Elsevier

European Journal of Cancer

Volume 44, Issue 17, November 2008, Pages 2623-2626
European Journal of Cancer

Maximising recruitment into randomised controlled trials: The role of multidisciplinary cancer teams

https://doi.org/10.1016/j.ejca.2008.08.009Get rights and content

Abstract

Multidisciplinary cancer teams offer many theoretical benefits, although few have been formally examined. This study evaluated the role of multidisciplinary team (MDT) meetings in recruitment into randomised controlled trials (RCTs). Consecutive MDT patient records were categorised into those with or without a recommendation for a national multicentre RCT. Clinical trial office records identified whether patients were subsequently screened and randomised.

In 125 MDT meetings, 350 new patients were discussed, of whom 103 were potentially suitable for a RCT. The MDT recommended 68 patients for the trial, of whom 58 (85%) were screened for trial eligibility. Of the 35 without an MDT trial recommendation, only 23 (66%) were screened (p = 0.022). This difference persisted and resulted in a greater proportion of MDT recommended patients being recruited (65% versus 49%; p = 0.12). This study demonstrates that trial recommendation by an MDT significantly increases trial screening rates and may improve recruitment.

Introduction

Multicentre randomised controlled trials are recognised as the most reliable study design for evaluating interventions in oncology. Recruitment difficulties are frequent, however, and this may delay trials leading to expensive protocol changes or closure if recruitment is poor. In 2001, England was recruiting approximately 4% of patients with a new diagnosis of cancer into clinical trials.1 Since then, significant national investment has been made through the formation of the National Cancer Research Institute and the National Cancer Research Network, and a rise in trial recruitment and a reduction in the average time taken to complete trials have been reported.2, 3 Many of the cancer initiatives developed by these organisations are implemented through the actions of multidisciplinary teams (MDTs) that coordinate the care of patients with cancer, and it has been suggested that MDTs are an essential tool to help doctors enrol patients in clinical trials.4

The multidisciplinary model of cancer care is rapidly becoming the standard in Europe. A recent European Union round-table on improving cancer control has recommended that multidisciplinary care is included in the national cancer plans of all European Union member states, and declares that ‘A multidisciplinary approach to cancer care is required to make the best decisions about each patient’s diagnosis, treatment and support’.5 In several European countries multidisciplinary cancer teams are already common,6, 7 and in particular, the United Kingdom has adopted MDTs universally across all cancer sites following publication of the National Health Service Cancer Plan in 2000.8 Worldwide, multidisciplinary team working occurs in a broad range of health services and in a number of forms, such as tumour boards in the United States,9 multidisciplinary cancer conferences in Canada10 and MDTs in Australia.11 Given that there is this widespread and increasing use of multidisciplinary team working, it is essential to examine the potential benefits to patient care.

Multidisciplinary teams bring specialists in relevant disciplines together, aiming to ensure that clinical decisions are fully informed, treatment planning is optimised and there is a coordinated delivery of care.12 Many potential benefits of MDT working have been suggested: improved cancer staging,13 prolonged patient survival,14 improved clinical decision making,15 as well as increasing recruitment into randomised controlled trials. Although team working has been widely implemented, there is a lack of definitive evidence evaluating the benefits of working in a team.12 The aim of this study was to investigate whether MDTs can contribute to improved recruitment of eligible patients to the national randomised trials of cancer treatment.

Section snippets

Patients and methods

Prospective MDT treatment recommendations from the central upper gastrointestinal cancer MDT of the Avon, Somerset and Wiltshire Cancer Network were retrospectively reviewed. The upper gastrointestinal MDT meets weekly at University Hospitals Bristol NHS Foundation Trust and discusses all relevant details for each patient. At the end of each discussion, the MDT recommendation is documented and projected in the meeting, so all team members have the opportunity to support or dissent the decision.

Results

During the study period, 125 MDT meetings discussed 350 new patients with oesophageal adenocarcinoma, of whom 103 were considered suitable for chemotherapy and resection. The MDT identified and flagged 68 patients for the OEO5 randomised trial, Group A. The 35 patients in Group B, who were not specifically recommended for the trial, had similar age and sex distribution similar to patients in Group A, and the same mix of disease stages (Table 1). There is evidence that MDT recommendation

Discussion

This study shows that trial recommendation by an MDT significantly increases the chances that patients are screened for trial entry, and as a result recruitment rates are improved. It is therefore recommended that during the MDT meeting itself, patients potentially eligible for a national RCT are flagged in the meeting records, as a simple and effective means of increasing trial recruitment.

Many strategies have been suggested to improve recruitment into randomised trials, and these are

Conflict of interest statement

None declared.

Acknowledgements

AM is supported by grants from the David Telling Charitable Trust and the above and beyond Foundation.

The authors would like to thank the upper gastrointestinal MDT in the United Bristol Healthcare Trust and the Avon, Somerset and Wiltshire Cancer Research Network. Specifically, the authors thank the Bristol Haematology and Oncology Centre Clinical Trials Unit, University Hospitals Bristol NHS Foundation Trust, the Oncology and Haematology Research Unit, Royal United Hospital, Bath and the

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