Collaborative case conferences in rectal cancer: case series in a tertiary care centre.
BACKGROUND
In many hospitals, resource barriers preclude the use of preoperative multidisciplinary cancer conferences (mccs) for consecutive patients with cancer. Collaborative cancer conferences (cccs) are modified mccs that might overcome such barriers.


METHODS
We established a ccc at an academic tertiary care centre to review preoperative plans for patients with rectal cancer. Attendees included only surgeons who perform colorectal cancer procedures and a radiologist with expertise in cross-sectional imaging. Individual reviews began with the primary surgeon presenting the case information and initial treatment recommendations. Cross-sectional images were then reviewed, the case was discussed, and consensus on ccc-treatment recommendations was achieved. Outcomes for the present study were changes in treatment recommendations defined as "major" (that is, redirection of patient to preoperative radiation from straight-to-surgery or uncertain plan, or redirection of the patient to straight-to-surgery from preoperative radiation or plan uncertain) or as "minor" (that is, referral to a multidisciplinary cancer clinic, request additional tests, change type of neoadjuvant therapy, change type of surgery). Chart reviews provided relevant patient, tumour, and treatment information.


RESULTS
Between September 2011 and September 2012, 101 rectal cancer patients were discussed at a ccc. Of the 35 management plans (34.7%) that were changed as a result, 8 had major changes, and 27 had minor changes. Available patient and tumour factors did not predict for a change in treatment recommendation.


CONCLUSIONS
Preoperative cccs at a tertiary-care centre changed treatment recommendations for one third of patients with rectal cancer. Given that no specific factor predicted for a treatment plan change, it is likely prudent that all rectal cancer patients undergo some form of collaborative review.
Department of Surgery, Faculty of Health Sciences, McMaster University, Hamilton, ON;
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Eskicioglu
Department of Surgery, Faculty of Health Sciences, McMaster University, Hamilton, ON;
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Forbes
Department of Radiology, Faculty of Health Sciences, McMaster University, Hamilton, ON;
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Tsai
Department of Surgery, Roswell Park Cancer Institute, Buffalo, NY, U.S.A.;
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Francescutti
Department of Surgery, Faculty of Health Sciences, McMaster University, Hamilton, ON;
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Coates
Department of Surgery, Faculty of Health Sciences, McMaster University, Hamilton, ON;
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Grubac
Department of Surgery, Faculty of Health Sciences, McMaster University, Hamilton, ON;
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Sonnadara
Department of Surgery, Faculty of Health Sciences, McMaster University, Hamilton, ON;; Escarpment Cancer Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, ON.
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Simunovic
Colorectal or anal neoplasia