TABLE 1.
Results of studies included in the meta-analysis
| First author, year [ref.] | Setting | Study design | Patient group | MDM exposure (in detail) | Comparator | Outcomes |
| Forrest, 2005 [24] | 1997 and 2001 Glasgow, UK |
Retrospective/prospective cohort study | MDM group n=126; non-MDM group n=117 Consecutive presentations of inoperable stage III–IV NSCLC |
Implementation of MDM (two respiratory physicians, two surgeons, a medical oncologist, a clinical oncologist, a palliative care physician, a radiologist and a specialist respiratory nurse) | Prior to implementation of MDM in 1998 | From 1997 to 2001, receipt of chemotherapy increased from 7% to 23% (p<0.001) and median survival increased from 3.2 months to 6.6 months (p<0.001) |
| Stevens, 2008 [34] | 2004–2006 Auckland, New Zealand |
Retrospective cohort study | MDM group n=81; non-MDM group n=59 Consecutive presentations of stage I–II NSCLC |
Presented to MDM (several medical specialist groups) | Not presented to MDM | MDM discussion was associated with increased likelihood of curative management (p<0.001) |
| Bydder, 2009 [23] | 2006–2008 Nedlands, Western Australia |
Retrospective cohort study | MDM group n=81; non-MDM group n=17 Consecutive presentations of inoperable stage III or IV NSCLC captured from an Australian tertiary hospital cancer registry database |
Presented to MDM (respiratory physicians, cardiothoracic surgeons, medical oncologists, a radiation oncologist, a palliative care physician, a radiologist, a pathologist, a nuclear physician, a specialist lung cancer nurse as well as doctors receiving specialist training) | Not presented to MDM | Those discussed at MDM had better survival than those not discussed Mean survival 280 days versus 205 days (log-rank p=0.048) |
| Bjegovich-Weidman, 2010 [22] | 2007–2009 Wisconsin, USA |
Retrospective cohort study | Consecutive presentations of SCLC and NSCLC (patients from Aurora Medical Center– Sheboygan, a community hospital serving a predominantly rural county population) | Implementation of MDC (a thoracic surgeon, radiation and medical oncologists and a cancer care coordinator) | Prior to implementation of MDC | MDC implementation resulted in reduced mean time from diagnosis to initiation of treatment (18 days from 24 days) All patients were treated with definitive minimally invasive surgery Tertiary hospital thoracic surgical referrals increased by 75% |
| Boxer, 2011 [7] | 2005–2008 South West Sydney, Australia |
Retrospective cohort study | MDM group n=504; non-MDM group n=484 Consecutive presentations of SCLC, NSCLC and radiologically confirmed primary lung cancer with no pathological confirmation (captured from the South West Sydney Clinical Cancer Registry) |
Presented to MDM (radiation and medical oncologists, respiratory physicians, a cardiothoracic surgeon, radiologist, nuclear medicine physician, lung cancer care coordinator and trainee specialists) | Not presented to MDM during the same period | Treatment receipt for MDM patients versus non-MDM patients was 12% versus 13% for surgery (p>0.05); 66% versus 33% for radiotherapy (p<0.001); 46% versus 29% for chemotherapy (p<0.001); and 66% versus 53% for palliative care (p<0.001) MDM discussion did not influence survival |
| Mitchell, 2013 [33] | 2003–2008 Victoria, Australia |
Retrospective cohort study | MDM group n=234; non-MDM group n=607 Consecutive presentations of SCLC, NSCLC and clinically diagnosed lung cancer (from 1 January to 30 June 2003 and identified by Victorian Cancer Registry) |
Presented to MDM | Not presented to MDM | Patients discussed at MDM were more likely to receive active treatment (81.6% versus 70.5%, p=0.004), and had improved survival (10.8 versus 5.5 months, p<0.001) |
| Keating, 2013 [26] | 2001–2005 USA |
Retrospective cohort study | Consecutive presentations of SCLC and NSCLC (captured from Department of Veterans Affairs Central Cancer Registry) | Presented to MDM (surgeons, medical oncologists, radiation oncologists, pathologists, social workers and palliative care specialists) | Patients at a facility with no MDM | Patients presented to hospitals with MDMs were less likely to receive radiotherapy for unresected stage I–II NSCLC (63.8% versus 66.5%, p=0.04), and more likely to receive chemoradiotherapy for unresected stage IIIA NSCLC (35.6% versus 23.9%, p=0.02), and more likely to receive chemoradiotherapy for limited stage SCLC (62.9% versus 28.4%, p<0.001) There were no survival differences |
| Wang, 2014 [31] | 2005–2007 Taiwan |
Retrospective cohort study | MDM group n=2736; non-MDM group n=20 081 (before PS), MDM group n=2724; non-MDM group n=5448 (after PS) Consecutive presentations of SCLC and NSCLC |
Presented to MDT (clinical physicians, nursing staff, a psychological consultant, a social worker and a case manager) | Not specified (MDT nonparticipants, conventional treatments) | MDM participation was associated with an 11% lower likelihood of visit to an ED (OR 0.89, 95% CI 0.80–0.98) |
| Freeman, 2015 [18] | 2008–2013 Charlotte, NC, USA |
Retrospective cohort study | MDM group n=6627; non-MDM group n=6627 Consecutive presentations of stage I–III NSCLC |
Presented to MDM (medical and radiation oncology and thoracic surgery) | No access to MDM | Prospective MDM presentation improved adherence to national guidelines (p<0.0001) for staging and treatment (p<0.0001), timeliness of care (p<0.0001) and reduction in costs (p<0.0001) |
| Pan, 2015 [28] | 2005–2011 Taiwan |
Retrospective cohort study | MDM group n=4632; non-MDM group n=27 937 Consecutive presentations of NSCLC (patients who received treatment within the first year after diagnosis were captured from the 2005–2010 Taiwan Cancer Registry using ICD codes) |
Presented to MDM | Not specified (MDM nonparticipants) | The adjusted HR of death of MDM participants with stage III and IV NSCLC was significantly lower than that of MDM nonparticipants (adjusted HR 0.87, 95% CI 0.84–0.90) |
| Rogers, 2017 [30] | 2009–2012 South West Victoria, Australia |
Retrospective cohort study | Lung cancer MDM group n=386; non-MDM group n=207 Consecutive presentations of SCLC and NSCLC (from Barwon Health MDM programme) |
Presentation to MDM (treating physicians including at least one surgeon, medical oncologist, radiation oncologist, pathologist, radiologist and respiratory physician, as well as allied health and supportive care staff) | Treatment plan not discussed at MDM | MDM presented patients had an adjusted reduction in mortality (HR 0.62, 95% CI 0.50–0.76, p<0.01) |
| Bilfinger, 2018 [21] | 2002–2016 New York, USA |
Retrospective cohort study | MDM group n=1956; non-MDM group n=2315 Consecutive presentations of SCLC and NSCLC (abstracted from the Stony Brook University Hospital cancer registry) |
Presented to MDM (thoracic surgery, interventional pulmonology, medical oncology, radiation oncology and two dedicated nurse practitioners as the core group) | Serial treatment care model (patient and responsibility of care passed on to different specialists/subspecialists) | 5-year survival rates in propensity-matched sample were greater among MDM patients versus traditional care (33.6% versus 23.0%; p<0.001) Adjusting for potential confounders in the multivariable propensity-matched analyses, the MDM 5-year survival benefit was sustained (HR 0.65, 0.54–0.77) |
| Tamburini, 2018 [32] | 2008–2015 Ferrara, Italy |
Retrospective cohort study | MTB group n=246; non-MTB group n=186 (before PS), MDT group n=170; non-MDT group n=170 (after PS) Consecutive presentations of patients who underwent surgery with curative intent for NSCLC |
Discussion at weekly MTB with or without the patient present (MTB meeting attendees include surgeons, pulmonary oncologists, radiation oncologists, radiologists, nuclear medicine specialists, pulmonologists, pathologists, lung cancer care coordinators and trainees) | Treated prior to the conference's implementation of the MTB (before 2012) | Patients discussed at MTB had better complete staging evaluation, early TNM stages and 1-year survival rate when compared with those who were not discussed at the MTB |
| Stone, 2018 [19] | 2006–2012 Sydney, Australia |
Retrospective cohort study | MDT group n=295; non-MDT group n=902 Consecutive presentations of SCLC and NSCLC (captured from local institutional clinical cancer registry, diagnosed or receiving at least one treatment for lung cancer at the St Vincent's Hospital, Sydney campus) |
Presentation to MDT (1-h weekly meetings chaired by a respiratory physician and attended by staff from a full range of medical subspecialities, nursing and allied health; patients may be presented at various points in the course of their care) | Not presented to MDT | Stage-specific survival was greater in the MDT group at 1, 2 and 5 years for all stages except stage IIIB at 1-year post-diagnosis Adjusted survival analysis for the entire cohort showed improved survival at 5 years for the MDT group (HR 0.7, 0.58–0.85; p<0.001) |
| Peckham, 2018 [29] | 2013–2015 California, USA |
Retrospective cohort study | MDM group n=48; non-MDM group n=35 Consecutive presentations of stage I–II NSCLC |
Presentation to MDM (weekly meetings, coordinated and presented by the oncology nurse navigator) | Prior to implementation of MDM (specialists could assume care of patient at any point, no standardised use of guidelines, varied patient care) | After implementation, diagnosis of early-stage NSCLC and the use of diagnostic workups (pulmonologist, PFTs, PET-CT scan) increased Post implementation, a 37% increase was noted in the diagnosis of early-stage NSCLC |
| Hung, 2020 [25] | 2013–2018 Taipei, Taiwan |
Retrospective cohort study | MDM group n=242; non-MDM group n=273 Consecutive presentations of stage III NSCLC (from chart and computer record of Taipei Veterans General Hospital) |
Presentation to MDM | Discussions on a case-by-case basis | The median survival of patients who were treated after MDM discussion was 41.2 months and that of patients treated without MDM discussion was 25.7 months (p=0.018) |
| Nemesure, 2020 [27] | 2006–2015 New York, USA |
Retrospective cohort study | MDM group n=1179; non-MDM group n=865 Consecutive presentations of SCLC and NSCLC |
Presentation to MDM | Serial treatment care model (patient and responsibility of care passed on to different specialists/subspecialists) | A higher proportion of patients in the MDT remained disease-free at 1 year compared to standard care (80.0% versus 62.3%, p<0.01) Adjusted survival rates were significantly lower among LCEC participants (OR 0.68, 95% CI 0.51–0.90 at 1 year; OR 0.50, 95% CI 0.36–0.70 at 3-years) Recurrence was lower at 3 years in the MDM group (OR 0.51, 95% CI 0.32–0.79) |
| Linford, 2020 [17] | 2016–2017 Ontario, Canada |
Qualitative research study | MDC group n=6; non-MDC group n=6 Consecutive presentations of SCLC and NSCLC |
Presentation to MDM | Diagnosed via LDAP and managed by a respirologist in the LDAP either 3 months before or after MDC implementation, but external to MDC model | Patients in the MDC frequently reported convenience and a positive effect of family presence at appointments Physicians reported that MDC improved communication and collegiality, clinic efficiency, patient outcomes and satisfaction and consistency of information provided to patients |
| Ray, 2021 [20] | 2011–2017 Memphis, TN, USA |
Retrospective cohort study | eMTOC group n=864; non-eMTOC metropolitan group n=3464; non-eMTOC regional group n=1931 Consecutive presentations of NSCLC |
Presentation to MDM | Conventional referral processes (no other information) | eMTOC had the highest rates of stages I–IIIB (63 versus 40 versus 50), stage-preferred treatment (66 versus 57 versus 48), guideline-concordant treatment (78 versus 70 versus 63), and lowest percentage of nontreatment (6 versus 21 versus 28) (p<0.001) Compared with eMTOC, HR for death was higher in metropolitan (1.5, 95% CI 1.4–1.7) and regional (1.7, 95% CI 1.5–1.9) non-MTOC; hazards were higher in regional non-MTOC versus metropolitan (1.1, 95% CI 1.0–1.2) (p<0.05 after adjustment) |
| Lin, 2022 [5] | 2011–2020 Victoria, Australia |
Retrospective cohort study | MDM group n=5900; non-MDM group n=3728 Consecutive presentations of SCLC and NSCLC within VLCR |
Presentation to MDM | Not specified (MDM: formal meeting process with MDT participation) | Patients were less likely to be discussed at MDM if aged ≥80 years (OR 0.73, p<0.001), ECOG 4 (OR 0.23, p<0.001), clinical stage IV (OR 0.34, p<0.001) or referred from regional (OR 0.52, p<0.001) or private hospital (OR 0.18, p<0.001) Fewer non-MDM group participants received surgery (22.1% versus 31.2%), radiotherapy (34.2% versus 44.4%) and chemotherapy (44.7% versus 49.0%) MDM-presented patients had better median survival (1.70 versus 0.75 years, p<0.001) and lower adjusted mortality risk (HR 0.75; 95% CI 0.71–0.80, p<0.001) |
MDM: multidisciplinary meeting; NSCLC: nonsmall cell lung cancer; SCLC: small cell lung cancer; MDC: multidisciplinary clinic; PS: propensity score matching; MDT: multidisciplinary team; ED: emergency department; ICD: International Classification of Diseases; HR: hazard ratio; MTB: multidisciplinary tumour board; TNM: tumour, node, metastasis; PFT: pulmonary function test; PET: positron emission tomography; CT: computed tomography; LCEC: Lung Cancer Evaluation Center; LDAP: Lung Diagnostic Assessment Program; eMTOC: enhanced multidisciplinary thoracic oncology conference; VLCR: Victorian Lung Cancer Registry; ECOG: Eastern Oncology Conference Group performance status.