Analysis of the Implementation of Breast MDT Decisions Dr Alex Bates FY2 Doctor Gloucestershire NHS Foundation Trust

Background MDT Meetings Reduced time to diagnosis and treatment Optimal and individualised treatment plan

However… …evidence suggests that MDT decision often need revising: Upper GI Cancers Annals of Oncology 2006, 17: Analysis of clinical decision making in multi-disciplinary cancer teams Blazeby JM, Wilson L, Metcalfe C, Nicklin J, English R, Donovan JL

However… …evidence suggests that MDT decision often need revising: Colorectal Cancer Colorectal Dis Oct;10(8): An evaluation of treatment decisions at a colorectal cancer multi- disciplinary team. Wood JJ, Metcalfe C, Paes A, Sylvester P, Durdey P, Thomas MG, Blazeby JM

However… …evidence suggests that MDT decision often need revising: Breast Cancer Breast J Sep;18(5): A prospective analysis of implementation of multi-disciplinary team decisions in breast cancer. English R, Metcalfe C, Day J, Rayter Z, Blazeby JM; breast cancer multi- disciplinary team Aim: Compare this to CGH Breast MDT decision implementation

Method April 2011 MDTs Remove irrelevant cases Research databases and notes Identify implementation Identify reasons Analysis

Results Total Patients63 Age (Mean ± σ)58.69 ± Clinician 120 (32%) Clinician 220 (32%) Clinician 315 (23%) Clinician 43 (5%) Clinician 55 (8%) Site of CaLeft29 (45%)

Results Decisions not implemented -7 (11.1%) 95% CI 3.1% %. Patient choice-6 New information -1 No association to surgeon nor patient age, Odds Ratio = 2.4 and 1.0; p = 0.45 and 0.99 respectively

Patient Choice Of the 6 patients declining MDT Decision: ALL involved choice of surgery Declined excision1 Declined excision + sentinel node biopsy2 Declined mastectomy3

Conclusions Implementation of breast MDT decisions at CGH are in line with published standards Patient views often differ from that of medical professionals Due to the sensitive nature of breast cancer patients may be more likely to decline the advised surgery

Thank yous Mr Angus McNair, Miss Donna Egbeare, Mr Charlie Chan, Mr James Bristol