Background: Patient management following a multidisciplinary tumor board (MTB) recommendation has become standard of care in oncology and aims to ensure optimization and personalization of patient care. To assess the impact of MTB recommendations in clinical practice, adherence to the recommended procedures needs to be evaluated. Within this retrospective case series, we examined adherence rates to recommendations formulated at multidisciplinary myeloma tumor boards (MMTB) held at our institution. Specifically, we analyzed how often recommendations involving diagnostic procedures, therapies, and enrollment into clinical trials recommended by the MMTB were implemented. In addition, factors leading to non-adherence were evaluated. Methods: We reviewed all consecutive patient cases discussed at MMTBs held at the University Hospital of Bern, Switzerland, between 1 January and 31 December 2023. Adherence was assessed by systematically comparing all available clinical records with the recommendations formulated at the MMTBs. Results: In total, 218 patients were included in the study. Of all MMTB recommendations, 86% (n = 251) of all MMTB recommendations were followed. Of these, 84% (n = 244) were followed with complete adherence and 2% (n = 7) incompletely. All cases of non-implementation of MMTB recommendations concerning diagnostics or therapy were clinically justified. The main reason for non-adherence was patient decision. Other reasons included lack of cost coverage and relevant changes in the clinical scenario, including patient’s death. In total, 36% (n = 104) of MMTB recommendations included clinical trial enrollment. However, study enrollment occurred only in 32% (n = 33) of the 104 cases. In 41% (n = 29) of the cases, justification for non-enrollment was documented in the clinical records. The most frequent reasons were patient decision, unmet inclusion criteria, delays in recruitment, lack of reimbursement, and changes in the clinical scenario. Conclusions: Our study showed an overall high level of adherence to MMTB recommendations for diagnostic procedures and therapy. However, only one third of recommendations for clinical trial enrollment were implemented, frequently due to patient decisions. Our results highlight the relevance of regular assessments of adherence rates to MTB recommendations and suggest that considering patient preferences in MTB discussions might minimize deviations.
背景：遵循多学科肿瘤委员会（MTB）建议的患者管理已成为肿瘤学标准诊疗模式，旨在确保患者治疗的优化与个体化。为评估MTB建议在临床实践中的实际影响，需对建议措施的依从性进行考察。本回顾性病例系列研究旨在分析我院多发性骨髓瘤多学科肿瘤委员会（MMTB）所提建议的临床执行情况，重点评估涉及诊断程序、治疗方案及临床试验入组的建议实施频率，并对未依从原因进行探究。 方法：我们系统回顾了2023年1月1日至12月31日期间在瑞士伯尔尼大学医院MMTB讨论的所有连续病例。通过系统比对现有临床记录与MMTB建议内容，对建议依从性进行评估。 结果：研究共纳入218例患者。在全部MMTB建议中，86%（n=251）得到执行，其中完全依从占84%（n=244），部分依从占2%（n=7）。所有未执行的诊断或治疗建议均具有临床合理性。未依从的主要原因为患者自主决策，其他因素包括费用覆盖不足、临床情况变化（含患者死亡）等。在MMTB建议中，36%（n=104）涉及临床试验入组，但实际入组率仅为32%（n=33）。41%（n=29）的未入组病例在临床记录中载明原因，主要包括患者决策、不符合入组标准、招募延迟、费用报销问题及临床情况变化。 结论：本研究显示针对诊断与治疗方案的MMTB建议总体依从率较高，但临床试验入组建议的实施率仅达三分之一，患者决策是主要影响因素。研究结果凸显了定期评估MTB建议依从性的重要意义，并提示在MTB讨论中充分考虑患者偏好可能减少执行偏差。
Adherence to Multidisciplinary Tumor Board Recommendations in Patients with Multiple Myeloma
肿瘤(癌症)患者之家