Acher Peter L, Young Anthony J, Etherington-Foy Russell, McCahy Philip J, Deane Anthony M
William Harvey Hospital, Department of Urology, Ashford, Kent, TN24 0L2, UK.
Int J Surg. 2005;3(2):121-3. doi: 10.1016/j.ijsu.2005.06.006. Epub 2005 Aug 8.
In order to improve the outcomes of urological cancers, guidelines published by the National Institute of Clinical Excellence encourage the management of cancer patients by specific Multi-Disciplinary Teams (MDTs) with discussion of cancer patients at MDT Meetings. The aim of this prospective study was to examine the changes in management resulting from review at MDT Meetings in our unit.
Over a six month period 124 cancer cases were discussed at 10 meetings. Prior to the meetings consultants completed a form stating their proposed management and whether they thought this would be changed after discussion. At the meeting histological, radiological and clinical data were reviewed and a collective decision about the optimal treatment was made. Any changes were recorded.
Two of 124 cases had their clinical management changed as a result of the meeting. These were identified (amongst 10 others) as potential 'change cases' prior to the meeting. Four changes were made to histological reports and 1 to radiology; none of these affected clinical management.
Discussion of cancer cases at MDMs made no difference to the clinical management in over 98% of cases. Consultants correctly identified cases requiring discussion, indicating that a selective rather than blanket approach would be appropriate. This has the potential to reduce the considerable costs involved without affecting patient care.
为改善泌尿生殖系统癌症的治疗效果，英国国家临床优化研究所发布的指南鼓励由特定的多学科团队（MDT）对癌症患者进行管理，并在MDT会议上对癌症患者进行讨论。本前瞻性研究的目的是探讨在我们单位的MDT会议上进行病例讨论后管理方式的变化。
在六个月的时间里，在10次会议上讨论了124例癌症病例。在会议之前，会诊医生填写一份表格，说明他们提议的管理方式以及他们认为讨论后是否会有所改变。在会议上，对组织学、放射学和临床数据进行了审查，并就最佳治疗方案做出了集体决定。记录了所有的变化。
124例病例中有2例因会议而改变了临床管理方式。在会议之前，这2例（在其他10例中）被确定为潜在的“可能改变病例”。对组织学报告做了4处修改，对放射学报告做了1处修改；这些修改均未影响临床管理。
在超过98%的病例中，MDM会议对癌症病例的讨论对临床管理没有影响。会诊医生正确地识别出需要讨论的病例，这表明采用选择性而非全面性的方法是合适的。这有可能在不影响患者护理的情况下降低相当高的成本。
