EP788 - Multidisciplinary Tumor Boards for Colorectal Cancer: An Opportunity for Quality Improvement?

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Purpose/Background: Multidisciplinary tumor boards (MDTBs) have been shown to improve cancer outcomes. MDTBs may represent a key opportunity for quality improvement interventions. However, little is known about when and how MDTBs are conducted, particularly for colorectal cancer (CRC). This study aimed to characterize MDTB practice patterns for CRC among the 69 hospitals participating in the Michigan Surgical Quality Collaborative (MSQC) to guide future quality improvement interventions.

Methods/Interventions: We conducted an online survey of providers familiar with MDTB practices for colon and/or rectal cancers at one of 69 MSQC hospitals. The MSQC hospitals deliver 90% of surgical care in the state, pairing robust clinical data collection with annual quality improvement initiatives. Respondents were recruited in-person at the MSQC meeting or via email. The survey assessed availability and practice patterns of MDTBs. Responses were stratified by hospital size (small [ < 300 beds] vs. large [≥300 beds]) and rurality as defined by the Centers for Medicaid and Medicaid Services Rural Referral program. Descriptive statistics were performed using proportions and Fisher’s exact tests for comparison using p< 0.05 for significance.

Results/Outcomes: The survey response rate was 78.2% (54 of 69 hospitals). Among the 54 hospitals, 46% were large and 54% were rural. MDTBs to discuss CRC patients were available at 82% (44/54) of MSQC hospitals. Among the 44 hospitals with an MDTB, 86% of respondents (38) were familiar with the MDTB practices and responded to additional questions. Overall, MDTBs commonly met weekly (42%), but many met less frequently (biweekly 25%, monthly 22%, less than monthly 11%). MDTBs were commonly held in a hybrid format (69%), followed by virtual only (19%) or in-person only (11%). Most MDTBs also discussed other types of cancers (86%) in addition to CRC. Most MDTBs had a surgeon (general and/or colorectal), medical oncologist, radiation oncologist, diagnostic radiologist, and pathologist participating the majority of the time, but no hospitals reported that all core specialties were present the majority of the time (Figure 1). While there were trends toward greater MDTB availability, frequency, virtual format, and content focus exclusively on CRC among large and urban hospitals as compared to small and rural hospitals, no significant differences were identified.

Conclusion/Discussion: This study identified a high prevalence of MDTBs, most often occurring in the hybrid format every one to two weeks. However, one in three hospitals met no more than once per month and a comprehensive cohort of multidisciplinary providers were not present at the majority of MDTBs. Robust clinical data from the MSQC has previously shown variation in positive margin and adequate (>12) lymph node assessment rates after CRC operations. Future work is needed to understand how MDTs may be leveraged to conduct quality improvement initiatives aimed at reducing variation in CRC quality of care.