title: Multidisciplinarity and medical decision, impact for patients with cancer: sociological assessment of two tumour committees' organization.
abstract: OBJECTIVE
  Medical practices in oncology are expected to be multidisciplinary, yet few articles studied how this may be concretely applied. In the present study, we evaluated the organization of two multidisciplinary committees, one for breast cancer and one for sarcoma, in a French Comprehensive Cancer Centre.
  
  
  METHODS
  Both tumours were specifically chosen so as to emphasise substantial differences in relation with incidence, histological subtypes, management strategy, and scientific evidence. Between 2003 and 2004, 404 decision processes were observed, 210 for sarcoma (26 meetings) and 194 for breast cancer (10 meetings). The number of physicians who took part in the discussions and their medical specialties were systematically noted as well as the number of contradictory discussions, medical specialties represented in these contradictory discussions and the topics of contradiction. The last measured data was whether the final committee's decision was in conformity with the referent preferences or not. All these measures were related to the referent's medical speciality and working place, to the stage of the disease and to the disease management stage.
  
  
  RESULTS
  Committees' specificities concerned their organization, referent's medical specialties, the number of participants in discussions and their medical specialties. Discussions in the sarcoma committee tended to be more multidisciplinary, involving more specialties. Initial strategy proposal for one patient was modified during the discussions for 86 patients out of 210 (41%) and for 62 out of 194 (32%) respectively for sarcoma and breast cancer. However, there was no significant difference in the rate of contradictory discussions between breast cancer and sarcoma committees (32% versus 41% respectively; P = 0.08). The rates of contradictory discussions were similar for localized cancers, local relapse and metastasis disease (37%, 41% and 34% respectively; P = 0.86).
  
  
  CONCLUSIONS
  The present study reports more than 30% of changes concerning strategy for patient with cancer due to multidisciplinary discussions. This indicates that, providing tumour committees are adapted to the pathologies' characteristics, they can promote a collective and multidisciplinary approach to oncology.
authors.affiliation: Centre Leon-Bérard, Lyon, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Castel
authors.forename: Louis
authors.initials: L
authors.lastname: Tassy
authors.forename: Antoine
authors.initials: A
authors.lastname: Lurkin
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Blay
authors.forename: Pierre
authors.initials: P
authors.lastname: Meeus
authors.forename: Herve
authors.initials: H
authors.lastname: Mignotte
authors.forename: Christelle
authors.initials: C
authors.lastname: Faure
authors.forename: Dominique
authors.initials: D
authors.lastname: Ranchere-Vince
authors.forename: Thomas
authors.initials: T
authors.lastname: Bachelot
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Guastalla
authors.forename: Marie-Pierre
authors.initials: MP
authors.lastname: Sunyach
authors.forename: Nicole
authors.initials: N
authors.lastname: Guerin
authors.forename: Isabelle
authors.initials: I
authors.lastname: Treilleux
authors.forename: Perrine
authors.initials: P
authors.lastname: Marec-Berard
authors.forename: Philippe
authors.initials: P
authors.lastname: Thiesse
authors.forename: Isabelle
authors.initials: I
authors.lastname: Ray-Coquard
mesh_terms: D026683:Advisory Committees / Q000458:organization & administration* / Q000706:statistics & numerical data; D001943:Breast Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*; D002173:Cancer Care Facilities; D032921:Consensus; D003657:Decision Making; D005260:Female; D005602:France; D013502:General Surgery / Q000706:statistics & numerical data; D006127:Group Structure; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D008495:Medical Oncology / Q000706:statistics & numerical data; D008511:Medicine; D010338:Pathology, Clinical / Q000706:statistics & numerical data; D010348:Patient Care Team / Q000458:organization & administration* / Q000706:statistics & numerical data; D018787:Radiation Oncology / Q000706:statistics & numerical data; D011871:Radiology / Q000706:statistics & numerical data; D012509:Sarcoma / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*