Maximising recruitment into randomised controlled trials: The role of multidisciplinary cancer teams

Is it worth reorganising cancer services on the basis of multidisciplinary teams (MDTs)? A systematic review of the objectives and organisation of MDTs and their impact on patient outcomes

“…Although several papers reflected that MDTs worked in accordance with a regional or national policy strategy [20][21][22]26,29,31,34,41,[44][45][46][47][48][49][50][51][52] (with some exceptions [16,69,70]), teamwork was rarely framed by specific policy guidance. Its absence led to some problems, for instance, emotional exhaustion among team leaders and clinical nurses owing to the lack of defined professional roles and team training [43,63].…”

“…Instead, such an organisational mechanism-tumour board, cancer conference or other-evolves into the epicentre of a streamlined, comprehensive management approach made up of different components and interfaces, from diagnosis to treatment and follow-up. For example, MDT members undertook the role of 'agent' in explaining to patients the possibility of entering clinical trials in order to improve recruitment [43,44,56,57]; participated in tumour-based collaboration with psycho-oncologists and palliative care teams to improve care processes for advanced cancer patients [49]; and empowered nurse case managers to ensure continuity of care for patients within a network [58], coordinating follow-up programmes [59], or managing follow-up with other healthcare providers [55,60,61]. These examples involved an extension of specialised access and team control that goes beyond the treatment stage.…”

“…Treatment, toxicities, side effects, complications and information on second-and third-line treatments after recurrent disease were variously reported as having been discussed with patients before making decisions, sometimes by using written materials or by providing access to psychologists or social workers [18,20,23,38,42,52,53,56,58,59,61,64]. A number of papers identified the need to take into account patients' physical and psychological comorbidities when making clinical decisions; furthermore, they noted that special attention should be paid to provide the same clinical message and bridging gaps between teams and patients, as well as clearly setting out how to deal with the complexities of the health care system [43,44,53,54,56,60,63]. Other studies addressed issues such as the patient-doctor relationship within a multidisciplinary setting, the impact of pre-existing knowledge of the patient in MDT discussions, patient attendance at and involvement in MDT meetings, and the way in which the patients are approached to participate in clinical trials [46,48,56,64].…”

“…Step 1, selecƟon of papers: maintaining a commitment to research and clinical trials [15,16,18,26,38,43,44,56,57]. Secondary objectives also included providing a teaching environment for healthcare professionals and junior doctors [18,20,24,30,32,34,54]; acting as a quality improvement group [22,34,50,54]; and increasing enrolment in the tumour registry [16].…”

The Oncosurgery Approach to Managing Liver Metastases from Colorectal Cancer: A Multidisciplinary International Consensus

“…In addition, health care professionals and health services may benefit from MDTs through strengthened awareness, communication, and relationships among members and disciplines, increasing the opportunities for knowledge sharing and professional development (e.g., review sessions providing learning opportunities for staff) [136,147,148]. Other advantages include facilitation of clinical trial recruitment [149], minimization of duplication of effort, opportunities to pool resources and encourage crosstraining [150], and the potential to alleviate regional disparities in health care services.…”