A power presentation describing the role and need of multidisciplinary approach to cancer management

1. Multidisciplinary Approach to
Breast Cancer Management
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2. The presentation will begin
shortly
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3. Outline:
• Introduction
• History of MDTs
• Members of the Breast MDT
• Benefits of Breast MD Approach
• Limitations of Breast MD Approach and Strategies to Overcome
• Conclusion
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4. Introduction
• The optimal management of patients with breast cancer (BC) is complex (due to rapidly changing
evidence, new drugs approval, and scientific guideline updates) and requires the expertise of specialists
from different disciplines.
• This has led to the evolution of multidisciplinary teams (MDTs), allowing all key professionals to jointly
address individual patients’ needs and to contribute independently to clinical decisions.
• A co-ordinated, MDT approach enables shared decision-making and comprehensive care of patients with
cancer through a variety of medical specialties and support initiatives.1-4
• As well as diagnosing and treating the disease, MDTs provide support for the social, psychological, dietary,
and physical needs, and survivorship of patients with cancer based on the patients’ individual preferences
and circumstances.1-3
• Referral to an MDT is likely in complex cases that do not fit neatly into standard diagnostic/treatment
algorithms, and/or when there are significant changes to the patient’s condition and further treatment
options need to be considered.5
• An MDT approach is considered the gold standard for diagnosis and treatment of cancer and is an
evolving area of oncology.7-9
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5. History of MDTs
• Multidisciplinarity began >50 years ago, as reported in several reviews.10
• For example, Milligan et al illustrated different cases of patients, not only cancer patients,
discussed in laryngology multidisciplinary settings in the 1920s and reported patient
anamnesis, clinical history, all specialists' opinions given during discussion, and then a
conclusive report, specifying how the patient was treated and his/her condition a few months
later.11
• O’Brien described his experience during his time at Baylor Hospital from the late 1960s to the
early 1970s. Once weekly, medical oncologists, together with radiation oncologists and
surgeons, discussed all different types of cancer cases.12
• Then, in the 1990s, the multidisciplinary approach took hold in Europe’s clinical practice, as has
happened in UK and in Germany. Other countries managed to introduce the multidisciplinary
approach later (such as in Belgium, where it became mandatory from 2000).13-15
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6. Members of the MDTs
• “Core Team” is usually composed of oncologists, surgeons of different
subspecialties, pathologists, radiotherapists, and other specialists,
according to the type of cancer (e.g., head and neck, breast,
gastrointestinal, genitourinary).
• “Non–Core Team”, such as palliative-care physicians, medical
students, interns, residents, psychologists, or nursing-staff specialists,
research nurses, and coordinators
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7. Members of the Breast MDT
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8. Benefits of MDT Approach:
• Adherence to clinical guidelines
• Adherence to guidelines (evidence-based practise) is associated with an improvement in cancer patient outcome, preventing over-
and under-treatment and reducing mortality.16
• Outcome improvement and optimized management
• Survival benefit from Breast MDT meetings has been observed in a series of highly heterogeneous studies. This has reinforced the
need for multidisciplinary- and expert-care availability to optimize treatment choices and improve patient outcomes
• Improvements in Clinical Decision-Making and Patient Management
• Several studies have confirmed that MDT discussion results in a change in diagnostic or treatment plan in a considerable proportion of
cases. Focusing on breast cancer, Newman et al retrospectively described a change in predefined surgical plans after MDT revision of
pathological slides by dedicated breast pathologists in 9% patients pertaining to their center from an outside institution. 17
• Additionally, re-examination of previously acquired breast imaging led to surgery in 11% of cases where surgery was not considered a
first option before MDTB presentation. On the contrary, independently of pathological and radiological re-evaluation, the MTB
discussion suggested different surgical approaches in a remarkable portion of patients (32%) (eg, sentinel lymph–node biopsy vs
axillary lymph–node dissection, mastectomy vs conservative surgery).17
• Along these lines, a survey conducted by the Memorial Sloan Kettering Cancer Center showed that sharing individual surgical
inclinations in a cross-sectoral setting might reduce unnecessary invasive procedures, such as the adoption of axillary lymph–node
dissection in early breast cancer cases.18
• Enhanced patient centered care
• Research opportunities
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9. Limitations of Breast MD Approach and
Strategies to overcome them:
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10. Conclusion:
• A co-ordinated MDT approach in the management of patients with BC enables shared
decision making and comprehensive care through a variety of medical specialties and
‑
support initiatives.
• An MDT approach is considered the gold standard for diagnosis and treatment of BC.
• Recent research in this important area has provided further confirmation of the
positive effects of an MDT approach in cancer care.
• Future interventions to address systemic and attitudinal barriers as well as knowledge
gaps and suboptimal skills in the MDT, research to define KPIs and quality measures
and establish a definition of culpability, and an increased understanding of
medicolegal implications will further improve MDT practices. This improvement is
likely to translate to better management, treatment, quality of life, and outcome for
the patient with cancer.
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11. References:
1. Berghmans T et al. European Cancer Organisation Essential Requirements for Quality Cancer Care (ERQCC): lung cancer. Lung Cancer. 2020;150:221-39.
2. Hanna N. Leveraging the virtual landscape for effective multidisciplinary care. Presentation. ASCO Annual Meeting, 4 June, 2021.
3. Oxford University Hospitals NHS Foundation Trust. Multidisciplinary teams (MDT). 2021. Available at: https://www.ouh.nhs.uk/haematology/team/mdt.aspx. Last accessed: 18 August
2021.
4. Chang YL et al. Association between multidisciplinary team care and the completion of treatment for oral squamous cell carcinoma: a cohort population-based study. Eur J Cancer Care
(Engl). 2021;30(2):e13367.
5. Popat S et al. Navigating diagnostic and treatment decisions in non-small cell lung cancer: expert commentary on the multidisciplinary team approach. Oncologist. 2021;30(2):e306-15.
6. Díez JJ, Galofré JC. Thyroid cancer patients’ view of clinician professionalism and multidisciplinary approach to their management. J Multidiscip Healthc. 2021;14:1053-61.
7. Taylor C et al. A multi-method evaluation of the implementation of a cancer teamwork assessment and feedback improvement programme (MDT-FIT) across a large integrated cancer
system. Cancer Med. 2021;10(4):1240-52.
8. Warner R et al. Refocusing cancer multidisciplinary team meetings in the United Kingdom: comparing urology with other specialties. Ann R Coll Surg Engl. 2021;103(1):10-7.
9. Winters DA et al. The cancer multidisciplinary team meeting: in need of change? History, challenges and future perspectives. BJU Int. 2021;128(3):271-9.
10. Dickhoff C, Dahele M. The multidisciplinary lung cancer team meeting: increasing evidence that it should be considered a medical intervention in its own right. J Thorac Dis.
2019;11(3):311–314. doi:10.21037/jtd.2019.01.14.
11. Vlasto Milligan. Further reports on cases exhibited before the section at previous meetings, session 1921–1922. Proc R Soc Med. 1922;15: i.1–vii.1.
12. O’Brien JC. History of tumor site conferences at Baylor University Medical Center. Proc (Bayl Univ Med Cent). 2006;19(2):130–131. doi:10.1080/08998280.2006.11928145
13. Munro AJ, Swartzman S. What is a virtual multidisciplinary team (vMDT)? Br J Cancer. 2013;108(12):2433–2441. doi:10.1038/ bjc.2013.231
14. Hermes-Moll K, Dengler R, Riese C, Baumann W. Tumor boards from the perspective of ambulant oncological care. Oncol Res Treat. 2016;39:377–383. doi:10.1159/000446311
15. Horlait M, Baes S, Dhaene S, Van Belle S, Leys M. How multidisciplinary are multidisciplinary team meetings in cancer care? An observational study in oncology departments in Flanders,
Belgium. J Multidiscip Healthc. 2019;12:159–167. doi:10.2147/JMDH.S196660
16. Kabat GC, Matthews CE, Kamensky V, Hollenbeck AR, Rohan TE. Adherence to cancer prevention guidelines and cancer incidence, cancer mortality, and total mortality: a prospective
cohort study. Am J Clin Nutr. 2015;101(3):558–569. doi:10.3945/ajcn.114.094854
17. Newman EA, Guest AB, Helvie MA, et al. Changes in surgical management resulting from case review at a breast cancer multidisciplinary tumor board. Cancer. 2006;107(10):2346–2351.
doi:10.1002/cncr.22266
18. El Saghir NS, Charara RN, Kreidieh FY, et al. Global practice and efficiency of multidisciplinary tumor boards: results of an American Society of Clinical Oncology International Survey. J Glob
Oncol. 2015;1(2):57–64. doi:10.1200/JGO.2015.000158
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