title: Beneficial impact of multidisciplinary team management on the survival in different stages of oral cavity cancer patients: results of a nationwide cohort study in Taiwan.
abstract: OBJECTIVE
  The aim of this study was to investigate the association between multidisciplinary team (MDT) management and survival of oral cavity cancer patients using a nationwide database in Taiwan.
  
  
  METHODS
  A nationwide cohort study was conducted between 2005 and 2008. The follow-up end point was 2010. Claims data of oral cavity cancer patients were retrieved from the Taiwan Cancer Registry Database. Secondary data were obtained from the Taiwan's National Health Insurance Research Database. Among 19,766 newly diagnosed oral cavity cancer patients, we identified 16,991 patients who underwent treatment between 2004 and 2008 for further analyses.
  
  
  RESULTS
  Overall survival was compared between patients who received MDT management (n=3324) and those who did not (n=13,367). Hazard ratios (HR) of death in patients with MDT management were also analyzed. Patients with MDT management had a lower risk of death when compared with that of patients without MDT management (HR: 0.94, 95% confidence intervals (CI): 0.89-1.00; P=0.032). The effect of MDT management on survival was stronger for male patients than for female patients (HR: 0.94, 95% CI: 0.89-1.00; P=0.040 versus HR: 0.98, 95% CI: 0.75-1.27; P=0.866). In addition, the effect of MDT management was strong among patients with a Charlson Comorbidity Index between 4 and 6, in those without coexisting catastrophic illness/injury, and in patients with stage IV diseases.
  
  
  CONCLUSIONS
  Survival rates in oral cavity cancer patients with MDT management appeared to be marginally better than those of patients without MDT management.
authors.affiliation: Department of Health Services Administration, China Medical University, Taichung, Taiwan.
authors.forename: Wen-Chen
authors.initials: WC
authors.lastname: Tsai
authors.affiliation: Department of Healthcare Administration, Asia University, Taichung, Taiwan.
authors.forename: Pei-Tseng
authors.initials: PT
authors.lastname: Kung
authors.affiliation: Department of Health Services Administration, China Medical University, Taichung, Taiwan.
authors.forename: Shih-Ting
authors.initials: ST
authors.lastname: Wang
authors.affiliation: Department of Health Services Administration, China Medical University, Taichung, Taiwan.
authors.forename: Kuang-Hua
authors.initials: KH
authors.lastname: Huang
authors.affiliation: Department of Otolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan. Electronic address: saliu@vghtc.gov.tw.
authors.forename: Shih-An
authors.initials: SA
authors.lastname: Liu
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000628:therapy*; D010348:Patient Care Team; D013624:Taiwan
keywords: Beneficial impact; Multidisciplinary team; Nationwide database; Oral cavity cancer; Propensity score; Survival analysis