Brief Article
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastrointest Oncol. Mar 15, 2013; 5(3): 60-67
Published online Mar 15, 2013. doi: 10.4251/wjgo.v5.i3.60
Does in-house availability of multidisciplinary teams increase survival in upper gastrointestinal-cancer?
Christian Kersten, Milada Cvancarova, Svein Mjåland, Odd Mjåland
Christian Kersten, Milada Cvancarova, Department of Oncology, Southern Hospital Trust, 4604 Kristiansand, Norway
Svein Mjåland, the Centre for Cancer Treatment, Department of Oncology, Southern Hospital Trust, 4604 Kristiansand, Norway
Odd Mjåland, the Section of Abdominal Surgery, Department of Abdominal Surgery, Southern Hospital Trust, 4604 Kristiansand, Norway
Author contributions: All authors have contributed to the conception, design and interpretation of data and participated in drafting the manuscript, revised it critically and approved the final version; the detailed writing process and analysis of the data was performed by Cvancarova M and Kersten C.
Correspondence to: Christian Kersten, MD, PhD, Oncologic Consultant, Department of Oncology, Southern Hospital Trust, Postbox 416, 4604 Kristiansand, Norway.
Telephone: +47-913-39443 Fax: +47-381-46601
Received: September 26, 2012
Revised: December 30, 2012
Accepted: January 17, 2013
Published online: March 15, 2013

AIM: To investigate the effect of the establishment of in-house multidisciplinary team (MDT) availability (iMDTa) on survival in upper gastrointestinal cancer (UGI) patients.

METHODS: In 2001, a cancer centre with irradiation and chemotherapy facilities was established in the Norwegian county of West Agder with a change of iMDTa (WA/MDT-Change). “iMDTa”-status was defined according to the availability of the necessary specialists within one institution on one campus, serving the population of one county. We compared survival rates during 2000-2008 for UGI patients living in counties with (MDT-Yes), without (MDT-No), with a mix (MDT-Mix) and WA/MDT-Change. Survival was calculated with Kaplan-Meier method. Cox model was used to uncover differences between counties with different MDT status when adjusted for age, sex and stage.

RESULTS: We analyzed 395 patients from WA/MDT-Change and compared their survival to 12 135 UGI patients from four other Norwegian regions. Median overall survival for UGI patients in WA/MDT-Change increased from 129 to 300 d from 2000-2008, P = 0.001. The regions with the highest level of iMDTa achieved the largest decrease in risk of death for UGI cancers (compared to the county with MDT-Mix: MDT-Yes 11%, P < 0.05 and WA/MDT-Change 15%, P < 0.05). Analyzing the different tumour entities separately, patients living in the WA/MDT-Change county reached a statistically significant reduction in the risk of death [hazard ratios (HR)] compared to patients in the county with MDT-Mix for oesophageal and gastric, but not for pancreatic cancer. HR for the study period 2000-2004 are given first and then for the period 2005-2008: The HR for oesophageal cancers was reduced from [HR = 1.12; 95%CI: 0.75-1.68 to HR = 0.60, 95%CI: 0.38-0.95] and for gastric cancers from [HR = 0.87, 95%CI: 0.66-1.15 to HR = 0.63, 95%CI: 0.43-0.93], but not for pancreatic cancer [HR = 1.04-, 95%CI: 0.83-1.3 for 2000-2004 and HR = 1.01, 95%CI: 0.78-1.3 for 2005-2008]. UGI patients treated during the second study period in the county of WA/MDT-Change had a higher probability of receiving chemotherapy. In the first study period, only one out of 43 patients (2.4%, 95%CI: 0-6.9) received chemotherapy, compared to 18 of 42 patients diagnosed during 2005-2008 (42.9%, 95%CI: 28.0-57.8).

CONCLUSION: Introduction of iMDTa led to a two-fold increase of UGI patients, whereas no increase in survival was found in the MDT-No or MDT-Mix counties.

Keywords: Gastric cancer, Gastroesophageal cancer, Oesophageal cancer, Pancreatic cancer, Multidisciplinary treatment, Multidisciplinary team, Survival