The impact of multidisciplinary cancer meetings in guiding treatment intent in patients with upper tract urothelial carcinoma

Introduction: Patient presentation at multidisciplinary cancer meetings (MDMs) is a key quality indicator in cancer care and may have particular utility in rare malignancies, such as upper tract urothelial carcinoma (UTUC). This study aims to investigate what proportion of patients diagnosed with UTUC had treatment intent changed at MDM, the nature of these changes, and what patient factors may correlate with a suggested change.

Methods: This study analyzed patients diagnosed with UTUC between 2015 and 2020 at an Australian tertiary referral center. MDM discussion rate and suggested treatment intent changes were analyzed. Patient factors that may prompt change, including age, estimated glomerular filtration rate (eGFR), Charlson Comorbidity Index (CCI), and Eastern Cooperation Oncology Group performance status (ECOG PS), were assessed.

Results: Seventy-five patients were diagnosed with UTUC of whom 71 (94.6%) were discussed at an MDM upon diagnosis. Change to palliative intent was suggested in 8/71 (11%) patients. Patients for whom change to palliative treatment was suggested had a higher age (median 85 vs. 78 years, p<.01), CCI (median 7 vs. 4, p<.005), ECOG PS (median 2 vs. 0, p<.002), and lower eGFR (mean 31 vs. 66 mL/min/1.73 m², p< .0001), compared to those who underwent radical treatment. No patient had an MDM recommendation to change from palliative to curative treatment.

Conclusion: MDM discussion resulted in clinically important changes of treatment intent in a substantial proportion of patients with UTUC, potentially sparing futile treatments. Several patient factors were associated with suggested changes, highlighting the requirement for accurate, in-depth patient information at MDM discussion.