1. S Strong 1,2, NS Blencowe 1,2,T Fox 1, C Reid 3, T Crosby 4, H.Ford 5, J M Blazeby 1,2 1 School of Social and Community Medicine, Canynge Hall, University of Bristol, Bristol UK. 2 Division of Surgery, Head & Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, UK. 3 Division of Specialised Services, University Hospitals Bristol NHS Foundation Trust, Bristol, UK. 4 Velindre NHS Trust, Unit 2 Charnwood Court, Nantgarw, Cardiff 5 Addenbrooke’s Department of Oncology & Cambridge Cancer Trials Centre, Cambridge The role of multi-disciplinary teams in decision making for patients with recurrent malignant disease

2. MDT meetings Picture of mdt team

4. UGI cancer survival 1. Allum et al. Journal of Clinical Oncology. 2009

5. Aims 1.investigate role MDT in decision-making for patients with disease recurrence 2.Consider how issues addressed nationally

6. Methods Sequential MDT records screened Patients with possible recurrence identified Notes reviewed and info recorded about: symptoms reason for referral & source treatment decision & implementation

7. Results Patients discussed n=304 Suspected recurrence n=34 Confirmed recurrence n=29 Local n=19 Mets n=9 54 MDT meetings, 1181 discussions about 304 pts Recurrence confirmed in 29 pts

8. Results, n=29 Mostly surgical referrals (n=25) Symptoms pain (n=8), dysphagia (n=7), weight loss (n=7)

9. Results, n=29 MDT treatment decisions, best supportive care (n=10), chemo (n=9), stent (n=5), radio (n=3), surgery (n=2) 19 (65.5%) reviewed by oncologist after MDT

10. Results, n=29 25 (86.2%) recommendations implemented Reasons for non-implementation were; declining health (n=2) patient preference (n=2)

11. Summary 29 patients (9%) of new MDT patients recurrence discussed Majority 19 (66%) were offered further treatments and all received CNS support Pts with recurrence benefit from MDT

12. Implications Should discussion of pts with recurrence at MDT be mandatory? Uncertain which type of MDT is optimal