Data from Alex Keen - Curated by EPG Health - Last updated 12 April 2018
The focus of this year’s European Breast Cancer Conference (EBCC), being held in Barcelona from 21–23 March, is the ‘importance of teamwork and interactions between all professionals and specialties involved in breast cancer’. The event stresses the significance of a truly multidisciplinary approach to breast cancer care, utilising a wide range of skills and expertise to provide the most appropriate treatment.
Multidisciplinary teams were first introduced to enable healthcare professionals to cope with the growing complexity of treatments. With an ever expanding number of therapy options and more intricate diagnostic testing becoming the norm, collaboration between specialisms proved necessary to make the most of these novel therapies. Breast cancer screening, a good example of inter-specialty collaboration in cancer care, was introduced in many countries in the late eighties and has since evolved to include the whole diagnosis and treatment process, with the first national and international multidisciplinary breast cancer guidelines being published not long after.
A growing amount of evidence supports the implementation of multidisciplinary teams for the treatment of all cancers, not just breast. A 2012 retrospective, comparative, interventional cohort study investigated the effect of multidisciplinary guideline implementation in the Greater Glasgow area from 1995‒2000, when compared with other areas of western Scotland. The multidisciplinary teams were led by a specialist breast cancer surgeon, with pathologists, oncologists, radiologists and specialist nurses all involved. Evidence based guidelines were written and adhered to, weekly formal meeting took place to discuss patients, and clinical activity was monitored and audited. These measures were designed to encourage rigorous and open discussion about the approach to treatment, drawing on a wide base of specialist knowledge to establish the most effective and appropriate regimen for each patient. After 5 years, breast cancer mortality rates were 18% lower when compared with the other areas of western Scotland, which ultimately led to further guideline development and a nationwide rollout.
Most major guidelines now recommend a multidisciplinary approach, whether that be through a ‘tumour board’, a panel of specialist doctors that discuss patient treatment, or a multidisciplinary bedside hospital team. These guidelines specify which specialists should make up the teams, contain various tools to aid compliance, and emphasise the importance of putting the patient at the heart of the decision making process. Their inclusion allows them to gain a better understanding of every possible treatment pathway so they feel their doctors have carefully considered, explored and shared all possible options.
The establishment of ‘breast units’ has taken multidisciplinary working one step further, bringing all the specialists and support staff together as one dedicated organisation to care for large numbers of patients in the most efficient and effective way possible. In Europe, various national and regional authorities are encouraging the universal establishment of breast units, however dedicated standardised Europe-wide guidelines for their set-up and operation are still lacking, leading to a large disparity in the quality of care provided.
The general consensus regarding the multidisciplinary approach is favourable, with scientific studies and clinical opinion supporting their use. A recent survey of 2,000 healthcare professionals showed that 90% believe multidisciplinary teams result in improved clinical decision making and quality of care. Others are more critical, stating that their resource intensive nature, and consequently high cost makes them unfeasible and uneconomical, consuming resources that could otherwise be better spent elsewhere.
In a world where healthcare budgets are being squeezed and cancer is increasing in prevalence, a major challenge will be making sure that there are enough teams working smoothly and efficiently to cover the needs of all patients. Progress must also be made to promote uptake of and improve compliance with multidisciplinary practices, especially in lower- and middle-income countries. These parts of the world can struggle reaching more remote rural areas to provide care in the community, have a lack of properly trained medical professionals and have inadequate recording practices.
Generally, the evidence supports the implementation of multidisciplinary practices due to their ability to encourage cooperation and the pooling of resources and experience. The focus now needs to be on further educating healthcare professionals worldwide to highlight the positive impact collaborative working has on quality of care.
Resources & further reading
Anderson BO, et al. Optimisation of breast cancer management in low-resource and middle-resource countries: executive summary of the Breast Health Global Initiative consensus, 2010. Lancet Oncol. 2011;12(4):387-98.
Keeson EM, et al. Effects of multidisciplinary team working on breast cancer survival: retrospective, comparative, interventional cohort study of 13 722 women. BMJ. 2012;344:e2718.
Taylor C, et al. Benefits of multidisciplinary teamwork in the management of breast cancer. Breast Cancer : Targets and Therapy. 2013;5:79-85.
Taylor C, et al. Multidisciplinary team working in cancer: what is the evidence? BMJ. 2010;340:c951.Visit the Communicating Metastatic Breast Cancer Learning Zone