Multidisciplinary team management in neuro-oncology provides benefits for patients with complex cases or limited treatment evidence. Studies show that multidisciplinary team discussions result in changed treatment plans over 10% of the time, indicating their clinical significance. For neuro-oncology patients specifically, multidisciplinary team meetings do not delay time to surgery and allow for more treatment options to be considered. However, further research is still needed to evaluate their impact on patient satisfaction and quality of life outcomes.

1. Multidisciplinary Team Management in
Neuro -Oncology:
More than just a concept?
Dr. Heba Gomaa
MBBCh., MSc., MD
Radiation Oncology Department
King Abdullah Medical City

2. Multidisciplinary (MDT ) meeting can be defined as a regularly scheduled
discussion of patients, comprising professionals from different
specialties.

3. Why MDT in Oncology ?
 The greatest benefit is observed in
patients with advanced-stage
malignancies and/or complex
comorbidities.
 The need to apply evidence into clinical
practice is more challenging in cancer
subtypes for which limited level 1 or 2
evidence is available.
 This challenge is further influenced by
the local context, including treatment
availability and technical abilities and
deficiencies.
Gopalakrishna N. et al. Nature reviews clinical oncology 2019

4. COST
EFFECTIVENESS

5. Out of 47 cases (94 %) have concurred results.
The annual costs of running this colorectal local MDT alone were estimated at £162,734þ per
annum with opportunity costs of at least twice that. The costs of MDT meetings are very high
producing a small clinical impact. The clinical results of this study cannot be generalized beyond
this specific colorectal MDT, but can be validated by undertaking further audits of other teams
with different working methods and at various stages of development and experience.

6. MDT in Neuro-oncology ??
In 2006 in the United Kingdom (UK), the
National Institute for Health and Clinical
Excellence (NICE) guideline manual for
improving outcomes for patients with CNS
tumours declared neuro-oncology MDT
meetings to be ‘pivotal’ in the
management of patients with CNS
tumours, that attendance should be
essential, and that all patients should be
reviewed in an MDT meeting.
Formal Canadian recommendationsfor the
treatment of glioblastoma multiforme
state that all new patients should be
presented and discussed at an MDT.
Mason et al Curr Oncol 2007

7. •
The time to surgery was not significantly
different between patients referred in
the pre-MDT era (8 days) compared with
those referred in the MDT era (9 days) ( P
0.6).
Conclusion:
Referral to neuro-oncology MDT is safe
in that it does not delay time to
operation for patients with brain
tumours.

9. Ideally the neuro-oncology MDT would
include a neurologist with specific interest in
neuro-oncology, and a palliative care
physician.
It is also important to include allied health
staff such as social workers.
Annual case load of 200 patients,
5 patients weekly discussed in 30
minutes

10. Clinician survey responses
K.M. Field et al. / Journal of Clinical Neuroscience , 2010.

12. High Impact Decision (HID)
M. Ameratunga et al. / Journal of Clinical Neuroscience 56 (2018)
A high impact decision (HID) was defined
as any case in which the pre-MDT plan
was substantially modified, or a
treatment plan was developed where
none existed prior to the meeting.
To be defined as a HID, the classification
had to be agreed upon by clinicians of
both neurosurgical and medical oncology
teams.
Changes considered high impact include
changes in treatment modality, or
additional diagnostic tests which would
significantly alter clinical management.
An HID rate of greater than ten percent is
considered clinically significant.

13. • There was no significant
association between
tumour type (solid
tumour, high-grade
glioma, low-grade
glioma, other) and HID,
although there was a
trend to more high-
impact decisions in the
small number of low
grade gliomas, with five
out of six cases having a
HID (p = 0.06).

14. M. Ameratunga et al. / Journal of Clinical Neuroscience 2018)

15. Time For Discussion
 There was no statistically significant
difference in time taken depending upon the
type of case discussed.
 There was no statistically significant
change in time taken for case discussion
depending on the order of the case.
 This was not statistically significant with a
mean time taken 5 min versus 4 min for first
versus fourth quartile of cases (p = 0.29).
 There was no statistically significant
difference in time taken for discussion for
new versus recurrent cases (p = 0.88).
M. Ameratunga et al. / Journal of Clinical Neuroscience 56 (2018)

16. Compliance
 The Frequency of HID Strongly
Correlated with The Post treatment plan.
 Taken together, these data suggest
that there was no systematic bias for
cases discussed at the start or end of
a meeting in terms of duration of
discussion, suggesting that each case
was discussed on its merit, and that
the allocated time for MDT discussion
of patients was sufficient.
M. Ameratunga et al. / Journal of Clinical Neuroscience 56 (2018)

17. Quality Of Life ?
There was a non-significant
trend to improved median
survival.

18. What We Still Miss?
Amongst the published studies, none evaluated how MDT meetings impacted
upon aspects of patient satisfaction.
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.
 The frequency at which the MDT meeting recommended plan is actually followed for
patients.

19. Further studies are needed to:
(1) define a molecular tumor board.
(2) understand the current extent disease-
state-specific molecular data is utilized in
treatment decisions.
(3) provide consensus recommendations
for molecular data utilization in neuro-
oncology MDTs.
(4) identify key cases for a dedicated
molecular tumor board.
What We Still Miss?

20. Home Message

22. 237 Cases

23. THANK YOU