Multidisciplinary Care, a paradigm shift
Multidisciplinary care is a paradigm shift in cancer care. Using multidisciplinary cancer care, the team of medical oncologists, radiation oncologists and surgeons are all working together to take care of the patient. Typical cancer care today, especially in solid malignancies such as lung cancer or breast cancer, includes the use of multimodality therapy that is giving chemotherapy and radiation therapy as well as surgery. The best way to deliver this kind of care is using the multidisciplinary team approach.
There is a challenge in this kind of care. Obviously, it’s time-intense and, obviously, practitioners need to make time in their busy schedules to be able to accommodate this kind of care. We typically act on patients with new cancer diagnoses using a multidisciplinary care approach in 2 different ways. First, every cancer care conference should now be a typical prospective multidisciplinary cancer conference.
The discussion of each patient’s treatment plan, diagnosis, additional testing, and staging information should all be done collaboratively with a medical oncologist, radiation oncologist, and surgeon at the same time at a cancer conference.
Using cancer navigators to help the patients navigate through the different modalities of therapy is another important key factor in the success of multidisciplinary cancer care. Prospective case discussion allows the patient to be discussed with all the potential treating physicians and to come up with a cohesive team plan where there’s a consensus along all modalities.
A great example of this would be in the area of lung cancer or breast cancer where a decision about the patient’s getting chemotherapy and/or radiation therapy first versus getting it after surgery is crucial on the outcome of the patient both in terms of survival as well as in terms of patient outcomes–like complications.
The next level of multidisciplinary cancer care is the potential use of a multidisciplinary clinic. In this model, physicians from all the specialties, including medical oncology, radiation oncology, and surgery, see a patient in one place at one time. That is facilitated by having a space within the cancer center and having a nurse navigator who’s committed to this team approach. Physicians set aside a block of their time and allow themselves to see the patients with their team members at the same time.
Typically, the patient is seen in one exam room in one area and the physicians revolve around the patient rather than sending the patient from office to office over a wide geography and typically over a broad period of time, sometimes as much as 6 weeks or even several months. Using a multidisciplinary clinic approach, the entire team sees the patient.
The patient then hears from the team members or from the cancer navigator the consensus of their plan on how best to treat their patient. And when that patient leaves, when they go home that day, they will have in hand a treatment plan that’s designed specifically for them that takes into account all the different modalities of therapy.
In terms of patient outcomes, the number one outcome that has been shown to be approved using a multidisciplinary care model to this patient’s satisfaction, patients like the fact that they get more information, that they as a consumer understand exactly what the physician’s plan is. They like the fact that there’s a care navigator and that there is someone who’s the go-to individual to help them through their cancer journey.
Patients have also been shown to have better staging, and better staging usually leads to better and appropriate use of treatment, which could possibly also eventually lead to better survival, although to date, there are few areas of cancer care where multidisciplinary cancer care has actually been proved to improve long-term survival. All of these other surrogate endpoints have been shown to have improved outcomes.