MDT meetings are an almost ubiquitous feature of modern oncology practice. They were established in the 1990s and 2000s as a means of establishing the most appropriate treatment for a patient. There are often multiple doctors involved in a patient's care, including the GP, surgeon, a specialist physician, a medical oncologist, a radiation oncologist, and palliative care physician. There can also be a number of allied health and nursing staff involved, including specialist cancer nurses, speech pathology, dietician and physiotherapy. In isolation, there is the potential for less appropriate treatment to be recommended in the absence of input from other specialists. Finally, clinical trials may be available to a patient but only known about by a non-diagnostic specialist (eg. radiation or medical oncology).
Therefore, the function of MDT meetings is:
- To offer patients the best care available from the consensus of the numerous specialists and following of clinical guidelines
- This is perhaps most relevant for cases where surgery is not always the best initial treatment, eg: locally advanced rectal cancer, oropharyngeal squamous cell carcinoma.
- Speedier access to this care
- Involvement in clinical trials
- Better surgical outcomes
- Involvement of allied health from an earlier stage
- Support and education of specialist clinicians
Evidence for benefit of MDT Meetings
There is strong evidence of benefit for MDT meetings for the following cancers:
- Breast: Observational studies have demonstrated improved adherence to clinical guidelines after introduction of MDT meetings. Patient satisfaction also appears to be improve with introduction of MDT meetings
- Colorectal and Oesophagus: Improved survival has been demonstrated for patients with these cancers by evaluating outcomes before and after implementation of MDT meetings.
- Lung: An Australian review of outcomes in patients who were presented versus not presented at MDT demonstrated improved uptake of radiation and chemotherapy, but no improvement in survival. A systemic review of the evidence has suggested a benefit
- Head and Neck: Outcomes in head and neck cancer were shown to be superior for patients who were presented at MDT in a UK study comparing patients who presented before and after MDT meetings were introduced.
Clinical members of MD teams typically report positive experiences (80-90%).
Problems with the Evidence
MDT meetings are typically introduced, and outcomes compared in the patient group treated before and after this introduction. This may confound the results, as newer treatments typically become available with time and outcomes improve regardless. Despite this, there does seem to be significant improvement in patient outcomes and satisfaction with MDT meeting presentation. It is also too late to run a randomised trial of MDT meetings as there is no longer clinical equipoise in most clinicians.
Negative Aspects of MDT Meetings
MDT meetings may have negative impact on patient care and clinician morale:
- MDT Meetings may delay patient care: In some cases, waiting for an MDT meeting may delay appropriate patient care. An example would be in head and neck cancer, where a patient with an oral cavity cancer may have surgery delayed in order to discuss them at a meeting. This can lead to progression of disease and inability to perform single-modality treatment. These problems are exacerbated at holiday times (Christmas/New Year is the worst example in Australia)
- MDT Meetings may not capture all patients: A number of patients may not be presented at MDT meetings, or be presented after they have had radical surgery. This limits the usefulness of meetings. An example would be a patient with high risk prostate cancer who undergoes radical prostatectomy, and is then presented post-operatively after they are found to have positive margins and extracapsular extension.
- MDT Meetings may impact on morale: In some institutions treatment decisions may be governed by an autocratic member who overrides team decisions through their behaviour. Other members of the MDT may feel powerless and have reduced morale; they may leave the institution and exacerbate problems with treatment.