Abstract
Background: Lung cancer resection and survival rates in the UK vary; the reasons for this are unclear.
Aims: To compare lung cancer MDT decision outcomes in 4 hospitals in one cancer network.
Methods: Each lung cancer MDT randomly selected 5 of their MDT cases and submitted them to the other MDTs for assessment. MDT decision outcomes for each case, including each MDT's own previously discussed MDT cases were collated. Mean percentage agreement of MDT outcomes was calculated for TNM staging and referrals for PET scan, curative surgery, radical radiotherapy and palliative chemotherapy.
Results: 3 hospital MDTs discussed 15 cases as well as having previously discussed their own 5 cases. 1 hospital submitted their 5 previously discussed cases but failed to discuss the other cases submitted to them. There were 17 non-small cell lung cancer cases, 2 indeterminate cases and 1 small cell lung cancer case. The number of cases referred for curative surgery varied between 6 to 7 cases per MDT. Percentage agreement was 83% for T staging, 91% for N staging, 98% for M Staging, 87% for referral for PET scan, 98% for curative surgery referral, 95% for radical radiotherapy referral and 93% for palliative chemotherapy referral.
Discussion: There was good agreement for staging and very high agreement for treatment referral. In this pilot study the high agreement for potentially curative treatment does not support the view that some MDTs are not referring patients for potentially curative treatment. As numbers are small we propose this issue be addressed by a national web-based quality assurance programme where each MDT assesses and reports sample cases each month and is given formative feedback.
- © 2011 ERS