Multidisciplinary Care in Mesothelioma Treatment

Multidisciplinary care in cancer treatment refers to a treatment modality that brings together all the medical professionals who will be dealing with a specific patient's cancer. These medical professional teams are generally organized like a board of directors, commonly led by a nurse who acts as a liaison between the board and the patient. They also generally include a counselor, psychologist or therapist who provides much-needed psychological support during intensely traumatic times.

Other medical professionals can include (but are not limited to) an oncologist, or physician specially licensed in cancer care; a hematologist or blood specialist, or an oncological pathologist who examines tissue biopsies, blood and bodily fluids for the evidence of cancer cells or cancer spread; , a radiologist or radiation oncologist who deals primarily with interpreting whole- or part-body scans (X-rays, CT scans and MRIs); a surgeon who specializes in cancer removal, as well as a general surgeon; chemotherapy and pain-care nurses; a nutritionist; and a social worker who will provide information about, and access to, hospice care if and when the cancer becomes terminal.

Between them, these health professionals will diagnose cancer, stage it - that is, determine how advanced it is - and develop a treatment plan, and it is this continuity and cooperation across medical disciplines that has been proven to provide the most comprehensive and successful cancer care.

The National Cancer Institute supports a number of nationwide hospitals whose aim it is to provide the best in multidisciplinary care for cancer victims, and their designated cancer centers - ranging from the H. Lee Moffitt Cancer Center and Research Institute at the University of South Florida in Tampa, to the Fred Hutchinson/University of Washington Cancer Consortium in Washington State - deliver the sort of continuity of care, via a team approach, that provides for the highest percentage of cures.

These hospitals, which serve as teaching hospitals or research hospitals providing clinical cancer trials and novel, new cancer treatments, comply with the National Breast Cancer Center's objective of providing an integrated team approach to cancer care in which all providers consider all possible treatment options to collaboratively develop an individual treatment plan for each patient, often structured around a patient's own wishes or goals.

In addition, the Comprehensive Cancer Care Improvement Act (CCCIA; S. 1773), introduced in October of 2009, aims to advance a number of proposals designed to provide multidisciplinary, or integrated, cancer care via improved communications between multidisciplinary teams and patients regarding treatment options and follow-up care.

Multidisciplinary cancer care can provide continuity, case-appropriate modalities, effective referral networks, dynamic care evaluation via multidisciplinary inputs, and a sense (on the patient's part) that nothing is being overlooked. This latter is essential to patient confidence, and confidence is half the battle to winning the war against cancer.

Multidisciplinary approaches also improve the coordination of services, preventing overlapping and potentially dangerous tests like CT scans from being duplicated. It also provides for patients being included in clinical trials, which are essential to finding cures, and improves the communication between team members, who must share vital information in order to develop future treatment protocols.

An example of how effective this approach is in developing treatment protocols is provided by the 2006 example, published in the journal Cancer, which showed that, of 149 breast cancer patients sent to the University of Michigan's multidisciplinary breast cancer clinic for a second opinion, more than half received an opposing surgical recommendation after their case was reviewed by a multidisciplinary team of breast cancer specialists.

Not only does the multiple-discipline approach to cancer care provide better treatment protocols, but the mere fact of coordinating care can narrow the gap between first diagnosis and the initial treatment by providing imaging, blood test, and tumor marker studies to the tumor board in a timely manner.

For example, notes one oncologist affiliated with Beaumont Hospital in Royal Oak, Michigan, improved coordination for lung cancer patients at the hospital, thanks to a multidisciplinary approach, has narrowed the gap between diagnosis and treatment from two or three months to about two weeks or less.

However, not all hospitals use the multidisciplinary approach. A 2000 study of Australian hospitals by the National Breast Cancer Centre found that 27 percent did not have protocols for managing women with breast cancer; 12 percent did not offer core support services (social and psychological services); and 15 percent did not provide referrals to reconstructive surgeons or psychiatrists.

Additionally, a 1994-1995 study among Washington State residents with breast cancer showed that, of 1,188 women surveyed - either in or out of multidisciplinary approaches to treatment - only 29 percent of the latter consulted with a radiation oncologist before surgery; less than half (46.6 percent) of the latter consulted with either a medical oncologist or radiation oncologist; and, of the former, 6.7 times as many chose radiation as part of breast conserving surgery, rather than electing radical mastectomies.

Although all forms of cancer benefit from the multidisciplinary approach, and NCI-certified hospitals invariably offer such an approach, some cancer victims never experience the benefits. This is unfortunate because there are some forms of cancer, and some cancer test results, that almost mandate it. These include difficult-to-interpret scans or pathology results; combination treatment approaches occurring close together, like radiation and chemotherapy; or a difference of opinion between two highly relevant specialists, like the oncologist and oncological radiologist.

Sources for information on this page: National Cancer Institute, University of Rochester, Tasmanian Care Center, National Coalition for Cancer Survivorship

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