Multidisciplinary Cancer Care
Multidisciplinary care (MDC) is a concept that is considered to lead to the best practice of medicine. MDC involves a team approach to patient management, whereby all the medical and allied health professionals relevant to a particular patient's problems have input into the management of individual patients prior to, or at an early time after diagnosis.
There are many models for applying MDC. These depend on many factors, including:
- Demographic - Does the patient live in a rural or urban area? Are the required services and expertise available locally? Does the patient's psychosocial situation or cultural beliefs increase the need for multidisciplinary discussion?
- Tumour - The requirement for multidisciplinary discussion may be reduced in cancers with well defined management protocols. Conversely the requirement may be increased for complex situations or rare tumours, for which individual health professionals have limited experience and expertise.
- Treatment - Is there a single treatment modality proposed, or a combination of modalities; if a combination, what is the appropriate sequencing and timing? Do the patient's co-morbidities influence these decisions; if so, in what manner?
Due to this wide range of factors, it is clear that the practice of MDC needs to be flexible, to suit the local arrangements. However it is arranged, MDC should follow a set of principles which will lead to best practice. These are:
- Identification of the team members - In general MDC is based on tumour type (eg breast cancer, lung cancer etc) or anatomical region (eg head and neck, thorax etc). For each tumour type or region, there will be a "core" group of disciplines that are required for all cases. For most solid tumours, this will consist of surgeons, radiation oncologists and medical oncologists. Depending on need and availability, this will be supplemented by other medical specialists, including pathologists, radiologists, palliative care physicians, paediatricians, and so on. In addition, allied health staff should be included as appropriate, such as speech, occupational and physiotherapists, and nurses (eg breast nurses). Some of these disciplines may be required infrequently and for selected cases.
- Communication - Communication is the key and critical issue for effective MDC. All disciplines must be able (and prepared) to present an opinion regarding the management of the patient. Whether this occurs in a formally convened face-to-face meeting, or as electronic communication, again depends on the circumstances. The amount of discussion necessary to arrive at an individual management plan will depend on the caseload and complexity of the case. All relevant information should be available to enable the MDC team to make the best informed recommendation. The frequency of MDC meetings will depend on the caseload and the availability of key team members.
- Standards of care - MDC should follow agreed guidelines and protocols to offer best practice as it is defined in a particular country. The recommendations of the MDC team should attempt to ensure that all patients are offered the management plan and treatments that represent best practice. Decisions reached by the MDC team should be documented. If necessary, the MDC team may solicit national or international assistance - this is of particular relevance for rare tumours.
- Involvement of the patient - MDC recommendations should be presented to the patient in a timely and appropriate manner, taking into account the patient's preferences and their psychosocial, cultural and language background. The health professional who is most suitable the MDC recommendations to the patient will depend on the local circumstances. The patient should have the opportunity to ask questions and to have a support person (family or friend) present.
The advantages of MDC are that patients are offered a management plan that represents best practice, taking into account the evidence based opinions of health professionals from varying disciplines. The MDC core team acts as a focus for the development and maintenance of guidelines and protocols, and to ensure that management recommendations are consistent with current best practice.