• 2,500 women
    were determined to be at high risk for breast cancer by the High Risk Screening Program in Ontario in 2014
  • 84%
    of cancer patients saw a registered dietitian at a regional cancer centre within 14 days of referral in 2015
  • 72%
    of stage III colon cancer patients received chemotherapy within 60 days after surgery
  • 84%
    of all cancer surgery patients received their consult within the recommended wait time in 2015, and 88% received their surgery within the recommend wait time
  • 29%
    of patients with oropharynx cancer and 20% with cervical cancer visited the emergency department while undergoing a course of curative radiation therapy between 2012 and 2015
  • 44%
    of breast cancer patients, 48% of colon cancer patients and 62% of lymphoma patients visited the emergency department or were admitted to hospital at least once while receiving chemotherapy
  • About 25%
    of patients who undergo lung, prostate and colorectal surgery have an unplanned hospital visit following cancer surgery
  • 64%
    of cancer patients had a first consult with an outpatient palliative care team within 14 days of referral in 2015
  • 40%
    of cancer patients visited the emergency department in the last 2 weeks of life in 2012
  • 361,991
    unique patients were screened for symptom severity using ESAS in 2015, representing 60% of patients
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Team-Oriented Care: Multidisciplinary Cancer Conferences

Measure Desired Direction As of this Report
Adherence to standards criteria of reported MCCs Black Arrow Up Green Arrow Up
See Methodology and Approach to find out how the ratings are calculated.

Key findings

In Fiscal Year (FY) 2015/2016, more than 40,000 patients were discussed at comprehensive multidisciplinary cancer conferences (MCCs), an increase from 24,000 patients since FY2010/2011. MCC standards criteria also were met 77% of the time during the third quarter (Q3) of FY2015/2016 (up from 56% in Q3 FY2012/2013), nearing Cancer Care Ontario’s target of 80% for FY2015/2016. There are now more MCCs for more types of cancer—with participation from more disciplines in more hospitals—across the province.

What are MCCs?

In my words

It is important for me to be fully informed about possible short or long term safety risks associated with my care in order that I can participate in decision-making.

Patient/Family Advisor
  • MCCs are regularly scheduled meetings where healthcare providers from different disciplines discuss and make recommendations on the best treatment plan for individual cancer patients.
  • While the treating physician (in discussion with the patient) ultimately is responsible for the final treatment decision, the main purpose of the MCC is to ensure that all of the appropriate diagnostic tests and treatment options are considered, and that the most suitable treatment recommendations are made for each cancer patient.

What are MCC standards criteria?

  • Cancer Care Ontario has developed the MCC standards, which define best practice recommendations for the organization and the implementation of MCCs. These standards were developed to ensure high-quality care and optimal cancer treatment outcomes.
  • Nine (9) criteria are required to satisfy the minimum standards for an MCC. They include:
    • prospective review of patient cases;
    • weekly or biweekly MCCs (an MCC must occur a minimum of 5 times every 3 months);
    • assignment of an MCC coordinator;
    • assignment of an MCC chair; and
    • attendance by a surgeon, medical oncologist, pathologist, radiation oncologist and radiologist 75% of the time. Nursing attendance is preferred, although it is not required, and the participation of specific disciplines may vary according to the type of cancer.
  • Hospitals across the province that treat more than 35 unique cancer patients per year (either via surgery, radiation or systemic therapy) for a specific type of cancer (i.e. colon cancer or lung cancer) are accountable for providing access to MCCs for patients with that type of cancer.
  • Hospitals can either host their own MCC, or they can video conference via the Ontario Telemedicine Network into an MCC being hosted at another hospital. Typically, non-regional cancer centre hospitals will conference into MCCs at the regional cancer centres (RCCs) to ensure that all appropriate healthcare providers and disciplines are available to discuss patients. Current data show that while there has been great improvement in access to (and quality of) MCCs, performance differs between RCC and non-RCC hospitals.
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What do the results show?

MCC standards are being followed at a higher percentage at RCCs than non-RCC hospitals (Figure 1).

  • RCCs have increased their MCC standards concordance from 71% in FY2012/2013 to 85% in FY2015/2016, surpassing the Cancer Care Ontario’s program target of 80%.
  • MCC standards concordance at non-RCC hospitals has been increasing from 44% in FY2012/2013, and it met the previous 75% target that had been established for FY2014/2015. A new target of 80% was implemented for FY2015/2016, and non-RCC hospitals were at 70% concordance; a decline of 5 percentage points from the previous year.
  • Cancer Care Ontario is currently working with non-RCC hospitals to increase compliance with MCC standards.

Increased recognition of the importance of multidisciplinary consultation and care is shown by the improvement in concordance with the MCC standards (Figure 2).

  • Hospitals across the province have shown improvement in meeting the standards criteria for MCCs, improving from 56% in FY2012/2013 to 77% in FY2015/2016. This is very close to the rate of 79% in FY2014/2015.
  • Large regional variation exists, with many Local Health Integration Networks (LHINs) exceeding the FY2015/2016 program target of 80%.
  • The South West LHIN had the highest rate of meeting standards criteria in FY2015/2016 (94%); the South East LHIN had the lowest (63%).
  • Over the last 5 years, the number of hospitals participating in MCCs has grown from 53 in FY2010/2011 to 62 in in FY2015/2016 (data not shown). In FY2015/2016, only 1 hospital required to participate in MCCs did not participate in any.
  • In FY2015/2016, more than 40,000 patients were discussed at an MCC (data not shown). This has grown significantly since FY2010/2011, when 24,000 patients were discussed at an MCC (data not shown).

Why is this important to patient care?

  • Cancer care is complex, and research has provided patients and clinicians with more options to treat and cure the disease. Making the best choice for the situation and an individual patient is facilitated by multidisciplinary discussion at MCCs.
  • MCCs are a way to bring together multidisciplinary teams of clinicians with different areas of expertise to discuss all treatment options and make recommendations to a patient’s treating physician.

Benefits of MCCs

  • Evidence suggests that patients whose cases are reviewed at an MCC are more likely to receive evidence-based care, to have all treatment options considered and to have better survival rates than patients whose cases were not discussed at an MCC1.
  • Internationally, MCCs are considered the standard for cancer care2,3.
  • In addition to the benefits to a patient’s treatment plan, MCCs also are a mechanism for peer review (quality assurance) of pathology reports and diagnostic images.
  • MCCs help build care teams and communities of practice, which decrease clinical isolation and encourage hospitals across regions to work together. Some Ontario MCCs also use videoconferencing, allowing expertise to be shared between hospitals.
  • This video highlights the value added to providers and patients by participating in MCCs is also available.

Find out more

More information on MCCs can be found on Cancer Care Ontario’s website.

View Notes

  1. Bydder S, Nowak A, Marion K, Phillips M, Atun R. The impact of case discussion at a multidisciplinary team meeting on the treatment and survival of patients with inoperable non-small cell lung cancer. Internal Medicine. 2009; 39:838–841.
  2. Wright FC, De Vito C, Langer B, Hunter A. Multidisciplinary cancer conferences: a systematic review and development of practice standards. Eur J Cancer. 2007; 43(6):1002–1010.
  3. Vinod SK, Sidhom MA, Delaney GP. Do multidisciplinary meetings follow guideline-based care? J Oncol Pract. 2010; 6(6):276–281.
  4. Brar SS, Provvidenza C, Hunter A, Irish J, MacLeod RS, Wright FC. Improving multidisciplinary cancer conferences: a population-based intervention. Ann Surg Oncol. 2014; 21(1):16–21.