Role Of Multidisciplinary Teams In The Management Of Early Breast Cancer Patients: An Analysis Of Discordance Decision-Making Risk Factors

Objective:The incidence of breast cancer is rapidly increasing in China,particularly in urban areas.A multidisciplinary team(MDT)approach for the management of breast cancer is the standard of care in developed health systems.However,this model is still at an early stage of implementation in China.The aim of this retrospective study is to evaluate the effectiveness of MDT in the management of breast cancer patients of low-middle regions in China.Methods:This study recruited a cohort of 531 early breast cancer patients who were managed by MDTs consisted of breast surgeons,medical oncologists,radiotherapy oncologists,radiologists,pathologists and breast care nurses,and underwent surgical procedures between 1 January 2014 and 31 December 2017 in Shanxi Dayi hospital,China.MDT decisions were documented as care plans.We assessed concordance between MDT decisions and subsequent patient managements.Logistic regression method was used to analyze factors involved in discordance.Results:Overall,70.6%(375 out of 531)of MDT decisions were concordant,whereas29.4%(156 out of 531)were not.Age,family history of cancer and tumor biologic subtypes appeared to significantly affect implementation of MDT decisions.Thediscordance rate of patients older than 70 was 3.9 times higher compared with those aged under 40 years old(95%CI1.3-12.5,P=0.02).Patients with family histories of cancer were3.5 times more likely to change their treatment plans than those without family histories(95%CI:1.2-10.2,P=0.02).Compared to patients with HR+/HER2-breast cancer,those with HR-/HER2+ and HR+/HER2+ subtypes had 11.9 and 14.2 times higher discordance,respectively(95%CI:5.7-24.7,P<0.001;95%CI:6.7-30.7,P<0.001).Conclusion:Our results demonstrate that although management by MDTs significantly improves clinical outcomes of breast cancer patients of low-middle income regions in China,the MDT decision discordance rate is noticeably high,especially in aged patients and those with cancer family histories.Patients with HER2+ tumors are also prone to discordance.Thus,implementation of the MDT approach in the treatment of breast cancer in patients from low-middle income population needs to be strengthened and measures should be taken to ensure adherence to MDT decisions.