title: Multidisciplinary cancer conferences for gastrointestinal malignancies result in measureable treatment changes: a prospective study of 149 consecutive patients.
abstract: BACKGROUND
  In most jurisdictions, a minority of patients are discussed at multidisciplinary cancer conference (MCC) despite recommendations for such reviews. We assessed the impact of MCC review of gastrointestinal (GI) cancers at a stand-alone cancer center.
  
  
  METHODS
  Patient data were prospectively collected on consecutive cases presented at a GI MCC during a 6-month period. Original treatment plans were collected confidentially before presentation and compared to post-MCC treatment plans. We defined changes in management plans as major (change in treatment modality) or minor (testing prior to original plan).
  
  
  RESULTS
  A total of 149 cases were evaluated: 115 upper GI (gastric/small bowel-10 %, liver-32 %, pancreaticobiliary-36 %), and 34 lower GI (23 %). Reasons for presentation were: questions regarding progression/metastases (44 %), management (26 %), diagnosis (21 %), pathology (15 %), and resectability (7 %). Physicians were certain of their original plans being the final recommendations in 84 % (n = 125). Change in management was recommended in 36 %; 72 % were major and 28 % were minor. Patients underwent all recommended treatments at our institution in 77 % of cases, a portion in 5 %, and no recommended treatments in 18 %. On multivariate analysis, physician degree of certainty for original management plan was not predictive of a change in management plan (p = 0.61).
  
  
  CONCLUSIONS
  Although certainty of prediscussion treatment plan is high, changes in treatment recommendations occurred in more than one-third of patients after GI MCC. This prospective study demonstrates the value of MCC in GI cancer sites, even at a stand-alone cancer center.
authors.affiliation: Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA, jackieofrg@yahoo.com.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Oxenberg
authors.forename: Wesley
authors.initials: W
authors.lastname: Papenfuss
authors.forename: Iyare
authors.initials: I
authors.lastname: Esemuede
authors.forename: Kristopher
authors.initials: K
authors.lastname: Attwood
authors.forename: Marko
authors.initials: M
authors.lastname: Simunovic
authors.forename: Boris
authors.initials: B
authors.lastname: Kuvshinoff
authors.forename: Valerie
authors.initials: V
authors.lastname: Francescutti
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D005770:Gastrointestinal Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010347:Patient Care Planning; D010348:Patient Care Team; D011379:Prognosis; D011446:Prospective Studies; D055815:Young Adult