Multidisciplinary team working in cancer: what is the evidence?

Abstract

Cancer care is increasingly delivered by multidisciplinary teams. Cath Taylor and colleagues argue that stronger evidence is needed of their effectiveness

An Official American Thoracic Society/European Respiratory Society Statement: The Role of the Pulmonologist in the Diagnosis and Management of Lung Cancer

“…Data show that multidisciplinary teams provide improved adherence to evidence-based guidelines, better treatment decisions, and better clinical outcomes with longer survival for oncologic patients (27,28), and specifically for patients with lung cancer (23,29). Pulmonologists participate in and often lead multidisciplinary efforts to provide prompt, state of the art, and costeffective care to patients with lung cancer.…”

“Do no harm”: Fortifying MDT collaboration in changing technological times

“…Intuitively they are good practice because all of the professional groups are involved in the clinical decisions affecting individual developments has led to this increase in the routine use of MDTMs: (i) clinical practice guidelines (CPGs) that specify that MDTMs should be used [4], (ii) increasingly specialised healthcare [5], (iii) recognition that diagnostic accuracy can be improved through clinical, radiological and pathology collaboration in the decision [6,2], and (iv) more complex treatment protocols that require high levels of coordination between specialist services [2]. Despite their popularity, it is acknowledged that there is little concrete evidence that patient outcomes benefit from MDT collaboration [7,8]. Guidelines from the National Institute for Health and Clinical Excellence (NICE) in the United Kingdom, for instance, recommend MDT work but categorise the evidence for this recommendation as Level lll, or Level IV evidence [9], that is, evidence based on quasi-experimental, or observational studies with narrow population spectra, or non-blinded studies (which are considered weak) and professional consensus.…”

“…The mandatory MDTM has been described as one of those initiatives causing a split in the medical profession, into those who believe it can improve patient safety, and those who believe it may be indirectly affecting patient outcomes by reducing continuity of care and training opportunities [11,8]. Some argue about the adoption of mandatory 'guidelines' by the professions and question the validity of some of the recommendations in practice.…”

“…However, there is a growing body of evidence that MDTs are associated with improved clinical decision making [15], clinical outcomes [16], patient experience, and working lives of MDT members [8]. We ask 'what is it that improves clinical decision making, or provides benefits for patients?'…”

Multidisciplinary clinical approach to the management of head and neck cancer

“…In the past, treatment for all but a few patients with cancer was based on decisions that were made unilaterally, without necessarily following an evidence-based approach [3]. One of the aims of cancer management by a multidisciplinary team hopes to ensure that all patients will benefit from the wisdom of a variety of specialist team members who can share their expertise, professional perspective, and knowledge [1,3,4] and has become the model of care in many countries [5]. The introduction of MDTs in England was given impetus by the production of tumour-specific guidance (Improved Outcomes Guidance; IOG), which aimed to standardise and improve the outcomes of cancer care [6].…”