The Importance of Multidisciplinary Care in Cancer Treatment
Dr. Athanasios Argyris
Multidisciplinary Care: In recent years have seen significant developments in the treatment of cancer patients. Newer techniques and drugs have found clinical application to cure or increase survival, but at the same time minimizing side effects and improving quality of life.
As there are more therapeutic options available, treatment decisions have become more complex. Many specialties are involved in the treatment of cancer, whose contribution is essential to a more effective approach and resolution of the complex problems that are commonly encountered. Successful management of cancer requires full diagnostic screening and staging of the disease, as well as molecular analyses, when appropriate, to assess prognosis and the possibility of treatment with targeted drugs.
Accurate treatment planning requires a multidisciplinary team of specialised physicians who must work closely together from the beginning of the disease to co-decide on the design and strategy to be followed. As a separate body, no single physician has the scientific background to make an optimal treatment decision on his or her own without the input of other specialties. If the team is absent, there is the risk that the patient will not be properly and fully assessed and the most appropriate treatment will not be given.
The multidisciplinary approach involves the meeting of several specialized doctors and other health professionals, called a multidisciplinary or oncology council, during which treatment planning is discussed. Oncology councils should include at least the three main cancer treating specialties, which are surgery, radiation oncology and pathology oncology. It is also essential that doctors from other disciplines participate, depending on the case being treated, such as radiologists, pathologists, dentists, oral and maxillofacial surgeons, pulmonologists, general pathologists and other specialists such as speech and language therapists, nurses, psychologists and nutritionists. The decisions made in this approach in oncology boards lead to individualised treatment plans, based on the type and biology of the specific cancer, the current guidelines and available treatment methods, as well as the needs and specificities of the patient.
Head and neck cancer is a prime example of the application of multidisciplinary care and oncology consultations. Due to its location in areas affecting functions such as swallowing, breathing and speech, head and neck cancer presents complex problems and usually requires combined treatment approaches involving the collaboration of two or more medical specialties. Several times, after the multidisciplinary discussion at oncology consultations, the initial treatment plan is changed and the most appropriate treatment methods are proposed as the contribution of each specialist is maximised. It has been documented in many in-depth articles in medical journals that multidisciplinary treatment leads to better survival. For example, a published study examining treatment outcomes in 224 patients with head and neck cancer demonstrated that when mandatory participation in oncology consultations was implemented to decide and recommend the most effective therapy, patient survival increased by approximately 25% (Liu et al. Laryngoscope 2020). Many other studies agree and support these results. Furthermore, it has been found that decisions made by multidisciplinary teams are more likely to be in line with the elementary guidelines than those made individually by the treating physician. Cancer treatment guidelines from recognised organisations such as the NCCN (National Comprehensive Cancer Network) in the U.S. emphasise the need for patients to be assessed in specialist centres.
Recognising the importance of oncology meetings for the successful outcome of oncology patients, many countries have established legal frameworks that require oncology meetings to be held. In several European countries legislation requires hospitals and treating physicians to conduct oncology consultations and to formally indicate in writing the treatment recommendations for each patient. All new cases must be presented to the board before treatment is started, and all modifications to treatment must be discussed. The decision of the board, including the treatment plan and the names of the participants, shall be recorded and filed in the patient's file. If the treatment administered is ultimately different from that recommended by the oncology panel, the attending physician shall record the reasons for not complying with the decision. So while the oncology board has been a reality for many years abroad, in Greece the multidisciplinary approach to oncology patients through the oncology board started quite late. It was only in 2012 that Law 4052 was passed, which establishes the multidisciplinary care of patients suffering from malignant neoplasms.
Multidisciplinary care and decisions in oncology boards are not always feasible or easy to achieve because they require an organised health system, good administrative support and time availability on the part of medical specialists. Also, the patients concerned need to be educated about the need for a multidisciplinary approach so that they realise its importance for them. Informed patients can ask their doctors to conduct an oncology meeting (which can be done with their own participation if appropriate) and consider this to be an additional medical service that is clearly to their benefit. With the news of a new diagnosis and the many tests and procedures that are often required, the importance of multifactorial assessment and close monitoring by all specialists is sometimes overlooked. However, it is suggested that our patients consult the multidisciplinary teams to more fully analyze the therapeutic options and the expected benefits and risks of each treatment. The benefits of a multidisciplinary approach are many and include improved communication, collaboration and decision-making between health providers.
Multifaceted assessment and individualisation of treatment in oncology boards and harmonious collaboration between medical specialties are considered essential for a successful outcome of the disease.
Literature
NCCN. National Comprehensive Cancer Network. Available at https://www.nccn.org/. Accessed 16/3/2021.
ΕSMO Cancer Guides For Patients. https://www.esmo.org/for-patients/patient-guides. Accessed 16/3/2021.
Liu JC, Kaplon A, Blackman E, Miyamoto C, Savior D, Ragin C. The Impact of the Multidisciplinary Tumor Board on Head and Neck Cancer Outcomes. Laryngoscope 2020;13094):946-50.
Glykeria Memekidou. "Longitudinal assessment of the operation of the oncology board of the Athens Naval Hospital". PhD Thesis, Department of Economic Science, University of Piraeus, 2017.
Bossi P, Alfieri S. The Benefit of a Multidisciplinary Approach to the Patient Treated with (Chemo) Radiation for Head and Neck Cancer. Curr Treat Options Oncol 2016; 17:53.
Heineman T, St John MA, Wein RO, Weber RS. It Takes a Village: The Importance of Multidisciplinary Care. Otolaryngol Clin North Am 2017; 50:679–687.
Wheless SA, McKinney KA, Zanation AM. A prospective study of the clinical impact of a multidisciplinary head and neck tumor board. Otolaryngol Head Neck Surg 2010; 143:650–654.
Friedland PL, Bozic B, Dewar J, Kuan R, Meyer C, Phillips M. Impact of multidisciplinary team management in head and neck cancer patients. Br J Cancer 2011; 104:1246–1248.
Prades J, Remue E, van Hoof E, Borras JM. Is it worth reorganising cancer services on the basis of multidisciplinary teams (MDTs)? A systematic review of the objectives and organisation of MDTs and their impact on patient outcomes. Health Policy 2015; 119:464–474.