Towards sustainable multidisciplinary renal cancer tumour boards: redesigning the referral pathway

Abstract

Objectives To develop and evaluate a complexity‐stratified referral pathway aimed at improving the sustainability, efficiency and resource utilisation of specialist multidisciplinary team (SMDT) meetings within a high‐volume tertiary renal cancer service. Patients and Methods We performed a retrospective cohort study of benign and malignant renal cancer cases discussed at SMDT meetings between January and December 2023 at the Royal Free Specialist Centre for Kidney Cancer. Patient demographics, tumour characteristics, SMDT discussions and management outcomes of patients were analysed to identify protocolised lower complexity cases suitable for alternative MDT pathways. Based on these findings, dedicated Standard of Care (SoC) and Benign MDTs were developed and implemented to manage lower complexity renal cases outside the main SMDT. The impact of the revised referral structure on SMDT workload, discussion efficiency and specialist resource utilisation was subsequently evaluated. Results In 2023, 2228 patients with benign and malignant renal pathology underwent 4154 SMDT discussions. Most patients (96.3%) required under seven discussions. Patients aged >70 years with renal masses <2 cm frequently underwent repeated SMDT review, despite surveillance or conservative management representing the most common management recommendation. Bosniak I–II cysts were predominantly discharged, whilst Bosniak IIF cysts were mainly managed with surveillance. Following implementation of the revised referral structure incorporating SoC and Benign MDTs, cases discussed at the main SMDT decreased from a mean of 83 to 63 patients with cancer per week, whilst discussion time per patient increased by 30.8%. The revised pathway also reduced the requirement for full SMDT attendance for protocolised cases. Conclusion Complexity‐stratified MDT referral structure improved efficiency and sustainability by diverting lower complexity protocolised cases to dedicated Benign and SoC MDTs. This enabled the main SMDT to prioritise clinically complex decision making and optimise utilisation of specialist multidisciplinary expertise.