Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK.
Br J Cancer. 2013 Oct 29;109(9):2295-300. doi: 10.1038/bjc.2013.586. Epub 2013 Oct 1.
The benefits of multidisciplinary working in oncology are now accepted as the norm and widely accepted as being pivotal to the delivery of optimal cancer care. Central to this are the multidisciplinary meetings (MDMs) and we have evaluated decision outcomes and financial costs of these.
We reviewed the electronic patient records of 551 newly referred patients, discussed at 14 tumour site-specific MDMs for adult solid tumours and lymphoma (paediatric oncology and acute leukaemia were excluded) over a 1-month period, a total of 52 MDMs were studied. In addition, the records of a further 81 patients from 10 different MDMs were reviewed where the treating consultant had clearly recorded their opinion of how the patient should be managed and this was compared with the final MDM's consensus view. We also costed the MDMs utilising two different methodologies.
The mean age of the 551 patients in the study was 62 years. In all, 536 (97.3%) patients were treatment naive before MDM discussion and 15 (2.7%) had prior treatment. Median time to treatment after the MDM was 16 days. In 535 (97.1%) cases, the MDM discussions were clearly documented, 16 (2.9%) were not clearly documented. In total, 319 (57.9%) patients were discussed once, and 232 (42.1%) were re-discussed (one to six occasions). In 62 (12.7%) patients, there were delays in MDM discussion, 30 (48.4%) were related to radiology, 26 (41.9%) to histopathology and 6 (9.7%) a combination of both. Adherence to the MDM management plan decision occurred 503 times (91.3%) with 48 (8.7%) deviations. In the smaller cohort of 81 patients, the consultant management plan and MDM consensus was compatible 71 (87.6%) times. On four occasions, there were major alterations in management while six were minor. The cost per month of our MDMs ranged from £2192 to £10 050 (median £5136) with total cost of £80 850 per month and the cost per new patient discussed was £415.
Adherence to MDM decisions by health-care professionals occurs in the majority of patients. MDMs are costly, which may have relevance in the currently challenged health-care financial environment. There is a need to improve MDM efficiency without losing the considerable benefits associated with regular MDMs.
多学科协作在肿瘤学中的益处现已被普遍认可，并且被认为是提供最佳癌症护理的关键。这其中的核心是多学科会议（MDM），我们已经评估了这些会议的决策结果和财务成本。
我们回顾了 551 名新转诊患者的电子病历，这些患者在一个月内参加了 14 个针对成人实体瘤和淋巴瘤的肿瘤部位特定的 MDM 会议（排除了儿科肿瘤学和急性白血病），共研究了 52 个 MDM 会议。此外，我们还回顾了另外 10 个 MDM 会议中 81 名患者的记录，其中治疗顾问明确记录了他们对患者管理方式的意见，这与最终 MDM 的共识观点进行了比较。我们还利用两种不同的方法对 MDM 进行了成本核算。
研究中 551 名患者的平均年龄为 62 岁。所有患者在 MDM 讨论前均为治疗初治，其中 536 例（97.3%）患者为初治，15 例（2.7%）患者有既往治疗。MDM 讨论后开始治疗的中位数时间为 16 天。在 535 例（97.1%）患者中，MDM 讨论记录清楚，16 例（2.9%）记录不清楚。共有 319 例（57.9%）患者讨论了一次，232 例（42.1%）患者进行了再次讨论（一次至六次）。有 62 例（12.7%）患者的 MDM 讨论存在延迟，其中 30 例（48.4%）与放射学有关，26 例（41.9%）与组织病理学有关，6 例（9.7%）与两者都有关。有 503 次（91.3%）遵循了 MDM 管理计划决策，其中 48 次（8.7%）存在偏差。在 81 名较小的患者队列中，顾问管理计划和 MDM 共识有 71 次（87.6%）相匹配。有 4 次出现了重大管理改变，6 次出现了较小的改变。我们的 MDM 每月成本范围从 2192 英镑到 10050 英镑（中位数为 5136 英镑），每月总成本为 80850 英镑，每位讨论的新患者成本为 415 英镑。
大多数患者的医疗保健专业人员都能遵循 MDM 决策。MDM 成本高昂，这在当前医疗保健财务环境中可能具有重要意义。需要提高 MDM 的效率，同时不影响定期 MDM 带来的可观效益。
