Tumor conferences are multidisciplinary meetings at which the management of cancer patients is discussed. They have been an integral part of oncology services and are regarded as an essential component of quality control and continuing medical education. There are data to suggest that the tumor conference enhances patient care. Many studies of effectiveness have been conducted. Reported benefits include improved patient management and treatment. In this presentation, I'll try to assess the role of the multidisciplinary tumor conference in patient management in gynecologic oncology services.

1. Impact of M.D.T. on Treatment
Outcome For
Gynecologic Malignancies
Emad Shash, MBBCh., MSc., MD.
Medical Oncology Department
National Cancer Institute, Cairo University

2. Disclosures Specific to Today’s Topic
• No Financial Disclosures
• I’m a medical Oncologist, not:
• Gynecological Oncologist
• Surgical Oncologist
• Radiation/Clinical Oncologist
• I do believe that we need
“Evolution” to adapt for OUR
PATIENTS better care.

3. No Offense to any Specialty!

4. What we always hear about MDT?
• Multidisciplinary teams and/or clinics are associated with:
• Changes in staging/diagnosis
• Initial management plans
• Higher rates of treatment
• Shorter time to treatment after diagnosis
• Better survival
• Adherence to clinical guidelines.
Pillay et al., Cancer Treatment Reviews. 2016

5. MDT: Definition
Individual Specialties Together Either Physically or Virtually
Discussing Therapeutic Strategy of a Given Patient

6. MDT in Oncology Setting
• The MDT meeting serves as a platform for the coordinated delivery of care through consultation amongst
different professionals in a single setting.
• The MDT meeting can be defined as a regularly scheduled discussion of patients, comprising professionals
from different specialties:
• Surgeons
• Medical Oncologists
• Radiation oncologists
• Radiologists,
• Pathologists
• Nurse specialists
• In addition:
• Pharmacy
• Palliative medicine
• Mental health
• Other allied health disciplines
Pillay et al., Cancer Treatment Reviews. 2016

7. Is MDT a leisure
or a MUST?

9. Background & History in UK!
• In the early 1990s, the EUROCARE study demonstrated poorer survival in
the UK than in other European countries most types of cancer.
• Following this publication, it was proposed that all patients with cancer
should be seen by MDTs
• 15 years ago less than 20% of patients with cancer in England were
managed by a specialist team.
• Current National Institute of Health and Clinical Excellence (NICE) guidance
and peer-review recommendations are that 95-100% of patients should be
discussed at a MDT meeting.
N. Chinai et al. Clinical Radiology 2013

10. Estimated MDT Costs
N. Chinai et al. Clinical Radiology 2013
• Out of 47 cases (94 %) have a concurred results.
• Does the clinical benefit gained weight the cost?
• Do all patients need to be discussed in the MDT?

11. Do We really need MDT in
Oncology?

12. B. Pillay et al. Cancer Treatment Reviews 2016

13. 3 main Groups
patient
assessment and
diagnosis
15 articles
patient
management and
clinician practice
25 articles
patient outcomes
7 articles
Pillay et al., Cancer Treatment Reviews. 2016
• Critically evaluate Current literature regarding the impact of MDT
meetings on:
1. Patient outcomes
2. Assessment
3. Diagnosis
4. Management
5. Clinician practice.

14. Patient assessment/Management Changes
• Results indicated that 56% of studies (5/9) reported changes to diagnostic findings for
• More than 10% of patients discussed at MDT meetings.
• Similarly, 54% of studies (7/13) reported that management plans were altered for
• More than 10% of patients discussed at MDT meetings.
• Not all positive: Findings of 3 studies
• Did not support a strong association between MDT meetings and improvements in patient
assessment and management.
• effectiveness of MDT meetings is dependent on a range of factors such as
• Structural Components
• Functional components
• Expertise of participant
Pillay et al., Cancer Treatment Reviews. 2016

15. Patient Outcome Changes
• Few studies in this review evaluated patient outcomes.
• Those which did assess outcomes focused on survival rates, with a few studies
assessing other clinical indicators (e.g. CRM rates for rectal cancer patients).
• The conduct of MDT meetings may indirectly lead to survival benefits through
more efficient selection of treatment options for patients and by better case
management.
• However, there is little evidence demonstrating a relationship between MDT
meetings and survival.
Pillay et al., Cancer Treatment Reviews. 2016

16. What piece of information we still miss?
• Amongst the published studies, none evaluated how MDT meetings
impacted upon aspects of patient satisfaction or quality of life.
• It is possible that patients experience:
• Sense of satisfaction or wellbeing if they are involved in decision-making
during the MDT meeting process.
• Sharing of information regarding the outcome of the discussion and providing
patients with support in making an informed decision regarding treatment
options.

17. What about the role of MDT in
Gynecological Malignancies?

18. Cohen et al. Int J Gynecol Cancer 2009
The aim of this study was to assess the impact of the twice weekly
gynecologic oncology tumor conferences on the management of
women with a diagnosis of or suspected of having a gynecologic
malignancy
• The gynecologic tumor conference at Auckland City Hospital is
consultative.
• All referrals comprise both preoperative and postoperative patients.
• The meetings are multidisciplinary, with participants including:
• Gynecologic pathologist
• Gynecologic oncologists
• Medical oncologists
• Radiation oncologists
• Radiologists
• Trainees in gynecology and oncology
• Oncology nurses.

19. Change in tumor site, histological type, stage, or grade: Can
Result in different patient management.
Summary of major diagnostic discrepancies after
histopathologic review at MTC
Summary of major diagnostic discrepancies after
radiological review at MTC
Cohen et al. Int J Gynecol Cancer 2009
• The rate of major discrepancies in this study is 5.9%
• The involvement of specialized pathologist is a must

20. Do we need Tumor Biology
Discussion Boards?

21. Classical Histological Endometrial Cancer
Classification “as an Example”
Murali R, Lancet Oncol 2014
Endometrial Cancer
Type I
Endometrioid
adenocarcinoma (80%–90%)
Type II
Non-Endometrioid subtypes
(10%-20%)
Serous
Clear Cell
Undifferentiated Carcinomas
Carcinosarcoma/Malignant
Mixed Mullerian tumor

22. The Cancer Genome Atlas (TCGA) website

23. G Getz et al. Nature 2013
Mutation spectra across endometrial carcinomas
Gene expression across integrated subtypes in endometrial carcinomas
Pathway alterations in endometrial carcinomas

24. The changing Landscape of Endometrial Cancer
Prognostic Classification & Treatment Impact
Bokhman WHO The Cancer Genome Atlas
Basis Clinical and
epidemiological
features
Histological features Genome-wide genomic characterisation
Categories Type I
Type II
Endometrioid
Serous
Clear cell
POLE (ultramutated), MSI
(hypermutated), copy-number low
(endometrioid), copy-number high
(serous-like)
Copy-number high (serous-like)
NA

25. Right Patient
Right
Treatment
Right Time
Cost
Effectiveness
Every Physician’s Aim!

26. Take Home Message
• You need to be specialized & experienced enough to optimize your
patients’ management.
• Learn to communicate effectively with your peers.
• Structural debates supported by evidence based medicine results in
better patient outcomes.
• Future ahead: You need to engage your patient in the DECISION
Making!

27. “Coming together is a beginning.
Keeping together is a progress.
Working together is a success”
Henry Ford (July 30, 1863 – April 7, 1947) was an American industrialist, the founder of the Ford
Motor Company, and the sponsor of the development of the assembly line technique of mass production.
Thank You