Care coordination |
Prades et al., 2015 [31] |
22 |
Format, data management and professional roles of TBs impacted positively on care coordination for professionals and patients. |
Diagnosis (Patient assessment, diagnosis, staging) |
Lamb et al., 2011 [30] |
3 |
Improvement in diagnostic accuracy was reported. |
Prades et al., 2015 [31] |
8 |
Multidisciplinary setting improved diagnosis and staging accuracy. |
Pillay et al., 2016 [32] |
15 |
Diagnostic reports changed after the meeting in 4–35% of patients discussed. |
6 |
The impact of the TB on assessment and diagnosis was significant (higher accuracy in staging). |
Basta et al., 2017 [34] |
1 |
No changes in diagnosis or stage were reported after validation by pathology or after follow-up. |
4 |
TBs changed the diagnoses formulated by referring physicians in 18.4–26.9% of cases. |
2 |
TBs formulated an accurate diagnosis in 89 and 93.5% of evaluated cases. |
2 |
Discussion during the TB influenced staging. After introduction of the TB, more patients underwent computed tomography (CT) before operation and patients discussed more often received a complete staging evaluation. |
Treatment (Practice patterns, clinical practice, patient management, Implementation of treatment changes) |
Coory et al., 2008 [33] |
1 |
A not statistically significant larger percentage of patients discussed in TB (43%) received radical treatment than the control group (33%). |
|
1 |
A statistically significant increase in the percentage of patients older than 70 years receiving radical radiotherapy (from 3% in 1995 to 12% in 2000; p = 0.004) was reported. The percentage receiving palliative radiotherapy decreased (from 65 to 55%). |
|
1 |
A statistically significant increase in the percentage of patients receiving chemotherapy (from 7% in 1997 to 23% in 2001; p < 0.001) was reported. The percentage of patients receiving palliative care decreased (from 58 to 44%; p = 0.0045) and the percentage of patients being formally staged increased (from 70 to 81%; p = 0.035). |
|
3 |
Surgical resection rate was higher in MD groups. |
Lamb et al., 2011 [30] |
6 |
Changes in care management decisions were reported in 2–52% of cases. |
|
1 |
TBs improved adherence to clinical guidelines. |
|
1 |
Likelihood of patients being offered chemotherapy increased (from 7 to 23%) |
|
6 |
Care management decisions by TBs were not implemented in 1–16% of cases due to contradictory patient choice or because of comorbidities. |
Prades et al., 2015 [31] |
21 |
TBs ensured more appropriate treatment through preoperative review of imaging and pathology results; multidisciplinary approach guaranteed the most up-to-date treatment, and set up a structured follow-up care plan. |
Pillay et al., 2016 [32] |
25 |
Changes in patient management/clinical practice were measured. Three studies reported minimal change in clinical management (less than 9% of cases), four studies indicated that the percentage of patients who underwent changes in treatment plans ranged from 19 to 34.5%. Other studies reported that changes in patient management plan following a TB occurred in 4.5–52% of cases. |
13 |
Patients who were discussed were more likely to receive neoadjuvant or adjuvant treatment. Greater adherence to National Comprehensive Cancer Network (NCCN) guidelines was found in two studies. |
Basta et al., 2017 [34] |
9 |
Treatment plan formulated by the referring physician was altered in 23.0–41.7% of evaluated cases. |
5 |
TB decisions on treatment plan were implemented in 90–100% of evaluated cases. The reasons for not following TB advice were comorbidity (45%) and patient preferences (35%), followed by new clinical information (10%), different opinion of the treating physician (5%), and unknown (5%). |
|
3 |
TBs increased adherence to guidelines. Treatment plan more often adhered to national guidelines: 98% versus 83%. |
Quality of life |
Coory et al., 2008 [33] |
1 |
No statistically significant difference between groups was found |
Prades et al., 2015 [31] |
6 |
Improvement of patients’ quality of life |
Recurrence and metastasis after resection |
Pillay et al., 2016 [32] |
2 |
TB discussion had little positive impact on local recurrence rates of rectal cancer and incidence of metastases and remaining pelvic tumour after resection. |
Satisfaction (patient or clinician) |
Coory et al., 2008 [33] |
1 |
TBs resulted in better satisfaction for organisation of investigations and personal experience of care. |
Prades et al., 2015 [31] |
5 |
TBs improved patient and clinician satisfaction as a consequence of team work communication and cooperation. |
Survival |
Coory et al., 2008 [33] |
2 |
Two studies reported statistically significant survival improvement. 1 study reported an improvement of 3.2 months in median survival of patients with inoperable NSCLC, the other an increase from 18.3 to 23.5% in 1-year survival of lung cancer patients older than 70. |
3 |
Three studies did not show a statistically significant improvement. |
Lamb et al., 2011 [30] |
1 |
Patients being offered chemotherapy showed a significant increase in survival (from 3.2 to 6.6 months). |
Prades et al., 2015 [31] |
10 |
Improvements in survival were reported for colorectal, head and neck, breast, oesophageal, and lung cancer. |
Pillay et al., 2016 [32] |
4 |
TB discussion was not associated with overall survival. However, in one of these studies, rectal cancer patients discussed had improved post-operative mortality. |
2 |
Significant association was shown between TB discussion and survival of patients. |
Visits to general practitioners |
Coory et al., 2008 [33] |
1 |
Significantly fewer visits were reported for the MD group than the control group. |
Waiting times |
Coory et al., 2008 [33] |
3 |
In one study the median time from presentation to first treatment was 3 weeks in the MD arm (7 weeks in the control arm) but there was no difference in the time from diagnosis to radical treatment. Another study reported a reduction in mean time from presentation to surgery of 15 days. In the last study, a reduction of days from diagnosis to treatment from 29.3 to 18.8 was reported. |
Prades et al., 2015 [31] |
10 |
TBs resulted in reduction of time from diagnosis to treatment, and achievement of early and appropriate referral patterns. |
Pillay et al., 2016 [32] |
2 |
In two studies patients discussed in TBs had fewer mean days from diagnosis to treatment. |
1 |
One study found an opposite trend. |
Other |
Prades et al., 2015 [31] |
7 |
TBs promoted the establishment of a teaching environment for healthcare professionals and junior doctors. |
9 |
A commitment to research and clinical trials was maintained. |
1 |
The enrolment in the tumour registry increased. |