A study of factors influencing access to MDT among patients with stage III to stage IV colorectal cancer: a national multicenter survey

Background and objective The disease burden of colorectal cancer (CRC) in China is relatively heavy, and although the multidisciplinary treatment (MDT) model can improve efficacy and resource efficiency, there are inequalities in its accessibility. The aim of this study was to investigate the key factors affecting access to MDT among patients with stage III to stage IV CRC. Methods A multi-stage stratified sampling method is adopted to conduct a cross-sectional survey of 4,589 stage III-IV colorectal cancer (CRC) patients across 19 hospitals nationwide. Results Only 796 (17.3%) of the 4,589 patients with stage III-IV CRC included in this study participated in MDT, with more males (61.4%) than females (38.6%). Univariate analysis showed that:patients’ location, medical visits to provincial-capital-city-hospitals and prefecture-level-city-hospitals, education background, number of medical institutions been visited, family income, patients’ circumstance of disease, initial diagnosis stage, whether metastasis occurred at initial diagnosis, endoscopic interventional therapy, chemotherapy, targeted therapy, traditional Chinese medicine(TCM) or palliative treatment, and treatment efficacy (p0.05) are factors influencing patient participation in MDT. Multivariate analysis shows that patients in North China (OR: 2.69, 95% CI: 1.98-3.67), Central China (OR: 1.59, 95% CI: 1.15-2.21), Southwest China (OR: 5.19, 95% CI: 3.78-7.11), and Northwest China (OR: 2.28, 95% CI: 1.51-3.43) are more likely to participate in MDT. Patients treated at city-level hospitals (OR: 1.84, 95% CI: 1.50-2.26) and those receiving care at two hospitals (OR: 1.28, 95% CI: 1.02-1.61) also show higher MDT participation rates. Those in the recurrent treatment phase (OR: 3.21, 95% CI: 1.56-6.58) are significantly more likely to engage in MDT. Additionally, patients undergoing chemotherapy (OR: 2.62, 95% CI: 1.75-3.93), targeted therapy (OR: 1.38, 95% CI: 1.10-1.73), or traditional Chinese medicine (TCM)/palliative treatment (OR: 1.76, 95% CI: 1.41-2.22) have an increased likelihood of MDT participation. There is a positive association between participation in MDT and the overall health-related quality of life (HRQOL) score in colorectal cancer patients. Conclusion Different regions, healthcare organizations, patients’ stage of treatment, modalities of treatment and quality of life influence access to MDT for patients with Stage IV CRC, while MDT care is significantly associated with better quality of life.