Reforming Cancer Multidisciplinary Team Meetings: Introducing a Novel Clinical Radiological Assessment Meeting (CRAM) to Reduce Response Times and Workloads.

Introduction Multidisciplinary team (MDT) meetings are now considered part of the standard of care for decision-making and management of patients with cancer. However, most MDTs now face capacity issues and supplementary approaches should be considered. We report our experience with a novel clinical radiological assessment meeting (CRAM) as a 'mini-MDT' to expedite decision-making and enhance the function of the parallel specialist MDT.  Methods A retrospective analysis of new referrals to a high-volume peritoneal malignancy unit between September 2016 and August 2018 was performed. Time to first response and decision following referral were assessed for the traditional referral pathway and after the introduction of the CRAM in September 2017. Response times were calculated from the receipt of the referral to the date of the first response and were classified into one of four categories: 'specialist peritoneal malignancy MDT review,' 'outpatient review,' 'recommendation for local follow-up', or 'further information required'. The Mann-Whitney U test was used to compare the response times between the two pathways. Results In total, 1478 new referrals were received in the two-year period, 769 pre-CRAM and 709 after CRAM introduction. The median referral to first response time was eight days using traditional pathways and five days after the introduction of the CRAM (p <0.001). In the traditional pathway, 234/769 (30.4%) patients were discussed further in the specialist MDT, compared with 122/709 (17.2%) after the CRAM assessment.  Conclusion A novel CRAM significantly reduced first response times to the referring team facilitating rapid and safe assessment with quicker decisions for the patients. It enabled more appropriate use of an ever-expanding MDT.