Web Exclusive: When is Multidisciplinary Care Really Needed?

There has been a lot of emphasis on the multidisciplinary approach to cancer care, and it certainly makes sense, because surgery, radiation, and medication are all part of cancer care and are administered by different specialists with different areas of expertise. Add in proper imaging and pathology and it is clear that many disciplines are necessary for proper diagnosis and treatment. But isn’t this true of all aspects of medicine? After all, don’t doctors often order several tests that are interpreted by someone else, or refer their patient to specialists for consultations?

So, when should you, as a patient, ask for a multidisciplinary approach? Every cancer case or every decision may not require a multidisciplinary team. The types of issues that should set off a signal for shared decision-making include the following:

• An X-ray, MRI, or some other form of imaging that is difficult to interpret, especially when the results affect the treatment—such as the staging of cancer or the type of surgery or extent of radiation needed
• Confusion as to the diagnosis or subtype of a cancer from the pathology test
• Treatments that are given at the same time, or in a critical sequence, such as pre-operative chemotherapy or combined radiation and chemotherapy
• When two specialists have different opinions on the diagnosis or treatment plan

Often, a multidisciplinary evaluation may occur behind the scenes, such as a discussion at a tumor board, or just via phone calls and hallway conversations. In other cases, the team might actually see the patient together. Also, the team may only need to assemble and confer at the beginning of treatment or at the time of an important milestone, such as if the cancer progresses or when one phase of treatment is complete. Of course, it is difficult for the patient to know when multidisciplinary input is needed, but simply knowing its value should empower them to at least ask several questions, including the ones below:

• Is my diagnosis and stage established with certainty?
• Is the pathology unequivocal and are there special tests that are needed to help customize my therapy?
• Are the imaging studies clear in telling us where the cancer is?
• Is my surgery one that requires a specialist? (You may want to know if your surgeon is proficient at the procedure and if other surgical options that may spare some side effect are available)
• Do the different treatments (surgery, radiation, chemotherapy/biological therapy) need to be coordinated and sequenced, and if so, do all the specialists agree with the treatment plan?
• Do any new developments, such as recurrence, complication of therapy, or unexpected findings of any type, require the “team” to confer upon the next course of action?

If you are not getting straight answers to these questions, or just to the direct and basic question as to whether a multidisciplinary approach is needed, then it may be time to seek a second opinion at a larger center that features a full multidisciplinary team.