Best of the Best Oral Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2020

Variation in Colorectal Cancer MDT, treatment and survival outcomes: A population-based linked data study in South Australia (SA) (#85)

Elizabeth Buckley 1 , Carol Holden 2 , Dagmara Poprawski 3 , Nimit Singal 4 , Deborah Turnbull 5 , David Roder 1 , Matthias Wichmann 3 , Julie Ratcliffe 6 , Timothy Price 7
  1. University of South Australia, Adelaide, SA, Australia
  2. South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
  3. Mount Gambier Regional Hospital, , Mount Gambier, South Australia, Australia
  4. Royal Adelaide Hospital, Adelaide, South Australia, Australia
  5. School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
  6. College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
  7. The Queen Elizabeth Hospital, Adelaide, South Australia, Australia

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.