Department of Radiation Oncology, Yamagata University School of Medicine, 2-2-2, Iida-nishi, Yamagata, 990-9585, Japan.
BMC Med Inform Decis Mak. 2022 Apr 27;22(1):111. doi: 10.1186/s12911-022-01849-y.
Cancer treatment requires a multidisciplinary approach. Therefore, multidisciplinary team meetings (MDTMs) have been widely used to determine the direction of treatment. However, no standard provisions exist for conducting MDTMs, and recommendations discussed in MDTMs are sometimes not implemented. This study analyzed the indications for radiotherapy discussed and recommended at MDTMs, identified the rate of radiotherapy recommendations for patients that were not implemented, and clarified the reasons at a single academic center in Japan.
This was a cross-sectional study that analyzed the minutes and electronic medical records of cases discussed at MDTMs held between April 2012-March 2017 at Yamagata University Hospital. We categorized how radiotherapy was initially presented at MDTMs, determined the rate of radiotherapy recommendations made through MDTMs, analyzed whether treatment recommendations were subsequently implemented, and examined the causes of non-implementation. We performed a statistical analysis to assess some clinical factors (sex, age, number of multidisciplinary team meetings, and classification of planned treatment) associated with the non-implementation of radiotherapy recommendations from MDTMs.
A total of 1813 cases were discussed at MDTMs, of which 71% (1293 cases) were presented with treatment plans, including radiotherapy. Further, 66% (1205 cases) were recommended for radiotherapy through the MDTMs. Recommendations from MDTMs were not implemented in 7% (142 cases). The most typical reason for non-implementation was the clinician's opinion (30%), followed by patient preferences (27%) and disease progression (20%). Change in cancer stage and improvement in symptoms were 12% and 4%, respectively. These ratios were similar each year. We could not find the factors associated with the non-implementation of radiotherapy recommendations from MDTMs.
MDTMs had a significant effect on the recommendation of radiotherapy for each patient with a tumor. The primary reason for the non-implementation of decisions made at MDTMs was the opinion of clinicians and the patient's preference. These results were similar to previous studies. We need to establish a monitoring system where patients themselves can decide the treatments based on their choices while using the recommendations from MDTMs.
癌症的治疗需要多学科的综合治疗。因此，多学科团队会议（MDTMs）被广泛用于确定治疗方向。然而，目前并没有关于如何进行 MDTMs 的标准规定，MDTMs 中讨论的建议有时也并未得到执行。本研究旨在分析在日本某一学术中心的 MDTMs 中讨论并推荐的放疗指征，明确未执行 MDTM 推荐的放疗患者比例，并阐明原因。
本研究采用横断面研究方法，分析了 2012 年 4 月至 2017 年 3 月在山形大学医院举行的 MDTM 讨论的病例记录和电子病历。我们根据 MDTM 最初提出的放疗方式对病例进行分类，确定 MDTM 推荐放疗的比例，分析治疗建议是否随后得到实施，并检查未实施的原因。我们进行了统计学分析，以评估一些临床因素（性别、年龄、MDTM 会议次数和计划治疗分类）与 MDTM 推荐的放疗不实施的相关性。
共讨论了 1813 例病例，其中 71%（1293 例）提出了治疗计划，包括放疗。进一步的，66%（1205 例）的病例在 MDTM 中被推荐接受放疗。但 MDTM 推荐的放疗建议中有 7%（142 例）未被执行。未执行的最常见原因是临床医生的意见（30%），其次是患者的偏好（27%）和疾病进展（20%）。癌症分期的变化和症状的改善分别占 12%和 4%。这些比例每年都相似。我们未发现与 MDTM 推荐的放疗不实施相关的因素。
MDTMs 对每位肿瘤患者的放疗建议有显著影响。MDTMs 决策未实施的主要原因是临床医生的意见和患者的偏好。这些结果与之前的研究相似。我们需要建立一个监测系统，让患者自己根据自己的选择决定治疗方案，同时利用 MDTM 的推荐。
