Discrepancies in regional lung cancer multidisciplinary team decisions can be reduced through national consensus meetings

BACKGROUND: Multidisciplinary team (MDT) meetings are a gold standard in lung cancer care. A recent study identified discrepancies in staging and treatment recommendations among Danish lung cancer MDTs based on fictitious cases. This short report presents the results from a national lung cancer MDT meeting, which reevaluated these difficult cases.

METHOD: Fifteen difficult cases were reevaluated by 52 lung cancer specialists from across Denmark, representing oncology, pulmonology, radiology, nuclear medicine, and thoracic surgery. Participants were grouped together with their usual MDT colleagues. Cases were presented in a plenary session, and participants discussed cases staging, treatment intent, and treatment options as they would in a regular MDT with their colleagues. If disagreement between the individual MDT groups occurred, the case was further discussed in plenum. Descriptive statistics were used to assess agreement.

RESULTS: Complete agreement on tumor node metastasis (TNM) staging, treatment intent, and recommended treatment was reached in three cases (20%). Agreement on stage was reached in 10 cases (67%). Discrepancies regarding stage arose from debates regarding multifocal versus synchronous lung cancers, degree of lymph node involvement and the malignancy status of pleural fluid. Differences in treatment recommendations were mainly due to insufficient information about performance status.

INTERPRETATION: Staging and treatment intent discrepancies among Danish lung cancer MDTs were considerably reduced when complex cases were discussed in a national plenary session. However, for difficult lung cancer cases, MDTs recommend different treatment, highlighting the need for a national MDT meeting for a select group of lung cancer patients.