The Importance of Multidisciplinary Team Management of Patients with Non-Small-Cell Lung Cancer

Abstract

Historically, a simple approach to the treatment of non-small-cell lung cancer (nsclc) was applicable to nearly all patients. Recently, a more complex treatment algorithm has emerged, driven by both pathologic and molecular phenotype. This increasing complexity underscores the importance of a multidisciplinary team approach to the diagnosis, treatment, and supportive care of patients with nsclc. A team approach to management is important at all points: from diagnosis, through treatment, to end-of-life care. It also needs to be patient-centred and must involve the patient in decision-making concerning treatment. Multidisciplinary case conferencing is becoming an integral part of care. Early integration of palliative care into the team approach appears to contribute significantly to quality of life and potentially extends overall survival for these patients. Supportive approaches, including psychosocial and nutrition support, should be routinely incorporated into the team approach. Challenges to the implementation of multidisciplinary care require institutional commitment and support. KEY WORDSNon-small-cell lung cancer, multidisciplinary care INTRODUCTIONLung cancer is a major public health problem and the cause of the largest number of deaths from cancer in Canada, with approximately 25,500 new cases having been diagnosed and 20,600 deaths having occurred in 2011 1 . Despite the magnitude of this health problem, significant stigmas are associated with a diagnosis of lung cancer 2,3 . Questions have even been raised about whether treatment should be offered for a smoking-related illness. Historically, much nihilism surrounds the effectiveness of systemic therapies, and only since the early 1990s has sufficient evidence been developed to support the routine use of chemotherapy for advanced nonsmall-cell lung cancer (nsclc) 4 .Fortunately, significant advances in the management of nsclc have been made since 2000. Data have emerged supporting not only first-, but also secondand third-line therapies [5][6][7] . Postoperative adjuvant therapy has become the standard of care for many patients with resected nsclc 8,9 . Combined-modality treatment approaches-either chemoradiation 10 or trimodality treatments 11 -are widely adopted for well-functioning patients with locally advanced disease. Histologic differentiation of squamous from non-squamous disease has become a factor in treatment selection 12 , and the discovery of molecular abnormalities in the EGFR (epidermal growth factor receptor) gene 13,14 and the ALK (anaplastic lymphoma kinase) gene 15 have led to treatment approaches driven by the molecular profile of tumours 16,17 . All of those changes have moved treatment from a simple approach applicable in most patients to a more complicated algorithm in which histology and molecular phenotype are important factors. This increasing complexity underscores the importance of taking a multidisciplinary approach to management that extends throughout the continuum of care from diagnosis to supportive and end-of-lif...

Long-Term Effect of an Interdisciplinary Supportive Care Intervention for Lung Cancer Survivors After Surgical Procedures

“…Multidisciplinary care planning in early stage NSCLC likely reduces delays in treatment and improves adherence to treatment guidelines. 10 However the use of an interdisciplinary approach to focus on the survivor’s physical, emotional, and spiritual well-being during post-operative recovery has not been reported. An interdisciplinary team approach integrates various disciplines into holistic survivor-centered encounters.…”

Palliative care in thoracic oncology

“…It is believed that lung cancer care in general as well as palliative care can be provided more successfully by a multidisciplinary team [25,26]. The wide variety of problems that have been outlined in this article shows the need to be organised in a multiprofession manner, and research seems to confirm this recommended approach.…”

Analysis of advanced lung cancer patients diagnosed following emergency admission

“…For the management of DFEA patients, a multidisciplinary approach is also necessary to improve PS and facilitate patient-centred decision making for most patients. Furthermore, previous studies also demonstrated that this approach had many benefits for patients with advanced lung cancer [27][28][29][30]. Therefore, a multidisciplinary approach should be employed for the treatment of advanced lung cancer patients, especially for DFEA patients.…”