Causes and consequences of deviation from multidisciplinary care in thoracic oncology.

BACKGROUND: Multidisciplinary decision making is advocated in thoracic oncology because of the multiplicity of management options. This approach is difficult to implement, and its benefits are empirical and likely depend on compliance with recommendations. We evaluated patient outcomes after discussion in a multidisciplinary thoracic oncology conference (MTOC).
METHODS: Retrospective review of all cases presented at a weekly MTOC from February 1, 2006 to October 30, 2009. Patients were separated into cohorts based on concordance between MTOC recommendations and actual clinical care. Patient characteristics, MTOC recommendations, clinical care, and outcomes were compared between the two cohorts using appropriate statistical methods.
RESULTS: Three hundred seventy-six patients were discussed at MTOC, and 454 sets of recommendations were made. Thirty-seven percent of patients received discordant care. Health insurance status and race were the only demographic factors significantly associated with receipt of discordant care. The likelihood of concordance with specific recommendations varied significantly. Patients who received concordant care had significantly shorter delay to onset of definitive therapy (p < 0.002), longer overall (p < 0.004), and progression-free survival (p < 0.02). The stage-adjusted hazard ratio for overall and progression-free survival in the concordant care cohort was 1.7 and 1.4, respectively. Sixty percent of all discordant care could be attributed to clinicians' decision.
CONCLUSIONS: Deviation from multidisciplinary recommendations may be associated with significantly worse outcomes in patients discussed in an MTOC. Further investigation into the causes of discordant care is warranted.