Introduction:
Multi-disciplinary tumor boards (MDTBs) are a fundamental component of cancer treatment
and are believed to result in improved outcomes. However, not much is known about
compliance to tumor board recommendations. Therefore the aim of this study was to
analyse outcomes of non-compliance to MDTB verdict and factors contributing to non-compliance.
Methods:
The study was conducted as a retrospective analysis of all HNSCC patients presented
at MDTBs between 2008 and 2009 at the National Cancer Centre of Singapore (NCCS).
Independent-sample T test and chi-squared test for two-way tables were used to compare
the compliance of patients to continuous and categorical variables respectively. Kaplan
Meier curves were used for survival analysis and the log-rank test to compare survival
and recurrence-free survival curves for the compliance and non-compliance group.
Results:
A total of 294 patients were discussed, of which 68 were excluded. Of the non-compliant
group (n = 54), 42 (77.8%) were due to patient factors, 2 (3.7%) were due to doctor
factors and 10 (18.5%) were due to disease factors. At a mean survival time of 38.0
months (95% CI 27.5 – 48.6) for non-compliant patients and 67.6 months (95% CI 61.8
– 73.4) for compliant patients, compliant patients had an increased overall survival
(p < 0.001) and recurrence free survival (p = 0.012). In a multivariate analysis compliance
showed as an independent factor for survival (HR: 2.53; 95% CI 1.59 – 4.02; p = 0.001).
Conclusion:
Patients who adhered strictly to MDTB recommendations demonstrated improved overall
survival and recurrence free survival, highlighting the importance of tumour boards
and interdisciplinary work in modern-day cancer treatment.
