The University of Liverpool, School of Medicine, Liverpool, L69 3GE, UK.
Department of Otolaryngology, Head and Neck Surgery, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK.
Eur Arch Otorhinolaryngol. 2020 Mar;277(3):947-952. doi: 10.1007/s00405-019-05781-2. Epub 2020 Jan 8.
A multidisciplinary team (MDT) approach to cancer management is gold-standard. With an increasing disease incidence and growing research into human papillomavirus (HPV)-related oropharyngeal cancer (OPC), updated UK management guidelines were recently published. This study aimed to evaluate the MDT decision-making process among OPC patients at a tertiary centre.
MDT meetings over a 12-month period were analysed retrospectively. MDT decisions were compared with guidelines and patient records examined to identify decision implementation. Reasons behind any discordant decisions were explored.
This study included 140 OPC patients. Thirty-three (23.6%) were not tested for HPV. Patients over 70 years with a smoking history treated palliatively were less likely to be tested (P = 0.017). Eighty-five percent of MDT decisions followed guidelines with the majority not complying (76.2%) related to patient comorbidity. Ten decisions (7.1%) were not implemented. Reasons included: Seven due to patient choice, of which four patients (57.1%) were only seen following the MDT meeting, and three due to clinician decisions as new clinical information emerged.
The majority of MDT decisions followed guidelines and any discordant decisions were justifiable. Discussing management options with patients beforehand facilitates decision implementation as decisions can potentially change after seeing the patient. Progress is still needed with regards to HPV testing. Reasons for not testing could include subliminal decision-making among clinicians, and patients falling between centres. Crucially, the role of the MDT in head and neck cancer should be to ratify decisions rather than making them, hence the need to see patients prior to MDT discussion.
癌症管理的多学科团队（MDT）方法是金标准。随着疾病发病率的增加和对人乳头瘤病毒（HPV）相关口咽癌（OPC）的研究不断深入，最近发布了更新的英国管理指南。本研究旨在评估一家三级中心的 OPC 患者的 MDT 决策过程。
回顾性分析了 12 个月期间的 MDT 会议。将 MDT 决策与指南进行比较，并检查患者记录以确定决策的实施情况。探讨了任何不一致决策的背后原因。
本研究纳入了 140 例 OPC 患者。其中 33 例（23.6%）未进行 HPV 检测。70 岁以上有吸烟史并接受姑息治疗的患者不太可能接受检测（P=0.017）。85%的 MDT 决策符合指南，其中大多数（76.2%）与患者合并症无关。有 10 项决策（7.1%）未实施。原因包括：7 项是由于患者选择，其中 4 名患者（57.1%）仅在 MDT 会议后就诊，3 项是由于新的临床信息出现，临床医生做出了决策。
大多数 MDT 决策都符合指南，任何不一致的决策都是合理的。在患者面前讨论管理方案有助于决策的实施，因为在见到患者后，决策可能会发生变化。HPV 检测仍需进一步改进。未进行检测的原因可能包括临床医生潜意识中的决策，以及患者介于各中心之间。至关重要的是，MDT 在头颈部癌症中的作用应该是批准决策，而不是做出决策，因此需要在 MDT 讨论之前见到患者。
