gms | German Medical Science

Background: Within the framework of the National Cancer Plan, cancer centers were established. They take over the coordination of care for cancer pts in a region as well as the diagnosis and treatment according to the latest evidence. For this purpose, all pts with a cancer diagnosis should be discussed in a multidisciplinary tumor board (MTB). In the MTB, an individual treatment plan is discussed and therapy recommendations are given. Whether these recommendations are implemented in the daily routine has not been widely investigated. As of yet, no study has investigated the impact of the implementation of MTB-recommendations on survival and respective differences by healthcare organization (cancer centers, day clinics, outpatient providers). The healthcare organizations involved in implementing the treatment differ by their connectivity to a cancer center and can thereby affect adherence to MTB-recommendations.

Question and objective: Therefore, we investigate:

1.

how are the recommendations from tumor boards being adhered to;

2.

which factors determine the adherence of MTB-recommendations;

3.

what differences there are in the implementation of MTB-recommendations depending on the healthcare organization and

4.

what is the relationship between the adherence of MTB-recommendations and pt outcomes in terms of OS?

Method: Data from 1,784 pts with lung cancer discussed in MTB in one certified lung cancer center in Northern Germany between 2014–2018 were documented and evaluated according to the adherence to MTB-recommendations. An analysis of the first 386 cases analyzed will be presented. Data was analyzed descriptively.

Results: Median age of the 386 pts was 66 rs (26–91 yrs) and 64% (n=247/386) of them were male. Most of the patients had an ECOG of 0 or 1 (78%; n=301/386) and 87% of them were current/ex heavy smoker (n=335/386). 70% (n=267/386) of the pts that have been discussed in the MTB, were afterwards further treated at the same certified lung cancer center. In 79% (n=304/386) of pts, the treatment recommendations from the MTB were completely adhered to. There were different reasons for non-adherence, e.g. patient’s wish, patient characteristics and death before starting therapy. The median OS for the 386 pts was 13 months. Pts with a complete adherence to the MTB-recommendation had an OS of 16 months (n=304) compared to 5 months (n=41) for pts with a partial adherence compared to 1 months (n=33) for pts with a non-adherent treatment (p<0.001).

Discussion: Preliminary results give a hint to the fact that patients with an adherent treatment after first diagnosis had a longer OS than pts with another therapy. More cases will be presented at the meeting using a multivariate analysis which includes pts characteristics and healthcare organizations that took over further treatment as predictors.

Practical implications: Furthermore, the findings can be used to design interventions that improve the adherence of MTB-recommendations in outpatient oncology care, optimize the quality of care, and thus potentially make a significant contribution to the implementation of the German cancer plan.

Appeal for practice (science and/or care) in one sentence: The results can be used to improve the quality of cancer care.