Table 1.
Characteristics of the included studies
| Author, year | Inclusion period | Countries | Study designs | Aims | Tumor | Participants | Results |
|---|---|---|---|---|---|---|---|
| Basta et al., 201631 | 2012–2013 and 2013 | Netherlands | Prospective cohort study | To evaluate the decision-making process of a GI cancer MDT, together with factors influencing this process | HCC, colorectal cancer, esophageal and gastric cancer, biliary and pancreatic cancer | 551 | 21.8% Change in referral dx, of which both stage and dx were changed for 3.2%, stage alone was changed for 4.9%, and dx alone was changed for 12.2%. 6% were diagnosed with benign disease. Different management was advised in 5.8% |
| Bumm et al., 200718 | 1999–2006 | Germany | Before–after study | To describe the design and operation of a daily intradisciplinary tumor board in a university hospital setting | Gastroesophageal cancer | 2450, of which 1545 MDT decisions were evaluated | In 15 and 21% of cases, the MDT rejects modifies the concept decision, respectively. 96% of MDT decisions were implemented |
| Burton et al., 200619 | 1999–2002 | UK | Retrospective cohort study | To assess the impact of an MDT on implementing an MRI-based preoperative treatment strategy | Rectal cancer | 298 | For patients discussed by the MDT, the CRM+ rate was 8 versus 26% CRM+ rate for patients NOT discussed by the MDT (p < 0.001) |
| Davies et al., 200613 | 1999–2002 | UK | Prospective cohort study | To investigate the influence of an MDT on clinical staging accuracies and treatment selection | Gastroesophageal cancer | 118 | The MDT formulates a correct dx in 88–89% of all cases presented, compared with pathological dx |
| Dickinson et al., 200720 | 1995–2005 2005–2006 |
UK | Before–after study | To determine if the introduction of MDT meetings has affected the natural history of this disease | Pancreatic body cancer | Pre-MDT: 23 Post-MDT: 8 |
More patients received chemotherapy (according to guidelines) post-MDT, 43.5 versus 25.0% pre-MDT (p = 0.433). No influence on survival (p = 0.376) |
| Fernando et al., 201530 | 2013–2014 | New Zealand | Prospective cohort study | To determine which patients benefit most from MDTs | CRC | MDT group: 459 Nondiscussed group: 182 |
An initial management plan was determined in 94 patients, which was changed in 22 (23%) patients after discussion by the MDT. The MDT changed the clinical staging in 20 (4%) cases. Patients with colon cancers are less often discussed in an MDT compared with patients with rectal cancer |
| Freeman et al., 201125 | 2001–2004 2005–2007 |
US | Before–after study | To compare patients with esophageal cancer treated before and after the establishment of a multidisciplinary care conference | Esophageal cancer | Pre-MDT: 117 Post-MDT: 138 |
97% of patients received a complete staging versus 67% pre-MDT (p < 0.0001). In the post-MDT group, 9% endoscopic resection versus 3% pre-MDT (p = 0.036) |
| Meguid et al., 201632 | 2015 | US | Prospective cohort study | To determine if implementation of disease-specific multidisciplinary programs with associated conferences and clinics result in a change of dx and/or change in management for patients | Pancreas and biliary cancer; esophagus and gastric cancer; liver and NET cancer; colorectal cancer | 1747 | 26.9% Change in dx, 20.5% radiographic or endoscopic, resulting in stage change, 4.9% radiographic evaluations that resulted in change in clinical dx, 1.9% change in path review, 6.4% incidental findings, and 28.1% change in treatment recommendation |
| Oxenberg et al., 201521 | 2012–2013 | US | Prospective cohort study | To assess change in treatment plan from pre- and post-MDT discussion | GI malignancy | Upper GI: 115 Lower GI: 34 |
36% of initial management plans were changed by the MDT, of which the original stated plan was preceded by additional treatment for 15, and the change was ‘major’ for 38 |
| Pawlik et al., 200822 | 2006–2007 | US | Before–after study | To evaluate the impact of an MDT on the advice of patients compared with prior advice | Pancreatic cancer | 203 | dx for 38 patients was altered by MDT: 3 patients turned out to be irresectable, 26 were metastasized, 4 patients had benign diseases, and 5 turned out to be resectable |
| Schmidt et al., 201529 | 2010–2012 | US | Prospective cohort study | To prospectively analyze the evolution in staging and treatment plans and subsequent level of adherence | Esophageal cancer | 185 | Primary care provider treatment plans were changed for 48 (26%) patients. Diagnostic procedures (staging) were altered for 30 patients (16%). 98% of MDT decisions were followed |
| Snelgrove et al., 201528 | 2012–2013 | Canada | Prospective cohort study | To assess the quality of the MDT, the effect of the MDT on the original treatment plan, compliance with the MDT treatment plan, and the clinical outcomes | Rectal cancer | 42 | A change in treatment plan occurred in 29% (n = 12) of patients, of which five had their treatment changed because of reinterpretation of the MRI, and six because of tumor factors. One patient had his treatment changed because of comorbidities. All MDT decisions were implemented |
| van Hagen et al., 201323 | NR, duration 8 months | Netherlands | Prospective cohort study | To determine the effect of an MDT on clinical decision making | Upper GI | 171 | 34.5% (n = 87) of initial treatment plans changed after discussion by the MDT; 8 changed from curative to palliative, and 2 changed from palliative to curative. For 31, a different treatment modality was preferred, and, for 29, a more extensive workup was needed. For two cases, a different treatment within the same treatment modality was advised |
| Wood et al., 200826 | 2005–2006 | UK | Prospective cohort study | To analyze if MDT decisions are implemented and what factors influence this | Colorectal cancer | 201 Treatment decisions for 157 patients | Of the 20 decisions (10%) that changed after the meeting, the most common reason was comorbidity (n = 16). Seven decisions changed due to patient wishes and two changed in light of new clinical information. One was changed by the treating physician |
| Ye et al., 201227 | 1999–2006 | China | Retrospective cohort study | To assess the effect of MDTs on the management of patients | Colorectal cancer | Pre-MDT: 297 Post-MDT: 298 |
Pre-MDT, 41.1% of patients underwent CT staging versus 81.3% post-MDT (p < 0.001). In the pre-MDT group, 26.7% had liver metastasis 6 months after dx versus 9.3% post-MDT (p < 0.05). MDTs increased 5-year survival from 62.4 to 79.1% (p = 0.015) |
| Zhang et al., 201324 | 2009–2012 | US | Retrospective cohort study | To examine how a single-day MDLC affected recommendations compared with prior recommendations | Liver cancer | 343 | For 26 patients, diagnoses were altered, 8 from malignant/indeterminate to benign, 5 from benign to malignant. Management plans were initially formulated for 168 patients, of which 70 were changed; from irresectable to resectable for 5 patients and vice versa for 4 patients |
MDT multidisciplinary team, NR not reported, MDLC multidisciplinary liver clinic, GI gastrointestinal, MRI magnetic resonance imaging, HCC hepatocellular carcinoma, CRC colorectal carcinoma, NET neuroendocrine tumor, dx diagnosis, CRM circumferential resection margin, CT computed tomography, Major change changes between liver-directed therapies, chemotherapy, radiation therapy, type of surgery, ablative therapies, observation and endoscopic procedures21