Annals of Oncology Advance Access originally published online on March 8, 2006
Annals of Oncology 2006 17(8):1337-1338; doi:10.1093/annonc/mdl046
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© 2006 European Society for Medical Oncology
letter to the editor |
The multidisciplinary management of patients with cancer
We read with interest the recent article by Blazeby et al. [1
], which described the implementation of decisions made by a multidisciplinary team (MDT). The study evaluated 273 decisions about patient management made at a central MDT meeting in Bristol, which assessed cases of patients with upper gastrointestinal cancer, including cases from several surrounding satellite hospitals. They found that 41 of 273 (15%) decisions about treatment made at the MDT meeting were not implemented. In the majority of cases this resulted in patients receiving a more conservative treatment than suggested by the MDT. The main reasons why decisions were not implemented were co-morbid health issues (44%), patient choice (34%) and decisions being changed when more clinical information was available (20%). In this study it was not possible to evaluate the quality of the decisions made at the MDT.
These findings highlight some important issues regarding the multidisciplinary management of cancer patients. First, in order for MDT meetings to function effectively they require adequate information about the patient's disease as well as any physical or psychological co-morbid health issues. It is also recommended that information about the patient's concerns, preferences and social circumstances is presented at the meeting by someone who has met with the patient, such as a specialist oncology nurse or the treating physician [2]. Ideally, this would be done by teleconference for patients from satellite centres. At our centre, a nurse coordinator assesses all new patients seen within a particular tumour stream (e.g. lung) and educates them about the role of the MDT meeting in making treatment recommendations and when the results of the MDT discussion will be shared with the patient. This is important as it has been shown that provision of information about all treatment options can improve the mental health and well-being of adults with cancer [3].
Secondly, the role of the MDT meeting is first to carefully assess the stage of the patient's illness and then set treatment goals appropriate to that stage. In this way an individual treatment plan can be developed in collaboration with the patient. Shared decision-making between patients and their treatment team is considered to be best practice as well as the approach preferred by most patients [4, 5]. Once a treatment plan has been established, relevant members of the MDT can be mobilised to implement the treatment plan. Although all patients will require someone to coordinate appropriate psychosocial support, the specific make-up of the team implementing the treatment will otherwise depend on the goals of care and the relevant treatment plan. This team may differ from that which initially assessed the patient as part of the MDT meeting. For example, the appropriate MDT required for decision-making and care implementation for the patient with advanced pancreatic cancer who is close to death will be different from the team required for a patient planning to undergo surgery followed by adjuvant treatment for early pancreatic cancer. Applied in this way, multidisciplinary care should fulfil its promise of improving patient and clinician satisfaction, reducing mortality and improving patient quality of life [2]. Future research into the quality of MDT management should be encouraged.
Division of Haematology and Medical Oncology, Peter MacCallum Cancer Centre, East Melbourne, Australia
* (E-mail: Linda.Mileshkin{at}petermac.org)
References
1. Blazeby JM, Wilson L, Metcalfe C et al. Analysis of clinical decision-making in multi-disciplinary cancer teams. Ann Oncol 2006; 17: 457–460.
2. The National Breast Cancer Centre. Multidisciplinary Meetings for Cancer Care: a Guide for Health-service Providers. Camperdown, NSW, Australia: National Breast Cancer Centre 2005.
3. The National Breast Cancer Centre and Cancer Control Initiative. Clinical Practice Guidelines for the Psychosocial Care of Adults with Cancer. Camperdown, NSW, Australia: National Breast Cancer Centre 2004.
4. Jefford M, Tattersall MH. Informing and involving cancer patients in their own care. Lancet Oncol 2002; 3: 629–637.[CrossRef][ISI][Medline]
5. Brock DW. The ideal of shared decision making between physicians and patients. Kennedy Inst Ethics J 1991; 1: 28–47.[Medline]
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