448 SYSTEMATIC IMPLEMENTATION OF A REGIONAL MULTIDISCIPLINARY TEAM MEETING IMPROVES PROGNOSIS FOR ESOPHAGEAL CANCER PATIENTS. (14th September 2020)

• Record Type: Journal Article
• Authors: Luijten, J; Haagsman, V; Luyer, M; Heesakkers, F; Schrauwen, R; Jürgens, M; Buster, E; Vincent, J; Kneppelhout, J; Verhoeven, R; Nieuwenhuijzen, G
• Is Part Of: Diseases of the esophagus. Volume 33(2020)Supplement 1
• Publication Date: 2020-09-14
• Subjects: Esophagus -- Diseases -- Periodicals; 616.32
• DOI: 10.1093/dote/doaa087.112
• Languages: English
• ISSNs: 1120-8694

Abstract

Abstract: : Surgery for esophageal cancer (EC) has been centralized in the Netherlands. However, patients are still diagnosed in referral centers and not all patients are discussed with a resection center. The aim of this study was to examine the impact of the implementation of the regional Upper-GI video multidisciplinary team meeting (MDT) in the Eindhoven region in which all regional patients should be discussed, on the decision-making process, treatment, and survival of patients with EC. Methods: All patients diagnosed between 2012 and 2018 with EC, in hospitals currently working together with the Catharina hospital, were selected from the Netherlands Cancer Registry (n = 1119). The regional MDT was implemented in 2 hospitals in May 2014 and the other hospitals gradually joined. The primary outcome of this study was the proportion of patients discussed in any MDT. Secondary outcomes were involvement of a resection center in MDT, treatment and survival. Outcomes were described prior to and after participation in the regional MDT and analyzed by chi-square tests. Kaplan–Meier curves and log-rank tests were used to compare overall survival. Results: Since participation in the regional MDT more patients were discussed in any MDT (80%-89%, p < 0.0001) and involvement of a resection center during the MDT almost doubled (43%-82%, p < 0.0001). The proportion of patient who underwent treatment with a curative intent remained the same (75%). However, esophagectomy (41%-43%) and endoscopic resections (2%-6%) were performed more often and the use of definitive chemoradiation therapy decreased (31%-25%)(p = 0.049). The use of palliative systemic therapy increased (39%-52%, p < 0.001). Three-year overall survival for all EC patients increased significantly (24%-32%, p < 0.02)(Figure). A non-significant increase in 3-year survival in potentially curable patients (38%-48%, p = 0.09) and 1-year survival in palliative patients (18%-26%, p = 0.13) was observed. Conclusion: After implementation of the regional MDT more EC patients were discussed during a MDT and also more often with the involvement of a resection center. This is the first study showing an association of the implementation of a regional MDT with an improved survival. Hypothetically, the implementation of the regional tumor specific video MDT could have had a positive effect on the quality and effectiveness of decision making in patients diagnosed with EC.