Introduction
Metastatic breast cancer guidelines recommend multidisciplinary meetings (MDM), but there is limited research on their impact. This prospective study examines the impact of a metastatic breast MDM on clinician management plans and the associated implementation rate.
Methods
Consecutive patients presented at the Monash MDM were prospectively enrolled. Oncologists recorded their management plans before the MDM. Following the MDM, the consensus plan was recorded and compared to the pre-MDM plan. Plans were categorised as no change, low impact, or high impact. High impact was defined as major treatment changes or clinical trial referrals. Medical records were reviewed four months post-MDM to assess the management plan implementation rate. The primary endpoint was the proportion of patients in whom all high impact plan elements were implemented. A one-sample binomial test determined whether this rate was >75%, with 80% power. 75% was selected after reviewing MDM implementation rates in other tumour streams. Target accrual was 48. Demographic and oncological data were also collected in a study-specific prospective database.
Results
114 MDM presentations for 95 patients were recorded from 18 October 2023 to 3 July 2024. 66 (57.9%) presentations resulted in a plan change (p<.001), of which 33 (28.9%) were high impact (p<.001). Follow up data was collected for 77 MDM presentations, of which 65 (84.4%) were implemented. 43 MDM presentations had plans containing high impact elements, of which 40 (93.0%) had all elements implemented (p=0.005). The population was ethnically and linguistically diverse, with 52.6% born overseas and 24.4% from non-English speaking backgrounds.
Conclusion
This study demonstrated that metastatic breast MDMs significantly impact clinician management plans. The 92.6% high impact implementation rate underscores the effectiveness of MDMs in ensuring adherence to evidence-based and consensus-driven treatment strategies. The study demonstrates that MDMs are critical in enhancing the quality of care for a diverse patient population.