Impact of rectal cancer multidisciplinary conferences on patient care plans

Abstract

Aim

Multidisciplinary conferences (MDCs) are standard of care for rectal cancer, and literature suggests that MDCs result in changes in as many as 50% of treatments plans. The aim of this study was to determine the frequency of changes to treatment plans at MDCs at our local institution. Secondary outcomes included clinician attendance, change in pathology and radiology reports and the association between tumour stage and care plan changes.

Method

Pre- and postconference plans were prospectively collected. Care plan changes were defined as either major (intermodality) or minor (intramodality). Changes to radiology reports (T, N, M, extramural venous invasion or mesorectal fascial status) and pathology reports (primary diagnosis, status of mismatch repair or high-risk features) were tabulated. Associations between stage and conference plan outcome were determined with Fisher's exact test and multinomial logistic regression.

Results

Pre- and postconference plans were prospectively recorded for 44 consecutive meetings. A total of 276 patients were reviewed, with 137 being new diagnoses of rectal adenocarcinoma. Radiology reports were changed in 26% (35/137) of patients and pathology reports were changed in 3% (4/137). Major changes to treatment plans occurred in 12% (17/137) and minor changes occurred in 28% (38/137) of cases. Other than an association between Stage 3 cancers and minor changes, no factor was predictive of care plan changes or confirmation.

Conclusion

MDC review resulted in changes to 40% of treatment plans, and no factors predicted confirmation of pretreatment plans. Our study supports the value of comprehensive review of every rectal cancer by MDC.