Multidisciplinary Approaches to Care

Reducing lag time between cancer diagnosis and evaluation by the multiple specialists who will be treating a patient is particularly important for aggressive and highly complex cancers.

One way some community physicians expedite the process is by requesting a multidisciplinary tumor board review of their treatment recommendation, which also helps coordinate care.

But tumor boards within specialty clinics such as the Johns Hopkins Pancreas Multidisciplinary Cancer Clinic in Baltimore can reduce the time it would otherwise take to see gastroenterology, surgery, medical oncology, radiation and pathology specialists.

“Instead of driving around town seeing all these specialists, you have a one-week wait to get into the clinic,” says Christopher Lee Wolfgang, MD, PhD, co-director of the clinic. “All the specialists see you, and you have a treatment plan at the end of the day.”

Anyone being treated for pancreatic cancer, even an early-stage operable tumor, should have their case reviewed by a multidisciplinary tumor board, Wolfgang says. “They all ought to sit at the same table and discuss the case. I would consider that standard for treatment.”

The multidisciplinary approach drives individualized, personalized care based on many factors, including genetics.

Chemotherapy for an 80-year-old patient with cardiovascular issues will differ from that of an otherwise healthy 50-year-old.

Genetic analysis of the tumor could help determine treatment details. Certain mutations, such as a change in the gene for the epidermal growth factor receptor, might make patients respond better to certain types of chemotherapy. Also, family history may lead to genetic counseling and testing for an inherited predisposition. For example, a breast cancer patient with a BRCA mutation might choose to have a double mastectomy.

“It’s only at a multidisciplinary clinic like this that personalized medicine can actually develop, and it’s really only in its infancy as a medical approach,” Wolfgang says.