Evidence-based cancer care: assessing guideline adherence of multidisciplinary tumor board recommendations for breast and colorectal cancer in a non-academic medical center.

Abstract

Purpose: Multidisciplinary tumor boards (MTB) are associated with improved outcomes. Yet, most patients in Western countries receive cancer care at non-academic medical centers. Guideline adherence of MTB recommendations in non-academic medical centers as well as factors contributing to non-adherence remain largely unexplored.

Methods: This retrospective study followed the STROBE recommendations. All cases discussed at the MTB of the Landesklinikum Baden-Moedling, Austria, were eligible for inclusion. Guideline non-adherence was assessed by two reviewers independently using the AWMF S3 guidelines. Factors associated with guideline non-adherence were investigated using multivariable ordinal regression.

Results: In total, 579 patients were included in the final analysis: 486 were female (83.9%) and 93 were male (16.1%), with a median age of 70 years (IQR 60-80). Most had breast cancer (n = 451; 77.9%), while 128 had colorectal cancer (22.1%). Complete adherence to guidelines was observed in 453 patients (78.2%), major deviations in 60 (10.4%), and minor deviations in 66 (11.4%) patients. Non-adherence was primarily due to patient preferences (n = 24; 40.0%), lack of surgical treatment recommendation (n = 24; 40.0%), and comorbidities (n = 9; 15.0%). After adjusting for relevant variables, predictors of non-adherence included older age at diagnosis (OR 1.02, 95% CI 1.00-1.04), colorectal cancer (OR 3.84, 95% CI 1.99-7.42), higher ECOG status (OR 1.59, 95% CI 1.18-2.16), and a more recent MTB conference (OR 1.20, 95% CI 1.03-1.41).

Conclusion: Overall, guideline adherence was high for colorectal and breast cancer and comparable to results from academic medical centers. However, results need to be confirmed in other tumor entities.