title: Effects of multidisciplinary team working on breast cancer survival: retrospective, comparative, interventional cohort study of 13 722 women.
abstract: OBJECTIVE
  To describe the effect of multidisciplinary care on survival in women treated for breast cancer.
  
  
  METHODS
  Retrospective, comparative, non-randomised, interventional cohort study.
  
  
  METHODS
  NHS hospitals, health boards in the west of Scotland, UK.
  
  
  METHODS
  14,358 patients diagnosed with symptomatic invasive breast cancer between 1990 and 2000, residing in health board areas in the west of Scotland. 13,722 (95.6%) patients were eligible (excluding 16 diagnoses of inflammatory cancers and 620 diagnoses of breast cancer at death).
  
  
  METHODS
  In 1995, multidisciplinary team working was introduced in hospitals throughout one health board area (Greater Glasgow; intervention area), but not in other health board areas in the west of Scotland (non-intervention area).
  
  
  METHODS
  Breast cancer specific mortality and all cause mortality.
  
  
  RESULTS
  Before the introduction of multidisciplinary care (analysed time period January 1990 to September 1995), breast cancer mortality was 11% higher in the intervention area than in the non-intervention area (hazard ratio adjusted for year of incidence, age at diagnosis, and deprivation, 1.11; 95% confidence interval 1.00 to 1.20). After multidisciplinary care was introduced (time period October 1995 to December 2000), breast cancer mortality was 18% lower in the intervention area than in the non-intervention area (0.82, 0.74 to 0.91). All cause mortality did not differ significantly between populations in the earlier period, but was 11% lower in the intervention area than in the non-interventional area in the later period (0.89, 0.82 to 0.97). Interrupted time series analyses showed a significant improvement in breast cancer survival in the intervention area in 1996, compared with the expected survival in the same year had the pre-intervention trend continued (P=0.004). This improvement was maintained after the intervention was introduced.
  
  
  CONCLUSIONS
  Introduction of multidisciplinary care was associated with improved survival and reduced variation in survival among hospitals. Further analysis of clinical audit data for multidisciplinary care could identify which aspects of care are most associated with survival benefits.
authors.affiliation: NHS Greater Glasgow and Clyde, West House, Gartnavel Royal Hospital, Glasgow, UK. Eileen.Kesson@nhs.net
authors.forename: Eileen M
authors.initials: EM
authors.lastname: Kesson
authors.forename: Gwen M
authors.initials: GM
authors.lastname: Allardice
authors.forename: W David
authors.initials: WD
authors.lastname: George
authors.forename: Harry J G
authors.initials: HJ
authors.lastname: Burns
authors.forename: David S
authors.initials: DS
authors.lastname: Morrison
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000628:therapy; D015331:Cohort Studies; D016001:Confidence Intervals; D019468:Disease Management; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D016522:Oncology Service, Hospital / Q000458:organization & administration / Q000592:standards; D010348:Patient Care Team / Q000458:organization & administration / Q000592:standards; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012606:Scotland; D013222:State Medicine; D014932:Women's Health Services / Q000458:organization & administration / Q000592:standards