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Multidisciplinary tumor boards and their analyses: the yin and yang of outcome measures
BACKGROUND: The standard to ensure utmost cancer treatment is a prerequisite in national cancer plans for comprehensive cancer centers (CCCs) and ensured through multidisciplinary tumor boards (MTBs). Despite these being compulsory for CCCs, various analyses on MTBs have been performed, since MTBs a...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7891134/ https://www.ncbi.nlm.nih.gov/pubmed/33596881 http://dx.doi.org/10.1186/s12885-021-07878-6 |
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author | Engelhardt, Monika Ihorst, Gabriele Schumacher, Martin Rassner, Michael Gengenbach, Laura Möller, Mandy Shoumariyeh, Khalid Neubauer, Jakob Farthmann, Juliane Herget, Georg Wäsch, Ralph |
author_facet | Engelhardt, Monika Ihorst, Gabriele Schumacher, Martin Rassner, Michael Gengenbach, Laura Möller, Mandy Shoumariyeh, Khalid Neubauer, Jakob Farthmann, Juliane Herget, Georg Wäsch, Ralph |
author_sort | Engelhardt, Monika |
collection | PubMed |
description | BACKGROUND: The standard to ensure utmost cancer treatment is a prerequisite in national cancer plans for comprehensive cancer centers (CCCs) and ensured through multidisciplinary tumor boards (MTBs). Despite these being compulsory for CCCs, various analyses on MTBs have been performed, since MTBs are resource-intensive. Outcome measures in these prior analyses had been survival (OS), MTB-adherence and -satisfaction, inclusion of patients into clinical trials and better cancer care. MAIN BODY: A publication from Freytag et al. performed an analysis in multiple tumor entities and assessed the effect of number of MTBs. By matched-pair analysis, they compared response and OS of patients, whose cases were discussed in MTBs vs. those that were not. The analysis included 454 patients and 66 different tumor types. Only patients with > 3 MTBs showed a significantly better OS than patients with no MTB meeting. Response to treatment, relapse free survival and time to progression were not found to be better, nor was there any difference for a specific tumor entity with vs. without MTB discussions. An in-depth discussion of these results, with respect to the literature (PubMed search: “MTBs AND cancer”) and within the author group, including statisticians specialized in data analysis of cancer patients and questions addressed in MTBs, was performed to interpret these findings. We conclude that the results by Freytag et al. are deceiving due to an “immortal time bias” that requires more careful data interpretation. CONCLUSIONS: The result of Freytag et al. of a seemingly positive impact of higher number of MTBs needs to be interpreted cautiously: their presumed better OS in patients with > 3 MTB discussions is misleading, due to an immortal time bias. Here patients need to survive long enough to be discussed more often. Therefore, these results should not lead to the conclusion that more MTBs will “automatically” increase cancer patients’ OS, rather than that the insightful discussion, at best in MTBs and with statisticians, will generate meaningful advice, that is important for cancer patients. |
format | Online Article Text |
id | pubmed-7891134 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-78911342021-02-22 Multidisciplinary tumor boards and their analyses: the yin and yang of outcome measures Engelhardt, Monika Ihorst, Gabriele Schumacher, Martin Rassner, Michael Gengenbach, Laura Möller, Mandy Shoumariyeh, Khalid Neubauer, Jakob Farthmann, Juliane Herget, Georg Wäsch, Ralph BMC Cancer Correspondence BACKGROUND: The standard to ensure utmost cancer treatment is a prerequisite in national cancer plans for comprehensive cancer centers (CCCs) and ensured through multidisciplinary tumor boards (MTBs). Despite these being compulsory for CCCs, various analyses on MTBs have been performed, since MTBs are resource-intensive. Outcome measures in these prior analyses had been survival (OS), MTB-adherence and -satisfaction, inclusion of patients into clinical trials and better cancer care. MAIN BODY: A publication from Freytag et al. performed an analysis in multiple tumor entities and assessed the effect of number of MTBs. By matched-pair analysis, they compared response and OS of patients, whose cases were discussed in MTBs vs. those that were not. The analysis included 454 patients and 66 different tumor types. Only patients with > 3 MTBs showed a significantly better OS than patients with no MTB meeting. Response to treatment, relapse free survival and time to progression were not found to be better, nor was there any difference for a specific tumor entity with vs. without MTB discussions. An in-depth discussion of these results, with respect to the literature (PubMed search: “MTBs AND cancer”) and within the author group, including statisticians specialized in data analysis of cancer patients and questions addressed in MTBs, was performed to interpret these findings. We conclude that the results by Freytag et al. are deceiving due to an “immortal time bias” that requires more careful data interpretation. CONCLUSIONS: The result of Freytag et al. of a seemingly positive impact of higher number of MTBs needs to be interpreted cautiously: their presumed better OS in patients with > 3 MTB discussions is misleading, due to an immortal time bias. Here patients need to survive long enough to be discussed more often. Therefore, these results should not lead to the conclusion that more MTBs will “automatically” increase cancer patients’ OS, rather than that the insightful discussion, at best in MTBs and with statisticians, will generate meaningful advice, that is important for cancer patients. BioMed Central 2021-02-17 /pmc/articles/PMC7891134/ /pubmed/33596881 http://dx.doi.org/10.1186/s12885-021-07878-6 Text en © The Author(s) 2021 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Correspondence Engelhardt, Monika Ihorst, Gabriele Schumacher, Martin Rassner, Michael Gengenbach, Laura Möller, Mandy Shoumariyeh, Khalid Neubauer, Jakob Farthmann, Juliane Herget, Georg Wäsch, Ralph Multidisciplinary tumor boards and their analyses: the yin and yang of outcome measures |
title | Multidisciplinary tumor boards and their analyses: the yin and yang of outcome measures |
title_full | Multidisciplinary tumor boards and their analyses: the yin and yang of outcome measures |
title_fullStr | Multidisciplinary tumor boards and their analyses: the yin and yang of outcome measures |
title_full_unstemmed | Multidisciplinary tumor boards and their analyses: the yin and yang of outcome measures |
title_short | Multidisciplinary tumor boards and their analyses: the yin and yang of outcome measures |
title_sort | multidisciplinary tumor boards and their analyses: the yin and yang of outcome measures |
topic | Correspondence |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7891134/ https://www.ncbi.nlm.nih.gov/pubmed/33596881 http://dx.doi.org/10.1186/s12885-021-07878-6 |
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