Multidisciplinary Tumor Boards (MDTs) Significantly Alter Treatment Decisions and Improved Guideline Adherence in a Resource-Limited LMIC Cancer Center in a Low Resource Setting

Introduction: Multidisciplinary Tumor boards (MDT) are integral to modern oncology, optimizing limited
resources in low- and middle-income countries (LMICs). While MDTs improve outcomes in a high-income setting, robust evidence in LMICs remain sparse. This retrospective study evaluates the real world impact of MDTs on treatment decision-making, guideline adherence, and clinician satisfaction in a resource-constrained radiotherapy center.

Methodology: This was a retrospective cohort study conducted at Ahsania Mission Cancer and General Hospital, Dhaka, Bangladesh, from January 2023 to June 2025. All patients (n=370) discussed in MDTs were included. Data collected about demographics, cancer type, pre- and post-MDT treatment plans changes in modality/sequence, clinician satisfaction (via validated 5-point Likert survey),treatment changes were classified as major (modality switch) or minor (sequencing/dose adjustments). Adherence to NCCN/ESMO guidelines which was assessed pre- and post MDT.

Results: Of 370 patients, 60 % patients had breast and lung cancer, however rest were head neck, GIT and Sarcoma cases.MDT altered treatment in 64% of cases (n=237): 28% major (e.g, surgery, neoadjuvant chemo), 36% minor (e.g., chemo, RT sequence). Guideline adherence increased from 52% to 89%. Clinician satisfaction with MDT recommendations was 4.6/5 (response rate: 92%). Challenges included specialist unavailability (18% of cases) and logistics, yet recommendations were followed in 91% of cases. In 91% cases MDT recommendations implemented. Main Barriers were specialist availability gaps (18%), scheduling constraints and coordination logistics.

Conclusion: Despite resource constraints, MDTs significantly improve treatment decision-making and
guideline adherence in LMIC settings. This study provides actionable evidence for integrating MDTs as a
core component of cancer care in low-resource environments.

Conflict of interests: The authors declare no conflict of interest.

Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

License: © Author(s) 2026. This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, and unrestricted adaptation and reuse, including for commercial purposes, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

To view a copy of this license, visit https://creativecommons.org/licenses/by/4.0/.