Kehl Kenneth L, Landrum Mary Beth, Kahn Katherine L, Gray Stacy W, Chen Aileen B, Keating Nancy L
The University of Texas MD Anderson Cancer Center, Houston, TX; Harvard Medical School; Dana-Farber Cancer Institute; Brigham and Women's Hospital, Boston, MA; RAND Corporation, Santa Monica; and University of California Los Angeles, Los Angeles, CA.
The University of Texas MD Anderson Cancer Center, Houston, TX; Harvard Medical School; Dana-Farber Cancer Institute; Brigham and Women's Hospital, Boston, MA; RAND Corporation, Santa Monica; and University of California Los Angeles, Los Angeles, CA
J Oncol Pract. 2015 May;11(3):e267-78. doi: 10.1200/JOP.2015.003673. Epub 2015 Apr 28.
Multidisciplinary tumor board meetings are common in cancer care, but limited evidence is available about their benefits. We assessed the associations of tumor board participation and structure with care delivery and patient outcomes.
As part of the CanCORS study, we surveyed 1,601 oncologists and surgeons about participation in tumor boards and specific tumor board features. Among 4,620 patients with lung or colorectal cancer diagnosed from 2003 to 2005 and seen by 1,198 of these physicians, we assessed associations of tumor board participation with patient survival, clinical trial enrollment, guideline-recommended care, and patient-reported quality, adjusting for patient and physician characteristics.
Weekly physician tumor board participation (v participation less often or never) was not associated with patient survival, although in exploratory subgroup analyses, weekly participation was associated with lower mortality for extensive-stage small-cell lung cancer and stage IV colorectal cancer. Patients treated by the 54% of physicians participating in tumor boards weekly (v less often or never) were more likely to enroll onto clinical trials (odds ratio [OR], 1.6; 95% CI, 1.1 to 2.2). Patients with stage I to II non-small-cell lung cancer (NSCLC) whose physicians participated in tumor boards weekly were more likely to undergo curative-intent surgery (OR, 2.9; 95% CI, 1.3 to 6.8), although those with stage I to II NSCLC whose physicians' meetings reviewed > one cancer site were less likely to undergo curative-intent surgery (OR, 0.1; 95% CI, 0.03 to 0.4).
Among patients with lung or colorectal cancer, frequent physician tumor board engagement was associated with patient clinical trial participation and higher rates of curative-intent surgery for stage I to II NSCLC but not with overall survival.
多学科肿瘤专家会诊在癌症治疗中很常见，但关于其益处的证据有限。我们评估了肿瘤专家会诊的参与情况和结构与治疗实施及患者预后之间的关联。
作为CanCORS研究的一部分，我们就参与肿瘤专家会诊的情况以及特定的肿瘤专家会诊特征对1601名肿瘤学家和外科医生进行了调查。在2003年至2005年确诊并由其中1198名医生诊治的4620例肺癌或结直肠癌患者中，我们评估了肿瘤专家会诊参与情况与患者生存率、临床试验入组、指南推荐治疗以及患者报告的质量之间的关联，并对患者和医生的特征进行了调整。
每周参与肿瘤专家会诊的医生（与较少或从不参与相比）与患者生存率无关，不过在探索性亚组分析中，每周参与与广泛期小细胞肺癌和IV期结直肠癌较低的死亡率相关。由54%每周参与肿瘤专家会诊的医生（与较少或从不参与相比）治疗的患者更有可能参加临床试验（比值比[OR]，1.6；95%置信区间，1.1至2.2）。I至II期非小细胞肺癌（NSCLC）患者中，其医生每周参与肿瘤专家会诊的更有可能接受根治性手术（OR，2.9；95%置信区间，1.3至6.8），不过I至II期NSCLC患者中，其医生会诊讨论超过一个癌症部位的则不太可能接受根治性手术（OR，0.1；95%置信区间，0.03至0.4）。
在肺癌或结直肠癌患者中，医生频繁参与肿瘤专家会诊与患者参加临床试验以及I至II期NSCLC更高的根治性手术率相关，但与总生存率无关。
