Adherence to Multidisciplinary Tumor Board Recommendations in Patients with Multiple Myeloma

Patient management following a multidisciplinary tumor board (MTB) recommendation has become standard of care in oncology and aims to ensure optimization and personalization of patient care. To assess the impact of MTB recommendations in clinical practice, adherence to the recommended procedures needs to be evaluated. Within this retrospective case series, we examined adherence rates to recommendations formulated at multidisciplinary myeloma tumor boards (MMTB) held at our institution. Specifically, we analyzed how often recommendations involving diagnostic procedures, therapies, and enrollment into clinical trials recommended by the MMTB were implemented. In addition, factors leading to non-adherence were evaluated.

We reviewed all consecutive patient cases discussed at MMTBs held at the University Hospital of Bern, Switzerland, between 1 January and 31 December 2023. Adherence was assessed by systematically comparing all available clinical records with the recommendations formulated at the MMTBs.

In total, 218 patients were included in the study. Of all MMTB recommendations, 86% (n = 251) of all MMTB recommendations were followed. Of these, 84% (n = 244) were followed with complete adherence and 2% (n = 7) incompletely. All cases of non-implementation of MMTB recommendations concerning diagnostics or therapy were clinically justified. The main reason for non-adherence was patient decision. Other reasons included lack of cost coverage and relevant changes in the clinical scenario, including patient's death. In total, 36% (n = 104) of MMTB recommendations included clinical trial enrollment. However, study enrollment occurred only in 32% (n = 33) of the 104 cases. In 41% (n = 29) of the cases, justification for non-enrollment was documented in the clinical records. The most frequent reasons were patient decision, unmet inclusion criteria, delays in recruitment, lack of reimbursement, and changes in the clinical scenario.

Our study showed an overall high level of adherence to MMTB recommendations for diagnostic procedures and therapy. However, only one third of recommendations for clinical trial enrollment were implemented, frequently due to patient decisions. Our results highlight the relevance of regular assessments of adherence rates to MTB recommendations and suggest that considering patient preferences in MTB discussions might minimize deviations.