Análisis del impacto del comité de tumores en el abordaje multidisciplinar del cáncer epidermoide de cabeza y cuello en el Área II de salud de la Región de Murcia

Resumen

ABSTRACT OBJECTIVES: The main objective is to ascertain the 2-year survival of patients with squamous cell cancer of the head and neck (HNSCC) treated by a multidisciplinary team (MDT) and without an MDT, determining whether there are statistically significant differences. Our secondary objectives are to define the characteristics of people with HNSCC treated in our area, quantify the impact of the committee on the staging of HNSCC, assess the influence of the committee on the change in the initial treatment proposed by the diagnostic service to determine whether the selection of treatment by the MDT influences therapeutic compliance and if follow-up is higher in patients treated by an MDT. METHODS: Observational, analytical, retrospective study of two cohorts, which aims to analyse the variables, both primary and secondary, in the cohort of patients handled by an MDT with respect to the cohort of patients without an MDT. We included all patients with an initial diagnosis of HNSCC at our centre between 2005 and 2012. The cohort without the MDT comprised those from 01/01/2005 to 31/12/2008 and the MDT cohort comprised those from 01/01/2009 to 31/12/2012. With access to the Pathological Anatomy database, the records of the MDT, the archived and computerised medical history, we collected the primary endpoint (survival at 2 years) and secondary endpoints related to the patient (age, sex, ECOG, toxic habits, comorbidity, initial symptom and diagnostic service), the tumour (date of diagnosis, degree of differentiation, location, and TNM stage), the treatment (therapy selected, change in treatment, compliance, reason for default, intent and chemotherapy regimen) and tracking (date of last follow-up, reason for loss of follow-up, date and cause of death). Definitive sample consists of 408 patients, 200 in pre-MDT cohort and 208 in post-MDT cohort. A descriptive analysis is given of the demographic and clinical and epidemiological characteristics of the sample, together with the comparative bivariate analysis of these characteristics in the cohorts and a survival analysis with rates calculated using the Kaplan Meier method. The log-rank test was used to assess the differences in survival between cohorts, and a Cox proportional-hazards regression model was used to perform the univariate and multivariate survival analysis. CONCLUSIONS: 1. The population served in our area presents demographic and clinical and epidemiological characteristics similar to those of other series published in our country, with increased incidence in women, non-smokers and moderate drinkers during the study period. 2. The MDT improved the staging of the tumour before treatment in a statistically significant way. 3. The change in treatment is higher, so as to be statistically significant, when the therapeutic planning is addressed by an MDT. 4. There is a statistically significant increase in the administration of treatments according to clinical guidelines when it is decided by an MDT, a greater rate of utilization of radiotherapy, chemoradiotherapy, induction chemotherapy, in combination cytostatic and monoclonal antibodies. 5. No statistically significant difference was observed in therapeutic compliance rates when treatment was decided by the MDT. 6. Patients treated at a centre with an MDT have increased monitoring, better compliance, and for a longer period. 7. Comorbidity with predominance of cardiovascular risk factors, cardiac and pulmonary disease is the leading non-specific cause of death in these cancer patients. 8. Age 70+, severe alcoholism and the administration of chemotherapy or unspecific palliative treatment are independent variables for poor outcome in terms of overall survival. 9. There is a statistically significant improvement in the survival of patients treated by MDT, this approach being an independent variable of better prognosis in terms of overall survival in our study.