U1086 "ANTICIPE" INSERM-University of Caen Normandie, U1086 "Anticipe" - Centre François Baclesse, 3, Avenue du Général Harris, 14000, Caen, France.
Digestive Cancer Registry of Calvados, University Hospital of Caen, Avenue de la Côte de Nacre, 14000, Caen, France.
BMC Health Serv Res. 2021 Oct 1;21(1):1032. doi: 10.1186/s12913-021-07022-x.
Multidisciplinary team meetings (MDTMs) are part of the standard cancer care process in many European countries. In France, they are a mandatory condition in the authorization system for cancer care administration, with the goal to ensure that all new patients diagnosed with cancer are presented in MDTMs.
Identify the factors associated with non-presentation or unknown presentation in MDTMs, and study the impact of presentation in MDTMs on quality of care and survival in patients diagnosed with colorectal cancer (CRC).
3999 CRC patients diagnosed between 2005 and 2014 in the area covered by the "Calvados Registry of Digestive Tumours" were included. Multivariate multinomial logistic regression was used to assess the factors associated with presentation in MDTMs. Univariate analyses were performed to study the impact of MDTMs on quality of care. Multivariate Cox model and the Log-Rank test were used to assess the impact of MDTMs on survival.
Non-presentation or unknown presentation in MDTMs were associated with higher age at diagnosis, dying within 3 months after diagnosis, unknown metastatic status, non-metastatic cancer and colon cancer. Non-presentation was associated with a diagnosis after 2010. Unknown presentation was associated with a diagnosis before 2007 and a longer travel time to the reference care centres. Presentation in MDTMs was associated with more chemotherapy administration for patients with metastatic cancer and more adjuvant chemotherapy for patients with stage III colon cancer. After excluding poor prognosis patients, lower survival was significantly associated with higher age at diagnosis, unknown metastatic status or metastatic cancer, presence of comorbidities, rectal cancer and non-presentation in MDTMs (HR = 1.5 [1.1-2.0], p < 0.001).
Elderly and poor prognosis patients were less presented in MDTMs. Geriatric assessments before presentation in MDTMs were shown to improve care plan establishment. The 100% objective is not coherent if MDTMs are only to discuss diagnosis and curative cares. They could also be a place to discuss therapeutic limitations. MDTMs were associated with better treatment and longer survival. We must ensure that there is no inequity in presentation in MDTMs that could lead to a loss of chance for patients.
多学科团队会议（MDTMs）是许多欧洲国家癌症治疗标准过程的一部分。在法国，MDTMs 是癌症治疗管理授权系统的强制性条件，目的是确保所有新诊断为癌症的患者都在 MDTMs 中进行讨论。
确定与 MDTMs 中未呈现或未知呈现相关的因素，并研究 MDTMs 中呈现对结直肠癌（CRC）患者治疗质量和生存的影响。
纳入 2005 年至 2014 年间在“卡尔瓦多斯消化肿瘤登记处”覆盖的地区诊断为 3999 例 CRC 患者。使用多变量多项逻辑回归评估与 MDTMs 呈现相关的因素。进行单变量分析以研究 MDTMs 对治疗质量的影响。使用多变量 Cox 模型和 Log-Rank 检验评估 MDTMs 对生存的影响。
MDTMs 中未呈现或未知呈现与诊断时年龄较大、诊断后 3 个月内死亡、未知转移状态、非转移性癌症和结肠癌相关。未呈现与 2010 年后的诊断相关。未知呈现与 2007 年前的诊断和到参考治疗中心的旅行时间较长相关。在 MDTMs 中呈现与转移性癌症患者接受更多化疗以及 III 期结肠癌患者接受更多辅助化疗相关。排除预后不良的患者后，较高的诊断年龄、未知的转移状态或转移性癌症、合并症、直肠癌和 MDTMs 中未呈现与较低的生存显著相关（HR=1.5[1.1-2.0]，p<0.001）。
老年和预后不良的患者在 MDTMs 中呈现较少。在 MDTMs 呈现之前进行老年评估可改善治疗计划的制定。如果 MDTMs 仅用于讨论诊断和治疗方法，那么达到 100%的目标是不切实际的。MDTMs 也可以是讨论治疗限制的场所。MDTMs 与更好的治疗和更长的生存相关。我们必须确保 MDTMs 呈现不存在使患者失去机会的不公平现象。
