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The role of multidisciplinary decision making in oropharyngeal cancer: do we follow guidelines and are treatment decisions being implemented?

European Archives of Oto-Rhino-Laryngology volume 277, pages 947–952 (2020)Cite this article

Abstract

Purpose

A multidisciplinary team (MDT) approach to cancer management is gold-standard. With an increasing disease incidence and growing research into human papillomavirus (HPV)-related oropharyngeal cancer (OPC), updated UK management guidelines were recently published. This study aimed to evaluate the MDT decision-making process among OPC patients at a tertiary centre.

Methods

MDT meetings over a 12-month period were analysed retrospectively. MDT decisions were compared with guidelines and patient records examined to identify decision implementation. Reasons behind any discordant decisions were explored.

Results

This study included 140 OPC patients. Thirty-three (23.6%) were not tested for HPV. Patients over 70 years with a smoking history treated palliatively were less likely to be tested (P = 0.017). Eighty-five percent of MDT decisions followed guidelines with the majority not complying (76.2%) related to patient comorbidity. Ten decisions (7.1%) were not implemented. Reasons included: Seven due to patient choice, of which four patients (57.1%) were only seen following the MDT meeting, and three due to clinician decisions as new clinical information emerged.

Conclusion

The majority of MDT decisions followed guidelines and any discordant decisions were justifiable. Discussing management options with patients beforehand facilitates decision implementation as decisions can potentially change after seeing the patient. Progress is still needed with regards to HPV testing. Reasons for not testing could include subliminal decision-making among clinicians, and patients falling between centres. Crucially, the role of the MDT in head and neck cancer should be to ratify decisions rather than making them, hence the need to see patients prior to MDT discussion.

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Author information

Affiliations

  1. The University of Liverpool, School of Medicine, Liverpool, L69 3GE, UK

    Randa Ghazal Asswad

  2. Department of Otolaryngology, Head and Neck Surgery, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK

    Sirhan Alvi, Katharine Davies, Terry M. Jones, Jeffrey Lancaster, Christopher Loh, Sankalap Tandon & Nick Roland

  3. Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, L3 9GA, UK

    Terry M. Jones

  4. Department of Otolaryngology, Head and Neck Surgery, Freeman Hospital, Newcastle Upon Tyne, UK

    David W. Hamilton

  5. Department of Clinical Oncology, The Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK

    Caroline Brammer

Authors
  1. Randa Ghazal Asswad
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  2. Sirhan Alvi
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  3. Katharine Davies
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  4. Terry M. Jones
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  5. David W. Hamilton
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  6. Caroline Brammer
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  7. Jeffrey Lancaster
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  8. Christopher Loh
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  9. Sankalap Tandon
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  10. Nick Roland
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Corresponding author

Correspondence to Nick Roland.

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Ghazal Asswad, R., Alvi, S., Davies, K. et al. The role of multidisciplinary decision making in oropharyngeal cancer: do we follow guidelines and are treatment decisions being implemented?. Eur Arch Otorhinolaryngol 277, 947–952 (2020). https://doi.org/10.1007/s00405-019-05781-2

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  • DOI: https://doi.org/10.1007/s00405-019-05781-2

Keywords

  • Multi-disciplinary team
  • Oropharyngeal neoplasms
  • Human papillomavirus
  • Decision making
  • Patient preference
  • Decision implementation