It has been well recognised that multidisciplinary care for patients with cancer results in many benefits for patients. Cancer Australia states that adopting multidisciplinary care results in increased survival, higher likelihood that treatment aligns with evidence-based guidelines, shorter timeframes between diagnosis and treatment commencement, greater patient access to accurate information and greater patient satisfaction.
With breast cancer (BC), it is generally accepted that the attendees of multidisciplinary team meetings include breast surgeon, medical oncologist, radiation oncologist, pathologist, radiologist, breast physician and breast nurse.
For women and men diagnosed with breast cancer, it is daunting to understand the plethora of information about their diagnosis and treatment options, as well as cope with the need for appointments with other specialists in the team and additional investigations. The need for a coordinated approach to managing BC patients is undoubtedly a challenge and has been cited as an area requiring further attention and research.
Studies reveal that over 90% of health professionals agree that clinical decision-making and provision of evidence-based medicine are best achieved when patients are discussed at multidisciplinary meetings. However, it has also been demonstrated that poor communication between team members and the lack of prospective data collection as to the treatment received and patient outcomes prevent ongoing quality assurance.
A team should comprise breast surgeons (ideally with oncoplastic expertise), medical oncologists, breast physicians, a genetic counsellor, nurses (for early and metastatic BC patients) and clinical psychologists and have a focus on education of both other health care providers and the community.
Availability for GP or patient-self referral in the setting of abnormal breast symptoms, heightened family risk of BC, abnormal screening mammography or confirmed malignant breast lump are important.
Team members need to regularly attend multidisciplinary meetings to enable a coordinated approach for patients and particularly for those with complex medical and social factors, diagnostic issues, which may require interventional image-guided biopsies, and the interpretation of pathological findings.
The Breast Cancer Research Centre – WA (BCRC-WA) has established a clinical arm, the Perth Breast Cancer Institute, to provide delivery of comprehensive care, including provision for patients to be offered involvement in clinical trials at a single site. This has been considered a strength for a multidisciplinary care approach to BC patients.
Patients who are appropriate for clinical trials have an opportunity to access neoadjuvant, adjuvant and metastatic BC trials. Patients recommended for and consenting to clinical trials are supported in this aspect of their care by one or more staff within the BCRC-WA.
To achieve optimal BC outcome, the application of evidence-based treatment needs to be pursued by the team. Yet optimal patient care also requires guidance, education and ongoing support of individual patients and their families. Each person is on an individual patient journey and assigned a BC nurse who can help coordinate care.
Published evidence underlies the importance of a multidisciplinary approach providing all the above elements of patient care, which will ideally result in the best possible patient outcome.
Key messages
- Multidisciplinary care has many benefits
- Team meetings and coordination is critical
- Each patient is on their own journey.
– References available on request
Author competing interests – nil