Implementation and clinical audit of a virtual thoracic oncology MDT in a low-resource setting in Malaysia

Cancer care is increasingly complex, and in Sarawak, Malaysia, geographic and resource limitations further complicate management. This clinical audit describes the implementation, structure and workflow of a virtual thoracic oncology multidisciplinary tumor board (MDT) in a resource-limited setting, and describe the cases discussed and key issues raised.

A MDT was established in Sarawak, comprising pulmonologists, oncologists, pathologists, thoracic surgeons, and radiologists. Monthly virtual meetings were held to discuss complex cases. This retrospective study analyzed cases from July 2022 to December 2024, focusing on cancer types, challenges, and recommendation. As an audit of clinical practice, no treatment adherence or outcome measures were assessed.

A total of 94 cases were discussed (median age 60 years; 59.6% male). Cases per year: 21 (2022), 24 (2023), and 49 (2024). Common diagnoses included lung cancer (48.9%), lung lesions from other solid cancers (26.6%), suspected lung cancer (12.8%), non-malignant respiratory conditions (9.6%), and thymic cancer (2.1%). Among solid cancers with lung lesions, colorectal cancer (36%) was most frequent, followed by breast (12%), gynaecological (12%), sarcoma (8%), and others (32%). The main reasons for MDT discussions were therapeutic issues (58.5%) and diagnostic challenges (41.5%). Imaging review (83%) and management discussions (80.9%) were the most common points of discussion. Among 46 lung cancer patients, 43.5% had early-stage, 30.4% locally advanced, and 19.6% metastatic disease. Key recommendations included surgery (35.1%), surveillance (16%), systemic therapy (13.8%), biopsy (11.7%), PET/MRI (7.4%), EBUS staging (5.3%), radiotherapy (4.3%), and clinical trials (2.1%).

This audit demonstrates that a virtual thoracic oncology MDT is feasible and can standardize multidisciplinary discussion, and improve access to specialist input in a resource-limited setting. While clinical outcomes were not evaluated, this audit provides insight into operational processes. Future prospective work incorporating structured data collection, MDT adherence and integration of electronic health records will help evaluate the MDT's impact on patient outcomes and guiding service improvement.