Cancer Management and Research Dovepress

open access to scientific and medical research

Open Access Full Text Article

REVIEW

Benefits and Limitations of a Multidisciplinary

Approach in Cancer Patient Management
This article was published in the following Dove Press journal:
Cancer Management and Research

Rossana Berardi Abstract: Over the years, a growing body of literature has confirmed as beneficial the
Francesca Morgese implementation of a multidisciplinary approach in the so-often-intricate scenario of cancer
Silvia Rinaldi patients’ management. Together with the consolidation of tumor-board experience in clinical
Mariangela Torniai practice, certain aspects have emerged as controversial and a source of current debate. In this
systematic literature review, we focused our attention on the impact of multidisciplinary tumor
Giulia Mentrasti
boards, assessing benefits and limitations as a result of the dissemination of such approaches. On
Laura Scortichini
the bright side, adherence to clinical guidelines, treatment outcomes, and overall improvement in
Riccardo Giampieri
decision-making processes have been recognized as advantages. On the other side, our analysis
Clinica Oncologica, Università Politecnica highlights a few limitations that should be taken into account to optimize cancer patients’
delle Marche, Azienda Ospedaliera
Universitaria Ospedali Riuniti di Ancona,
management. Of note, some issues, such as costs, legal responsibility, geographic barriers, and
Ancona, Italy treatment delays, have yet to be resolved. In order partly to address this matter, software
platforms and novel methods of computational analysis may provide the needed support.
Therefore, the aim of our analysis was to describe the multidisciplinary approach in cancer
care in terms of adherence to clinical guidelines, treatment outcomes, and overall improvement
in decision-making processes through a systematic review of the literature.
Keywords: multidisciplinary, tumor board, cancer patients, benefits, limitations

Introduction
Management of cancer patients is becoming a worldwide challenge, due to rapidly
changing evidence, new drugs approval, and scientific guideline updates. The
introduction of the multidisciplinary approach has helped clinicians meet the
growing needs of cancer patients. This can be achieved through multidisciplinary
clinics, as breast units, or multidisciplinary tumor boards (MTBs), also known as
multidisciplinary meetings. Breast units are working entities organized to ensure
patients’ clinical examination, diagnostic procedures, including imaging and biop-
sies, and therapeutic planning, all in one visit. All these procedures are achieved
through the combined efforts of different figures, such as clinical oncologists,
radiologists, and surgeons, dealing with breast cancer.1,2
In the National Cancer Institute’s dictionary, a tumor board (or review) is
defined as:

A treatment planning approach in which a number of doctors who are experts in

Correspondence: Rossana Berardi
Clinica Oncologica, Università Politecnica different specialties (disciplines) review and discuss the medical condition and treat-
Delle Marche, AOU Ospedali Riuniti Di ment options of a patient.3
Ancona via Conca 71, Ancona 60126, Italy
Tel +39 071 596-5715 In a cancer setting, this means that multidisciplinary teams discuss the management
Fax +39 071 5965053
Email [email protected] of cancer patients on a regular basis to provide them the best care, according to their

submit your manuscript | www.dovepress.com Cancer Management and Research 2020:12 9363–9374 9363
DovePress © 2020 Berardi et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.
http://doi.org/10.2147/CMAR.S220976
php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the
work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For
permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php).
Berardi et al Dovepress

experience and the latest guidelines. This latter approach is nursing-staff specialists, research nurses, and coordinators.
common in the US and accepted also in other countries. Some countries consider the role of nurse staff to be
Multidisciplinarity began >50 years ago, as reported in crucial in influencing treatment decisions and have
several reviews.4 For example, Milligan et al illustrated decided to include nurses in the core team rather than the
different cases of patients, not only cancer patients, dis- non–core team1,8,13 (Figure 1).
cussed in laryngology multidisciplinary settings in the Few studies have addressed the issue of patient partici-
1920s and reported patient anamnesis, clinical history, all pation in MTBs. Choy et al conducted a very interesting
specialists opinions given during discussion, and then pilot study to assess the usefulness of involvement of breast
a conclusive report, specifying how the patient was treated cancer patients in multidisciplinary meetings, participating
and his/her condition a few months later.5 O’Brien in their own treatment planning: 22 of 30 selected patients
described his experience during his time at Baylor agreed to take part, seven refused, and another agreed, but
Hospital from the late 1960s to the early 1970s. Once was not present at the time of the meeting. The authors
weekly, medical oncologists, together with radiation reported that patient involvement did not increase their
oncologists and surgeons, discussed all different types of anxiety and was helpful in improving their understanding
cancer cases.6 Then, in the 1990s, the multidisciplinary of treatment choices. Even health-care professionals were
approach took hold in Europe’s clinical practice, as has satisfied with this involvement, although some admitted that
happened in UK and in Germany. Other countries mana- patient participation in MTBs compelled them to be more
ged to introduce the multidisciplinary approach later (such alert and adjust their language so as to allow understanding
as in Belgium, where it became mandatory from 2000).7-–9 of the dialogues by patients.14 In another paper, Butow et al
Typically, multidisciplinary approaches are thought to be found that physicians had some reservations about
meetings where different specialists converge physically patients participating in MTBs, because they had to adjust
together to discuss several clinical cases. Actually, nowadays their language for all participants, constraining discussion
virtual meetings are also frequently used, allowing distant and delaying meetings.15 Finally, patient involvement may
physicians to confer with each other and decide the right contribute to the diagnostic process and therapeutic choice,
diagnostic and therapeutic path.10 Sometimes, resident hos- particularly when treatment decisions have a deep impact on
pital staff do not have access to have all required data to make their quality of life. In early prostate cancer, for example,
the right decision for each patient, and thus mini–tumor patients are able to express their preference among treat-
boards are born with the intent to allow only a few specialists ments of similar value.8
to take part in the discussion.1,11,12 Primary-care physicians are not considered an integral
A new variety of MTB is the so-called molecular part of MTB. However, they can have a meaningful role in
tumor board. Due to the impact of molecular biology as early identification of cancer, introducing patients to the
a tool to support different therapeutic decisions, there was team, and follow-up after hospital discharge. In addition,
the need to add to the “standard” MTB a series of specia- they are primarily involved in the management of a series
lists focused on molecular biology, such as pathologists, of unrelated comorbidities and symptoms (such as pain)
oncologists, hematologists, basic scientists, and genetic when the patient is at home, and their involvement can
counselors. In particular, due to the opportunity of using help in prompting identification of treatment-related side
genetic cancer-cell profiling to predict drug sensitivity and effects when the patient is discharged from hospital.16,17
resistance, molecular tumor boards provide clinicians with Despite technology being able to provide valuable
the right decision for each patient, due to their taking into help in physicians’ interactions, it promotes a different
account clinical factors and targetable genetic alterations way of communication that might influence MTB effec-
and their relative weight in influencing patient outcomes.1 tiveness. Mascia et al focused on this peculiar issue,
In an MTB, the “core team” is usually composed of comparing face-to-face vs electronic-based communica-
oncologists, surgeons of different subspecialties, patholo- tion among members of an Italian MTB taking place at
gists, radiotherapists, and other specialists, according to the Fondazione Policlinico Universitario Agostino
the type of cancer (eg, head and neck, breast, gastrointest- Gemelli IRCCS, an Italian research hospital, treating
inal, genitourinary). They are open to other members, too hepatocellular carcinoma patients since 2007. The
(“non–core team”), such as palliative-care physicians, authors demonstrated that physicians still prefer face-to
medical students, psychologists, physicians in training or face communication to exchange work-related

submit your manuscript | www.dovepress.com Cancer Management and Research 2020:12

9364
DovePress
Dovepress Berardi et al

Figure 1 Multidisciplinary tumor board.

information, particularly if they belong to the same clin- the multidisciplinary approach in terms of adherence to clin-
ical unit and the same hospital building, highlighting that ical guidelines, treatment outcomes, and overall improvement
physical proximity helps in better knowledge exchange. in the decision-making process. Selection was undertaken by
Among new communication tools, MTB specialists seem searching PubMed for clinical practice guidelines, original
to prefer WhatsApp messages, particularly members of articles, manuscript reviews and prospective and retrospective
the same clinical unit, probably given the informal rela- studies in English published from 1987 to November 2019.
tionship between workers and members with different The search term used was “multidisciplinary tumor board”.
expertise. As stated by Johnston et al, WhatsApp acts as This systematic review adheres to PRISMA guidelines.20
a tool capable of relating junior and senior colleagues.18 After analysis, we identified 194 potentially relevant articles:
Based on performance, Mascia et al underlined that mem- 126 were excluded due to not being in English, impertinence,
bers using face-to face communication showed better duplicatation, unavailablility of the full article, and being case
capability to coordinate and manage the implementation reports, studies on pediatric cancer patients, or surveys.
of discussed cases more promptly. Although easy to use, Figure 2.
these tools might hamper the quality of MTB
discussion.19 Benefits
Over the years, a solid body of literature has advocated the
Methods implementation of a multidisciplinary approach for adher-
We conducted a systematic literature search for ence to clinical guidelines, outcome improvement, and
available evidence on the benefits and limitations of cancer patient management.21 As such, the present evalua-
a multidisciplinary approach in cancer patients. The aim of tion on MTB advantages was performed focusing on these
the present evaluation of the current evidence was to describe major aspects.

submit your manuscript | www.dovepress.com

Cancer Management and Research 2020:12 9365
DovePress
Berardi et al Dovepress

N= 194 POTENTIAL RELEVANT ARTICLES

N= 126 EXCLUDED

N=15 FOREIGN LANGUAGE

N= 95 NON-PERTINENT PAPERS
N=1 NOT AVAILABLE FULL ARTICLES
N=8 STUDIES ON PEDIATRIC CANCER PATIENTS
N=5 SURVEY
N=2 CASE REPORTS
N= 68 SELECTED ARTICLES

Figure 2 PRISMA.

Adherence to Clinical Guidelines recommend multidisciplinary management of cancer

Clinical guidelines help to define the best therapeutic patients through the creation of MTBs. Adherence to
strategy for each cancer patient, based on high-quality MTB therapeutic indications to the best national and inter-
evidence. Adherence to guidelines is associated with an national guidelines is one of the most important para-
improvement in cancer patient outcome, preventing over- meters for assessing the quality of an MTB. Higher
and undertreatment and reducing mortality.22 In the last adherence to current guidelines has been observed for
few years, diagnostic and therapeutic options have both staging and treatment.25
increased significantly for cancer patients. Therefore, the Several studies have analyzed the degree of adherence
creation of MTBs has become necessary for interdisciplin- of MTB therapeutic decisions to guidelines, showing
ary cooperation and better optimization and integration of greater agreement compared to therapeutic decisions of
all therapeutic resources. In fact, several studies have individual clinicians. A retrospective study analyzed
shown that MTBs implement multimodal treatment, ensur- 3,815 cancer patient cases treated at the Centre for
ing greater adherence to guidelines and as a result an Integrated Oncology at the University Hospital Bonn.
improvement in patient outcomes.23 Therapeutic recommendations were formulated by three
MTBs offer benefits to patients, physicians, the com- tumor boards, according to types of tumor and best guide-
munity, and hospitals. In particular, they guarantee: lines. The study evaluated the degree of therapeutic
recommendation implementation after MTB evaluation:
1. uniformity of standards of care for cancer patients 80% of all recommendations were implemented, with
2. open communication lines to exchange information 8.3% of indications showing deviance, due to patient
among physicians who can benefit from both the wishes (36.5%), patient death (26%), and physicians’ deci-
best scientific evidence and guidelines and the sions, based to patient age, comorbidities, or adverse
experience of others, improving the decision- effects of the treatment (24.1%).26
making process thanks to case review, radiology- A recent retrospective study on patients with head and
and pathology-report revision, and discussion of neck cancers treated in a single urban academic medical
treatment options21 center analyzed the level of concordance between
3. a mechanism for review of the quality of profes- a multidisciplinary team’s therapeutic indications and
sional care24 National Comprehensive Cancer Network (NCCN)-
guideline recommendations. Adherence to NCCN guide-
The aim of MTBs is improving patient management and lines was observed in about 98% of patients assessed in
outcomes. Most national and international guidelines the MTB, while only 80% evaluated by a single specialist

submit your manuscript | www.dovepress.com Cancer Management and Research 2020:12

9366
DovePress
Dovepress Berardi et al

received a therapeutic indication in accordance with Nonconcordance was observed especially in WFO
NCCN guidelines. Deviations from guidelines were indications of aggressive treatment approaches in frail
mainly observed for a selected few patients, where MTB patients. MTBs also considered demographic characteris-
indication was based on patient age and comorbidities.27 tics, comorbidities, patient preferences and level of social
Brauer et al conducted a prospective study aiming to support in treatment choices. These aspects are not usually
evaluate the role of multidisciplinary teams in the manage- considered in guidelines, as there is a general lack of
ment of patients with pancreatic or gastrointestinal cancer. studies focused on these matters.31 Furthermore, the intro-
They found an adherence rate to NCCN guidelines of duction of MTBs has been demonstrated to improveability
100%, while previous series had reported adherence by to reach a decision, quality of information presentation,
single physicians of 80%. However, clinician adherence to and quality of teamwork.32 In conclusion, MTBs ensure
the treatment plan recommended by the MTB was not a high degree of concordance of therapeutic decisions with
complete, due to the need for further diagnostic investiga- guidelines. However, the advantage of MTBs is to ensure
tions or medical conditions.28 individualized therapy, especially for the most complicated
The therapeutic diagnostic algorithm of colorectal can- cases, taking into account patients’ clinical decisions and
cer patients is well specified in the guidelines, which conditions. MTBs allow for the discussion, spread, appli-
suggest a multidisciplinary approach within an MTB to cation, and implementation of the best guidelines.1
improve patient outcomes.29 A retrospective study ana- In order to improve the decision-making power of
lyzed the adherence of MTB decisions to NCCN guide- MTBs, several instruments have been investigated. Shah
lines on colorectal cancer, showing agreement of 97%. et al investigated the quality of MTBs through an observa-
However, compliance of doctors with MTB recommenda- tional tool — Colorectal Multidisciplinary Team Metric
tions was lower (87%), due to patient preference and for Observation of Decision-Making —evaluating quality
doctor discretion.10 The management of patients with and time used for presentation of patient history, radiolo-
rare tumors is complex, and guidelines recommend man- gical and pathological information, and contribution to
agement in expert centres within an MTB. A recent study decision-making of each team member. The authors iden-
evaluated the degree of concordance between MTB deci- tified areas for improving MTB procedures and optimizing
sions on indication for postoperative radiotherapy the decision-making process.33 Another study used the
andEuropean Society of Medical Oncology (ESMO) MTB Metric for Observation of Decision-Making’ tool
guidelines. MTB indications agreed with ESMO–Réseau to evaluate the decision-making process of a MTB. This
Tumeurs Thymiques (RYTHMIC) guidelines in 92% of tool considered the quality of information presented at the
cases. However, only 85% of patients received postopera- MTB, team-member contributions, and number of case
tive radiotherapy, due to excessive delays after surgery for reviews. Analysis showed that psychosocial elements,
clinical conditions.30 comorbidities, and cancer nurses’ contributions should be
In order to assess adherence to MTB therapeutic indi- used in decision-making processes and case reviews.34
cations and guideline recommendations, an Indian group
conducted a study evaluating the level of agreement Outcomes
between IBM’s Watson for Oncology (WFO) and MTB Multidisciplinary teams increasingly provide treatment of
recommendations from the Manipal Comprehensive cancer, but the effects of this approach on survival are
Cancer Center in Bangalore, India. WFO is an artificial unclear. Survival benefit from MTB meetings has been
intelligence (AI) system helping physicians in cancer- observed in a series of highly heterogeneous studies,
treatment decisions. WFO indications are processed from usually with small numbers of patients included. There is
a body of knowledge comprising medical journals and a suggestion that multidisciplinary- and expert-care avail-
textbooks, guidelines, and data on 550 breast cancer ability, particularly in cancer types where multimodal
cases, including cancer characteristics and stage, patient treatment is required, is crucial to optimize treatment
characteristics and comorbidities, and laboratory exams. choices and improve patient outcomes.
Treatment-recommendation concordance was demon- Serper et al performed a retrospective cohort study of
strated in 93% of breast cancer cases. Subgroup analysis all patients diagnosed with hepatocellular carcinoma
showed greater agreement in patients with stage II and III, (HCC) treated by 128 Veterans Affairs medical centers,
but low concordance for patients aged >75 years. demonstrating that MTB involvement was correlated

submit your manuscript | www.dovepress.com

Cancer Management and Research 2020:12 9367
DovePress
Berardi et al Dovepress

with overall survival (HR 0.83, 95% CI 0.77–0.90).35 lower than neighboring areas performing traditional care
Agarwal et al reported a retrospective analysis compar- (HR 0.82, 95% CI 0.74–0.91, P=0.004).39 Instead, Brauer
ing survival outcomes of 306 HCC patients managed in et al analyzed the impact of MTBs on the outcomes of 470
MTBs with survival outcomes for 349 patients who did prospectively collected cases of pancreatic and upper gas-
not reach MTB discussion from 2002 to 2011. These trointestinal diseases (presented during a 12-month per-
patients were treated in a single tertiary-care center in iod). Mean overall survival was not significantly different
Chicago. The two groups were essentially homogeneous, between cases with a change in plan as a result of
except that patients in the MTB group had less advanced MTBs vs no modifications in treatment choice (12.1±5.6
HCC than those in the non-MTB cohort. The rate of months vs 9.0±5.4 months, P=0.154).28 This concept was
treatment was higher among MTB patients (75%, OR further confirmed by a wide-ranging literature review by
2.80, 95% CI 1.71–4.59) vs the others (61%; Croke et al.21
P<0.0001).The MTB seemed to be an independent pre-
dictor factor of better survival on multivariate analysis
after stratification of tumor stage at onset. The MTB
Improvements in Clinical
promoted a multimodal approach for HCC patients, Decision-Making and Patient Management
allowing enhanced communication among the expert Several studies have confirmed that MTB discussion
team and patient follow-up. This approach further results in a change in diagnostic or treatment plan in
reduced the potential of examination duplication and a considerable proportion of cases. Focusing on breast
delayed or contradictory treatments.36 cancer, Newman et al retrospectively described a change
Liu et al conducted a retrospective analysis of 224 in predefined surgical plans after MTB revision of patho-
head–neck squamous-cell carcinoma patients treated at logical slides by dedicated breast pathologists in 13
Temple University, Philadelphia, Pennsylvania between patients (9%) pertaining to their center from an outside
October 2006 and May 2015, comparing patients who institution. Additionally, reexamination of previously
were treated before introduction of an MTB in the hospital acquired breast imaging led to surgery in 11% of cases
vs those who were discussed in MTBs. Median follow-up where surgery was not considered a first option before
was 2.8 years, and a majority of patients were in the MTB presentation. On the contrary, independently of
advanced stage (68%). Five-year overall survival and dis- pathological and radiological reevaluation, the MTB dis-
ease-specific survival were significantly better in the post- cussion suggested different surgical approaches in
MTB cohort vs pre-MTB cohort (40% vs 61% and 52% vs a remarkable portion of patients (32%) (eg, sentinel
75%, respectively; P=0.008 and P=0.003).37 Blay et al lymph–node biopsy vs axillary lymph–node dissection,
examined the outcome of 9,646 sarcoma patients treated mastectomy vs conservative surgery).40 Along these
by a network of 26 reference sarcoma centers with specia- lines, a survey conducted by the Memorial Sloan
lized MTBs between 2010 and 2014. This research was Kettering Cancer Center showed that sharing individual
funded by the French National Cancer Institute. Most surgical inclinations in a cross-sectoral setting might
cases presented to MTBs had a higher likelihood of having reduce unnecessary invasive procedures, such as the adop-
metastatic involvement at onset and more frequent unfa- tion of axillary lymph–node dissection in early breast
vorable prognostic factors (ie, largerprimary tumors, cancer cases.11
greater depth, higher grading, and more retroperitoneal With regard to other malignancies, Lee et al observed
locations; all P<0.001). Presentation to MTBs before treat- that modifications in formerly indicated diagnostic workup
ment was correlated with significantly lower 2-year local and treatment strategies at data evaluation occurred in
relapse-free survival (65.4% vs 76.9%, P<0.001) and almost half the gynecological tumors discussed within
2-year relapse-free survival (46.6% vs 51.7%, P<0.001).38 their MTB meeting. Interestingly, the authors found the
Kesson et al included 13,722 breast cancer patients in percentage of recommended changes to be higher than
a retrospective, comparative, nonrandomized interven- previous findings from a head–neck tumor prospective
tional cohort study conducted at an NHS hospital in study.41 In this respect, Wheless et al described
Scotland. Diagnosis of invasive breast cancer had been a variation of approximately 27% in therapy, diagnosis,
done between 1990 and 2000. After the introduction of or diagnostic procedures. More importantly, a major pro-
multidisciplinary care, breast cancer mortality was 18% portion of patients (65%) experienced a multimodal

submit your manuscript | www.dovepress.com Cancer Management and Research 2020:12

9368
DovePress
Dovepress Berardi et al

intensification of their treatment strategy following MTB A multimodal and interdiscipline-centered approach
presentation.42 Similarly, both a cohort chart review and might similarly compensate, as underlined by Herlemann
a prospective observational study respectively revealed et al, the absence of consolidated recommendations on
change in management in 36% and 25% of gastrointestinal timing and best-treatment sequence in metastatic hormone-
and pancreatic tumors after MTB discussion.28,43 sensitive prostate cancer.49 To corroborate this, Fazio et al
According to a study on colorectal cancer patients with suggested that an integrated multispecialty strategy might
stage IV disease, recommendations for preoperative che- be helpful also to optimize the management of lung neu-
motherapy have increased significantly in cases of oligo- roendocrine tumors, since the wider armamentarium avail-
metastatic disease (limited to one site) due to input from able for this subgroup compared to the poorly
MTB discussion. Lowes et al observed that after MTB differentiated counterpart.50 Furthermore, some evidence
confrontation, physicians were considerably more prone supports the implementation of MTB in surveillance. On
to refer elderly patients (>70 years) for treatment.44 behalf of the American College of Chest Physicians,
A retrospective study by Pawlik et al investigated the Rubins et al highlighted the importance of multidisciplin-
role of a multidisciplinary approach in respect to pancrea- ary management for early detection of treatment compli-
tic cancer. The study showed that some cases of declared cations, recurrences, or metachronous tumors in follow-up
unresectable disease profited from MTB-enriched surgical lung cancer patients after curative treatment.51 Taken alto-
experience. Notably, radiological reevaluation caused an gether, the work of Gambazzi et al agrees on multidisci-
plinary radiological surveillance in posttreatment non-
upstaging to metastatic disease in almost 70% of cases,
small-cell lung cancer.52 Finally, there have also been
requiring an adjustment of the patient’s plan of care.45 In
reports of increased clinical trial screening and patient
a single-center experience reported by Jury et al, the value
recruitment in clinical settings where patient recommenda-
of implementing an MTB approach was marked by an
tions are discussed by an MTB, as opposed to trial accrual
increasing number of patients for whom multimodality
counting exclusively on a dedicated research team.45,53 As
therapy was indicated after access to their clinic.23 As
to standardizing multidisciplinary management of cancer
stated by Ioannidis et al, gathering health-care profes-
patients in Europe, implementation of existing recommen-
sionals from different branches has been very beneficial
dations has been done through the creation of consensus
in rectal cancers. Multimodal treatment constitutes the
documents based on the Delphi method.54––56
standard of care for these patients, and is partially accoun-
table for outcome improvements achieved in this setting.29
Focus on Rare Tumors
Within this MTB framework, the opportunity to gain
Rare cancers often require multimodal therapy. A few rare
new and wide-ranging information is another central
cancer types (Merkel-cell carcinoma, sarcoma, and HCC)
aspect to take into consideration. On this point, Deressa
require multidisciplinary management to offer the best
et al observed that patients discussed at MTB were char- treatment choice. On top of being discussed in MTBs,
acterized by exhaustive staging, resulting in more accurate these cases should be referred to high-volume centres to
treatment plans. In contrast, those who had undergone tailor the best treatment strategy for each patient.57––61
surgery prior to MTB discussion had inadequate and
poor staging information.46 The quality of shared informa- Limitations
tion (case history, radiological information) has been A multidisciplinary approach certainly provides benefits in
related to high-standard decision-making in terms of cancer patient management, mostly resulting from the
recommendations given,47 and team members are expected sharing of decision-making processes in diagnostic and
to cooperate as constant supervisors for the level of patient therapeutic settings. However, various aspects of the mul-
care provided by the group.24 Additionally, when formal tidisciplinary approach might affect the applicability of
consolidated guidelines are lacking, a multisectoral MTBs in clinical practice, especially in suboptimal set-
approach might guide health-care professionals in the tings. These potential limitations still represent the subject
decision-making process, as advocated by Wotman et al of notable controversies and current debates.
in papillomavirus-positive oropharyngeal squamous-cell In this systematic review, ten of the papers selected
carcinoma with incomplete postchemoradiation node identified serious limitations regarding the multidisciplinary
response.48 approach in cancer patients.24,28,30,32,44,60,62–65 Among these,

submit your manuscript | www.dovepress.com

Cancer Management and Research 2020:12 9369
DovePress
Berardi et al Dovepress

the role of MTBs in patient outcomes might deserve special radiological, or pathological information still represented
attention, and remains a matter of debate. In this regard, obstacles to reaching clinical decisions.32 On the other
Brauer et al reviewed 470 cases of patients with benign and hand, an excessive amount of not strictly clinical informa-
malignant pancreatic and gastrointestinal diseases that had tion might lead to team members expressing contrasting
led to MTB discussion and been recorded in a prospectively opinions and the MTB producing more than one
collected database. Despite strong adherence to NCCN recommendation.63
guidelines, multidisciplinary discussion produced a change Another potential limitation of the multidisciplinary
in patient management in a minority (about a quarter) of approach is related to legal issues. MTBs represent an
cases. Nevertheless, survival time was no different between instrument of peer review for cancer patients. Due to the
these cases and patients without any variation in plan, sug- confidential nature of the relationship between patient and
gesting that MTB discussion might not have a significant their physician, it might be not so simple to maintain the
impact on outcome.28 In the same paper, the authors also same confidentiality within an MTB. Already in 1987,
focused on institutional resource utilization for MTBs, esti- Gross et al analyzed the prickly question of legal issues
mating total time expenditure of 16.5 hours and a cost of US related to tumor boards, focusing on team members’
$2,035 weekly.28 On the basis of these not-negligible responsibilities in confidentiality and anonymity of every
expenses, MTBs should be available only in those settings patient presented to an MTB.24
where justified by a high number of cases that require critical Furthermore, geographical barriers might represent
decisions, and regular assessment of their effectiveness concrete impediments to achieving an effective multidisci-
should be performed. plinary approach in oncology settings. Regarding extra-
Another potential limitation of the multidisciplinary European regions, MTBs still do not represent a common
approach concerns the quality of the information presented reality in Africa or the Middle East. A consensus of 22
to MTBs that might play a crucial role in team decision- urologists and oncologists from these areas firstly met in
making. Through a cross-sectional, observational study Quatar (February 2012) and then in Dubai (March 2013)
conducted at University Cancer Center Hamburg, to discuss local management of renal cell–carcinoma
a German hospital hosting 16 MTBs, Hahlweg et al eval- patients, frequently in the absence of an MTB. Zekri
uated the quality of single-case information using et al wrote a report on the consensus of opinion reached,
a scoring system with six main variables. Despite high identifying the main barriers to the multidisciplinary
variability among the 16 examined MTBs, data concerning approach and interdisciplinary referral as financial issues,
comorbidities and psychosocial context were almost patients’ social conditions, and deficiency of surgeons.64
always missing or superficially presented, affecting Geographical origin and socioeconomic conditions might
teams’ final decisions and recommendations.62 limit accessibility to national networks and MTBs, even in
Furthermore, low-quality information presented might ren- European countries, with significant urban–rural inequalities,
der the MTB unable to make a decision, especially when especially in the field of rare cancers. As reported in a recent
there is a lack of fundamental reporting (ie, imaging per- paper by Lowes et al, MTBs are not yet widespread, despite
formed at external centers), as deduced from an analysis of national guidelines recommending a multidisciplinary
68 consecutive cases presented at the Lung Oncology approach in the majority of neoplasms, representing a real
MTB of Peter MacCallum Cancer Centre (Melbourne, cornerstone in modern oncology.44 Fayet et al evaluated
Australia) between March and May 2011. In three of 68 efforts of French sarcoma networks in reducing geographical
patients, inadequacy of administrative support in quickly disparities that still affect cancer patients.65 Despite centrali-
finding missing information significantly reduced the zation representing an essential requirement in rare cancer
effectiveness of a multidisciplinary approach.63 Lamb management, with a significant correlation with prognosis,
et al achieved similar results in their prospective long- Sandrucci et al focused on its disadvantages for patients, as
itudinal study evaluating the quality of decision-making the obligation to move to referral centers caused notable
processes in 1,421 urological cancer patients presented to discomfort.60
MTBs of Whipps Cross University Hospital (London, UK) Finally, a multidisciplinary approach might be associated
over 2 years (from 2009 to 2011). Despite significant with treatment delays due to MTB-meeting schedules and
growth in teamwork quality and effectiveness due to frequently longer waiting lists in referral centers. Basse et al
improvement interventions, lacking anamnestic, wrote a retrospective analysis of 274 patients with thymic

submit your manuscript | www.dovepress.com Cancer Management and Research 2020:12

9370
DovePress
Dovepress Berardi et al

epithelial tumors discussed at the national RYTHMIC MTB authors found a high level of agreement — up to 93%.
focusing on postoperative radiotherapy. Despite MTB According to stage, concordance was higher in stage II and
recommendations, several patients did not receive treatment, III cancers. Including receptor status, final choices in triple-
mostly due to excessive delays after surgery, suggesting that negative metastatic breast cancer patients showed less agree-
MTB decisions should be quicker, avoiding any waste of ment than nonmetastatic HER2-positive cases. Different
time30 (Table 1). choices were adopted for patients aged 75 years older also.
Nonconcordance could have derived from different drug
availability in India and the US and differences in demo-
Future Perspectives
graphic characteristics, such as patient choice, comorbidities,
It has been said that humans make decisions by taking into
and presence of caregivers. This study demonstrated how AI
account five variables at most. The increasing complexity
can help clinicians’ decisions in breast cancer treatment,
in management of cancer patients has led to the develop-
notably if expert opinions are not easily achievable.31
ment of computer systems that can help clinicians in
Krupinski et al provided an overview of the use of
choosing the most adequate diagnostic and therapeutic
a software platform — Navify Tumor Board — helping
approach. In this context, Walsh et al provided
specialists improve workflow and preparation for MTBs.
a synopsis of decision-support systems: computer pro-
The authors reported on the experience of the breast can-
grams integrating all possible data, such as clinical history,
cer multidisciplinary team in Hospital del Mar, Barcelona.
imaging, genetics, and costs, to obtain validated predictive
Navify is an oncology-informatics platform facilitating the
models and realize precision medicine.66
coordination, preparation, scheduling, presentation, and
Somashekhar et al’s paper was based on the use of AI as
extraction of clinical, biological, radiological, and other
a possible new approach to consider in multidisciplinary
significant information during preparation of patient cases.
cancer patients care, too. They compared therapeutic choices
Oncologists, surgeons, radiologists, and pathologists took
made in a breast MTB of an expert panel of specialists in
part in this survey, revealing that using health-information
Bangalore, India to that suggested by IBM’s WFO. WFO is
technology can reduce time to provide recommendations
a unique system for oncology-therapy selection, deriving
for cases compared to current methods, rather pathologists
most of its knowledge from literature, protocols, and test
take the same time. Moreover, it is undoubtedly a way of
cases from Memorial Sloan Kettering Cancer Center. The
standardizing the presentation of cancer cases to be dis-
cussed in a multidisciplinary context.67
Table 1 Pros and Cons of the Multidisciplinary Approach
Finally, Gallagher et al proposed the realization of
Pros Cons a clinical database to improve patient care and research,
● Adherence to clinical ● Not a significant impact on describing all phases requested in constituting the
guidelines10,21,23,25–-29,31 outcomes21,28 Genitourinary Oncology Database, created by the
● Mechanism for review of ● High time expenditure and University of North Carolina. This project needed atten-
quality of professional care24 economic cost28 tion by all members of the MTB, accounting for their
● Management of rare tumors ● Low quality of information
personal experience and reviewing literature. Indeed,
and/or with clinical guidelines and lack of fundamental
lacking30,48–-50,57––61 reports presented to
there were several critical features, such as the security
● Improvement of ability to MTBs32,62,63 policy for patient data and reducing errors, in insertion of
reach decisions, quality of ● Excessive not strictly clinical baselines and updating them. The authors hoped that their
information presentation and information might lead to experience could mark the way for similar skills.68
quality of teamwork32,47 contrasting opinions62
● Improvement in patient ● Legal issues related to
outcomes29,35–-39 responsibilities in confidenti-
Conclusion
● Change in diagnostic or treat- ality and anonymity of every
Since its introduction in clinical oncology, multidisciplin-
ment plans23,28,29,40–-46 patient presented to MTBs24 ary management and specifically MTBs have met with
● Improvement in follow-up ● Accessibility to national net- increasing enthusiasm as ways to improve the quality of
accuracy51,52 works and MTBs, owing to patient care. Moreover, MTB implementation in everyday
● Improvement in clinical trial geographic origin and socioe- clinical practice should lead theoretically to increased
screening and patient conomic conditions44,60,64,65
knowledge, awareness, and reduction of anxiety for mem-
recruitment45,53 ● Risk of treatment delays30
bers who participate in discussions of MTBs. Although

submit your manuscript | www.dovepress.com

Cancer Management and Research 2020:12 9371
DovePress
Berardi et al Dovepress

several guidelines suggest that MTBs are crucial in differ- due to more efficiency (and thus better access to diagnostic
ent settings (particularly in rare cancer types), there is resources or treatment options, with an increase in costs).
a lack of general consensus on what can be done to assess Moreover, there is also a cost in terms of additional hours
properly whether MTB determines a real improvement in spent in MTB meetings, a cost that is usually outside that
cancer survival and which methods can be used to prove considered necessary for everyday patient care. Finally,
MTB effectiveness. Our review has shown that almost all MTBs occupy a gray area concerning their role in the
published papers agree on the fact that adherence to guide- patient–physician relationship. Strictly speaking, from
lines is one of the main factors that is encouraged by the a legal point of view there are a few unsolved issues in
implementation of MTB discussions. Since we believe that terms of responsibility. When a treatment decision that
adherence to guidelines is the factor that is more strongly was issued by the MTB (and was “wrong”) and was
associated with quality of treatment (ie, offering what is supported by the treating physician results in damage to
generally considered as must for each patient), we believe the patient, who is to blame? Is it the responsibility of the
that this factor should be the one used to check whether primary treating physician or of the MTB itself?
MTBs are working in an adequate (or not) fashion. These issues will have to be resolved, particularly in
Interestingly, though adherence of guidelines was main- the setting of medical oncology, where owing to the
tained, benefit in overall survival was usually less described, increasing complexity of the disease, it is foolish to
and sometimes adherence to guidelines did not determine believe that the oncologist by themselves is able to make
any change whatsoever in survival outcomes between all the adequate treatment choices for each patient.
patients discussed in MTBs vs those who were managed Nonetheless, as supported by the data that we have
outside the setting of MTBs. This can be partly explained reported, MTBs are also improving with the times, and
by the fact that MTBs take into account decisions based on we believe that with the implementation of novel methods
data that are actually presented in the discussions. There are of computational analysis, they could offer a wider range
a few factors (patient preference, social and financial status, of possibilities and more evidence-based treatment choices
and presence/lack of adequate caregiver) that are rarely dis- for patients who come to ask for our help.
cussed in the meetings (owing also to the lack of studies
inquiring about the real weight of these factors in influencing
Disclosure
treatment decisions). These factors can lead to changes in the
Rossana Berardi reports grants from Astra Zeneca,
proposed treatment plan, particularly when the disease that is
Novartis, Merck Sharp & Dohme, and Lilly and personal
treated is not a rare cancer type, thus reducing the impact of
fees from Otsuka, Boehringer, Merck Sharp & Dohme,
a multidisciplinary meeting recommendation.
and Lilly outside the submitted work. The other authors
Our review has also highlighted that though published
report no conflicts of interest in this work.
papers do support a benefit in implementation of MTB
discussion, there are a few limitations that should be
taken into account to optimize this treatment modality. References
First of all, MTBs are not a substitute for expertise, and 1. El Saghir NS, Keating NL, Carlson RW, Khoury KE, Fallowfield L.
it is required that experience in the management of that Tumor boards: optimizing the structure and improving efficiency of
multidisciplinary management of patients with cancer worldwide. Am
specific disease is proven for all members who participate Soc Clin Oncol Educ Book. 2014;e461–6. doi:10.14694/EdBook_A
in the MTB. For some instances, such as in the case of rare M.2014.34.e461
cancer types, this means that MTBs for the management of 2. Blamey RW, Cataliotti L. EUSOMA accreditation of breast units. Eur
J Cancer. 2006;42(10):1331–1337. doi:10.1016/j.ejca.2006.04.003
these tumor types should only be present in high-volume 3. National Cancer Institute. Defınition of tumor board review. Available
centers where such cases are concentrated. from: http://www.cancer.gov/dictionary?cdrid=322893.
4. Dickhoff C, Dahele M. The multidisciplinary lung cancer team meet-
Furthermore, there is a common misconception con- ing: increasing evidence that it should be considered a medical inter-
cerning MTBs regarding costs. It is usually hypothesized vention in its own right. J Thorac Dis. 2019;11(3):311–314.
that sharing knowledge during the course of MTBs should doi:10.21037/jtd.2019.01.14
5. Vlasto Milligan. Further reports on cases exhibited before the section
lead to improvement in patient survival just for the sake of at previous meetings, session 1921–1922. Proc R Soc Med. 1922;15:
improvement of management of the patient, with no addi- i.1–vii.1.
6. O’Brien JC. History of tumor site conferences at Baylor University
tional cost. All papers focusing on this matter highlighted Medical Center. Proc (Bayl Univ Med Cent). 2006;19(2):130–131.
that MTB implementation leads to an increase in costs, doi:10.1080/08998280.2006.11928145

submit your manuscript | www.dovepress.com Cancer Management and Research 2020:12

9372
DovePress
Dovepress Berardi et al

7. Munro AJ, Swartzman S. What is a virtual multidisciplinary team 25. Riquet M, Mordant P, Henni M, et al. Should all cases of lung cancer
(vMDT)? Br J Cancer. 2013;108(12):2433–2441. doi:10.1038/ be presented at tumor board conferences? Thorac Surg Clin. 2013;23
bjc.2013.231 (2):123–128. doi:10.1016/j.thorsurg.2013.01.003
8. Hermes-Moll K, Dengler R, Riese C, Baumann W. Tumor boards 26. Hollunder S, Herrlinger U, Zipfel M, et al. Cross-sectional increase
from the perspective of ambulant oncological care. Oncol Res Treat. of adherence to multidisciplinary tumor board decisions. BMC
2016;39:377–383. doi:10.1159/000446311 Cancer. 2018;18(1):936. doi:10.1186/s12885-018-4841-4
9. Horlait M, Baes S, Dhaene S, Van Belle S, Leys M. How multidisci- 27. Shah BA, Qureshi MM, Jalisi S, et al. Analysis of decision making at
plinary are multidisciplinary team meetings in cancer care? An observa- a multidisciplinary head and neck tumor board incorporating
tional study in oncology departments in Flanders, Belgium. evidence-based National Cancer Comprehensive Network (NCCN)
J Multidiscip Healthc. 2019;12:159–167. doi:10.2147/JMDH.S196660 guidelines. Pract Radiat Oncol. 2016;6(4):248–254. doi:10.1016/j.
10. Takeda T, Takeda S, Uryu K, et al. Multidisciplinary lung cancer prro.2015.11.006
tumor board connecting eight general hospitals in Japan via a 28. Brauer DG, Strand MS, Sanford DE, et al. Utility of
high-security communication line. JCO Clin Cancer Inform. a multidisciplinary tumor board in the management of pancreatic
2019;3:1–7. doi:10.1200/CCI.18.00115 and upper gastrointestinal diseases: an observational study. HPB.
11. El Saghir NS, Charara RN, Kreidieh FY, et al. Global practice and 2017;19(2):133–139. doi:10.1016/j.hpb.2016.11.002
efficiency of multidisciplinary tumor boards: results of an American 29. Ioannidis A, Konstantinidis M, Apostolakis S, Koutserimpas C,
Society of Clinical Oncology International Survey. J Glob Oncol. Machairas N, Konstantinidis KM. Impact of multidisciplinary tumor
2015;1(2):57–64. doi:10.1200/JGO.2015.000158 boards on patients with rectal cancer. Mol Clin Oncol. 2018;9
12. El Saghir NS, El-Asmar N, Hajj C. Survey of utilization of multi- (2):135–137. doi:10.3892/mco.2018.1658
disciplinary management tumor boards in Arab countries. Breast. 30. Basse C, Thureau S, Bota S, et al. Multidisciplinary tumor board
2011;20(Suppl 2):70–74. doi:10.1016/j.breast.2011.01.011 decision making for postoperative radiotherapy in thymic epithelial
13. Lumenta DB, Sendlhofer G, Pregartner G, et al. Quality of teamwork tumors: insights from the RYTHMIC prospective cohort. J Thorac
in multidisciplinary cancer team meetings: a feasibility study. PLoS Oncol. 2017;12(11):1715–1722. doi:10.1016/j.jtho.2017.07.023
One. 2019;14(2):e0212556. doi:10.1371/journal.pone.0212556 31. Somashekhar SP, Sepúlveda MJ, Puglielli S, et al. Watson for
14. Choy E, Chiu A, Butow P, Young J, Spillane A. A pilot study to Oncology and breast cancer treatment recommendations: agreement
evaluate the impact of involving breast cancer patients in the multi- with an expert multidisciplinary tumor board. Ann Oncol. 2018;29
disciplinary discussion of their disease and treatment plan. Breast. (2):418–423. doi:10.1093/annonc/mdx781
2007;16:178–189. doi:10.1016/j.breast.2006.10.002 32. Lamb BW, Green JS, Benn J, Brown KF, Vincent CA, Sevdalis N.
15. Butow P, Harrison J, Choy E, Young J, Spillane A, Evans A. Health Improving decision making in multidisciplinary tumor boards: pro-
professional and consumer views on involving breast cancer patients spective longitudinal evaluation of a multicomponent intervention for
in the multidisciplinary discussion of their disease and treatment plan. 1,421 patients. J Am Coll Surg. 2013;217(3):412–420. doi:10.1016/j.
Cancer. 2007;110:1937–1944. doi:10.1002/cncr.23007 jamcollsurg.2013.04.035
16. Siddique O, Yoo ER, Perumpail RB, et al. The importance of 33. Shah S, Arora S, Atkin G, et al. Decision-making in colorectal cancer
a multidisciplinary approach to hepatocellular carcinoma. tumor board meetings: results of a prospective observational
J Multidiscip Healthc. 2017;Volume 10(10):95–100. doi:10.2147/ assessment. Surg Endosc. 2014;28(10):2783–2788. doi:10.1007/
JMDH.S128629 s00464-014-3545-3
17. Rainone F. Treating adult cancer pain in primary care. J Am Board 34. Jalil R, Akhter W, Lamb BW, et al. Validation of team performance
Fam Pract. 2004;17(Suppl 1):S48–56. doi:10.3122/jabfm.17.suppl_1. assessment of multidisciplinary tumor boards. J Urol. 2014;192
S48 (3):891–898. doi:10.1016/j.juro.2014.03.002
18. Johnston MJ, King D, Arora S, et al. Smartphones let surgeons know 35. Serper M, Taddei TH, Mehta R, et al.; VOCAL Study Group.
WhatsApp: an analysis of communication in emergency surgical Association of provider specialty and multidisciplinary care with
teams. Am J Surg. 2015;209(1):45–51. doi:10.1016/j. hepatocellular carcinoma treatment and mortality. Gastroenterology.
amjsurg.2014.08.030 2017;152(8):1954–1964. doi:10.1053/j.gastro.2017.02.040.
19. Mascia D, Rinninella E, Pennacchio NW, Cerrito L, Gasbarrini A. It’s 36. Agarwal PD, Phillips P, Hillman L, et al. Multidisciplinary manage-
how we communicate! Exploring face-to-face versus electronic com- ment of hepatocellular carcinoma improves access to therapy and
munication networks in multidisciplinary teams. Health Care patient survival. J Clin Gastroenterol. 2017;51(9):845–849.
Manage Rev. 2019. doi:10.1097/HMR.0000000000000246 doi:10.1097/MCG.0000000000000825
20. Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. 37. Liu JC, Kaplon A, Blackman E, Miyamoto C, Savior D, Ragin C.
Preferred reporting items for systematic reviews and meta-analyses: The impact of the multidisciplinary tumor board on head and neck
the PRISMA statement. Int J Surg. 2010;8:336–431. doi:10.1016/j. cancer outcomes. Laryngoscope. 2019;130:946–950.
ijsu.2010.02.007 38. Blay JY, Soibinet P, Penel N, et al. Improved survival using specia-
21. Croke JM, El-Sayed S. Multidisciplinary management of cancer lized multidisciplinary board in sarcoma patients. Ann Oncol.
patients: chasing a shadow or real value? An overview of the 2017;28(11):2852–2859. doi:10.1093/annonc/mdx484
literature. Curr Oncol. 2012;19(4):e232–8. doi:10.3747/co.19.944 39. Kesson EM, Allardice GM, George WD, Burns HJ, Morrison DS.
22. Kabat GC, Matthews CE, Kamensky V, Hollenbeck AR, Rohan TE. Effects of multidisciplinary team working on breast cancer survival:
Adherence to cancer prevention guidelines and cancer incidence, retrospective, comparative, interventional cohort study of 13 722
cancer mortality, and total mortality: a prospective cohort study. Am women. BMJ. 2012;344:e2718. doi:10.1136/bmj.e2718
J Clin Nutr. 2015;101(3):558–569. doi:10.3945/ajcn.114.094854 40. Newman EA, Guest AB, Helvie MA, et al. Changes in surgical
23. Jury RP, Nadeau L, Wasvary H, Levine R, Robertson J. management resulting from case review at a breast cancer multi-
Implementing a multidisciplinary open-access clinic at a private disciplinary tumor board. Cancer. 2006;107(10):2346–2351.
practice-based community hospital. J Oncol Pract. 2010;6(6):e38– doi:10.1002/cncr.22266
41. doi:10.1200/JOP.2010.000029 41. Lee B, Kim K, Choi JY, et al. Efficacy of the multidisciplinary tumor
24. Gross GE. The role of the tumor board in a community hospital. CA board conference in gynecologic oncology: a prospective study.
Cancer J Clin. 1987;37(2):88–92. doi:10.3322/canjclin.37.2.88 Medicine. 2017;96(48):e8089. doi:10.1097/MD.0000000000008089

submit your manuscript | www.dovepress.com

Cancer Management and Research 2020:12 9373
DovePress
Berardi et al Dovepress

42. Wheless SA, McKinney KA, Zanation AM. A prospective study of 55. Mañós M, Giralt J, Rueda A, et al. Multidisciplinary management of
the clinical impact of a multidisciplinary head and neck tumor board. head and neck cancer: first expert consensus using Delphi methodol-
Otolaryngol Head Neck Surg. 2010;143:650–654. doi:10.1016/j. ogy from the Spanish Society for Head and Neck Cancer (part 1).
otohns.2010.07.020 Oral Oncol. 2017;70:58–64. doi:10.1016/j.oraloncology.2017.04.004
43. AlFarhan HA, Algwaiz GF, Alzahrani HA, et al. Impact of GI tumor 56. Rueda A, Giralt J, Mañós M, et al. Multidisciplinary management of
board on patient management and adherence to guidelines. J Glob head and neck cancer: first expert consensus using Delphi methodol-
Oncol. 2018;4:1–8. doi:10.1200/JGO.17.00164 ogy from the Spanish Society for Head and Neck Cancer (part 2).
44. Lowes M, Kleiss M, Lueck R, et al. The utilization of multidisci- Oral Oncol. 2017;70:65–72. doi:10.1016/j.oraloncology.2017.04.005
plinary tumor boards (MDT) in clinical routine: results of a health 57. Bajetta E, Celio L, Platania M, et al. Single-institution series of
care research study focusing on patients with metastasized colorectal early-stage Merkel cell carcinoma: long-term outcomes in 95 patients
cancer. Int J Colorectal Dis. 2017;32(10):1463–1469. doi:10.1007/ managed with surgery alone. Ann Surg Oncol. 2009;16
s00384-017-2871-z (11):2985–2993. doi:10.1245/s10434-009-0615-1
45. Pawlik TM, Laheru D, Hruban RH, et al.; Johns Hopkins 58. Taddei TH. A multidisciplinary approach: group dynamics. J Clin
Multidisciplinary Pancreas Clinic Team. Evaluating the impact of a Gastroenterol. 2013;47:S27–9. doi:10.1097/MCG.0b013e3182
single-day multidisciplinary clinic on the management of pancreatic 9331de
cancer. Ann Surg Oncol. 2008;15(8):2081–2088. doi:10.1245/s10434- 59. Asghar AH, Abbasi AN, Jamal A, Haider G, Rizvi S. City tumour
008-9929-7. board Karachi: an innovative step in multidisciplinary consensus
46. Deressa BT, Cihoric N, Tefesse E, Assefa M, Zemenfes D. meeting and its two years audit. J Pak Med Assoc. 2013;63
Multidisciplinary Cancer Management of Colorectal Cancer in (12):1534–1535.
Tikur Anbessa Specialized Hospital, Ethiopia. J Glob Oncol. 60. Sandrucci S, Naredi P, Bonvalot S. Centers of excellence or excel-
2019;5:1–7. doi:10.1200/JGO.19.00014 lence networks: the surgical challenge and quality issues in rare
47. Solomon D, DeNicola N, Feferman Y, et al. Assessing the cancers. Eur J Surg Oncol. 2019;45(1):19–21. doi:10.1016/j.
Implementation of American College of Surgeons Quality ejso.2017.12.012
Indicators for Pancreatic Cancer Across an Integrated Health 61. Bui NQ, Wang DS, Hiniker SM. Contemporary management of
System. J Oncol Pract. 2019;15(8):e739–e745. doi:10.1200/ metastatic soft tissue sarcoma. Curr Probl Cancer. 2019;43
JOP.18.00587 (4):289–299. doi:10.1016/j.currproblcancer.2019.06.005
48. Wotman M, Ghaly M, Massaro L, et al. Management of the neck 62. Hahlweg P, Didi S, Kriston L, Härter M, Nestoriuc Y, Scholl I.
after definitive chemoradiation in patients with HPV-associated oro- Process quality of decision-making in multidisciplinary cancer team
pharyngeal cancer: an institutional experience. Am J Otolaryngol. meetings: a structured observational study. BMC Cancer. 2017;17
2019;40(5):684–690. doi:10.1016/j.amjoto.2019.06.003 (1):772. doi:10.1186/s12885-017-3768-5
49. Herlemann A, Washington SL, Cooperberg MR. Health care delivery 63. Ung KA, Campbell BA, Duplan D, Ball D, David S. Impact of the
for metastatic hormone-sensitive prostate cancer across the globe. lung oncology multidisciplinary team meetings on the management
Eur Urol Focus. 2019;5(2):155–158. doi:10.1016/j.euf.2018.12.003 of patients with cancer. Asia Pac J Clin Oncol. 2016;12(2):e298–304.
50. Fazio N, Ungaro A, Spada F, et al. The role of multimodal treatment doi:10.1111/ajco.12192
in patients with advanced lung neuroendocrine tumors. J Thorac Dis. 64. Zekri J, Dreosti LM, Ghosn M, et al. Multidisciplinary management
2017;9(Suppl 15):S1501–S1510. doi:10.21037/jtd.2017.06.14 of clear-cell renal cell carcinoma in Africa and the Middle East:
51. Rubins J, Unger M, Colice GL; American College of Chest current practice and recommendations for improvement.
Physicians. Follow-up and surveillance of the lung cancer patient J Multidiscip Healthc. 2015;27(8):335–344. doi:10.2147/JMDH.
following curative intent therapy: ACCP evidence-based clinical S85538
practice guideline (2nd edition). Chest. 2007;132(3):355S–367S. 65. Fayet Y, Coindre JM, Dalban C, et al. Geographical accessibility of
doi:10.1378/chest.07-1390 the referral networks in France. Intermediate results from the IGéAS
52. Gambazzi F, Frey LD, Bruehlmeier M, et al. Image analysis in research program. Int J Environ Res Public Health. 2018;15
posttreatment non-small cell lung cancer surveillance: specialists’ (10):2204. doi:10.3390/ijerph15102204
interpretations reviewed by the thoracic multidisciplinary tumor 66. Walsh S, de Jong EEC, van Timmeren JE, et al. Decision support
board. Multidiscip Respir Med. 2019;14:34. doi:10.1186/s40248- systems in oncology. JCO Clin Cancer Inform. 2019;3:1–9.
019-0198-z doi:10.1200/CCI.18.00001
53. Kuroki L, Stuckey A, Hirway P, et al. Addressing clinical trials: can 67. Krupinski EA, Comas M; Gallego LG on behalf of the GISMAR
the multidisciplinary tumor board improve participation? A study Group. A new software platform to improve multidisciplinary tumor
from an academic women’s cancer program. Gynecol Oncol. board workflows and user satisfaction: a pilot study. J Pathol Inform.
2010;116(3):295–300. doi:10.1016/j.ygyno.2009.12.005 2018;9:26. doi:10.4103/jpi.jpi_16_18
54. van de Velde CJ, Boelens PG, Borras JM, et al. EURECCA color- 68. Gallagher SA, Smith AB, Matthews JE, et al. Roadmap for the
ectal: multidisciplinary management: European consensus conference development of the University of North Carolina at Chapel Hill
colon & rectum. Eur J Cancer. 2014;50(1):1–e1. doi:10.1016/j. Genitourinary OncoLogy Database–UNC GOLD. Urol Oncol.
ejca.2013.06.048 2014;32(1):32–e1. doi:10.1016/j.urolonc.2012.11.019

Cancer Management and Research Dovepress

Publish your work in this journal
Cancer Management and Research is an international, peer-reviewed The manuscript management system is completely online and includes
open access journal focusing on cancer research and the optimal use of a very quick and fair peer-review system, which is all easy to use.
preventative and integrated treatment interventions to achieve improved Visit http://www.dovepress.com/testimonials.php to read real quotes
outcomes, enhanced survival and quality of life for the cancer patient. from published authors.

Submit your manuscript here: https://www.dovepress.com/cancer-management-and-research-journal

submit your manuscript | www.dovepress.com Cancer Management and Research 2020:12

9374
DovePress