Abstract
Background
Multidisciplinary team (MDT) is recognized as the best practice in the treatment planning and care for patients with cancer. MDT provides a comprehensive care for pediatric cancer patients that results in reduced treatment delays, improved care processes, improved treatment outcome, higher adherence to guidelines and enhanced support for both patients and their families. Here, we assess the implementation of MDT decision in SPHMMC for pediatrics solid Tumor patients and identify barriers to its effective implementation and provide valuable inputs that help to increase the Effectiveness of the implementation made.
Methods
institution based cross sectional study was conducted among patients discussed on MDT from April 2022 to December 2023. Data was collected using Data abstraction sheet from MDT format followed by review of medical records. Descriptive analysis was used to describe the percentages and number distributions of the variables in the study.
Result
A total of 148 MDT cases were included in the study. The average age of presentation was 3.7 years & most came from oromia region, followed by Addis Ababa. Retinoblastoma was the most commonly discussed cancer, followed by Wilms tumor, rhabdomyosarcoma, germ cell tumors and Hodkins lymphoma. 113 (76.3%) of the cases were discussed for the first time & 212 distinct management decisions were reached, of which 156(73.6%) were subsequently implemented. Decisions on follow up and palliative care followed by chemotherapy, EUA, surgery and Consults/ communications to other departments were most likely to be successfully enacted. Imaging, pathology testing & refer recommendations were less likely to be carried out. Absence of modality for the implementation of MDT decision made in the current set up is the major reason for non implemented MDT decisions, followed by illness and financial reasons. Timely implementation of MDT decisions was made for chemotherapy, Pathologic testing, EUA and consultation to other departments. Surgical decisions and cystoscopic biopsy took longer duration for implementation.
Conclusions
MDT discussions are the standard of care for patients with cancer worldwide. Adaptation of MDT discussions as a routine of care for pediatrics solid tumor patients is a major step up for improving the quality of care given in SPHMMC. All cancan centers in the country should also incorporate this standard of care into their practice. The success of the MDT discussion can further be augmented by increasing the accessibility of important modalities of diagnosis & treatment as genetic testing, intraarterial chemotherapy & radiotherapy respectively. Raising Public awareness on the benefits of community based health insurance will also help in relieving the financial burden and increase effectiveness of care given.