The influence of multidisciplinary team meetings on treatment decisions in advanced bladder cancer
BlaZIB Study Group
(2023) BJU International, volume 131, issue 2, pp. 244 - 252
(Article)
Abstract
OBJECTIVES: To investigate the role of specialised genitourinary multidisciplinary team meetings (MDTMs) in decision-making and identify factors that influence the probability of receiving a treatment plan with curative intent for patients with muscle invasive bladder cancer (MIBC). PATIENTS AND METHODS: Data relating to patients with cT2-4aN0/X-1 M0 urothelial cell carcinoma, diagnosed
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between November 2017 and October 2019, were selected from the nationwide, population-based Netherlands Cancer Registry ('BlaZIB study'). Curative treatment options were defined as radical cystectomy (RC) with or without neoadjuvant chemotherapy, chemoradiation or brachytherapy. Multilevel logistic regression analyses were used to examine the association between MDTM factors and curative treatment advice and how this advice was followed. RESULTS: Of the 2321 patients, 2048 (88.2%) were discussed in a genitourinary MDTM. Advanced age (>80 years) and poorer World Health Organization performance status (score 1-2 vs 0) were associated with no discussion (P < 0.001). Being discussed was associated with undergoing treatment with curative intent (odds ratio [OR] 3.0, 95% confidence interval [CI] 1.9-4.9), as was the involvement of a RC hospital (OR 1.70, 95% CI 1.09-2.65). Involvement of an academic centre was associated with higher rates of bladder-sparing treatment (OR 2.05, 95% CI 1.31-3.21). Patient preference was the main reason for non-adherence to treatment advice. CONCLUSIONS: For patients with MIBC, the probability of being discussed in a MDTM was associated with age, performance status and receiving treatment with curative intent, especially if a representative of a RC hospital was present. Future studies should focus on the impact of MDTM advice on survival data.
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Keywords: #BladderCancer, #blcsm, #uroonc, curative intent treatment, multidisciplinary team meeting, muscle-invasive bladder cancer, radical cystectomy hospital, treatment advice, Neoplasm Invasiveness, Humans, Patient Care Team, Cystectomy, Urinary Bladder Neoplasms/surgery, Aged, 80 and over, Neoadjuvant Therapy, Urinary Bladder/pathology, Urology, Journal Article
ISSN: 1464-4096
Publisher: Wiley-Blackwell
Note: Funding Information: The authors also thank the registration team of the Netherlands Comprehensive Cancer Organization (IKNL) for the collection of data for the Netherlands Cancer Registry. The BlaZIB study is funded by the Dutch Cancer Society (KWF; IKNL 2015‐7914). The funding agency had no role in the design, analysis, and interpretation of the results of this study. Funding Information: The authors also thank the registration team of the Netherlands Comprehensive Cancer Organization (IKNL) for the collection of data for the Netherlands Cancer Registry. The BlaZIB study is funded by the Dutch Cancer Society (KWF; IKNL 2015-7914). The funding agency had no role in the design, analysis, and interpretation of the results of this study. Members of the BlaZIB Study Group: Joost Boormans, MD, PhD (Erasmus Medical Center), Theo de Reijke, MD, PhD (Amsterdam University Medical Centers, location AMC), Sipke Helder (Patient association ‘Leven met blaas- of nierkanker’), Geert J.L.H. van Leenders, MD, PhD (Erasmus Medical Center), Anna M. van Leliveld, MD, PhD (University Medical Center Groningen), Richard P. Meijer, MD, PhD (University Medical Center Utrecht), Sasja Mulder, MD, PhD (Radboud University Medical Center), Ronald I. Nooter (St. Franciscus Ziekenhuis), Juus L. Noteboom, MD, PhD (University Medical Center Utrecht), Tineke J. Smilde, MD, PhD (Jeroen Bosch Ziekenhuis), Guus W.J. Vanderbosch (Patient association ‘Leven met blaas- of nierkanker’). Antoine G. van der Heijden, MD, PhD (Radboud University Medical Center), Michiel S. van der Heijden, MD, PhD (Netherlands Cancer Institute), Reindert J.A. van Moorselaar, MD, PhD, Prof (Amsterdam University Medical Centers, location VUmc), Joep G.H. van Roermund, MD, PhD (Maastricht University Medical Center), Bart P. Wijsman, MD, PhD (Elisabeth-TweeSteden Ziekenhuis). Lisa M.C. van Hoogstraten (IKNL). Publisher Copyright: © 2022 The Authors. BJU International published by John Wiley & Sons Ltd on behalf of BJU International.
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