Multidisciplinary Teams: The way forward in Cancer Care

Authors: Jitin Sekhri, Jo Roach and Jeanie Karalis

Background

In 1995 Cancer survival rates were compared across Europe, and the UK performed poorly, lagging behind Germany, Austria, France, the Netherlands and Spain 1 . In the UK, there has been no improvement in cancer survival rates for 30yrs with regional variation in survival rates 2 .

5-year lung cancer survival rates

Aim: To look at the evolving cancer care model Consultant A Patient’s perspective

“My husband had 8 doctors.. The cardiologist told me that (he) was doing reasonably well.. (the) lung specialist said that he is not getting better, he’s worse, he may die.. A nephrologist informed me that (his) kidneys were failing… finally a specialist in infectious diseases appeared.. This doctor.. took the time to explain that each of the doctors… had given an assessment only of the particular organ system he specialised in, not of (his) overall condition

.” 4 20 18 16 14 12 10 8 6 4 2 0 E ng US la nd & W al es S co tla nd NI A us tri a Fr an ce G er m an y S pa in D en m ar k Male Female

Radiographer

Source

: Office for National Statistics Cancer Survival. England and Wales.

This prompted the Calmin-Hine report: The aim was to create a network of care in England and Wales enabling any patient in UK to receive treatment and care of a uniformly high standard 3 .

Dietician

Key recommendations: 1. Multi-disciplinary consultation and management are essential.

2. The services of the cancer unit should include palliative care, access to counselling and other services such as physiotherapy, dietetics, speech therapy, occupational therapy, chaplaincy and social services.

Occupational Therapist Physiotherapist Speech and Language therapist Nurse Developments

- Cancer Services Collaborative (CSC) initiated in 1999: 30 cancer networks promoting the development of a holistic MDT in parallel with the medical model 2 .

- The aims were to ensure that all patients have equal access to highest quality care by developing MDTs who reviewed all patients before treatment. - MDT grew outside the realm of just doctors and nurses to include ward manager, physiotherapist, dietician, OT, social worker ensuring 5 : - Early referrals to dieticians, physiotherapists, occupational therapists, social workers - Discharge plans are discussed - Information is shared easily

Social Worker

References

1. Sant et al (2003) Eurocare-3: survival of cancer patients diagnosed 1990-94 Annals oncology 14: v61-118 2. Babu et al (2008) Developments in the management of patients with lung cancer have improved quality of care Proc Am Thorac soc Vol5. pp816-819 3. DOH (1995) The Calmin Hine Report "A Policy for Framework for Commissioning Cancer Services“ 4. Penson et al (2006) Teams: communication in multidisciplinary care The Oncologist 2006;11:520-526 5.Jeffries and Chan (2004) Multidisciplinary team working: is it both holistic and effective? Int J Gynecol cancer 2004, 14, 210-211

Conclusion

 There was a recognised need to change the way cancer care was organised.

 MDT is the main mechanism for ensuring holistic care for patients throughout their disease trajectory.

 “Patient and family wellbeing are directly linked to the quality of communication among a medical team.”