Evidence-based Cancer Care: Assessing Multidisciplinary Tumor Board Recommendations and Guideline Adherence in a Non- Academic Medical Center

Purpose Multidisciplinary tumor boards (MTB) are associated with improved outcomes. Yet, most patients in Western countries receive cancer care at non-academic medical centers. Guideline adherence of MTB recommendations in non-academic medical centers as well as factors contributing to non-adherence have so far not been systematically investigated. Methods All cases discussed at the MTB of the Landesklinikum Baden-Moedling, Austria were eligible for inclusion. Guideline non-adherence was assessed by two reviewers independently using the AWMF S3 guidelines. Factors associated with guideline non-adherence were investigated. Results In total, 579 patients were included in the final analysis: 486 were female (83.9%) and 93 were male (16.1%), with a median age of 70 years (IQR 60–80). Most had breast cancer (n = 451; 77.9%), while 128 had colorectal cancer (22.1%). Complete adherence to guidelines was observed in 453 patients (78.2%), major deviations in 60 (10.4%), and minor deviations in 66 (11.4%) patients. Non-adherence was primarily due to patient preferences (n = 24; 40.0%), lack of surgical treatment recommendation (n = 24; 40.0%), and comorbidities (n = 9; 15.0%). After adjusting for relevant variables, predictors of non-adherence included older age at diagnosis (OR 1.02, 95% CI 1.00-1.04), colorectal cancer (OR 3.84, 95% CI 1.99–7.42), higher ECOG status (OR 1.59, 95% CI 1.18–2.16), and a more recent MTB conference (OR 1.20, 95% CI 1.03–1.41). Conclusion Overall, guideline adherence was high for colorectal and breast cancer and comparable to results from academic medical centers. This study provides support for high-quality cancer treatment in the setting of a non-academic medical center. However, results need to be confirmed in other tumor entities.