. Our objective was to review the literature for the limiting factors to MDTMs that may introduce bias to patient care. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis was used to perform a literature review of MDTMs for neuro-oncology, pituitary oncology, cerebrovascular surgery, and spine surgery and spine oncology. Limiting factors to productive MDTMs and factors that introduce bias were identified, as well as determining whether MDTMs led to improved patient outcomes. We identified 1264 manuscripts from a PubMed and Ovid Medline search, of which 27 of 500 neuro-oncology, 4 of 279 pituitary, and 11 of 260 spine surgery articles met our inclusion criteria. Of 224 cerebrovascular manuscripts, none met the criteria. Factors for productive MDTMs included quaternary/tertiary referral centers, nonhierarchical environment, regularly scheduled meetings, concise inclusion of nonmedical factors at the same level of importance as patient clinical information, inclusion of nonclinical participants, and use of clinical guidelines and institutional protocols to provide recommendations. Our review did not identify literature that described the use of artificial intelligence to reduce bias and guide clinical care. The continued implementation of MDTMs in neurosurgery should be recommended but cautioned by limiting bias. [ABSTRACT FROM AUTHOR]

Multidisciplinary team meetings (MTMs) are considered a pillar of cancer care; however, evidence of the independent benefit of MTMs on survival in rectal cancer is controversial. This population-based cohort analysis included patients undergoing surgery for primary rectal cancer with curative intent. We drew data derived from three clinical audits conducted in Catalonia from 2011 to 2020. The primary outcome was 2-year survival. Multivariable Cox regression analysis was used to assess the hazard ratio for death in patients whose cases were versus were not discussed in a preoperative MTM. A total of 5249 patients were included (66.1 % male, 58.3 % aged 60–79 years, 63.2 % receiving anterior resection): 4096 cases were discussed in a preoperative MTM, and 1153 were not. Multivariable Cox proportional hazards regression analysis showed that the MTM group had better survival than those with no preoperative MTM (hazard ratio 1.22, 95 % confidence interval 1.02–1.48), after adjusting for potential confounders. Preoperative MTM may be associated with improved survival in patients with rectal cancer in Catalonia. Efforts to ensure universal access to MTMs for all newly diagnosed patients should be supported. • Between the audit periods 4096 (78 %) patients' cases were discussed at preoperative MTM • The coverage rate of patients' cases discussed increased from 67.6 % to 87.1 % • More advanced disease increased the likelihood of case discussion at preoperative MTM. • Very advanced age (≥80 years) was not a risk factor for no preoperative MTM. • Preoperative MTM is associated with improved survival in patients with rectal cancer. [ABSTRACT FROM AUTHOR]

Les réunions de concertation pluridisciplinaire (RCP) ont pour objectif de proposer la meilleure prise en charge aux patients en fonction de l'état de la science. Si la RCP d'oncologie a su démontrer son importance, ce n'est pas le cas de la RCP de médecine interne. Nous avons conduit une étude descriptive rétrospective au sein du CHU de Grenoble Alpes, incluant les données issues de 247 comptes rendus de RCP établis sur la période de janvier 2013 à février 2019. Nous avons examiné les éléments relatifs aux patients, à la tenue des séances et aux avis rendus par la RCP. Les discussions pouvaient concerner une prise en charge diagnostique et/ou thérapeutique. Trois spécialités médicales, parmi lesquelles la médecine interne, étaient représentées au cours des réunions. Sur le plan des avis diagnostiques, 18 % des dossiers nécessitaient l'avis d'un médecin spécialiste, 12 % des dossiers étaient considérés « complexes ». Sur le plan thérapeutique, des recommandations étaient disponibles dans 35 % des cas ; 50 % des propositions thérapeutiques concernaient des thérapeutiques onéreuses, hors-AMM dans 75 % de ces situations. Les comptes rendus mentionnaient le référentiel utilisé pour la prise de décision dans 6 % des cas. L'avis formulé par la RCP était appliqué dans 72 % des cas. La RCP de médecine interne répond à un réel besoin de la part des médecins, dans l'intérêt final du patient. Une analyse prospective serait intéressante pour une meilleure définition des critères d'évaluation de ces RCP. Multidisciplinary team (MDT) meetings purpose is to optimize the disease management regarding state of science. While cancer MDT has proven its effectiveness, this is not yet the case with internal medicine MDT. We performed a descriptive monocentric retrospective study. Data were collected from 247 MDT meeting reports which took place at the Grenoble University Hospital over a 5 years period. We investigated the data related to patient, MDT features, and decision-making process and reporting. Discussions were classified as diagnostic and/or therapeutic. Three specialties, among which at least internal medicine, attended to meetings. While 12% of cases were considered as "complex", a specialist opinion was required in 18% of diagnostic discussions. With regards to therapeutic discussions, 35% were supported by guidelines, 50% of therapeutic implementation involved innovating and expensive drugs, with off-label prescription in 75% of them. The decision-making process was described in 6% of the reports. Treatment recommendations were actually implemented in 72% of the patients. MDT meetings in Internal medicine meets a real need of physicians, in the ultimate interest of the patient. A prospective analysis would be interesting for a better definition of the evaluation criteria of these MDT meetings, meeting the physicians' needs, in patient management best interest. Prospective analyses are needed to better define MDT meetings assessment criteria. [ABSTRACT FROM AUTHOR]

Accurate pathological subtyping of tumours is important in the diagnosis and management of patients presenting with primary lung carcinoma (cancer). For those patients who are considered suitable candidates for surgical resection, pathological evaluation and staging of the cancers within these specimens is also integral to this process, often providing additional information central to those management decisions. In this article, we aim to review the principles of the widely used clinical and pathological TNM staging process and guide an enhanced understanding of the significance of the pTNM and stage groupings provided with each surgical resection report for primary lung cancer. It will also highlight some of the major changes in moving from the 7th to the 8th TNM edition, reinforcing the importance of appreciating, when reading a report, which edition is or was being utilized at any given particular time in the evaluation of a patient's cancer. [ABSTRACT FROM AUTHOR]

We evaluate breast cancer (BC) pathway at a regional level including public, private and university institutions. We assessed the quality of multidisciplinary team meetings (MTM) and compliance with a panel of European high-quality indicators (EUSOMA QIs). We conducted a retrospective multicenter (n = 20) study in the largest health care region in France. Between January and April 2015, we included all patients discussed at an MTM after a diagnosis of BC (n = 619). We analyzed quality of MTM by assessing the quorum, the reliability of data transcription and the exhaustivity of pre-therapeutic MTM. We then analyzed the compliance with a selected panel of 16 EUSOMA QIs. During MTM discussion, data were more than 95% consistent with medical records for 9/11 items. Pre-operative tumor histology (90.6%) and post-operative resection margins (84.3%) were the least concordant between medical records and MTM. Minimum standards as defined by EUSOMA were reached for 11/16 QIs, but not reached for pathology reports in non-invasive BC (78.2%), proportion of exclusive sentinel lymph node biopsies in patients with clinically negative axilla (85.2%), performing adjuvant chemotherapy (76.6%), and proportion of patients discussed in pre-therapeutic and post-operative MTM (63.5%). In this multicentric study evaluating the quality of BC care with a representative sample of institutions, compliance with EUSOMA indicators was satisfactory for all type of institutions. However, too few patients were discussed in pre-therapeutic MTM (especially in non-university hospitals 43.7% [39.4–48.1]) versus 88.7% for others [82.2–95.1]) and data transcription was likely responsible for up to 15% of discordance. • Real-life breast cancer care access includes private, public and universitary institutions. • Compliance with EUSOMA Quality indicators was satisfactory in real-life conditions. • Improvements need to be made regarding discussion in pre-therapeutic MTMs. • Reliability of the data transcription for pathology reports exceeded 95%. • Up to 15% of pathology data regarding post-operative resection margins were missing. [ABSTRACT FROM AUTHOR]

Background: Comorbidity is very common among patients with cancer. Multidisciplinary team meetings (MDTs) are increasingly the context within which cancer treatment decisions are made internationally. Little is known about how comorbidity is considered, or impacts decisions, in MDTs. Methods: A systematic literature review was conducted to evaluate previous evidence on consideration, and impact, of comorbidity in cancer MDT treatment decision making. Twenty-one original studies were included. Results: Lack of information on comorbidity in MDTs impedes the ability of MDT members to make treatment recommendations, and for those recommendations to be implemented among patients with comorbidity. Where treatment is different from that recommended due to comorbidity, it is more conservative, despite evidence that such treatment may be tolerated and effective. MDT members are likely to be unaware of the extent to which issues such as comorbidity are ignored. Conclusions: MDTs should systematically consider treatment of patients with comorbidity. Further research is needed to assist clinicians to undertake MDT decision making that appropriately addresses comorbidity. If this were to occur, it would likely contribute to improved outcomes for cancer patients with comorbidities. [ABSTRACT FROM AUTHOR]

Background and Purpose: Working collaboratively as a multidisciplinary team in the treatment and care of cancer patients is proven effective in increasing the quality of patient care. A multidisciplinary team (MDT) meeting (MDTM) is the main vehicle that facilitates this collaborative work between different healthcare specialities, and an appropriate meeting record is essential to communicate the meeting's outcomes. There is limited research to date regarding MDTM documentation, and here we report on a sample of healthcare professional's perspectives on current practices.Methodology: A survey, distributed to a purposive snowball sample, is used to collect the perceptions on record-keeping at MDTMs from involved healthcare workers. The survey is descriptive and exploratory in nature and uses closed and open-ended questions offered in both English and Swedish.Results: With a response of 37 healthcare workers, several commonly understood practices of MDTMs are confirmed, documentation is mostly electronic, encompasses suggested information, and the record is mostly acceptable in quality. The issues of responsibility, registering attendance, and verification of documentation can be improved.Conclusion: Electronic documentation is a laudable step that shows advancement in MDTM record-keeping. The highlighted quality of the records suggests that MDTM proceedings are reasonably well documented. There remain some important questions, with regard to standardization, centralization, and the responsibility for record-keeping at MDTMs. [ABSTRACT FROM AUTHOR]

Abstract: Australian breast cancer specialists'' involvement in multidisciplinary team (MDT) treatment planning meetings was ascertained in a cross sectional survey. The format of MDT meetings was also investigated. Medical specialists were regular attendees (≥78%) compared to allied health staff and psychologists (≤28%). Clinicians based in a major city (AOR 1.90; 95%CI: 1.01–3.58) and who treated ≥50 new cases a year (AOR 7.34; 95%CI: 3.38–15.96) were more likely to attend. Over 69% reported that the proportion of time devoted to case discussions was ≥75%. Topics always discussed were pathology, extent of disease, surgery performed and a treatment plan (≥83%). The majority of respondents stated that MDT meetings were effective and improved referrals. Suggested improvements included that all key personnel attend, meetings are structured and that the views of all be heard. Work is needed to ensure MDT''s function and co-operate as intended in treatment planning meetings. [Copyright &y& Elsevier]