title: Colorectal multidisciplinary meeting audit to determine patient benefit.
abstract: BACKGROUND
  New Zealand tumour standards require discussion of all cases of colorectal cancer in a multidisciplinary meeting (MDM), but supporting evidence is lacking. The aim was to determine which patients benefit from MDM discussion.
  
  
  METHODS
  A retrospective and prospective audit was undertaken of all patients discussed in the Christchurch Hospital colorectal MDM over 12 months to November 2014, who were compared with contemporaneous patients not discussed and identified through Hospital discharge codes.
  
  
  RESULTS
  In total, 641 patients were identified, with 459 (70%) discussed in the MDM, on average 7 years younger than not discussed. The proportion discussed by location was 39.2% colon, 63% rectosigmoid, 98% rectal, 96.6% anal. Discussed patients were more likely to have magnetic resonance imaging (68% cf 9.3%), fluorodeoxyglucose positron emission tomography scan (18% versus 2%) and chest computerized tomography scan (50% versus 26%). For colon cancer, American Joint Committee on Cancer (AJCC) stage I and II, 91% of 68 non-discussed patients went straight to surgery compared with 48% of 27 discussed in the MDM; for AJCC stage III uptake of adjuvant chemotherapy was the same whether discussed or not. An R0 resection was achieved for 91% of discussed patients, and 96% of not discussed. A clear referrer's plan, prospectively recorded in 94 patients, was changed after the MDM in 23%. Clinical staging was changed in 20 patients (4%), none with colon cancers.
  
  
  CONCLUSIONS
  Discussion in the MDM influenced management, but was unlikely to change management for AJCC stage I/II colon cancer, who could be spared mandatory review in the MDM and be discussed selectively as treating clinicians decide.
authors.affiliation: University of Otago, Christchurch, Christchurch, New Zealand.
authors.forename: Chris
authors.initials: C
authors.lastname: Fernando
authors.affiliation: Department of Surgery, University of Otago, Christchurch, Christchurch, New Zealand.|Christchurch Colorectal, Christchurch, New Zealand.
authors.forename: Frank
authors.initials: F
authors.lastname: Frizelle
authors.affiliation: Department of Surgery, University of Otago, Christchurch, Christchurch, New Zealand.|Christchurch Colorectal, Christchurch, New Zealand.
authors.forename: Chris
authors.initials: C
authors.lastname: Wakeman
authors.affiliation: Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand.
authors.forename: Chris
authors.initials: C
authors.lastname: Frampton
authors.affiliation: Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand.|Oncology Service, Canterbury District Health Board, Christchurch, New Zealand.
authors.forename: Bridget
authors.initials: B
authors.lastname: Robinson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant / Q000379:methods; D054869:Clinical Audit / Q000379:methods*; D015179:Colorectal Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D019468:Disease Management; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data; D008297:Male; D009367:Neoplasm Staging / Q000379:methods; D009520:New Zealand / Q000453:epidemiology; D000072078:Positron Emission Tomography Computed Tomography / Q000706:statistics & numerical data; D011446:Prospective Studies; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data
keywords: clinical audit; colorectal neoplasm; meeting; multidisciplinary team; staging