Aims: Guidelines for colorectal cancer (CRC) recommend patients are discussed at Multidisciplinary team (MDT) meetings. A systematic scoping review showed younger people and those with more advanced stage are more likely to be discussed by MDTs. The association between MDTs and treatment outcomes is less clear. We explored the impact of age and MDTs on treatment and survival outcomes.
Methods: SA registered CRC cases diagnosed in 2006-2013 were linked to hospital admissions, Medicare claims, clinical registry and National Death Index records. Follow up of cases continued until December 31, 2014 or date of death, if earlier. Demographic, clinical, treatment and death information were extracted. Descriptive statistics, logistic and competing risk regression of complete data estimated associations with study outcomes.
Results: Analysis of 5384 CRC cases identified variation in cases discussed by MDTs. Cases discussed by MDTs were younger (ORadj≥2.4 [95%CI:1.25-8.6]), residing in regional areas (ORadj=4.3 [95%CI:2.9-6.4]), with higher comorbidity burden (ORadj=1.7 [95%CI:1.1-2.6]), and more advanced stage (ORadj=2.9 [95%CI:1.5-5.9]). Predictors of surgical treatment included younger age (ORadj≥1.7 [95%CI:1.2-2.5]) and stage B or C (ORadj≥2.8 [95%CI:2.2-4.3]) but not MDT participation. CRC mortality was lower in the younger ages (ORadj≤0.7 [95%CI:0.8-0.4]), and increased in those with advanced stage (ORadj=19.4 [95%CI:13.8-27.5]), or greater comorbidity (ORadj=2.5 [95%CI:2.1-3.1]). In younger people discussed at MDTs, CRC mortality was lower (but not achieving statistically significance, ORadj=0.6 [95%CI:0.5-1.02]) compared with older people. Comorbidity burden was a significantly stronger predictor of mortality for younger age (<75) than older age (75+) (ORadj=4.7 [95%CI:3.1-7.2] and 2.0 [95%CI:1.5-2.7], respectively).
Conclusion: Our data show that MDTs do not discuss all cases as recommended by guidelines, particularly among the older ages. We also found the association of comorbidity with mortality differed by age. The association of MDTs with mortality should be explored further as benefits may be clearer in larger samples.