The Effects of Multidisciplinary Team Meetings on Clinical Practice for Colorectal, Lung, Prostate and Breast Cancer: A Systematic Review

Simple Summary Multidisciplinary team meetings have increasingly been implemented in cancer care worldwide to ensure timely, accurate and evidence-based diagnosis, and treatment plans. Nowadays, multidisciplinary team meetings are generally considered indispensable. However, they are considered time-consuming and expensive, while the effects of multidisciplinary team meetings are not yet fully understood. The aim of this systematic review is to update and summarize the literature and create an overview of the existing knowledge. Cancer types such as colorectal, lung, prostate and breast cancer with rapidly increasing incidence rates will inevitably impact the workload of clinicians. Understanding the effects of the widely implemented multidisciplinary team meetings in oncology care is fundamental in order to optimize care pathways and allocate resources in the rapidly diversifying landscape of cancer therapies. Abstract Objective: The aim of our systematic review is to identify the effects of multidisciplinary team meetings (MDTM) for lung, breast, colorectal and prostate cancer. Methods: Our systematic review, performed following PRISMA guidelines, included studies examining the impact of MDTMs on treatment decisions, patient and process outcomes. Electronic databases PUBMED, EMBASE, Cochrane Library and Web of Science were searched for articles published between 2000 and 2020. Risk of bias and level of evidence were assessed using the ROBINS-I tool and GRADE scale. Results: 41 of 13,246 articles were selected, evaluating colorectal (21), lung (10), prostate (6) and breast (4) cancer. Results showed that management plans were changed in 1.6–58% of cases after MDTMs. Studies reported a significant impact of MDTMs on surgery type, and a reduction of overall performed surgery after MDTM. Results also suggest that CT and MRI imaging significantly increased after MDTM implementation. Survival rate increased significantly with MDTM discussions according to twelve studies, yet three studies did not show significant differences. Conclusions: Despite heterogeneous data, MDTMs showed a significant impact on management plans, process outcomes and patient outcomes. To further explore the impact of MDTMs on the quality of healthcare, high-quality research is needed.


Introduction
Multidisciplinary care has increasingly been implemented in cancer care pathways worldwide, with oncology multidisciplinary team meetings (MDTMs) as a central platform for coordinated care delivery. An MDTM can be defined as "a group of healthcare professionals with different specialties who meet periodically (e.g., weekly) to discuss patient cases, diagnosis and treatment recommendations" [1]. MDTMs are often tailored as disease-specific and therefore differ in organization, i.e., in meeting frequency, duration or core team. The goal of the MDTM is to ensure timely, accurate and evidence-based diagnosis, treatment plans and follow-up for all discussed patients [2]. In 1995, Calman-Hine showed a positive correlation between multidisciplinary care and optimal decision making for cancer patients [3]. Since the publication of the Calman-Hine report, MDTMs have increasingly been adopted as part of routine cancer care pathways and are nowadays generally considered indispensable [2]. However, at the same time, MDTMs are considered time-consuming and expensive. The total workload of clinicians, occupied by MDTMs, is expected to increase, especially for cancer types with continuously increasing incidence rates, such as colorectal, lung, prostate and breast cancer [4].
These cancer types together constitute the top four cancer types in terms of global annual incidence [5]. Therefore, it is of great importance that the impact of MDTMs on different aspects of the clinical pathway and patient outcomes are well-understood. Previous systematic reviews showed weak evidence of impact on diagnosis and management plans. However, these studies found little evidence that MDTMs improve clinical outcomes [6][7][8].
We are the first to report on multiple cancer types in detail, to compare the effects of MDTMs in the four cancer types (colorectal, lung, prostate and breast cancer) that are expected to have a high impact on global healthcare. The aim of this systematic review is to update and summarize the literature and create an overview of the existing knowledge regarding the effects of MDTMs for colorectal, lung, prostate and breast cancer and to identify their value in these patient care pathways.

Methods
This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and Cochrane Collaboration's double-data collection and extraction methodology [9,10].

Protocol and Registration
The protocol of this systematic review is registered in the PROSPERO database (CRD42019127476) [11].

Search Strategy
Relevant studies were searched in the following electronic databases: (1) PUBMED, (2) EMBASE, (3) Cochrane Library and (4) Web of Science. A librarian was consulted for the search strategy, and the search strategy combined variations for 'multidisciplinary team meetings' and 'colorectal cancer', 'lung cancer', 'prostate cancer' or 'breast cancer', (Supplementary Tables S1 and S2). No language restrictions were applied. Time limits were from 1 January 2000 to 31 December 2020. In addition, reference lists of relevant systematic reviews were screened to identify additional studies.

Study Selection Criteria
The inclusion criteria consisted of randomized controlled trials (RCT), non-randomized controlled trials, observational studies and before-and-after studies. Typically, observational studies evaluated plans prior to and after MDTM discussion and before-and-after studies compared a cohort of patients that were discussed in MDTM with a control cohort.
Studies were included if the impact of MDTMs was examined for colorectal cancer, lung cancer, prostate cancer or breast cancer. Studies that evaluated mixed cohorts, such as urological cancers, were included if extracting specific data on prostate cancer was feasible.
MDTMs were defined as "regular meetings where a multidisciplinary team of specialists attend and discuss diagnosis and treatment recommendations for patients" [1].
Studies that did investigate MDTMs for any of the four cancer types were critically evaluated and excluded if they met any of the following exclusion criteria. Study designs that were excluded were qualitative studies and studies without control groups. Studies were also excluded if they investigated: (1) the effect of another intervention, implemented in addition to the MDTM (e.g., telecommunication), (2) the implementation process, (3) opinions of healthcare professionals or (4) adherence to MDT advice.

Data Collection and Extraction
Abstracts of articles yielded from the search were imported in Endnote, and duplicates were removed [12]. Thereafter, the web application Rayyan QCRI was used for the screening process [13]. Two reviewers (L.K. and H.W.) independently performed a title-abstract screening, and articles that met the inclusion criteria were selected for full-text screening. Subsequently, the full-text articles were retrieved and reviewed (L.K. and H.W.). Disagreements on selection were discussed regularly and resolved by consensus. If no agreement could be reached, a third independent investigator (R.M.) could be consulted. Cohen's kappa was calculated to determine the inter-observer variability of full-text screening. The data were extracted independently by two reviewers to ensure correct extraction (L.K. and H.W.). Meta-analysis in general was not possible due to the heterogeneity of the data, however a few parameters were calculated. A weighted average was calculated for changes in management plans per cancer type, weighing the percentage of changed plans with the number of included patients. Studies that did not perform statistics were not included in the analysis of data. Summative tables were created to present the data.

Quality Assessment
Two researchers (L.K. and H.W.) independently assessed the risk of bias, using the ROBINS-I tool for non-randomized studies [14]. In addition, the quality of evidence of the studies was assessed with the GRADE scale [15] by the same researchers (L.K. and H.W.). Any disagreements were first discussed between the reviewers, and if required, a third researcher (R.M.) could be consulted.

Results
A total of 20,912 articles were retrieved from electronic database searches ( Figure 1). After removal of duplicates, 13,246 studies were evaluated in the title-abstract screening. Following title-abstract screening, 165 full-text articles were assessed for eligibility, and 41 studies were included in the final analysis. The measured Cohen's Kappa for the interobserver agreement between reviewers was 0.656, indicating substantial agreement [16]. It was not necessary to consult a third reviewer during title-abstract and full-text screening, as no disagreements remained after discussion.
Nine studies assessed the effect of MDTMs on process outcomes. Reported process outcomes included time to treatment, time to diagnosis, costs and other process outcomes ( Table 2).
For colorectal cancer, two studies showed significantly increased length of time to surgery in the MDTM cohort [26,37]. Chinai et al., estimated the annual costs of colorectal MDTMs, including direct and overhead costs, at £162,734 [19].
For lung cancer, Boxer et al., found a significantly increased time to start chemotherapy with palliative intent, while time to all other treatments remained unchanged [38]. Freeman et al., however showed a significantly shorter time to treatment when patients were discussed in the MDTM. They also assessed the mean cost of care and found that mean costs reduced significantly in the MDTM group compared to the control group. Furthermore, they also showed a significantly increased adherence to national guidelines and research participation [40]. Muthukrishnan et al. found that the MDTM group showed a significantly longer time to complete staging, time from imaging to diagnosis, staging to therapy and imaging to therapy. However, for a subgroup with stage I-III, only the time from staging to therapy was significantly longer in the MDTM group [47].
Brandão et al. showed that time from diagnosis to treatment for breast cancer patients was not significantly different between control and MDTM groups. Furthermore, they confirmed the cost-effectiveness of MDTM implementation [55].
Two articles reporting on process outcomes did not perform statistical analysis [29,43].
Six articles subdivided the whole cohort according to disease stage. For colorectal cancer (CRC) patients, one study showed that the percentage of management plans changed less often in newly diagnosed CRC cases (7.6%) compared to recurred CRC cases (16.4%) [21]. In prostate cancer, four articles reported changes in management plans subdivided according to cancer characteristics, presenting conflicting results. De Luca et al. showed that management plans changed more often in advanced (46.9%) and metastatic (33.4%) disease compared to local disease (23.2%) [49]. Similarly, Rao et al. showed changes in management plans in 23% of localized and 38% of metastatic prostate cancer cases [52]. El Khoury et al. and Kurpad et al., showed no trends when subdividing the patients according to Gleason score and disease stage, respectively [50,51]. Murthy et al., showed that changes were more common in early breast cancer patients (Stage 0-IIB: 8-27%) than in advanced patients (stage IIIA-IV: 0-7%) [54].
One article measured other outcomes in colorectal cancer patients, i.e., the type of MDT presentation (preoperative, follow-up, etc.) and whether the initial plan was tentative or definitive. Postoperative management plans (6.3%) changed significantly less often compared to initial (32.4%) or follow-up plans (35.2%). Tentative management plans (45.5%) changed significantly more than definitive plans (9.6%) [22].

Effect on Diagnostics and Treatment
Twenty-three studies investigated the effects of MDTMs on diagnostics and/or treatments using either a before-after or a case-control study design. In contrast to management plans, these studies focused on the diagnostics and/or treatments the patients actually received. These outcomes were not reported for prostate cancer.

Diagnostics
Six studies investigated the effect of MDTMs on diagnostics received by colorectal cancer patients, i.e., MRI, CT, ultrasound or colonoscopies (Table 4). Of these six studies, three measured MRI imaging, and all showed a significant increase in the MDTM cohort, compared to the control group [17,20,36]. CT imaging was shown to increase significantly by four studies [17,20,35,37], and one study showed no significant effect [36]. In addition, Fernando et al., showed that the use of chest CT significantly increased, while CT of the abdomen did not change significantly in the MDTM group [20]. Three studies found no significant difference in ultrasound imaging [17,20,36]. Of the four studies investigating colonoscopies, three showed no significant difference between MDTM and control groups [20,28,36].
Two studies did not perform statistical analyses on (all) of these outcomes [17,27].

Surgery
Fourteen studies investigated the preferred surgical type and whether surgery was performed (Table 4).   In colorectal cancer, all studies reporting on resection of primary tumors indicated a reduction in the MDTM cohort [23,37], and all studies reporting on surgical type showed a significant effect of MDTMs on the preferred surgical type [27,28,33]. Foucan et al., showed that colorectal cancer patients with advanced disease received different treatments depending on the MDTM status, unlike patients with early-stage disease. Stage III and IV patients without MDTM discussion most often received surgery alone, whereas patients in the MDTM group received mostly surgery followed by chemotherapy [37]. In lung cancer, Boxer et al., showed no significant effect on the number of performed surgeries [38], however Freeman et al., showed a significant reduction in (non-therapeutic) surgical procedures [40]. Tamburini et al., showed a significant effect on preferred surgical type [44]. For breast cancer, no significant increases in surgery or surgery type were identified [55].

Radiotherapy, Chemotherapy and Palliative Care
Twelve studies investigated the effects of MDTMs on how many patients received chemotherapy, radiotherapy and palliative care (Table 4).
In colorectal cancer, Lan et al., showed a significant increase in the use of radiotherapy in the MDTM cohort [23], while MacDermid et al., showed no significant effect of MDTMs [24]. Similarly, in lung cancer, Boxer et al., showed a significant increase in the use of radiotherapy in the MDTM cohort [38], while Bydder et al., showed no significant effect of MDTMs [39]. Brandão et al., found no significant changes in radiotherapy for breast cancer patients [55] (Table 4).
According to Lan et al., the number of colorectal cancer patients who received chemotherapy was significantly higher in the MDTM cohort [23]. However, Ye et al., showed a significant decrease in overall cohort and stages I and IIA colorectal cancer, while stages IIB-IV showed no significant differences between the cohorts [35]. In lung cancer, Boxer et al., showed a significant increase of chemotherapy in the MDTM cohort [38], however Bydder et al., found no significant difference [39] (Table 4). In breast cancer, Brandão et al., showed that MDTM implementation did not lead to significant changes in the use of (neoadjuvant) chemotherapy or endocrine therapy [55].
Lan et al., showed a significant increase in the number of colorectal cancer patients in MDTM cohorts who received palliative chemotherapy, however MacDermid et al., showed no significant difference [23,24]. In lung cancer, two studies also showed a significant increase in palliative care [38,40], however three additional studies showed no significant difference between MDTM cohorts and control groups [39,43] (Table 4).
Finally, Tsai et al., found no significant differences between MDTM and control groups in any treatment combinations for breast cancer patients [56].
Muthukrishnan et al., provided no statistical analysis on these specific outcomes [47].

Patient Outcomes
Eighteen studies reported on patient outcomes, i.e., survival, recurrence or metastasis, mortality and other patient-related outcomes (Table 5). These outcomes were not measured for prostate cancer.
Six out of eight studies that reported on survival showed a significant increase in survival of colorectal cancer patients that were discussed in MDTMs [18,[23][24][25]35,37]. Of which, three studies only showed a significant effect of MDTMs on specific subgroups [24,25,37]. MacDermid et al., showed a significant increase in survival of patients with Dukes C disease while remaining unchanged for patients with Dukes B disease [24]. Similarly, Munro et al., showed that 5-year cause-specific survival for advanced cases increased significantly with MDTMs, while it did not change for early disease cases [25]. Foucan et al., showed a significantly increased survival duration after diagnosis, but not after surgery [37]. One out of eight studies reporting on survival did not show significant effects of MDTMs in colorectal cancer pathways [34], while one other study did not perform statistical analysis on the survival outcomes [27].  Besides survival, other patient-related outcomes were measured. Swellengrebel et al., showed no significant effect on resection margin rates [31]. Wille-Jørgensen et al. and Lan et al., showed that postoperative mortality decreased significantly after implementation of MDTMs in colorectal cancer [23,34], while recurrence and metastasis rates were not significantly affected [34]. Ye et al., showed a significantly lower tumor recurrence and longer time to recurrence for colorectal cancer patients who were discussed during MDTMs [35]. Chen et al. and Munro et al., both identified a significantly lower hazard ratio (HR) of death in the MDTM groups [18,25].
All five studies reporting on survival of lung cancer patients showed a significant improvement in survival of patients discussed during MDTMs [39,41,43,44,46]. Pan et al., showed a significantly lower adjusted hazard ratio (HR) of death in patients with stage III and IV non-small cell lung cancer that were discussed in MDTMs [41]. In particular, Hung et al., showed a prolonged length of survival for stage III lung cancer patients [46]. Quality of surgery was measured by Tamburini et al. and showed no significant differences between non-MDTM and MDTM groups, while overall mortality was significantly decreased [44].
In total, three studies reported on patient outcomes for breast cancer, of which all found a higher overall survival rate in the MDTM group compared to the control group [55][56][57].
Brandão et al., found a significantly higher survival rate in early breast cancer (Stage 0-III), while MDTM discussion in patients with metastatic breast cancer did not lead to a survival benefit. Furthermore, no significant increases in the proportion of clean surgical margins and complete axillary surgery were identified [55]. Brandão et al., found no significant differences in recurrence rate, while Tsai et al., showed a significant decrease in the MDTM group [55,56]. Yang et al., showed that survival was significantly higher in patients compliant with MDTM recommendations compared to the non-compliant group [57].

Summary of Evidence
We systematically reviewed scientific literature and identified the impact MDTMs can have on colorectal, lung, prostate and breast cancer care. Overall, results showed that the implementation of MDTMs can have a significant impact on treatment decisions, patient outcomes and process outcomes (Table 6). However, all studies showed a low to very low quality of evidence and a critical or serious risk of bias. While our review suggests benefits of MDTMs in colorectal, lung, prostate and breast cancer care, there is need for more high-quality research.
Studies reporting on process outcomes such as cost-or time-related components are limited. Results suggest that MDTMs can have an effect on these process outcomes, however due to the limited evidence, no solid conclusions can be drawn. The systematic review by Ke et al., suggested that the investments in MDTMs are justified, but similar to our findings, Ke et al., also stated that there is a need for more rigorous studies on costeffectiveness [58]. Some of the studies suggested that effects of MDTMs on management are less in early-stage (or non-recurrent) disease, which will typically constitute cases where the recommended treatment is more standardized and benefits of MDTM discussion may be limited [21,24,37,49,52]. This suggests a focus of future research on the cost-effectiveness of specific patient subgroups, i.e., early and advanced disease.
Results indicated that the impact on changes in management plans are different per cancer type and per hospital type (e.g., general hospital, university hospital). Overall, MDTM discussion resulted in more changes in lung cancer management plans (53-58%), compared to colorectal (6-29%), prostate (1.6-43%) and breast cancer (42.1%). This might be explained by the following aspects of lung cancer care. Typically, guidelines for lung cancer are less comprehensive and more frequently updated compared to, for example, prostate and breast cancer. In addition, management plans must be comprised in a short timespan due to the high mortality of lung cancer [59]. Of the 14 studies that reported on changes in management plans, 5 were performed in a university hospital, 5 were performed a tertiary referral cancer center and 4 in a general hospital. In all cancer types, general hospitals had the lowest percentage of changes in management plans, suggesting less impact of MDTMs on management plans in general hospitals. The latter might be the result of different case mix between general hospitals and tertiary referral centers or university hospitals. In addition, clinical trials might offer more diagnostic and therapy opportunities to be considered in university hospitals. Furthermore, due to the researchers' affiliations with teaching and academic hospitals, more research is conducted there instead of general hospitals [1].
Studies that reported on changes in management plans generally showed a high risk of bias in measurement of outcomes, for several reasons. First, physicians who formulated the management plans prior to MDTMs often attended the meeting, and potentially affected the final recommendation with their opinion. Second, the final MDTM recommendation might also be influenced by knowledge of the initial plans, even when the physician who developed the initial plan did not attend the MDTM. Third, in some studies, the physicians who formulated the initial MDTM plans were also the outcome assessors that subjectively evaluated the changes made during the MDTM. A few studies minimized this outcome bias by blinding the MDTM to the initial plans or had an independent physician draw up the initial plans [29,45].  [26,37] Time to treatment: increased in MDTM group [38,47], no effect [38], decreased in MDTM group [40] Costs: mean cost of care reduced in MDTM group [40] Other: increased guideline adherence and research participation in MDTM group [40] Time to treatment: no effect [55] Costs: MDTM is cost-effective [55] N/A Proportion of cases with changed overall management plans in % Studies that compared MDTM groups to (historical) control groups in terms of the number of patients that received certain types of diagnostics and/or treatment were focused on colorectal, lung and breast cancer patients. These outcomes were not reported for prostate cancer. All papers reporting on number of MRI scans and most papers on CT scans showed a significant increase in the MDTM cohort, suggesting more accurate staging. The systematic review of Pillay et al., showed similar outcomes, and also concluded that patients discussed at an MDTM were more likely to receive appropriate staging [7]. The results suggest that MDTM discussion often affects the treatment that patients received, typically less so for surgery, and different surgical types. Radiotherapy, chemotherapy and palliative care were chosen equally or more often. However, it is uncertain whether these trends are completely the result of MDTM discussion. Studies that reported on the impact of MDTMs on treatment patients received often compared the MDTM cohort with a control group over a long time period. For example, Lan et al., measured from 2001 to 2010, while MDTM was introduced in 2007. Therefore, differences in MDTM and control groups might also be affected by changes in techniques, guidelines and clinical practice. Lan et al., stated that there were significant differences in many aspects of the diagnosis and treatment during their measurement time, i.e., the introduction of targeted therapy. Thus, the impact of MDTMs might be overestimated.
Most studies investigating the effects of MDTMs on survival showed a significantly improved survival rate for colorectal, lung and breast cancer patients. A few studies identified the effects of MDTMs in certain patient subgroups based on disease stage and/or treatment combination [18,24,25,41,55,57]. Often, the overall survival rate was significantly improved, while some subgroups did not show significant differences in survival. Similar to the improved staging mentioned earlier, the improved survival might be partially explained by improvements in techniques, guidelines and clinical practice during the long measurement time of the studies.
Overall, most of the results in this systematic review are in agreement with previously published work. Results showed evidence for improved survival for colorectal, lung and breast cancer. Changes in clinical diagnostic and treatment decision making for colorectal, prostate and breast cancer was identified but rated as weak [7,8,[60][61][62]. The reported patient and process outcomes in this systematic review were investigated in colorectal, lung and breast cancer, and not in prostate cancer. The review of Holmes et al., also concluded that the number of articles that studied the effect of MDTMs in prostate cancer is limited. Similar to our findings, Holmes et al., did encounter many abstracts, suggesting potential future publications on the topic [63]. For breast cancer, Blackwood et al., also showed evidence that an MDT approach is associated with improved clinical outcomes, however they did not report on the effect of MDTMs in particular [64].

Strengths and Limitations
Our systematic review has several strengths. Two independent researchers screened over 13,000 articles in a title-abstract screening and 165 articles in full-text, following the PRISMA-P 2015 and the Cochrane Collaboration's double-date collection and extraction methodology [9,10]. We are the first to specifically evaluate and compare the effect of MDTMs on colorectal, lung, prostate and breast cancer care.
Our review also has some limitations. First, we acknowledge that selective reporting and publication bias cannot be ruled out. During the screening process, 27 abstracts met the inclusion criteria but were excluded due to a lack of information. In most cases, these abstracts did not result in a published paper, which might indicate a publication bias. Second, during the screening process, MDTMs might be misclassified as 'multidisciplinary (MDT) approach' due to limited or unclear information and the lack of a consistent definition for multidisciplinary team meetings [61,65]. Articles reporting the effect of 'MDT approach' were excluded, because 'MDT approach' is a broad term for collaboration between medical specialists, that may or may not include MDTMs. Subsequently, we cannot rule out exclusion of misclassified MDTMs. Third, general observations on MDTMs are limited due to small numbers of articles, inadequate statistical analysis and heterogeneity of patient and process outcomes. Finally, all studies included in this review had an observational study design. According to the GRADE scale, observational studies without special strengths or important limitations provide low quality of evidence. Therefore, the level of evidence of the included studies had to be rated low to very low. In contrast, an RCT without important limitations provides high-quality evidence according to the GRADE scale. However, MDTMs are often considered mandatory, and denying patients an MDTM discussion might be considered unethical. Therefore, an RCT might not be feasible in the evaluation of the effect of MDTMs. In conclusion, before discarding the low level of evidence, the level of evidence might never be higher than this.

Future Research
An unequal distribution of cancer types was identified in the literature with regard to the effects of MDTMs on treatment decisions, patient outcomes and process outcomes. As a result, current evidence of the potential benefits of MDTMs differs per cancer type, yet none of the evidence presented in the included studies is strong. In particular, current literature lacks studies that reported on the effect of MDTMs on patient outcomes and process outcomes for prostate cancer. Overall, high-quality research is required for all cancer types to confirm the potential benefit of MDTMs, preferably in a multicenter study with appropriate statistical analysis (e.g., a power calculation).
Another valuable focus for future research might be to investigate whether all patients should be discussed at MDTMs. Most studies showed that the majority of management plans did not change after MDTM discussion. Several of the included studies showed that MDTMs only had a significant effect on a specific subset of cancer patients, typically advanced cases. MDTMs are considered time-consuming and expensive, however these statements are mostly based on physicians/clinical experience. The increasing incidence of colorectal, lung, prostate and breast cancer might further pressure effort, time and financial resources. In this context, it might be important to re-evaluate the recommendations to discuss every patient in MDTMs and to focus on the cost-effectiveness of MDTMs. Cost-effectiveness studies on all four cancer types could be beneficial. In order to better understand the impact of MDTMs in addition to the clinical outcomes, cost-effectiveness studies would be essential, allowing for a critical evaluation of the effectiveness of MDTMs, based on clinical and process outcomes.

Conclusions
The number of studies that evaluated the effect of MDTMs is sparse, especially for lung, prostate and breast cancer compared to colorectal cancer. The reported evidence suggests that the implementation of MDTMs can have a significant impact on treatment decisions for colorectal, lung, prostate and breast cancer. In colorectal cancer, there is weak evidence that MDTMs result in more accurate staging. There is weak evidence that MDTMs improve patient outcomes (e.g., survival) for colorectal, lung and breast cancer patients.

Supplementary Materials:
The following are available online at https://www.mdpi.com/article/10 .3390/cancers13164159/s1, Table S1: Database search string; Table S2: Search results per database; Figure S1: Risk of bias and quality of care.

Informed Consent Statement: Not applicable.
Data Availability Statement: Data sharing is not applicable to this article as no new data were created or analyzed in this study.