Towards sustainable multidisciplinary renal cancer tumour boards: redesigning the referral pathway
- 1University College London Medical School London UK
- 2Department of Urology The Royal Free London NHS Foundation Trust London UK
- 3Division of Surgery and Interventional Science University College London London UK
Abstract
Objectives: To develop and evaluate a complexity‐stratified referral pathway aimed at improving the sustainability, efficiency and resource utilisation of specialist multidisciplinary team (SMDT) meetings within a high‐volume tertiary renal cancer service.
Patients and Methods: We performed a retrospective cohort study of benign and malignant renal cancer cases discussed at SMDT meetings between January and December 2023 at the Royal Free Specialist Centre for Kidney Cancer. Patient demographics, tumour characteristics, SMDT discussions and management outcomes of patients were analysed to identify protocolised lower complexity cases suitable for alternative MDT pathways. Based on these findings, dedicated Standard of Care (SoC) and Benign MDTs were developed and implemented to manage lower complexity renal cases outside the main SMDT. The impact of the revised referral structure on SMDT workload, discussion efficiency and specialist resource utilisation was subsequently evaluated.
Results: In 2023, 2228 patients with benign and malignant renal pathology underwent 4154 SMDT discussions. Most patients (96.3%) required under seven discussions. Patients aged >70 years with renal masses <2 cm frequently underwent repeated SMDT review, despite surveillance or conservative management representing the most common management recommendation. Bosniak I–II cysts were predominantly discharged, whilst Bosniak IIF cysts were mainly managed with surveillance. Following implementation of the revised referral structure incorporating SoC and Benign MDTs, cases discussed at the main SMDT decreased from a mean of 83 to 63 patients with cancer per week, whilst discussion time per patient increased by 30.8%. The revised pathway also reduced the requirement for full SMDT attendance for protocolised cases.
Conclusion: Complexity‐stratified MDT referral structure improved efficiency and sustainability by diverting lower complexity protocolised cases to dedicated Benign and SoC MDTs. This enabled the main SMDT to prioritise clinically complex decision making and optimise utilisation of specialist multidisciplinary expertise.
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BibTeX
@article{ghoshal2026towards,
title = {{Towards sustainable multidisciplinary renal cancer tumour boards: redesigning the referral pathway}},
author = {Bhargab Ghoshal and Sarika Nalagatla and Max Roberts and Adam Mann and David Cullen and Victoria Horsfall and Andrea Da Silva and Abhishek Reekhaye and Prasad Patki and Ravi Barod and Faiz Mumtaz and Axel Bex},
journal = {Bju International},
year = {2026},
month = oct,
doi = {10.1111/bju.70451},
url = {https://doi.org/10.1111/bju.70451},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Towards sustainable multidisciplinary renal cancer tumour boards: redesigning the referral pathway
AU - Bhargab Ghoshal
AU - Sarika Nalagatla
AU - Max Roberts
AU - Adam Mann
AU - David Cullen
AU - Victoria Horsfall
AU - Andrea Da Silva
AU - Abhishek Reekhaye
AU - Prasad Patki
AU - Ravi Barod
AU - Faiz Mumtaz
AU - Axel Bex
PY - 2026
DA - 2026/10/01
JO - Bju International
DO - 10.1111/bju.70451
UR - https://doi.org/10.1111/bju.70451
AB - Objectives: To develop and evaluate a complexity‐stratified referral pathway aimed at improving the sustainability, efficiency and resource utilisation of specialist multidisciplinary team (SMDT) meetings within a high‐volume tertiary renal cancer service. Patients and Methods: We performed a retrospective cohort study of benign and malignant renal cancer cases discussed at SMDT meetings between January and December 2023 at the Royal Free Specialist Centre for Kidney Cancer. Patient demographics, tumour characteristics, SMDT discussions and management outcomes of patients were analysed to identify protocolised lower complexity cases suitable for alternative MDT pathways. Based on these findings, dedicated Standard of Care (SoC) and Benign MDTs were developed and implemented to manage lower complexity renal cases outside the main SMDT. The impact of the revised referral structure on SMDT workload, discussion efficiency and specialist resource utilisation was subsequently evaluated. Results: In 2023, 2228 patients with benign and malignant renal pathology underwent 4154 SMDT discussions. Most patients (96.3%) required under seven discussions. Patients aged >70 years with renal masses <2 cm frequently underwent repeated SMDT review, despite surveillance or conservative management representing the most common management recommendation. Bosniak I–II cysts were predominantly discharged, whilst Bosniak IIF cysts were mainly managed with surveillance. Following implementation of the revised referral structure incorporating SoC and Benign MDTs, cases discussed at the main SMDT decreased from a mean of 83 to 63 patients with cancer per week, whilst discussion time per patient increased by 30.8%. The revised pathway also reduced the requirement for full SMDT attendance for protocolised cases. Conclusion: Complexity‐stratified MDT referral structure improved efficiency and sustainability by diverting lower complexity protocolised cases to dedicated Benign and SoC MDTs. This enabled the main SMDT to prioritise clinically complex decision making and optimise utilisation of specialist multidisciplinary expertise.
SN - 1464-4096
SN - 1464-410X
ER -