Table 3 Outcomes and outputs in the reviews retrieved. Main findings
From: The impact of tumor board on cancer care: evidence from an umbrella review
Outcome / Output | Author / Year | N. of studies | Results / Findings |
|---|---|---|---|
Care coordination | Prades et al., 2015 [31] | 22 | Format, data management and professional roles of TBs impacted positively on care coordination for professionals and patients. |
Diagnosis (Patient assessment, diagnosis, staging) | Lamb et al., 2011 [30] | 3 | Improvement in diagnostic accuracy was reported. |
Prades et al., 2015 [31] | 8 | Multidisciplinary setting improved diagnosis and staging accuracy. | |
Pillay et al., 2016 [32] | 15 | Diagnostic reports changed after the meeting in 4–35% of patients discussed. | |
6 | The impact of the TB on assessment and diagnosis was significant (higher accuracy in staging). | ||
Basta et al., 2017 [34] | 1 | No changes in diagnosis or stage were reported after validation by pathology or after follow-up. | |
4 | TBs changed the diagnoses formulated by referring physicians in 18.4–26.9% of cases. | ||
2 | TBs formulated an accurate diagnosis in 89 and 93.5% of evaluated cases. | ||
2 | Discussion during the TB influenced staging. After introduction of the TB, more patients underwent computed tomography (CT) before operation and patients discussed more often received a complete staging evaluation. | ||
Treatment (Practice patterns, clinical practice, patient management, Implementation of treatment changes) | Coory et al., 2008 [33] | 1 | A not statistically significant larger percentage of patients discussed in TB (43%) received radical treatment than the control group (33%). |
|  | 1 | A statistically significant increase in the percentage of patients older than 70 years receiving radical radiotherapy (from 3% in 1995 to 12% in 2000; p = 0.004) was reported. The percentage receiving palliative radiotherapy decreased (from 65 to 55%). | |
|  | 1 | A statistically significant increase in the percentage of patients receiving chemotherapy (from 7% in 1997 to 23% in 2001; p < 0.001) was reported. The percentage of patients receiving palliative care decreased (from 58 to 44%; p = 0.0045) and the percentage of patients being formally staged increased (from 70 to 81%; p = 0.035). | |
| Â | 3 | Surgical resection rate was higher in MD groups. | |
Lamb et al., 2011 [30] | 6 | Changes in care management decisions were reported in 2–52% of cases. | |
| Â | 1 | TBs improved adherence to clinical guidelines. | |
| Â | 1 | Likelihood of patients being offered chemotherapy increased (from 7 to 23%) | |
|  | 6 | Care management decisions by TBs were not implemented in 1–16% of cases due to contradictory patient choice or because of comorbidities. | |
Prades et al., 2015 [31] | 21 | TBs ensured more appropriate treatment through preoperative review of imaging and pathology results; multidisciplinary approach guaranteed the most up-to-date treatment, and set up a structured follow-up care plan. | |
Pillay et al., 2016 [32] | 25 | Changes in patient management/clinical practice were measured. Three studies reported minimal change in clinical management (less than 9% of cases), four studies indicated that the percentage of patients who underwent changes in treatment plans ranged from 19 to 34.5%. Other studies reported that changes in patient management plan following a TB occurred in 4.5–52% of cases. | |
13 | Patients who were discussed were more likely to receive neoadjuvant or adjuvant treatment. Greater adherence to National Comprehensive Cancer Network (NCCN) guidelines was found in two studies. | ||
Basta et al., 2017 [34] | 9 | Treatment plan formulated by the referring physician was altered in 23.0–41.7% of evaluated cases. | |
5 | TB decisions on treatment plan were implemented in 90–100% of evaluated cases. The reasons for not following TB advice were comorbidity (45%) and patient preferences (35%), followed by new clinical information (10%), different opinion of the treating physician (5%), and unknown (5%). | ||
| Â | 3 | TBs increased adherence to guidelines. Treatment plan more often adhered to national guidelines: 98% versus 83%. | |
Quality of life | Coory et al., 2008 [33] | 1 | No statistically significant difference between groups was found |
Prades et al., 2015 [31] | 6 | Improvement of patients’ quality of life | |
Recurrence and metastasis after resection | Pillay et al., 2016 [32] | 2 | TB discussion had little positive impact on local recurrence rates of rectal cancer and incidence of metastases and remaining pelvic tumour after resection. |
Satisfaction (patient or clinician) | Coory et al., 2008 [33] | 1 | TBs resulted in better satisfaction for organisation of investigations and personal experience of care. |
Prades et al., 2015 [31] | 5 | TBs improved patient and clinician satisfaction as a consequence of team work communication and cooperation. | |
Survival | Coory et al., 2008 [33] | 2 | Two studies reported statistically significant survival improvement. 1 study reported an improvement of 3.2 months in median survival of patients with inoperable NSCLC, the other an increase from 18.3 to 23.5% in 1-year survival of lung cancer patients older than 70. |
3 | Three studies did not show a statistically significant improvement. | ||
Lamb et al., 2011 [30] | 1 | Patients being offered chemotherapy showed a significant increase in survival (from 3.2 to 6.6 months). | |
Prades et al., 2015 [31] | 10 | Improvements in survival were reported for colorectal, head and neck, breast, oesophageal, and lung cancer. | |
Pillay et al., 2016 [32] | 4 | TB discussion was not associated with overall survival. However, in one of these studies, rectal cancer patients discussed had improved post-operative mortality. | |
2 | Significant association was shown between TB discussion and survival of patients. | ||
Visits to general practitioners | Coory et al., 2008 [33] | 1 | Significantly fewer visits were reported for the MD group than the control group. |
Waiting times | Coory et al., 2008 [33] | 3 | In one study the median time from presentation to first treatment was 3 weeks in the MD arm (7 weeks in the control arm) but there was no difference in the time from diagnosis to radical treatment. Another study reported a reduction in mean time from presentation to surgery of 15 days. In the last study, a reduction of days from diagnosis to treatment from 29.3 to 18.8 was reported. |
Prades et al., 2015 [31] | 10 | TBs resulted in reduction of time from diagnosis to treatment, and achievement of early and appropriate referral patterns. | |
Pillay et al., 2016 [32] | 2 | In two studies patients discussed in TBs had fewer mean days from diagnosis to treatment. | |
1 | One study found an opposite trend. | ||
Other | Prades et al., 2015 [31] | 7 | TBs promoted the establishment of a teaching environment for healthcare professionals and junior doctors. |
9 | A commitment to research and clinical trials was maintained. | ||
1 | The enrolment in the tumour registry increased. |