Determinants and outcomes of adherence to recommendations from a multidisciplinary tumour conference for hepatocellular carcinoma

Abstract

Background: The multidisciplinary tumour conference (MTC) represents the standard of care in the management of hepatocellular carcinoma (HCC). Clinical outcomes in relation to adherence and non-adherence to MTC recommendations have not been studied. Methods: A total of 137 patients with HCC and cirrhosis whose cases were submitted to a first MTC discussion between 1 January 2009 and 31 December 2010 were identified. Clinical data, management recommendations, adherence, treatment regimens and overall survival were reviewed. Results: There were 419 MTC discussions on 137 patients with cirrhosis and HCC. The MTC recommendations made in 145 discussions on 90 separate patients were not followed. Patient-related reasons for deviation from MTC recommendations included failure to attend for follow-up (n = 24, 16.6%), clinical deterioration (n = 19, 13.1%) and patient preference (n = 13, 9.0%). Physician-related reasons for discordance included treating physician preference (n = 43, 29.7%) and finding that the patient was not a candidate for the recommended intervention (n = 37, 25.5%). After the first MTC discussion, 62.0% of patients received the recommended treatment; these patients were more likely to be alive at 1 year compared with those who did not receive the recommended treatment (P = 0.007). More of the patients who followed recommendations underwent liver transplantation (25.6% versus 14.4%; P = 0.10). Conclusions: There are patient-related as well as physician-related reasons for non-adherence to recommendations. Non-adherence affects clinical outcomes and can be avoided in selected cases.