Author of

• 11946

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  P2.24 - Poster Session 2 - Supportive Care (ID 157)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Supportive Care
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/29/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 12004

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    P2.24-058 - Thoracic Multidisciplinary Meeting Discussion Outcomes at Auckland City Hospital: Concordance with Actual Patient Management for Lung Malignancies (ID 3423)

    09:30 - 09:30  |  Author(s): L. Cossar
    • Abstract

    Background
    Discussion of patients at multidisciplinary meetings (MDMs) is now considered the standard of care for management of thoracic malignancies. However, there is limited evidence regarding concordance of decisions made at MDMs with subsequent actual treatment. This study aimed to assess the concordance between MDM outcomes and subsequent treatment received by patients with thoracic malignancy at our centre, and to identify factors that contributed towards any deviation from the MDM management plan.

    Methods
    In this retrospective audit, patients discussed at 12 Auckland City Hospital MDMs between 1[st] May and 31st July 2012 were identified, using the MDM lists for each session and chairperson summaries of discussion and decisions. The electronic cases records of these patients were then reviewed for demographical data, information on the MDM outcome and to ascertain the eventual treatment received by these patients. Any discrepancies between MDM recommendations and eventual patient management were noted, and the reasons stated for this.

    Results
    There were 121 cases identified from 138 documented patient presentations; 17 patients were re-presented within the study period, and the presentation at which anti-cancer treatment was determined was analysed (if achieved). Of the 121 cases, 93 included a pathologically confirmed diagnosis (80 primary lung or pleural tumours, 13 other tumours or pulmonary metastases), and 28 did not, including 4 with suspected malignant pleural effusions. A decision for radical therapy was made for 22 cases at the MDM. 18 of these cases received treatment as determined at MDM: 13 of 15 surgical resection, 1 of 3 radical radiotherapy, 3 of 3 radical chemo-radiotherapy, and 1 was deemed not to need adjuvant chemotherapy. A decision for one or more palliative treatments was made for 72 cases. Of these, the MDM determined treatment was actually received in 41 (57% of cases): 5 of 7 palliative surgery cases (1 died pre-op, 1 patient declined), 18 of 28 chemotherapy as initial treatment, and 13 of 23 radiotherapy as initial treatment. In 14 cases with an MDM decision recorded recommending both palliative chemotherapy and radiotherapy, 5 received both modalities, 7 radiotherapy alone and 2 neither. Reasons for discordance between MDM decision and treatment included patient deterioration or poor performance status (n=14), patient choice (n=8), patient and doctor agreed choice (n=5) and did not attend/lost to follow up (n=4) In the remaining 27 cases, best supportive care was recommended in 7 and no definitive treatment decision was able to be made in 20.

    Conclusion
    This study demonstrated excellent concordance between decisions made for radical therapy at the MDM and actual treatment. Concordance was less for palliative therapies, and this is likely to reflect on the poorer performance status of these patients at presentation and the perceived benefit versus adverse effects of palliative measures to the patient and the clinician. Since this study, a standardised electronic MDM template has been introduced to ensure accurate and complete information is available.