Effect of Breast Cancer Multidisciplinary Team Meetings (Mdtm) on Patient-care at Kenyatta National Hospital (KNH)

Abstract

Background: Many of the published studies in USA, Europe and Asia show that multidisciplinary team meetings (MDTM) are beneficial in management of cancer patients. There is paucity of study in our context. Study objective: To study the effect of breast cancer MDTM on surgical patient-care at a local institution, Kenyatta National Hospital (KNH) in terms of patient flow and documentation of breast cancer evaluation in accordance to Kenya National Cancer Guidelines (KNCG). Methodology: This was a retrospective cross sectional study carried out in the month of November, 2019. Data was extracted from files of all patients who had been discussed at breast cancer MDTM and were undergoing surgery for breast cancer at KNH over an eighteen month period. Data on patient demographics, flow and documentation of breast cancer evaluation was collected. These were compared with results of an audit carried out at KNH in 2017 before the installation of breast-MDTM. Data was analyzed for means and proportions. Results: The mean age at diagnosis was 50.2 ± 11.8 years. Duration of time from referral to index breast clinic consultation was 8 days, down from 10.9 days in pre-MDT period. Duration of time from specialty consultation to surgery was 55 days, down from 64 days in pre-MDT period. From 89 files, the most prominent risk factors were reproductive history (89.9%) and hormonal use (82%) while the most frequent presentation is breast lump (95.5%); All the patient had their renal function test with very few having calcium (4.5%) test done. Mammogram (70.8%) is a very frequent test for diagnosis while chest CT scan (73.0%) for staging is the most common test. Majority of decisions were made from core biopsy (98.9%), immunohistochemistry was performed ix

in 84.3% of cases. In 77.5% there was documentation of TNM staging. Compared to pre-MDT study there was improvement in documentation of every aspect of breast cancer evaluation. Conclusion: This study suggests that breast-MDTM have improved patient flow and documentation of breast cancer assessment in accordance to KNCG and thus patient-care at KNH