Breast cancer: multidisciplinary care and clinical outcomes.
A multidisciplinary approach to the management of breast cancer is the standard of care in developed health systems. We performed a systematic review to assess the extent and quality of evidence on whether multidisciplinary care (MDC), or related aspects of care contribute to clinical outcomes in breast cancer, and in particular whether these influence survival. Only two primary studies have looked at MDC and neither of these studies considered long-term outcomes. The studies of MDC (case series) provide weak evidence that MDC may alter treatment patterns. Several population-based cohort studies showed that related aspects of team work, specialist (surgeon) and hospital workload and specialisation, are associated with improved survival. This group of studies used better quality design with more clearly defined outcome measures, and most of the studies have allowed for possible confounding variables. Evidence of a survival benefit was most consistent for specialist (surgeon) effect. However, the reasons behind the improved survival reported in these studies are unclear, and it is unlikely that this is entirely attributable to treatment patterns. We conclude that although intrinsically multidisciplinary care should be associated with better survival, there remains a paucity of evidence to support this. Studies of the long-term clinical effects of MDC in breast cancer should be a priority for future evaluation.
Houssami
Nehmat
N
Screening and Test Evaluation Program (STEP), School of Public Health, A27, University of Sydney, Sydney, NSW 2006, Australia. nehmath@health.usyd.edu.au
Sainsbury
Richard
R
D001943:Breast Neoplasms / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D010348:Patient Care Team / Q000458:organization & administration / Q000592:standards*; D016019:Survival Analysis; D016896:Treatment Outcome